ß-Blocker use and incidence of chronic obstructive pulmonary disease exacerbations.

BACKGROUND: ß-Adrenergic antagonist (ß-blocker) use in patients with chronic obstructive pulmonary disease (COPD) has been avoided as a result of potential risk of pulmonary adverse effects. However, recent studies indicate that ß-blocker use in patients with COPD can decrease outpatient visits and either decrease or have no effect on the number of hospitalizations. Long-term treatment with ß-blockers has been shown to increase survival and decrease exacerbations in patients with COPD. OBJECTIVE: To assess the impact of ß-blocker use on the incidence of exacerbations in patients with COPD. METHODS: In a retrospective cohort study of patients with COPD from 2 academic primary care practice sites who were seen in 2010, patients were identified using International Classification of Diseases, 9th revision, Clinical Modification codes for COPD and reviewing active medication lists for COPD-specific medications (tiotropium). Patients were classified as either a ß-blocker user or a nonuser. Primary outcomes were incidence and severity of COPD exacerbations. Secondary outcomes included COPD exacerbations distinguished by ß-blocker cardioselectivity and all-cause hospitalizations. RESULTS: The study enrolled 412 patients. Of those, 166 patients were ß-blocker users and 246 were ß-blocker nonusers. ß-Blocker users were less likely to have a COPD exacerbation (OR 0.61, 95% CI 0.40-0.93) and had fewer mild exacerbations (OR 0.56; 95% CI 0.34-0.89). There was no significant difference in COPD exacerbations based on ß-blocker cardioselectivity (OR 0.84, 95% CI 0.38-1.83). When controlled for, using a backwards stepwise logistic regression, ß-blocker use was a variable in the model that predicted exacerbations but alone was not statistically significant (adjusted OR 0.62, 95% CI 0.39-1.01). CONCLUSIONS: Patients with COPD prescribed a ß-blocker were significantly less likely to have a COPD exacerbation and had fewer mild COPD exacerbations.

Features and outcomes of neonatal neuroblastoma.

PURPOSE: Neonatal neuroblastoma (NNBL) is a rare tumour with few reported cases in the literature. The prognosis of NNBL is unclear with reported survival between 76 and 91%. The growing use of ante-natal ultrasound (USS) in recent years has resulted in an increasing incidence of NNBL. The purpose of this study is to review our experience with incidence, clinical features and outcome of NNBL in those children diagnosed ante-natally compared to those diagnosed post-natally. METHODS: Twelve cases of NNBL were detected ante-natally or in the neonatal period (0-28 days) from a cohort of 120 children diagnosed with neuroblastoma (10%) over a 10-year period at the study institutions. Review of these 12 children forms the basis of this report. RESULTS: Ante-natal diagnosis (ADNB) was made in six children (50%) and post-natal diagnosis (PDNB) in six (50%). Tumour site in both cohorts were predominantly adrenal and tumour staging was similar in both groups. There was no difference in outcome in ADNB compared to PDNB with overall 100% survival for the entire group. CONCLUSIONS: NNBL is a subset of neuroblastoma with apparent excellent outcome irrespective of the time of diagnosis. Clinical features and outcomes of ADNB are no different to PDNB.

Predicting the efficacy of convection warming in anaesthetized children.

BACKGROUND: We previously described a convection warming technique (Cassey J, Armstrong P, Smith GE, Farrell PT. Paediatr Anaesth 2006; 16: 654-62). This study further analyses the children in that original study with three aims: (i) to investigate factors purported to influence children's heating rates, (ii) to describe the most effective usage of this warming technique, and (iii) to understand better the physiology of convection warming. METHODS: Children having anaesthesia for elective surgery lasting longer than 90 min in ambient temperature 21 degrees C were warmed by a 'Bair Hugger' attached to a custom-built heat dissipation unit. Relationships between child and procedure characteristics and various thermal measures were analysed, and a thermodynamic model was evaluated. RESULTS: Thirty-nine children (aged 2 days to 12.5 yr) were studied. There were statistically significant correlations between a number of factors (e.g. height and weight) and heating efficacy. Our model demonstrated the impact of changing patient characteristics on temperature profiles. Neither the morphological characteristics nor our model could predict an individual's T(core) behaviour. CONCLUSIONS: (i) Although the effectiveness of this warming technique is influenced by patient/procedure characteristics, these do not predict normothermia (uncertainty +/-28 min). Effectiveness is independent of simple thermal measures. (ii) Previously described measures of vasoconstriction are not valid in children. (iii) Our model shows children's thermal properties change with their T(core). However, key factors are unknown for an individual and our model does not predict heating efficacy. (iv) To minimize the risk of hyperthermia, we recommend continuous measurement of T(core) during convection heating. The device air temperature should be turned to medium (38 degrees C) as T(core) approaches 37 degrees C.

