Benchmarking the health of health sciences students at Kuwait University: towards a culture of health.

Health professional entry-to-practice programmes are intense, competitive and prolonged. The aims of this study were to benchmark the health of health sciences students at Kuwait University, thereby informing student health services, and to establish a base for individual student's health assessments throughout the programmes. We used a convenience sample of 176 students. Assessment included a health/wellness questionnaire (smoking, nutrition, physical activity, sleep and stress) and objective measures (resting heart rate, blood pressure, waist-to-hip ratio and random blood glucose). Students had suboptimal activity, diet, stress and sleep. Health was suboptimal based on significant proportions of students in unhealthy categories for resting heart rate, blood pressure and body composition. Health status of health sciences students at Kuwait University is not consistent with healthy health professionals in training, who should serve as role models for the public. A culture of health on campus is recommended to maximize the health of students and their capacity as health role models.

Benchmarking the health of health sciences students at Kuwait University: towards a culture of health

Health professional entry-to-practice programmes are intense, competitive and prolonged. The aims of this study were to benchmark the health of health sciences students at Kuwait University, thereby informing student health services, and to establish a base for individual student's health assessments throughout the programmes. We used a convenience sample of 176 students. Assessment included a health/wellness questionnaire [smoking, nutrition, physical activity, sleep and stress] and objective measures [resting heart rate, blood pressure, waist-to-hip ratio and random blood glucose]. Students had suboptimal activity, diet, stress and sleep. Health was suboptimal based on significant proportions of students in unhealthy categories for resting heart rate, blood pressure and body composition. Health status of health sciences students at Kuwait University is not consistent with healthy health professionals in training, who should serve as role models for the public. A culture of health on campus is recommended to maximize the health of students and their capacity as health role models

Les programmes de formation des professionnels de la santé sont intenses, compétitifs et longs. La présente étude visait à mesurer la santé des étudiants dans les facultés du Centre de Sciences médicales de l'Université du Koweit, permettant ainsi d'orienter les services de santé étudiante et d'établir des données de référence pour l'évaluation de la santé des étudiants dans l'ensemble des programmes. Nous avons recouru à un échantillon de commodité de 176 étudiants. L'évaluation incluait un questionnaire sur la santé/le bien-être [tabagisme, nutrition, activité physique, sommeil et stress] et des mesures objectives [rythme cardiaque au repos, tension artérielle, rapport taille-hanche, et glycémie aléatoire]. Les résultats ont montré que les étudiants avaient des niveaux d'activité, des régimes alimentaires, un niveau de stress et un sommeil suboptimaux. L'état de santé n'était pas optimal pour une proportion importante des étudiants ayant des mauvais résultats pour la composition corporelle, la fréquence cardiaque et la pression artérielle. L'état de santé des étudiants en sciences médicales de l'Université du Koweit ne correspond pas à ce que l'on attend de professionnels de la santé en formation, qui devraient servir de modèle pour le grand public. Une " culture de la santé " sur le campus est recommandée pour améliorer la santé des étudiants et leur capacité à servir de modèle pour les modes de vie sain

Role of embolisation in the treatment of bronchopulmonary sequestration.

BACKGROUND: Sequestrations represent bronchopulmonary malformations that are increasingly diagnosed antenatally. After birth, the therapeutic approach in asymptomatic children is debated, as some may spontaneously regress. OBJECTIVE: To evaluate the efficacy of embolisation of the feeding systemic artery in the treatment of bronchopulmonary sequestration. MATERIALS AND METHODS: Sixteen children with bronchopulmonary sequestration were treated by endovascular embolisation of the feeding systemic artery. RESULTS: Ten patients were considered cured by embolisation alone. One patient was operated on after unsuccessful embolisation, three had partial regression of the lung mass and two are still under follow-up. CONCLUSIONS: Our experience indicates that bronchopulmonary sequestrations in children can be treated by embolisation alone.

[Liver transplantation with a living related donor in the child]. / Transplantation hépatique avec donneur vivant apparenté chez l'enfant.

OBJECTIVES: Liver transplantation with living related donor has been recently developed to compensate for the insufficient number of liver grafts for children. The major problem is ethical because it implies voluntary mutilation of a healthy person. This paper report results in 37 living related donors. PATIENTS: Recipients were followed in Enfants-Malades Hospital. Investigations and donor surgery were performed at the Digestive Surgery Unit of Beaujon Hospital. RESULTS: One donor was re-operated for bleeding, and another one a biliary fistula treated with percutaneous drainage for one week. The post-operative course was uneventful in the other donors, with a follow-up of between 2 and 50 months. Thirty-three children are alive (90%), one of them underwent a second transplant for arterial thrombosis. Vascular and infectious complications, and the number of rejection episodes were the same as in transplantations with a deceased donor. Biliary complications were frequent (15 patients out of 37) and significantly increased morbidity. A teenage boy who received a small graft (0.9% of his weight) presented initially with hepatic insufficiency without encephalopathy. CONCLUSION: This technique has been shown to have a good balance between benefits and risks. Our experience confirms this, especially in very young children. Each case should be discussed individually and parental consent should be obtained without external pressure. Experience with this technique should be continued and at the same time the use of cadaveric grafts should be optimized.

