Lower alpha frequency of intraoperative frontal EEG is associated with postoperative delirium: A secondary propensity-matched analysis.

BACKGROUND: Postoperative delirium (POD) is a serious complication of surgery, especially in the elderly patient population. It has been proposed that decreasing the amount of anesthetics by titrating to an EEG index will lower POD rate, but clear evidence is missing. A strong age-dependent negative correlation has been reported between the peak oscillatory frequency of alpha waves and end-tidal anesthetic concentration, with older patients generating slower alpha frequencies. We hypothesized, that slower alpha oscillations are associated with a higher rate of POD. METHOD: Retrospective analysis of patients` data from a prospective observational study in cardiac surgical patients approved by the Bernese Ethics committee. Frontal EEG was recorded during Isoflurane effect-site concentrations of 0.7 to 0.8 and peak alpha frequency was measured at highest power between 6 and 17 Hz. Delirium was assessed by chart review. Demographic and clinical characteristics were compared between POD and non-POD groups. Selection bias was addressed using nearest neighbor propensity score matching (PSM) for best balance. This incorporated 18 variables, whereas patients with missing variable information or without an alpha oscillation were excluded. RESULT: Of the 1072 patients in the original study, 828 were included, 73 with POD, 755 without. PSM allowed 328 patients into the final analysis, 67 with, 261 without POD. Before PSM, 8 variables were significantly different between POD and non-POD groups, none thereafter. Mean peak alpha frequency was significantly lower in the POD in contrast to non-POD group before and after matching (7.9 vs 8.9 Hz, 7.9 vs 8.8 Hz respectively, SD 1.3, p < 0.001). CONCLUSION: Intraoperative slower frontal peak alpha frequency is independently associated with POD after cardiac surgery and may be a simple intraoperative neurophysiological marker of a vulnerable brain for POD. Further studies are needed to investigate if there is a causal link between alpha frequency and POD.

Immunohistochemical and FISH analysis of MDM2 and CDK4 in a dedifferentiated extraskeletal osteosarcoma arising in the vastus lateralis muscle: differential diagnosis and diagnostic algorithm.

Extraskeletal osteosarcoma is a rare neoplasia within the broad differential diagnostic spectrum of calcifying intramuscular lesions. We present a case of a slowly increasing mass within the left vastus lateralis muscle. At first presentation the patient showed a partially calcified well defined mass with a diameter of 5 cm and with no direct contact to the femur. A biopsy from the periphery revealed an ossifying lesion compatible with myositis ossificans. The patient returned 18 months later with the lesion having increased to a diameter of 25 cm. The resection specimen revealed a well delimitated tumor with a central core of partially necrotic neoplastic bone. Besides, histology showed high mitotic areas with pleomorphic spindle cells and regions with cartilaginous differentiation. Immunohistochemistry demonstrated: vimentin+, CD34-, desmin-, actin-, EMA- and pancytokeratin- with focal S100 protein positivity and a Ki-67 index of 20%. Comparative genomic hybridization (CGH) revealed a gain of chromosomal material on 12q; FISH analyses for the CDK4 and MDM2 region showed high level amplifications. Consequently, a high-grade dedifferentiated extraskeletal osteosarcoma was diagnosed. In conclusion, analysis of the MDM2 and CDK4 status is a powerful and discriminating diagnostic tool to distinguish dedifferentiated extraskeletal osteosarcoma from other benign/malignant ossifying lesions in the skeletal muscle.

Assessment of disease activity in alveolar echinococcosis: a comparison of contrast enhanced ultrasound, three-phase helical CT and [(18)F] fluorodeoxyglucose positron emission tomography.

BACKGROUND: Objective of the present study was to assess activity or vascularization of focal liver lesions in alveolar echinococcosis (AE) using [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) in comparison with contrast enhanced ultrasound (CEUS) and three-phase helical computed tomography (CT). METHODS: In this prospective study, 17 patients with confirmed AE of the liver were included (6 males, 11 females; average age: 59 +/- 16 years; average duration of disease: 10.5 years) and were then examined using FDG-PET, precontrast ultrasound (US), CEUS, and three-phase helical CT. We assessed metabolic activity (FDG-PET) and vascularization (CEUS and CT) of Echinococcus multilocularis specific hepatic lesions. RESULTS: FDG-PET identified increased metabolic activity in the corresponding lesions in seven patients (41.2%). A vascularization pattern of echinococcal lesions was visualized in 9 patients (52.9%) by CEUS and in 4 patients (23.5%) by CT. All positive FDG-PET findings were also positive at CEUS. CONCLUSIONS: There was association between findings of metabolic activity in AE at FDG-PET and vascularized lesions of the liver returned by CEUS. This suggests that CEUS may represent a cost-effective tool in the decision making to perform FDG-PET examination.

Cost containment in a school deworming programme targeting over 2.7 million children in Vietnam.

Vietnam is one of the countries in the world most affected by soil-transmitted helminthiases. Large areas of the country, such as the Northern Uplands and the North and Central Coast, are reported as having infection rates of 75-85% for Ascaris lumbricoides, 38-40% for Trichuris trichiura and 27-28% for hookworm infections. Periodical deworming of schoolchildren is therefore strongly recommended. Managers of the Helminth Control Programme decided to apply a number of measures to improve cost efficiency in order to deworm as many schoolchildren as possible with the limited financial resources available. This low-cost intervention targeted over 2.7 million schoolchildren. Coverage was estimated at over 95% and the cost for each treated child was US$ 0.03, which represents a saving of approximately 50% of costs presently reported in the literature. This article describes the measures applied that resulted in cost containment but maintained high treatment coverage.