Minimally-invasive airway management and early cleft palate repair in infants born with Robin sequence.

The objective of this study was to report outcomes of early cleft palate repair in infants born with Robin sequence (RS). A retrospective case series in a tertiary referral paediatric hospital was carried out, examining a consecutive series of 69 infants born with RS and cleft palate. A minimally invasive approach was taken to upper airway obstruction, with liberal nasopharyngeal airway (NPA) and non-invasive ventilation (NIV) use, guided by sleep studies. The palate was repaired between 6 and 9 months with a modified Malek technique. The most frequently used airway adjunct (59.4% of patients) was an NPA and the median duration of use was 5.6 months. All patients underwent a modified Malek cleft palate repair at a median of 7 months of age. Overnight oximetry demonstrated higher mean oxygen saturation (SpO2) across the group from initial neonatal admission to discharge (median 96.5% (interquartile range [IQR] 95-98%) vs 97.45% (IQR 96.5-98%) (P = 0.2, N = 34). Of those with a cardiorespiratory polysomnogram, the obstructive apnoea-hypopnea index (OAHI) was significantly lower postoperatively (5.9 vs 2.8, P = 0.028). This study supports the use of non-surgical airway strategies and early cleft palate repair in infants born with RS and cleft palate.

Metastatic tumor to the extraocular muscles: report of 5 cases.

We report the findings in 5 patients with metastases to the extraocular muscles. Familiarity with this condition will aid ophthalmologists in differentiating it from thyroid ophthalmopathy, the most common form of muscle enlargement. Palliative treatment is effective in ameliorating visual symptoms.

Baseline echographic characteristics of tumors in eyes of patients enrolled in the Collaborative Ocular Melanoma Study: COMS report no. 29.

PURPOSE: To report baseline echographic characteristics of tumors in patients enrolled in the Collaborative Ocular Melanoma Study (COMS) randomized trials, to determine how often these characteristics matched prespecified criteria for choroidal melanoma, to explore associations between echographic variables, and to compare specific echographic characteristics with pathologic characteristics of tumors in enucleated eyes. DESIGN: Retrospective analyses of baseline data from multicenter randomized clinical trials. PARTICIPANTS: Patients enrolled in the COMS large trial or medium tumor trials (N = 2320). METHODS: Standardized echography was used to document selected characteristics of tumors at baseline. Criteria were established to assess the consistency of echographic features with the diagnosis of melanoma. For eyes assigned to enucleation, the echographic diagnosis and evaluation for extraocular extension by the Echography Center were compared with gradings made by the Pathology Center and Pathology Review Committee. MAIN OUTCOME MEASURES: Presence of various echographic and pathologic characteristics. RESULTS: Two thousand forty-three tumors (88%) exhibited low to medium reflectivity (n = 1409), a mushroom shape (n = 101), or both (n = 533). Tumors with apical height > 10 mm were more likely (P<0.001) to have a mushroom shape and less likely to have a posterior location (P<0.001) than less elevated tumors. One thousand five hundred fifty-nine (99.7%) of 1563 tumors judged by echography to be consistent with the diagnosis of melanoma were confirmed by pathology to be choroidal melanoma. For measurable extrascleral tumors < 1.5 mm in height by pathology, the Echography Center graders judged extrascleral extension as possibly present in only 1 of 16 (6%) tumors, compared with 57% (4/7) of eyes with extrascleral extension measuring > or = 1.5 mm in height. CONCLUSIONS: Eighty-eight percent of the tumors in the COMS exhibited features characteristic for melanoma: low to medium reflectivity, the classic mushroom shape, or both. Using additional preset criteria, 96% of tumors exhibited baseline echographic characteristics consistent with the diagnosis of melanoma. Echography graders were able to detect extrascleral nodules > or = 1.5 mm in elevation but not minimally elevated extraocular tumor extension. Clinicians and echographers can use these data to improve their understanding of the echographic features of untreated uveal melanomas.

The effect of cooking on chlorpyrifos and 3,5,6-trichloro-2-pyridinol levels in chlorpyrifos-fortified produce for use in refining dietary exposure.

Various types of produce were fortified with chlorpyrifos and then boiled, baked, canned, or concentrated as appropriate for the type of produce. Both uncooked and cooked samples were analyzed for chlorpyrifos and 3,5,6-trichloro-2-pyridinol, and then, chlorpyrifos cooking factors were calculated by comparing the postcooked concentration to the uncooked concentration. The cooking factors were dependent upon the commodity and cooking procedure: 0.320-1.19 for boiled samples, 0.022-1.18 for baked pulp, and 0.119-0.661 for canned samples. Concentrating chlorpyrifos-fortified orange juice 4-fold resulted in a concentration factor of only 2.6, indicating a loss of chlorpyrifos. Green bean and green pepper plants treated in the greenhouse yielded higher chlorpyrifos concentrations but similar cooking factors to lab-fortified samples. The cooking factors can be used with food consumption databases and modeling tools to refine the dietary exposure according to current product label uses.

Consistency of observations from echograms made centrally in the Collaborative Ocular Melanoma Study COMS Report No. 13.

PURPOSE: To describe the methods used by the Collaborative Ocular Melanoma Study (COMS) Echography Center for grading tumor echograms and to assess reliability of the grading system. METHODS: Tumor echograms were graded at the COMS Echography Center using a specific protocol. To assess consistency, a five-percent random sample of all echographic gradings received as of June 30, 1996 was selected by the COMS Coordinating Center for re-evaluation at the COMS Echography Center. The results were compared with original data. Agreement between the two sets of gradings was evaluated by calculating overall percent agreement, and by using the kappa statistic for categorical features and intra-class correlation coefficients (ICC) for continuous measures. RESULTS: Overall agreement between original gradings and regradings was high. Agreement, based on the kappa statistic, between the original grading and the regrading was classified as 'moderate,' 'substantial,' or 'almost perfect' for nearly every variable graded. Kappas ranged from 0.47 for extrascleral extension to 0.82 for tumor shape. Intra-class correlation coefficients were 0.99 or higher for tumor height measurements and for the clock hour designation of the tumor apex. The only variable graded by the COMS Echography Center that did not have good agreement was 'confidence in tumor measurement.' CONCLUSIONS: The level of agreement (after adjusting for chance agreement) ranged from 'moderate' to 'almost perfect.' Grading for 'confidence of tumor measurement' differed between the original grading and the regrading but there was little difference in the tumor measurements. The COMS Echography Center has demonstrated that its grading protocol is consistent over time.