Atrophy of the quadriceps muscle in children with a painful hip.

The objective of this study was to determine the degree of muscle wasting of various components of the quadriceps muscle in children with a painful hip. Between January 1994 and September 1997, 327 consecutive children with a unilateral painful hip and/or limping were evaluated prospectively with ultrasonography. Quadriceps thickness was measured on both sides. Moreover, muscle thickness was measured in 59 control subjects. The patients were divided into eight groups; transient synovitis (n = 134), Perthes' disease (n = 35), slipped capital femoral epiphysis (n = 5), osteomyelitis (n = 4), aspecific synovitis (n = 5), rheumatoid arthritis (n = 3) and miscellaneous (n = 16). In 125 patients, no sonographic and radiological abnormalities were found and during follow-up the symptoms disappeared ('no pathology' group). Ipsilateral muscle wasting was present in all patient groups, whereas the control subjects showed no significant difference in muscle thickness between legs. The degree of muscle wasting was compared between transient synovitis, the 'no pathology' group, Perthes' disease and control subjects. For both quadriceps and vastus intermedius muscles, there was a significant difference between these groups, except between control subjects and the 'no pathology' group. For the rectus femoris muscle, there was a significant difference between these groups, except between transient synovitis and 'no pathology'. Muscle wasting showed a positive correlation with duration of symptoms and pre-existing muscle mass. In conclusion, different diseases show different degrees of muscle wasting, and there are different patterns of muscle wasting of various components of the quadriceps femoris muscle.     

The role of topical negative pressure in wound repair: Expression of biochemical markers in wound fluid during wound healing

The clinical effects of topical negative pressure therapy (TNP) on wound healing are well described in numerous articles. While the mechanism(s) of action are not completely understood, it is postulated that reduction of local and interstitial tissue edema, increased perfusion of the (peri-) wound area, changed bacterial composition, and mechanical stimulation of the woundbed contribute to the clinical success. Our hypothesis is that with the removal of excessive fluid, proteolytic enzymes negatively influencing the healing process are removed. Our aim was to assess whether the concentrations of albumin, matrixmetalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase (TIMP-1) were different between wounds treated with TNP and conventional gauze therapy. We analyzed wound fluid samples of 33 wounds treated with either TNP therapy ( n =15) or conventional therapy ( n =18) on albumin, pro- and activated MMP-9, TIMP-1, and the ratio of total MMP-9/TIMP-1. Albumin levels were found to increase significantly in acute wounds compared with chronic wounds; however, no difference could be found on comparing TNP with conventional therapy. We did find significantly lower levels of pro-MMP-9 and lower total MMP-9/TIMP-1 ratio in TNP-treated wounds during the follow-up of 10 days. These data strongly suggest that TNP therapy influences the microenvironment of the wound.     

Do heart rate and velocity variability derived from umbilical artery velocity waveforms change prior to clinical pregnancy-induced hypertension?

OBJECTIVE: To investigate the hypothesis that alterations in heart rate variability, peak systolic velocity variability and time-averaged velocity variability in the human umbilical artery may predict early signs of dysfunctional fetal-placental coupling in pregnancies that later develop pregnancy-induced hypertension. METHODS: Doppler flow velocity recordings from the umbilical artery were performed at 10-20 weeks of gestation in 12 nulliparous women who subsequently developed pregnancy-induced hypertension. From umbilical artery velocity waveforms of at least 12 s in duration we determined absolute values and beat-to-beat variability in fetal heart rate, peak systolic and time-averaged velocity and compared these findings with those in normal nulliparous pregnant women matched for gestational age. RESULTS: Absolute values for fetal heart rate, peak systolic and time-averaged velocity as well as beat-to-beat variability in fetal heart rate did not differ significantly between women later developing pregnancy-induced hypertension and normal controls. However, variability in peak systolic velocity and time-averaged velocity were decreased in women who subsequently developed pregnancy-induced hypertension. CONCLUSIONS: Whereas fetal heart rate variability was similar, umbilical artery flow velocity variability was reduced in women developing pregnancy-induced hypertension compared with controls. It is proposed from this study that variability of the umbilical artery flow velocity is associated with mechanical changes in the vascular bed of women who later develop pregnancy-induced hypertension.     

