Prophylactic methylprednisolone to reduce inflammation and improve outcomes from one lung ventilation in children: a randomized clinical trial.

BACKGROUND: One lung ventilation (OLV) results in inflammatory and mechanical injury, leading to intraoperative and postoperative complications in children. No interventions have been studied in children to minimize such injury. OBJECTIVE: We hypothesized that a single 2-mg·kg(-1) dose of methylprednisolone given 45-60 min prior to lung collapse would minimize injury from OLV and improve physiological stability. METHODS: Twenty-eight children scheduled to undergo OLV were randomly assigned to receive 2 mg·kg(-1) methylprednisolone (MP) or normal saline (placebo group) prior to OLV. Anesthetic management was standardized, and data were collected for physiological stability (bronchospasm, respiratory resistance, and compliance). Plasma was assayed for inflammatory markers related to lung injury at timed intervals related to administration of methylprednisolone. RESULTS: Three children in the placebo group experienced clinically significant intraoperative and postoperative respiratory complications. Respiratory resistance was lower (P = 0.04) in the methylprednisolone group. Pro-inflammatory cytokine IL-6 was lower (P = 0.01), and anti-inflammatory cytokine IL-10 was higher (P = 0.001) in the methylprednisolone group. Tryptase, measured before and after OLV, was lower (P = 0.03) in the methylprednisolone group while increased levels of tryptase were seen in placebo group after OLV (did not achieve significance). There were no side effects observed that could be attributed to methylprednisolone in this study. CONCLUSIONS: Methylprednisolone at 2 mg·kg(-1) given as a single dose prior to OLV provides physiological stability to children undergoing OLV. In addition, methylprednisolone results in lower pro-inflammatory markers and higher anti-inflammatory markers in the children's plasma.

Pilot study using an Internet-based program in informed consent.

PURPOSE: To examine the effect of an internet-based aid to informed consent on parent recall of potential surgical complications. METHODS: Parents of children scheduled for elective inguinal hernia repair were assigned to a control group or were enrolled in an internet-based program designed to aid in the consent process. Nine potential surgical complications were presented to the parent(s) in the consent discussion and in the Internet program. Parent recall of potential surgical complications was assessed immediately after the consent discussion and on the day of surgery. RESULTS: Overall recall of complications was poor in both groups, both immediately and on the day of surgery. Parents in the control group (n = 13) recalled a mean of 2.9 complications immediately and 1.5 on the day of surgery, approaching statistical significance (P = .056). The parents in the internet program group (n = 17) recalled a mean of 2.6 complications immediately and 2.9 on the day of surgery (P = NS). There was no significant difference in immediate recall between the two groups, but there was a trend towards statistically significant improvement in recall in the study group the day of surgery vs. controls (P = .06). CONCLUSION: Although overall recall of potential surgical complications was poor in both groups, there was a trend towards a significant improvement in recall in the study group after viewing the Internet-based program.

Malignant peripheral nerve sheath tumor arising from an adrenal ganglioneuroma in a 6-year-old boy.

This report describes the youngest patient to develop a malignant peripheral nerve sheath tumor arising from a ganglioneuroma (MPNST ex Ganglioneuroma). The patient, a 6-year-old boy, was never irradiated and had no history or stigmata of neurofibromatosis. The report also includes a review of the previously published related cases, and an analysis of the immunohistochemistry and electron microscopy data available to date on the subject.