Kikuchi's disease: report of three cases and an overview.

We describe, to our knowledge, the first native Finnish patients with Kikuchi's histiocytic necrotizing lymphadenitis. The diagnosis was based in all cases on histopathological findings in open biopsy. The disease was first detected in Japan in 1972, but in Scandinavia, until this decade, there had been no cases reported. Our patients were young, otherwise healthy women who had cervical lymphadenopathy, fever, and fatigue as their main symptoms. In two of them, the disease was mild and subsided spontaneously within 2-6 months. One patient with more fulminant lymphadenopathy was treated with antimicrobial and antiinflammatory drugs. She became symptomless in 3 months. The cause of Kikuchi's disease is unknown. A viral or postviral hyperimmune reaction has been proposed as its etiology. Malignant lymphoma and systemic lupus erythematosus are differential diagnoses. Histopathological findings are pathognomonic and pathologists must be aware of its typical characteristics.

Ketoprofen and fentanyl for pain after uvulopalatopharyngoplasty and tonsillectomy.

OBJECTIVES: The treatment of postoperative pain after uvulopalatopharyngoplasty (UPPP) and tonsillectomy presents a challenge. Opioids can cause sedation and respiratory depression. Nonsteroidal antiinflammatory drugs can increase postoperative bleeding. The authors have evaluated the severity of postoperative pain and the consumption of opioid in 53 adult patients undergoing either UPPP or tonsillectomy. STUDY DESIGN: A prospective, parallel-groups study. METHODS: A general endotracheal anesthesia was used in each patient. After surgery patients received ketoprofen 1 mg/kg as an intravenous bolus, followed by a continuous infusion of 4 mg/kg during 24 hours. For rescue analgesia patient-controlled intravenous fentanyl was used. RESULTS: Both UPPP and tonsillectomy are associated with intense postoperative pain. More than 40% of the patients had high pain scores during the first 24 postoperative hours. Postoperative pain after UPPP was more severe and the difference was significant during swallowing (P < .05). The need for fentanyl in the UPPP group was twice that of the tonsillectomy group (P < .01). There was a high interindividual scatter in the patient-controlled fentanyl attempts in both groups. The patients in the UPPP group needed significantly more oxygen supply during recovery (P = .007). No serious adverse effects occurred and none of the patients experienced postoperative bleeding that required any intervention. CONCLUSION: Individually tailored analgesic treatment protocol is essential for patients undergoing UPPP and tonsillectomy to ensure safe and effective pain alleviation.

Paranasal sinus mucormycosis: a report of two cases.

Mucormycosis of the nose and paranasal sinuses is a rare invasive fungal infection, which often has a very fulminant course and characteristic clinical findings. The patients are usually immunocompromised, with diabetic ketoacidosis being the commonest underlying disorder. In some immunocompetent patients, the disease is associated with local predisposing factors, such as chronic sinusitis. Although the prognosis has improved in recent decades, the disease can still be fatal. The underlying disease is an important determinant of prognosis and correction of the metabolic disorder, if present, is essential. Herein we report two cases: one of our patients was immunocompetent but had earlier suffered from polypous rhinosinusitis whereas the other had mild adult-type diabetes. Both patients were successfully treated with surgical debridement and amphotericin B.

Perioperative intravenous ketoprofen neither prolongs operation time nor delays discharge after adenoidectomy in children.

Because nonsteroidal anti-inflammatory drugs, such as ketoprofen, prolong bleeding time, their preoperative administration may both prolong operation time and delay discharge. Therefore, charts of 335 children who had undergone adenoidectomy were evaluated to determine the effect of ketoprofen on operation time (OPERTIME) and length of hospital stay (ACTUAL LOS). The study was conducted in three phases (I-III) which differed from each other in the dose of i.v. ketoprofen, 0.3-3 mg x kg(-1). All phases were conducted with parallel groups using a prospective, randomized, and double blind design; moreover, phases I and III were placebo-controlled. OPERTIMEs were similar between Placebo groups and Ketoprofen groups. The dose of ketoprofen did not affect OPERTIME or ACTUAL LOS. In phase I, ACTUAL LOS was significantly longer in the Placebo group (251 +/- 46 min, mean +/- SD) compared to the Ketoprofen group (225 +/- 44 min, P=0.006). In conclusion, preincisional ketoprofen did not prolong OPERTIME or delay discharge in children undergoing adenoidectomy.

