An improved technique for treating tracheostomal stenosis following laryngectomy

Stenosis of the tracheostome is an occasional complication following laryngectomy. Having tried a number of procedures recommended for correction of such stenoses with limited results, we developed a new technique. This technique which is based on multiple Y-V plasties has been applied to 20 patients. Measurements of the stomal area following surgery in 18 patients showed an average increase in stomal size by a factor of 3.8. One patient apparently had no increase of the stoma. In 2, no post-operative measurements were available. Post-operative infection resulted in recurrence of the stenosis in one patient. He was successfully reoperated using the same technique. Follow-up revealed that none of the patients had complaints related to their stoma.     

AN IMMUNOHISTOCHEMICAL STUDY OF TAL-1 PROTEIN EXPRESSION IN LEUKAEMIAS AND LYMPHOMAS WITH A NOVEL MONOCLONAL ANTIBODY, 2TL 242

Fifty formalin fixed, paraffin-embedded cases of T-acute lymphoblastic leukaemia (T-ALL) from 12 bone marrow trephines and 38 lymph nodes were stained with a new monoclonal antibody, 2TL 242, raised against recombinant TAL1 protein. The antibody recognizes TAL-1 polypeptides of molecular weight 39 and 41 kD (full length). In addition, a variety of other leukaemias and lymphomas were also stained with 2TL 242. Twenty-four of the 50 cases of T-ALL showed nuclear positivity, ranging from 10 to 90 per cent of leukaemic cells. A positive staining reaction was nuclear and stippled in pattern. Nuclear staining was not seen in any other type of leukaemia or lymphoma. Five cases of follicular lymphoma showed diffuse cytoplasmic staining of variable intensity. Although some background staining is obtained with this antibody, positive nuclear staining is easily distinguishable. This monoclonal antibody has a potential role in primary diagnosis and in the detection of minimal residual disease in T-ALL.     

Cerebral Blood Flow in Preterm Infants during the First Week of Life

ABSTRACT. Forty-two preterm infants of 28–33 weeks of gestation were studied once during the first week of life by 133-Xenon clearance after intravenous injection to estimate global cerebral blood flow. Count rates detected over the chest were corrected for chest wall contribution and used as arterial input function. A neonatal blood-brain partition coefficient of Xenon was used for the calculation of a mean flow estimator (CBF-∞). The techique was internally validated by use of differently obtained arterial input functions. In 11 infants wihout respiratory distress, CBF-∞ was 19.8 ml/100 g/min ±5.3 SD. In 24 infants treated with mechanical ventilation CBF-∞ was 11.8 ml/100 g/min ±3.2 SD. In 7 infants treated with continous positive airway pressure CBF-∞ was 21.3 ml/100 g/min ±12.0 SD. When the reduction of CBF-∞ associated with mechanical ventilation was taken into account, the 9 infants with subependymal/intraventricular haemorrhage had increased CBF-∞. The effects of gestational age, birthweight, mode of delivery, postnatal age, mean arterial blood pressure, PaCO2, blood haemoglobin and phenobarbitone medication were also analysed and found inconsistent. In conclusion, CBF was lower than expected and in infants requring mechanical ventilation the values were lower still.     

Mild Anaemia in African School Children: Effect on Running Performance and an Intervention Trial

ABSTRACT. Blood haemoglobin concentrations and reticulocyte counts were determined in 430 school children in grades 1, 3 and S in a small township in rural Zambia at the end of the rainy season. Running capacity was estimated by the 12-min running test. Age, sex, height, weight, social and nutritional indicators were recorded. Mean haemoglobin was 125.3 g/l ± T2.3 SD. Low haemoglobin was associated with indicators of a traditional way of life. After a controlled trial of iron, folic acid, tetrachlorethylene and chloroquine lasting for 6 weeks, mean haemoglobin in all the children was 128.8 g/l ± 10.0 SD. The mean haemoglobin was significantly higher in the 218 children who received iron than in the 212 children who did not receive iron. There were no other significant differences among the treatment grops. In a subgroup of 377 children who completed two running tests, those with lower haemoglobin ran significantly shorter distances, even when possible confounding factors were partialled out. The effect was reduced by excluding 12 children with haemoglobin less than 100 g/1 or 48 children with reticulocyte counts of 15%_± or more, but remained statistically significant.     

Socio-economic achievements of individuals born very preterm at the age of 27 to 29 years: a nationwide cohort study