Intussusception in infants and children: feasibility of ambulatory management.

To evaluate the ambulatory management of ileo-colic intussusception in infants and children, a retrospective study over 3 years of 113 children treated for ileo-colic intussusception in a paediatric emergency department was undertaken with the aim of shortening the length of stay. A total of 113 children aged 10 days to 9 years (median 12 months) were treated for intussusception between January 1993 and December 1996. None had septic shock or peritoneal aeric effusion. Barium enema reduction was attempted in all patients. Successful reduction rate was 81%. Fifty patients (44.2%) were completely ambulatory managed and 42 were hospital-supervised after successful enema reduction. Twenty-one children underwent laparotomy after failure of enema. With the ambulatory device, costs were reduced ($1000/case) compared with conventional in-patient treatment. Outpatient treatment of acute ileo-colic intussusception is secure and reduces costs. It depends on the willingness of the medical team but requires simultaneous adaptation of hospital funding to promote this trend.

Living-related liver transplantation in children: the 'Parisian' strategy to safely increase organ availability.

PURPOSE: The aim of the authors was to report their experience with living related liver transplantation (LRLT) in children, particularly focusing on the safety of the two-center "Parisian" strategy. METHODS: The records of donors and recipients of 26 pediatric living-related donor liver transplantations performed between November 1994 and March 1998 were reviewed retrospectively. Donors were assessed 1 year after transplantation for medical and overall status. RESULTS: Indications for LRLT included biliary atresia (n = 18), Byler's disease (n = 5), alpha-1-antitrypsin deficiency (n = 1), Alagille syndrome (n = 1), and undefined cirrhosis (n = 1). Liver harvesting consisted of either a complete left hepatectomy (n = 14) or left lateral hepatectomy (n = 12) without vascular clamping. The recipient procedure essentially was the same as in split liver transplantation. Mean overall cold ischemia time averaged 140 minutes (range, 90 to 230 minutes). Twenty-four of 26 patients had end-to-end vascular anastomoses without interposition. Biliary reconstruction consisted of a Roux-en-Y choledochojejunostomy in all patients. All recipients except one received cyclosporine A (CSA). Mean donor hospitalization was 8 days (range, 6 to 13) with normalization of all liver function assays by the time of discharge. There were no donor deaths and two postoperative complications (perihepatic fluid collection and bleeding from the wound). One year after donation, the initial 19 donors had resumed their pretransplant status. Two of the children who underwent transplant died. Thirteen of the recipients required reoperation for hepatic artery thrombosis (n = 2), portal vein thrombosis (n = 2), biliary complications (n = 6), fluid collection (n = 3), small bowel perforation (n = 1), and plication for diaphragmatic eventration (n = 1). With mean follow-up of 2 years, 24 of 26 patients are alive and well (patient and graft survival rate, 92%). CONCLUSIONS: LRLT is still controversial, even with minimal and decreasing donor risk. The "Parisian" strategy consists of harvesting the liver in an adult unit by an adult hepatic surgery team. The transplantation is then performed in a pediatric hospital by the pediatric liver transplantation team. The two steps of the procedure allow units specialized in adult surgery, on one hand, and pediatric liver transplantation, on the other hand, to dedicate themselves completely to their respective procedures, improving the safety of the harvest, and alleviating stress for both the medical staff and the families.

Early and prolonged intravenous immunoglobulin replacement therapy in childhood agammaglobulinemia: a retrospective survey of 31 patients.

OBJECTIVE: To evaluate the outcome of children who received prolonged intravenous immunoglobulin (IVIg) replacement therapy early in life for X-linked agammaglobulinemia (XLA). STUDY DESIGN: We performed a retrospective study of the clinical features and outcome of patients with genetic and/or immunologic results consistent with XLA. Patients receiving IVIg replacement therapy within 3 months of the diagnosis and for at least 4 years between 1982 and 1997 were included. RESULTS: Thirty-one patients began receiving IVIg replacement therapy at a median age of 24 months and were followed up for a median time of 123 months. IVIg was given at doses >0.25 g/kg every 3 weeks, and mean individual residual IgG levels ranged from 500 to 1140 mg/dL (median, 700 mg/dL). During IVIg replacement, the incidence of bacterial infections requiring hospitalization fell from 0.40 to 0.06 per patient per year (P <. 001). However, viral or unidentified infections still developed, including enteroviral meningoencephalitis (n = 3) causing death in one patient, exudative enteropathy (n = 3), and aseptic arthritis (n = 1). At last follow-up, 30 patients were alive at a median age of 144 months (range, 58 to 253 months). Among 23 patients who were evaluated by respiratory function tests and computed tomography, 3 had an obstructive syndrome, 6 had bronchiectasis, and 20 had chronic sinusitis. CONCLUSION: Early IVIg replacement therapy achieving residual IgG levels >500 mg/dL is effective in preventing severe acute bacterial infections and pulmonary insufficiency. More intensive therapy may be required to fully prevent the onset of bronchiectasis, chronic sinusitis, and nonbacterial infections, particularly enteroviral infections, in all cases.