Assessment of fetal heart rate variability and velocity variability by Doppler velocimetry of the descending aorta at 10-20 weeks of gestation.

OBJECTIVES: Determination of gestational age-related modulations in fetal heart rate and descending aorta blood flow velocity in the early human fetus and comparison of aortic variability data with data obtained from the umbilical artery. It is hypothesized that these modulations present in the umbilical artery also occur in the descending aorta. METHODS: Doppler studies of descending aorta velocity waveforms were performed at 10-20 weeks in 55 normal pregnant women. In 24 of the 55 women, Doppler recordings from both the descending aorta and the umbilical artery were collected. Absolute values and variability of fetal heart rate, peak systolic and time-averaged velocities were determined from flow velocity waveforms of at least 18 s in duration. RESULTS: From 10 to 20 weeks of gestation, the descending aorta peak systolic and time-averaged velocities increased, whereas the fetal heart rate decreased. The descending aorta peak systolic variability also increased. However, the time-averaged velocity variability and fetal heart rate variability remained constant during the study period. In the subset of 24 women, the fetal heart rate variability and velocity variability data from the descending aorta and umbilical artery were not significantly different. CONCLUSIONS: Reproducible fetal heart rate and velocity variability data can be derived from the descending aorta and umbilical artery. The increase in heart rate variability observed in the umbilical artery was not seen in recordings obtained from the descending aorta. Different fetal activity states may be the underlying mechanism for these heart rate variability discrepancies.     

Stability,tipping and relapse of bone-borne versus tooth-borne surgically assisted rapid maxillary expansion; a prospective randomized patient trial

This study evaluated stability, tipping and relapse after surgically assisted rapid maxillary expansion (SARME), comparing bone-borne and tooth-borne devices, in skeletally matured non-syndromal patients with transverse maxillary hypoplasia. The study is a randomized, open-label, clinical trial. Patients were randomized to bone-borne (n = 25) and tooth-borne (n = 21) groups. The surgical technique for corticotomy was the same in both groups. Expansion was performed using a bone-borne or tooth-borne device. Dental study casts, lateral and postero-anterior cephalograms were taken before treatment, after the distraction phase and at 12-month follow up. Stability, segmental maxillary tipping and relapse were studied. 23 bone-borne and 19 tooth-borne patients were analyzed. There were no significant differences between the two groups. Widening was comparable at canine, premolar and molar level. Relapse was not significant and at follow up the significant increase in distance was sustained. A significant increase in palatal width, at premolar and molar level, occurred in both groups. The maxilla moves slightly downward in SARME. Segmental maxillary tipping occurred in both groups and did not affect relapse. There is no significant difference between the two groups. In SARME, the widening achieved at dental level is stable after 12 months. Over-correction is not necessary. Tipping of the maxillary segments and increases in the retention period are equal in both groups.     

Doppler flow velocity waveforms in the fetal cardiac outflow tract: reproducibility of waveform recording and analysis

Reproducibility of flow velocity waveform recording and analysis was studied at fetal cardiac level (ductus arteriosus, pulmonary artery and ascending aorta) in 42 normal pregnancies. The flow velocity parameters studied were the peak systolic velocity (PSV), acceleration time (ACT), acceleration velocity (ACV), average velocity (AV) and flow velocity integral (FVI). In each patient, two consecutive measurements were performed (time delay 15 min) and of each measurement two hardcopies were analysed. A high reproducibility was achieved for the PSV, AV and FVI in all vessels studied; the coefficients of variation between readings of hardcopies were less than or equal to 3%, and the coefficients of variation between tests within patients were less than or equal to 7%. A moderate reproducibility was achieved for the ACT in the ascending aorta and pulmonary artery; the variation between tests was large for the ductus arteriosus. The reproducibility of the ACV was poor.     

