Belgian recommendations on perioperative maintenance fluid management of surgical pediatric population

The European recommendations on perioperative maintenance fluids in children have recently been adapted from hypotonic to isotonic electrolyte solutions with lower glucose concentrations. In Belgium, however, the commercially approved solutions do not match with these recommendations and there is neither consensus nor mandate about the composition and volume of perioperative maintenance fluids in children undergoing surgery despite the continuing controversy in literature. This paper highlights the significant challenges and shortcomings while prescribing fluid therapy for pediatric surgical patients in Belgium. It is sensible to the authors to address these issues with national guidance through an organization such as The Belgian Association for Paediatric Anaesthesiology, and to propose Belgian recommendations on perioperative fluid management in surgical children, with the intention of improving the quality of care in this population.

Drastic performance improvement of hand-operated sterilizers

In a great number of low-income countries, hand-operated sterilizers are commonly used for the sterilization of medical supplies, including porous loads and hollow instruments. Due to the socio-economic situation in these countries the introduction of fully automatic sterilizers is not (yet) feasible. During a course on sterilization technology for hospital technicians at the Polytechnic in Mombasa, Kenya, some performance tests have been done with locally used sterilizers with standard test loads and loads as are common in the hospitals that were visited. The results for porous loads were alarming due to poor air-removal. Immediately, a number of modifications in the processes were made and tested, based on a method of steam pulsing. This resulted in a significant improvement of performance and can be introduced at a very low cost.

Collagen vascular diseases and radiation therapy: a critical review

PURPOSE

Although many oncologists have the impression that patients with collagen vascular disease tolerate radiotherapy less well than other patients, until now this was never described in a review article.

METHODS AND RESULTS

The principal objective was to determine whether patients with collagen vascular diseases have a greater risk of severe radiation therapy complications, than those without a collagen vascular disease. However, most of the publications found on this topic are short anecdotal case reports of patients with increased toxicity after radiation. Consequently, the true incidence of these side effects is unknown.

CONCLUSIONS

Unless further studies on this subject are reported, each radiation oncologist should be cautious in treating these patients.

Primary sinonasal mucosal melanoma: three different therapeutic approaches to inoperable local disease or recurrence and a review of the literature

Sinonasal melanoma is an uncommon disease with a bad prognosis and a high local recurrence rate. The use of radiotherapy in such conditions remains controversial. A review of the literature is presented in an attempt to answer some of the questions regarding therapeutic options. Data on incidence, aetiology, pathology and prognosis are also provided. Case studies are reported of three patients with sinonasal melanoma referred to our department in a relatively short time period and needing radiotherapy as a single treatment modality, using a conformal three-dimensional treatment technique. One patient was also treated with temporary 1251 seeds, while another was treated using intensity modulation. Both intensity modulation and temporary 1251 seeds are feasible techniques, providing satisfactory dose distributions encompassing the tumour volume while sparing critical structures. Surgery remains the treatment of choice for sinonasal melanoma. Radiotherapy should be used postoperatively and is a good alternative in cases of inoperable disease. Adjacent critical structures limit the radiation dose to the tumour area, especially when high fraction doses are used. Therefore, beam intensity modulation and 1251 seeds can be used to increase the tumour dose without exceeding the radiation tolerance of the surrounding structures.

An unusual evolution of the serum CA 125 level in a ovarian cancer patient

The usefulness of serum CA 125 measurements in monitoring ovarian cancer has been firmly established in recent years. The CA 125 levels correlate well with tumor status, have a predictive value for second-look operations, indicate responsiveness to chemotherapy, and are a strong independent prognostic factor for survival. We report here a patient with an unusual evolution of the CA 125. The primary treatment consisted of surgery and whole-abdomen radiation followed by adjuvant alkylating agent chemotherapy. Six months after the primary treatment the normal CA 125 level increased to a pathological value during the adjuvant treatment. No tumoral progression could be documented and without changing the medication the value progressively decreased to normal values over a period of 18 months. Actually almost 5 years later the CA 125 remains normal and the patient disease free. After discussion of the different etiologic possibilities the most probably explanation seems to be a radiation-induced peritoneal inflammation. The time interval, the rapid increase, and the progressive decrease of the CA 125 level all correlate well with the histopathological appearance of chronic radiation toxicity.

Radiation treatment of rectal adenocarcinoma

The author makes an overview of the place of radiotherapy in the management of patients suffering from rectal cancer: pre-operative and post-operative radiotherapy, treatment of inoperable and recurrent disease are discussed.

High-dose alizapride versus high-dose domperidone: a double-blind comparative study in the management of cis-platinum-induced emesis

A double-blind, randomized crossover trial was carried out in 44 cancer patients receiving chemotherapy with cis-platinum to compare the anti-emetic effectiveness and tolerance of alizapride and domperidone given in high dosage. Patients received 5 administrations of either 4 mg alizapride/kg body weight or 0.6 mg domperidone/kg during a chemotherapy session and then the alternative anti-emetic during the next session. Treatment order was randomized. Patients were followed-up for 12 hours and details recorded of the total time during which there was some nausea, the duration of mild and severe nausea, and the number of episodes of mild and severe vomiting. A note was also made of the duration of mild and moderate sedation, and the incidence and severity of any other side-effects either probably or possibly related to anti-emetic medication. The investigator gave an overall assessment of the severity of nausea and vomiting experienced during each chemotherapy session and an opinion on the comparative effectiveness of the two anti-emetics. At the end of the two sessions, patients were asked to state a preference, if any, for one or other treatment and to select which they would like to have for their next chemotherapy session. The results showed that whilst both alizapride and domperidone appeared to be equally effective in limiting mild nausea, alizapride was significantly better in preventing severe nausea and episodes of vomiting. In those cases where a positive choice between treatments was made, alizapride was considered to be significantly better than domperidone by the investigator and more patients preferred alizapride and would select it for their next session.(ABSTRACT TRUNCATED AT 250 WORDS)

Scintigraphic imaging of an unusual liver displacement

The authors present a patient with a mass in the right lung due to a partial herniation of the liver.