The feasibility of pain treatment at home after adenoidectomy with ketoprofen tablets in small children.

In this study, we investigated the feasibility of pain treatment using ketoprofen 25 mg tablets (5 mg x kg(-1) x day(-1)) at home in children after daycase adenoidectomy. We also determined the adverse events and the incidence of postoperative bleeding during the first week after surgery. Initially, we studied 611 children aged 1-9 years. The study design was prospective, longitudinal, and open. The final data consisted of 555 (91%) children, and 522 children who received ketoprofen at home. The parents administered four (1-10, median with 10th and 90th percentiles) ketoprofen tablets to their children during the first week. A total of 20% of the parents experienced problems in administering tablets, and problems were three times more common in children under 48 months compared to older children. The main problems were swallowing difficulties and the unpleasant taste of the tablet. Neither serious adverse events, nor clinically significant bleeding occurred. Ketoprofen at the dose of 5 mg x kg(-1) x day(-1) proved to be a safe analgesic in children for short-term use after adenoidectomy.

I.v. intraoperative ketoprofen in small children during adenoidectomy: a dose-finding study.

We have investigated if a low dose of ketoprofen (0.3 mg kg-1) i.v., provided as good analgesia with less adverse effects than higher doses (1.0 and 3.0 mg kg-1) in 220 children, aged 1-7 yr, undergoing adenoidectomy, in a prospective, randomized, double-blind, placebo-controlled, parallel group study. The postoperative analgesic effect was notable even after the lowest dose of ketoprofen. However, the higher doses seemed to provide better analgesia with no increase in adverse events or intraoperative bleeding. None of the children experienced postoperative bleeding which would have required intervention or delayed discharge from hospital. This study confirms the efficacy and safety of intraoperative ketoprofen in children during adenoidectomy.

Postoperative pain after adenoidectomy in children.

We have investigated if pain intensity or analgesic requirements in hospital predicted pain intensity, pain duration or analgesic requirements at home in 611 children, aged 1-7 yr, after day-case adenoidectomy. We also investigated if ketoprofen 0.3-3.0 mg kg-1, administered pre-emptively i.v. during operation, modified pain at home. In hospital, a prospective, randomized, double-blind, placebo-controlled study design was performed. A standard anaesthetic technique was used in all children and fentanyl i.v. was available for rescue analgesia. After discharge, the study design was open, experimental, prospective and longitudinal. On return home, children were prescribed ketoprofen tablets 5 mg kg-1 day-1. Parents were asked to complete an analgesia diary; non-responders were contacted by telephone. The response rate was 91%. The number of doses of fentanyl given in hospital correlated with pain intensity at home (P < 0.001). There were no other correlations and no pre-emptive effect of ketoprofen.

IV perioperative ketoprofen in small children during adenoidectomy.

We have investigated the analgesic and opioid sparing effect of perioperative i.v. ketoprofen in a randomized, double-blind, placebo-controlled, parallel group study in 164 children, aged 1-7 yr, after adenoidectomy. A standard anaesthetic method was used and all children received fentanyl 1 microgram kg-1 i.v. during induction. Children in the ketoprofen group received ketoprofen 1 mg kg-1 i.v. after induction of anaesthesia followed by an infusion of ketoprofen 1 mg kg-1 over 2 h. Children in the placebo group received 0.9% saline. All children received fentanyl 1 microgram kg-1 i.v. as rescue analgesia. In the ketoprofen group less children required postoperative fentanyl (64% vs 77%, P = 0.006) and the total number of fentanyl doses was smaller compared with the placebo group (mean 1.0 (SD 1.1) (95% confidence intervals (CI) 0.8-1.3) vs 1.5 (1.1) (95% CI 1.2-1.7), P = 0.012). Worst pain observed in the postanaesthesia care unit was also lower in the ketoprofen group both at rest (P = 0.028) and during swallowing (P = 0.001). There were no difference in the number of adverse reactions between the groups. No serious adverse reactions occurred.

