Feasibility of 4% Topical Lidocaine for Pain Management During Negative Pressure Wound Therapy Dressing Changes in Pediatric Patients: A Case Study.

BACKGROUND: Opioid analgesics such as morphine are frequently used for pain management in pediatric patients undergoing dressing changes for negative pressure wound therapy (NPWT). While these medications reduce associated pain, they are also associated with adverse side effects ranging from constipation, headache, and dizziness to respiratory depression, chest wall rigidity, and death. Alternative analgesic approaches are needed for pediatric patients undergoing NPWT. METHODS: Four percent topical lidocaine was used for pain management during dressing changes for NPWT in a 15-year-old Hispanic male with necrotizing adenopathy. CONCLUSION: The 4% topical lidocaine reduced the pain associated with dressing changes during NPWT. No adverse side effects were observed.

Cumulative doses of adjunct 131I treatment depend on location of residual thyroid tissue after total thyroidectomy in differentiated thyroid cancer.

PURPOSE: The aim of this study was to review the outcome after adjunct postoperative 131I therapy in patients with differentiated thyroid carcinoma (DTC) treated with total thyroidectomy (excluding medullary thyroid carcinoma). METHODS: Retrospective chart review: Management protocol is total thyroidectomy with cervical node sampling, 131I whole-body scan 3 weeks postoperatively to document residual thyroid tissue or metastatic lesions. Adjunct treatment consists of one or more 131I (100-200 mci/1.73 m2). Patients are considered disease free if 2 consecutive 131I whole-body scan are negative with undetectable thyroglobulin level. RESULTS: Twenty-one patients, 14 females and 7 males, with a mean age of 13.6 years were treated. Whole-body scan postoperatively revealed uptake in the thyroid bed (TB) in 10 patients, in cervical lymph nodes (CLN) in 9 patients, and in CLN and lungs in 2 patients. Patients with residual uptake in TB received a significantly lesser dose of 131I (mean, 122 +/- 53 mci) than those with metastatic CLN (357 +/- 182 mci) (P < .004) (t test) or lung mets (523.5 mci). With a mean follow-up of 7.8 years (range, 1-16 years), overall survival is 100% but disease-free survival is 100%, 66%, and 0% respectively for patients with residual disease in TB, CLN, and lungs. CONCLUSION: Patient with residual thyroid tissue in the TB required a significantly lesser number of treatments and doses of 131I compared to patients with cervical node metastases with a 100% disease-free survival. The best management of immediate postoperative residual cervical nodes (surgical excision vs 131I) remains to be defined. The efficacy of 131I therapy in patients with lung metastases remains controversial with complete remission unlikely.

Prophylactic thyroidectomy in pediatric carriers of multiple endocrine neoplasia type 2A or familial medullary thyroid carcinoma: mutation in C620 is associated with Hirschsprung's disease.

PURPOSE: Prophylactic total thyroidectomy is now recommended after having confirmed RET mutations in children of parents with multiple endocrine neoplasia type 2 or familial medullary thyroid carcinoma. We reviewed our experience to determine the incidence of medullary thyroid carcinoma with respect to age at surgery, the location of the mutation, and its association with Hirschsprung's disease (HD). METHODS: A retrospective review from 1996 to 2005 revealed 20 children with genetic screening for multiple endocrine neoplasia type 2A or familial medullary thyroid carcinoma who underwent a prophylactic total thyroidectomy with parathyroid gland preservation. RESULTS: The median age of the 20 patients (9 boys and 11 girls) included in this study was 8.2 years (range, 3.7-16.9 years) at the time of their surgery. Final pathology revealed normal thyroid tissue (n = 3; median age, 5.9 years), C-cell hyperplasia (n = 13; median age, 10 years), or medullary thyroid carcinoma (n = 4; median age, 8 years). Four children, all with mutations in C620, had a previous diagnosis of HD. At a median follow-up of 3.7 years (range, 1 month to 8.4 years), all patients were well and cancer free. CONCLUSIONS: There is no correlation between histologic findings and median age at surgery. Hirschsprung's disease was found in 50% of the patients with the RET mutation in C620. In children of C620 parents, symptoms of HD should be actively sought, and if such are found, rectal biopsies should be performed even if mutation results are not yet available. Based on the age of the earliest cancer and the safety of total thyroidectomy, children should promptly undergo surgery after genetic screening and before their fifth year of life.

Alcoholic solution of zein (Ethibloc) sclerotherapy for treatment of lymphangiomas in children.

PURPOSE: The aim of this study was to report the experience and efficacy of Ethibloc sclerotherapy as treatment of lymphangiomas. METHODS: Between 1992 and 2004, 63 patients had Ethibloc sclerotherapy for lymphangiomas at our institution. Computed tomographic scan or magnetic resonance imaging and clinical evaluation determined efficacy of the treatment. Results were classified as excellent (> or =95% decrease in lesion volume), satisfactory (> or =50% decrease and asymptomatic), or poor (<50% decrease or symptomatic). RESULTS: Sixty-three patients with 67 lesions underwent sclerotherapy with a median of 2 treatments per patient. Thirty-five involved the neck; 10, the head and face; and 22, the thorax or limb. Thirteen were predominantly microcystic; 28, macrocystic; and 26, mixed. Of the 63 patients, 6 underwent sclerotherapy for postsurgical residual lesions. Results were classified by type: of the 54 macrocystic/mixed cases, 26 (49%) had excellent, 19 (35%) had good, and 9 (16%) had poor results; in the 13 predominantly microcystic lesions, 3 (23%) had excellent, 7 (54%) had good, and 3 (23%) poor results. Five patients (7.7%) required surgery for complications; 2, for scar revision; 2, for persistent drainage; and 1, for a salivary fistula. Infection occurred in 4 patients (6.2%) after sclerotherapy. Follow-up averaged 3.5 years (range, 12 months to 12 years). CONCLUSION: Ethibloc sclerotherapy is a safe and effective alternative to surgical excision of macrocystic lymphangiomas and can be used for postsurgical recurrences.