Elective orchidopexy in the paediatric population: a trial of intra-operative spermatic cord block.

It is well established that pre-emptive and multimodal analgesia improve pain control and decrease narcotic use as well as the length of stay. Whilst some form of local anaesthetic (LA) block is almost routine for most inguinal procedures in children, the best modality is uncertain for orchidopexy. We sought to explore as to whether the addition of spermatic cord block (SCB) to our standard ilio-inguinal block (IIB) in this situation had any impact on analgesic requirements post-operatively. A retrospective review of a single surgeon and single centre experience of LA block for elective orchidopexy is described for a 9-year period. In the first half of the study, the LA technique was an IIB. An SCB was added to the IIB in the second half using the same total dose of 0.8 ml/kg bupivacaine. In the entire group, 35% of the SCB + IIB boys required narcotics as compared to 56% with IIB alone (p > 0.05). On subgroup analysis of a "medium risk" procedure (i.e. inguinal approach for a superficial pouch testis) only 35% required narcotics in the SCB + IIB group as compared to 70% in the IIB (p < 0.05). Use of a SCB + IIB in elective orchidopexy in a paediatric population has additional benefit to IIB alone.

Cystic partially differentiated nephroblastoma.

Cystic partially differentiated nephroblastoma is a relatively rare tumour of the kidney usually affecting infants. Cystic Wilms' tumour and multilocular cystic nephroma should be distinguished from cystic partially differentiated nephroblastoma. Multilocular cystic nephroma is a benign tumour whereas cystic Wilms' tumour is at the malignant end of the range of classification of such tumours. Cystic partially differentiated nephroblastoma may undergo local recurrence but there is no report of metastasis.

Magnetic resonance imaging findings of a foregut duplication cyst of the floor of the mouth in a fetus.

The MRI findings are described in a case of foregut duplication cyst arising from the floor of the mouth in a fetus.

An evaluation of the Faces Pain Scale with young children.

The psychometric characteristics of the Faces Pain Scale (FPS) were evaluated in three groups of preschool and school-aged children (3. 5-4.5; 4.5-5.5 and 5.5-6.5 years, respectively). The FPS was adequately comprehended by even young children. It was easily administered and was valid and discriminating. It did not, however, possess the linear scalability claimed by its authors.

Evaluation of long-term central venous patency in children with chronic venous catheters using image-directed Doppler ultrasonography.

All children in the Oncology Unit in the Royal Hospital for Sick Children, Edinburgh who had had long-term central venous catheters removed between 1987 and 1991 underwent central venous assessment by image-directed Doppler ultrasound scanning techniques. In this study, the implant vein remained patent after decannulation, and we believe should be re-accessed rather than moving to another site.

Omentectomy with peritoneal catheter placement in acute renal failure.

Catheter function was retrospectively analysed after surgical placement in 21 children requiring peritoneal dialysis for acute renal failure due to haemolytic uraemic syndrome. Substantial benefits were shown to have accrued from partial omentectomy which resulted in reliable access and trouble-free drainage in the 11 patients in whom it was carried out. Conversely 4 of 10 patients in whom partial omentectomy was not done experienced total catheter blockage whilst the other 6 experienced intermittent poor drainage. Partial omentectomy should be considered as integral to the surgical technique of peritoneal catheter placement for both short-term and long-term dialysis in children.

Urinary tract calculi in aboriginal children.

Forty-three Aboriginal children with urinary tract calculi are reviewed. There was a preponderance of male children and the majority presented early in life with urinary tract infection. Associated gastrointestinal and other problems were also common. The calculi caused considerable morbidity: 34 major surgical procedures were undertaken and three kidneys were lost.