CT scan patterns of pulmonary alveolar proteinosis in children.

BACKGROUND: To study computed tomographic (CT) findings in children with pulmonary alveolar proteinosis (PAP) more extensively. OBJECTIVE: To describe the CT features at the time of diagnosis and after therapeutic broncho-alveolar lavage (BAL). MATERIALS AND METHODS: We retrospectively reviewed the CT scans of five children (aged 3 months to 4 years) examined because of incidental bronchitis (n = 1), disease in a sibling (n = 1) and relapsing fever, cough and dyspnoea (n = 3). Each patient had an initial CT scan. Two asymptomatic cases were not treated but were followed up by plain chest films. The other three had BAL and follow-up CT. RESULTS: Initial CT in all cases showed a diffuse reticulomicronodular pattern associated in three cases with posterior bilateral alveolar infiltrates. CT in the two asymptomatic patients remained unchanged or slightly improved without BAL. After BAL, a variable decrease of lung infiltrates was observed. CONCLUSIONS: Correlation between the extent of alveolar consolidation and severity of disease was found. Anatomical and pathological considerations allow us to consider that the classical reticulomicronodular pattern is not due to an interstitial infiltration but to alveoli filled with the abnormal material characteristic of PAP.

Imaging of lung vascularization and perfusion in children.

Imaging techniques to evaluate lung perfusion are continuously evolving. Chest film is still the first step. Spiral CT has revolutionized chest imaging in children, MRI is still progressing and thanks to it, multiplanar abilities will probably take a great importance in the future. The accessibility of the machine is still a limiting factor. Angiography is now restricted to interventional procedures.

Inflammatory pseudotumor of the liver: a rare benign tumor mimicking a malignancy.

We describe a 9-month-old boy in whom a hepatic tumor called angioma was diagnosed on ultrasonography, performed for abdominal pain. He was asymptomatic until 9 months later, when he presented with weight loss, jaundice, and a hard tumor in the left liver lobe. Radiological examination showed a calcified and heterogeneous tumor, amputation of the left portal vein, and dilatation of bile ducts, strongly suggesting malignancy. However, liver biopsy showed the typical findings of inflammatory pseudotumor, which are myofibroblastic cells and perivascular plasmocytes in a dense collagenous stroma. The tumor was surgically removed without local recurrence with a 2-year follow-up. Inflammatory pseudotumor in childhood is more common in the lung and elsewhere is often mistaken for a slowly growing cancer. This case points out the difficulties in the radiological evaluation of liver tumors in childhood and the importance of the histological differentiation of this lesion from malignancy before laparotomy for adequate indication of the treatment, which includes no medical treatment and surgery as conservative as possible.

[What is new in pediatric pneumology?]. / Quoi de neuf en pneumologie pédiatrique?

Have been selected for this review: 1) the recent and impressive development of high-resolution and spiral CT scan in pediatric thoracic imaging; 2) the emerging of new and promising therapies for asthma (long acting inhaled beta 2-agonists, leukotriene antagonists, anti-IgE monoclonal antibodies); 3) the multifactorial origin of asthma in childhood; 4) the development of thoracoscopic surgery, a minimal-invasive approach beneficial in numerous circumstances.

Thoracoscopic treatment of mediastinal cysts in children.