Aim  To describe the socio economic achievement of individuals born very preterm (VPT) at the age of 27 to 29 years.
Method  Demographic and social data were extracted from national registers for all individuals born between 1974 and 1976 in Denmark ( n =208 656). Of these, 203 283 individuals were alive in 2006. We compared VPT individuals (gestational age <33wks, n =1422; 51.8% males, n =736) with individuals born at term (>36wks, n =192 223; 51.1% males, n =98 240), of whom 4.08% ( n =58) of the VPT and 0.19% ( n =373) of the term individuals had a diagnosis of cerebral palsy (CP).
Results  Overall results in the two groups were similar, but significant differences appeared. The VPT group had a lower educational level than the term group: 23.9% versus 16.3% had a basic education (corresponding to attendance at basic school for 9y or less; odds ratio [OR] =1.61, 95% confidence interval [CI] 1.42–1.82). Similarly, 31.9% versus 37.6% had a tertiary education (corresponding to different levels of professional education; OR=0.77, CI 0.69–0.86). Net income was 11% lower in the VPT group and 10.8% versus 5.3% were receiving welfare support (OR=2.14, CI 1.81–2.55). In the VPT group 59% versus 52% did not have children ( p <0.001) and there were more individuals living alone without children (28.8% vs 21.8%; OR=1.45, CI 1.29–1.63).
Interpretation  VPT birth in the 1970s in Denmark is associated with a highly statistically significant educational and social disadvantage persisting into young adulthood. CP increased the relative risk of social disadvantage in VPT individuals. However, the majority of the survivors are well integrated in society.     

Severe Hypocarbia in Preterm Infants and Neurodevelopmental Deficit

ABSTRACT. We report significant neurological abnormality at 18 months of age in 3 of 7 very low birth weight infants (≤ 1500 g), who during mechanical ventilation inadvertently became severely hypocarbic (arterial carbondioxide tension less than 2.0 kPa (15 mmHg)) at some time during the first 24 h of life. Although the number is small the outcome was significantly worse than the outcome in two fairly similar groups of infants selected as controls ( p =0.026). The infants in one of the control groups were also mechanically ventilated but remained normocapnic. Germinal layer haemorrhage (GLH) was more frequent among these infants compared with the severely hypocarbic infants ( p =0.022). The infants in the other control group was not mechanically ventilated. In all the severely hypocarbic infants the Bayley mental developmental index uncorrected for prematurity was at or below the median for the total sample ( p =0.01). The results suggest that neonatal cerebral ischaemia, for instance due to hypocarbia, is of greater prognostic significance than GLH.     

Anxiety in adolescents born preterm or with very low birthweight: a meta‐analysis of case–control studies

Aim To determine if adolescents who are born very preterm (<32wks; of gestation) and/or with very low birthweight (VLBW; <1500g) have a higher risk of experiencing clinically significant anxiety problems. Method We used a systematic review and meta‐analysis. We searched the databases ISI Web of Knowledge, PubMed, PsycNET, Educational Resources Information Center (ERIC), Latin American and Caribbean Literature on the Health Sciences (LILACS), and Virtual Health Library (VHL) with equivalent search expressions (from the databases’ inception to June 2011). Also, we screened reference lists of identified articles. We selected case–control studies of adolescents 11 to 20 years old who were very preterm/VLBW and had a matched reference group born at term with normal birthweight that reported a validated anxiety outcome measure. For data extraction, two authors independently reviewed titles, abstracts, and full articles identified through the searches. Subsequently two authors independently extracted data. Results We included six studies with 1519 adolescents (787 very preterm/VLBW, 732 comparisons). The general risk of developing clinically significant anxiety problems was nearly doubled (p<0.05) in the very preterm/VLBW population (OR 2.27, 95% confidence interval 1.15–4.47). The overall prevalences were 9.9% in the very preterm/VLBW group and 5.5% in the comparison group. Interpretation Those born very preterm/VLBW have an increased risk of developing clinically significant anxiety problems in adolescence.     

Perinatal Growth Retardation in Preterm Infants

Greisen, G. and Petersen, M. B. (Department of Neonatology, Rigshospitalet, Copenhagen, Denmark). Perinatal growth retardation in preterm infants. Acta Paediatr Scand Suppl 360: 43, 1989.
Perinatal and 4-year follow-up data were analysed for 137 children born after 26 to 35 weeks of gestation. All were free of severe prenatal or neonatal illness and of major handicaps. Infants who were light-for-gestation at birth were approximately 0.6 SDS smaller at 4 years than the appropriate-for-gestation infants as regards height, weight, and head circumference (p< 0.005). The McCarthy general cognitive score was reduced (p = 0.03). Motor scores, standardised for cognitive function, were also reduced (p = 0.02) indicating that motor—perhaps cerebellar—function is particularly vulnerable to perinatal growth retardation.     

Atrial Natriuretic Peptide during Exercise in Patients with Coronary Heart Disease before and after Single Dose Atenolol and Acebutolol

Plasma atrial natriuretic peptide (ANP) was measured during dynamic exercise in 10 patients with coronary heart disease before and after single dose atenolol 50 mg and acebutolol 200 mg, respectively. Systolic blood pressure, heart rate and the rate-pressure product increased during exercise before and after β-blockade, but levels were lower after β-blockade. Plasma ANP levels at rest were unchanged after atenolol, but rose after acebutolol (p<0.01). During exercise plasma ANP increased significantly both before and after β-blockade, but plasma ANP levels were higher after acebutolol at all workloads (p<0.05), whereas plasma ANP levels after atenolol were higher at 125 W exclusively (p<0.05). The augmented ANP levels during exercise after β-blockade probably reflect catecholamine-stimulated ANP release, whereas the elevated plasma ANP levels after acebutolol at rest might be a β-adrenoceptor-mediated ANP release due to the intrinsic sympathomimetic effect of acebutolol.