Comparison of perioperative ketoprofen 2.0 mg kg-1 with 0.5 mg kg-1 i.v. in small children during adenoidectomy.

We have investigated if ketoprofen 0.5 mg kg-1 i.v. provided as good analgesia with less adverse effects compared with ketoprofen 2.0 mg kg-1 i.v. in 107 children, aged 1-7 yr, after adenoidectomy, in a randomized, double-blind, parallel group study design. A standard anaesthetic method was used and all children received fentanyl 1 microgram kg-1 i.v. during induction. Children in group 2.0 received ketoprofen 2.0 mg kg-1 and children in group 0.5, 0.5 mg kg-1 i.v. during induction. If the child was in pain, fentanyl 1 microgram kg-1 was given i.v. as rescue analgesia. We found that ketoprofen provided good analgesia and only 49% of children required fentanyl in the post-anaesthesia care unit. There were no differences between the groups in the number of fentanyl doses, pain scores or frequency of adverse reactions. No serious adverse reactions occurred.

Analgesic efficacy of rectal acetaminophen and ibuprofen alone or in combination for paediatric day-case adenoidectomy.

BACKGROUND: Acetaminophen and non-steroidal anti-inflammatory drugs have different mechanisms of action. We investigated if combining rectal acetaminophen with ibuprofen would provide better postoperative analgesia compared with either drug alone after adenoidectomy in children. METHODS: 160 children, aged 1-6 yr, undergoing day-case adenoidectomy, were randomized to receive either acetaminophen 40 mg kg(-1), ibuprofen 15 mg kg(-1), their combination, or placebo rectally immediately after anaesthetic induction. A standard anaesthetic method was used and all children received alfentanil 10 micro g kg(-1) i.v. during induction. Meperidine 5-10 mg i.v. was used for rescue analgesia for a pain score (Objective Pain Scale) over 3. Recovery times, sedation scores and the need for rescue analgesia and adverse events during the first 24 h after anaesthesia were recorded. Rescue analgesic at home was ibuprofen 10 mg kg(-1). RESULTS: Total meperidine requirements were significantly less in the groups receiving acetaminophen, ibuprofen, or their combination compared with the group receiving placebo indicating an opioid-sparing effect of 19-28% (P<0.05). Children given acetaminophen were more sedated than those given ibuprofen (P<0.05). Discharge criteria were fulfilled earlier in the ibuprofen group than in all the other groups (P<0.05). At home, less children (49%) needed rescue analgesia in the combination group compared with the other groups (74-77%) (P<0.02). CONCLUSIONS: We conclude that prophylactically administered rectal acetaminophen combined with ibuprofen does not improve analgesia after adenoidectomy in the immediate postoperative period compared with either drug alone but does decrease the need for analgesia at home. Ibuprofen results in lesser sedation and faster discharge than when acetaminophen is used.

Spectral properties of light affect plasma and pituitary gonadotropins in male rats.

In order to find out whether different light spectra have any role in regulating the gonadotropin levels in male rats, we compared the 24-hour patterns of plasma and pituitary gonadotropins in rats kept for 7 days in natural or in cool white artificial lighting (exp. I). The intensity and periodicity of the two lighting conditions were adjusted as similar as possible. Further, we measured plasma and pituitary gonadotropins in the middle of the light period and in the middle of the dark period in rats kept for 7 days under artificial lightings of three different spectra (exp. II). In both experiments, in all lighting conditions we found higher plasma levels of LH and FSH during the dark than the light period. The differences were statistically significant only when the illumination contained more long and/or short wavelengths than the usual cool white laboratory lighting. The pituitary contents of gonadotropins were not found to vary with the periodicity of lighting. In the 24-hour patterns the overall plasma levels were higher and the pituitary contents of gonadotropins lower in natural lighting than in cool white lighting. It was concluded that the spectral properties of light influence the secretion of gonadotropins in male rats, but the mechanism involved remains to be clarified.