BACKGROUND/PURPOSE: The development of thoracoscopic surgery has made many procedures possible, including the treatment of mediastinal cysts in children. The authors report their experience with this procedure between 1992 and 1997. METHODS: Surgery was performed on 22 children aged from 1 month to 9 years (median, 27 months), weighing 5 to 49 kg (median, 12.5 kg). Diagnosis was made by antenatal ultrasound scan in six cases (27%), with a chest x-ray performed for respiratory symptoms in 14 cases, and with a chest x-ray performed for positive tuberculin intradermoreaction in two cases. Decision to resect the cyst was determined by thoracoscopy in 21 of the 22 cases, and by open surgery in one case only (subcarinal compressive cyst with left lung distension and a mediastinal shift). RESULTS: Eighteen of the 21 (86%) cases were treated successfully by thoracoscopy. In three cases of bronchogenic cysts, we performed an associated thoracotomy because the dissection was too difficult and dangerous. In three cases, a small part of a common wall between the cyst and the bronchus was not removed. The pathological diagnosis was bronchogenic cysts in 15 cases (71%), pleuropericardiat cysts in three cases (14%), esophageal duplication in two cases (10%), and cystic hygroma in one case (5%). Two postoperative complications were observed: one esophageal wound and a case of recurrent pneumothorax after chest tube removal. Patients were discharged after 2 to 11 days (median, 3 days). Follow-up was uneventful. CONCLUSIONS: Treatment of mediastinal cyst by thoracoscopy is feasible in most cases. Compressive cysts with lung distension and mediastinal shift remain a contraindication. If the cysts have a common wall with the bronchus or esophagus, or if they are subcarinal, the dissection may be difficult and dangerous, and thoracotomy may be preferable.

A double-blind CT study comparing the safety and efficacy of iopentol and ioxaglate in paediatric patients.

Iopentol (Imagopaque); 300 mg I/ml was compared with ioxaglate (Hexabrix; 320 mg I/ml in 89 patients (45 and 44 patients, mean age 8.5 and 7.9 years in the contrast groups, respectively), in paediatric intravenous CT contrast enhancement. The dose injected was 2 ml/kg b.w. with an upper limit of 100 ml. There was a total of 18 patients who reported adverse events other than sensations of heat or cold, 6 (13%) in the iopentol group and 12 (27%) in the ioxaglate group. Two patients (4%) in the iopentol group reported possible contrast-related events as described above, whereas the number was 8 (18%) in the ioxaglate group. There was no statistically significant difference between the two groups regarding adverse events, blood pressure, nor heart rate changes after injection. The overall quality of CT enhancement was excellent or sufficient in 96 and 93% of the cases in the iopentol and ioxaglate groups, respectively. Iopentol was shown to be a safe and effective contrast medium in examinations of children.

Bronchopulmonary dysplasia: value of CT in identifying pulmonary sequelae.

OBJECTIVE: Pulmonary dysfunction is common in children who survive bronchopulmonary dysplasia. Chest radiographs are not satisfactory for the identification of the sequelae of bronchopulmonary dysplasia because, although they often show abnormalities, the abnormalities are usually minor and sometimes absent. We therefore assessed the value of CT for identifying the sequelae of bronchopulmonary dysplasia. MATERIALS AND METHODS: Twenty-three children (mean age, 4 years) who had survived neonatal bronchopulmonary dysplasia and had signs of chronic pulmonary dysfunction (recurrent episodes of coughing, wheezing, dyspnea, pneumonia, respiratory insufficiency) were examined with chest radiographs and high-resolution CT scans of the chest. Two reviewers qualitatively analyzed the chest radiographic and CT findings by describing the most consistently found lesions and their frequencies. RESULTS: The chest radiographs showed hyperexpansion in 17, hyperlucent areas in 11, and linear opacities in 10 of the 23 children. Pleural thickening was not observed, and four children had normal findings on chest radiographs. All 23 CT scans showed abnormalities, including multifocal areas of hyperaeration, well-defined linear opacities, and triangular subpleural opacities with an external base and an internal apex. In 20 of 23 children, all three abnormalities were present. For the three other children, two of these three abnormalities were found. No bronchiectasis was observed in any of the cases. CONCLUSION: Lesions in survivors of bronchopulmonary dysplasia with chronic pulmonary dysfunction are visualized better on CT scans than on chest radiographs. Importantly, CT findings of multifocal areas of hyperaeration, numerous linear opacities facing triangular subpleural opacities visible on several consecutive sections, and no bronchiectasis should suggest the presence of sequelae of bronchopulmonary dysplasia.

Effects of naloxone infusion in patients with septic shock and renal failure: a limited experience.

Septic shock is frequently associated with acute renal failure. Management of these patients becomes complicated if either the renal or systemic hemodynamic derangement cannot be corrected. Although previously large doses of furosemide and naloxone infusion have been used separately in managing these patients, the combination of both agents has not been employed. We therefore report our limited experience with this combined treatment in 5 patients with septic shock, of which 4 had acute renal failure.

Cavitron ultrasonic surgical aspirator. Applications in urologic surgery.

The Cavitron Ultrasonic Surgical Aspirator is a unique modality for precise tissue removal which results in increased visibility, reduced bleeding, and shorter operating time when dealing with vascular lesions or organs. Herein, we present our experience in a dog laboratory as well as in a clinical setting with this new instrument. The mechanism of action, proper surgical technique required, and further application in urologic surgery are discussed.