Intra-arterial radionuclide infusion as an aid to assess chemotherapy perfusion patterns

Regional treatment of advanced head and neck cancer by intra-arterial infusion has been tried for several years. The aim of such treatment is to increase the concentration of the drug in the tumor area while decreasing systemic toxicity. The exact localization of the intra-arterial catheter is thereby the key to effective treatment. This report describes the results of radionuclide imaging as an aid to defining the perfusion pattern in comparison with vital dye injection and contrast angiography. It is concluded that radionuclide infusion imaging is the best method to monitor the localization of the catheter.

Influence of nandrolone decanoate on the repopulation of the thymus after total body irradiation of mice

It has been reported that nandrolone decanoate is helpful in overcoming the neutropenic phase following irradiation. In the present study the influence of nandrolone decanoate on the thymus' cellularity after total body irradiation was investigated. In comparison with a placebo-treated group, mice receiving nandrolone decanoate showed a similar pattern of thymus repopulation, but a significantly lower number of thymocytes over the whole period of treatment was found. Nonirradiated mice also had a significantly lower number of thymocytes when treated with nandrolone decanoate. In addition, the number of circulating leukocytes was also evaluated over a period of 1 month after total body irradiation. On 11 of the 21 days investigated, a significantly higher number of leukocytes was found in the nandrolone decanoate-treated group. We conclude that the action of nandrolone decanoate was not clearly distinct from that of testosterone regarding either granulopoiesis or thymic involution.

Ga-67 imaging in Hodgkin's disease

In order to answer the question if Ga-67 imaging has a practical utility for the management of the patient with Hodgkin's disease, 108 scans performed on 60 patients were reviewed. When used during the initial staging of the disease or during restaging because of recurrences, Ga-67 imaging-at least in our experience-gave many false negative results in the cervical, axillary and inguinal areas, whereas the majority of true positive scans was found at the mediastinal level (including the lower mediastinum), and also in the lung parenchyma and the upper epigastric regions. Because of its lack of sensitivity, Ga-67 imaging cannot replace other staging procedures, but nevertheless is a valuable adjunctive test, as it can identify tumor localization that may have remained undetected by other methods. Fifty-four scans were performed to monitor treatment with radiation therapy or chemotherapeutic agents. Disappearance or decreases of Ga-67 uptake after treatment usually corresponded to a disappearance or regression of the tumor as ascertained by other methods. When the treatment was shown to be ineffective, Ga-67 uptake persisted or even became more prominent. When during follow-up, a new concentration of Ga-67 appeared at the original location or elsewhere, a relapse was extremely likely. However, one must be aware of false positive images. In our material, no correlation was found between the intensity of the Ga-67 uptake and the histological subtypes of Hodgkin's disease. Neither did we observe any relation to the blood sedimentation rate or serum iron levels.

Cytostatic-associated vomiting effectively inhibited by domperidone (R 33 812)

The effect of domperidone on vomiting due to cytostatic treatment was studied during a double-blind trial involving 41 patients. One group received the sequence domperidone-placebo and the other the reverse sequence during two consecutive courses of cytostatic therapy (chlormethine alone or in combination with other cytostatics). Domperidone 2 mg/ml or the placebo was injected IV 1 h before the start of the cytostatic treatment. A similar injection was given 4 h later. Presence, duration, and incidence of nausea and vomiting before, during, and after the peak period (period from the second up to and including the sixth hour after cytostatic injection) were measured. With respect to vomiting, domperidone was significantly superior to placebo concerning duration and effect before and after the peak period in both sequences. There was no difference during the peak period. With respect to nausea, domperidone was superior to placebo concerning duration and effect during the peak period in the placebo-domperidone sequence. No difference was observed in the reverse order. A significant superiority of domperidone was noted before the peak period.

Controlled telethermographic study of the peripheral vasoactivity of oral piribedil

A single-blind crossover study was carried out in 10 subjects with a healthy arterial system to compare the effects of oral piribedil and placebo on the peripheral circulation. Using a telethermographic technique, skin temperature variations from baseline values were measured, at 15 minute intervals over a 2-hour period, after treatment with 3 x 20 mg piribedil tablets, after 1 x 50 mg piribedil in a sustained-release tablet formulation, and after placebo. In contrast to placebo, a vaso-active effect was observed afte piribedil administration on all but 3 occasions. Peak temperature changes appeared later after the sustained-release tablet. Side-effects of treatment were minimal and no significant changes were recorded in blood pressure.

Treatment of ankylostomiasis with levamisole

The authors communicate their experience in the treatment of ankylostomiase with levamisole; with a dose of 2.5 mg/kg body weight they achieved a positive result in two-thirds of the cases in a series of 119 without any toxic side effects.