Schizencephaly: diagnosis and progression in utero

Schizencephaly is an unusual condition of obscure etiology. Most theories of pathogenesis postulate an in utero insult leading to maldevelopment rather than destruction of brain. The cause has most often been described as vascular or idiopathic dysgenesis. The authors report a case in which two in utero ultrasound (US) examinations performed at 31 and 36 menstrual weeks demonstrated progressive deterioration of the relatively narrow, symmetrical clefts connecting the lateral ventricles with the subarachnoid space into broad defects that corresponded to the entire distribution of the middle cerebral arteries. The findings in this case document progressive destruction of brain tissue in utero and are consistent with a vascular cause rather than a failure of formation of portions of the cerebral mantle.     

Survival chances of patients diagnosed with cancer in 1975-1985 in southeast Noord-Brabant and north Limburg

In order to determine the population-based survival of patients with cancer and changes over time, a follow-up study with the Eindhoven Cancer Registry was carried out in 11 hospitals in southeastern Noord Brabant and northern Limburg. Data were collected from medical records and supplemented with information on date of death as of 31 December, 1987, and the relative survival, the ratio of observed and expected survival and trends in age-specific cancer mortality were calculated. Of 22,833 patients diagnosed in the period 1975-85 22,744 could be evaluated; 22% were over 75 years of age and 13% did not receive primary treatment of the tumour. The 5 and 10-year cumulative relative survival rates were 33% and 27% for men and 51% and 44% for women, respectively. The 10-year relative survival rate was more than 50% for Hodgkin's disease, melanoma and cancer of the testis, breast, larynx, thyroid, uterine cervix and corpus; it was less than 20% for multiple myeloma, cancer of the oesophagus, stomach, gallbladder, pancreas, lung and brain. Comparison with 5-year relative survival rates for the various tumours reported in Finland, the Canton of Vaud (Switzerland) and the United States revealed only small differences. The 5-year relative survival rate remained unaltered for men and increased from 50% in the period 1975-79 to 52% in 1980-85 for women; it improved mainly in patients below 45 years, while cancer mortality also declined below this age. In conclusion, there was a slight increase of survival of cancer patients, mainly the young and women.     

High fat,low carbohydrate,enteral feeding in patients weaning from the ventilator

Objective To study whether high fat, low carbohydrate enteral nutrition could reduce in patients during ventilator support and weaning from the ventilator in order to facilitate the weaning process.Design Prospective, randomized controlled study.Setting Medical ICU of a university hospital.Patients 32 ventilator-dependent patients with a prospect of weaning from mechanical ventilation.Interventions High fat feeding administered to 15 patients and standard isocaloric feeding administered to 17 patients, both in a dosage of 1.5 times basal metabolic rate.Measurements and results Respiratory and metabolic measurements were obtained both during mechanical ventilation and weaning procedures. High fat feeding was associated with significantly lower RQ values compared with standard feeding; the mean (±SEM) RQ values during mechanical ventilation amounted to 0.91±0.01 and 1.00±0.02 and during weaning to 0.72±0.02 and 0.86±0.02 for high fat and standard nutrition respectively (bothp-values<0.001). High fat feeding reduced the CO₂-excretion both during mechanical ventilation and weaning, but only the decrease during weaning proved to be significant; the mean (±SEM) CO₂-excretion amounted to 0.177±0.010 and 0.231±0.011 l/min STPD for the high fat and standard feeding respectively (p<0.01). No significant differences were found in the PaCO₂ during weaning between the two feeding groups.Conclusion High fat, low carbohydrate enteral feeding significantly reduced the RQ values in ventilated patients with decreases , but in this study failed to reduce PaCO₂ during weaning from the ventilator.