Limb lengthening by callus distraction: Complications in 53 cases operated 1980-1991

We reviewed our first 53 lengthenings performed in 45 patients with an average age of 19 years at the time of lengthening. The shortening was congenital in 16 patients, post-traumatic in 15 and had various causes in the 14 remaining. 31 femurs and 22 tibias with an average shortening of 6 and 5 cm, respectively, were lengthened 6 (2-14) cm. The aim was achieved in all but 4 patients, where lengthening had to be discontinued due to complications.

Potential complications of lengthening can be numerous but, if recognized, can in most cases be dealt with during the extended lengthening procedure. 38 cases of pin-tract infections healed with antibiotics. Restricted motion in one or more joints was registered in 49 cases during lengthening; minor restriction of joint motion persisted in 14 patients. 28 cases had angular deviations during lengthening. After additional surgery all but 10 could be corrected. 4 fractures occurred after removal of the external fixator. The total number of complications was 146, and of these 76 were minor, 42 moderate and 28 severe. 36 of the 42 patients available to follow-up were satisfied with the results of the lengthening procedure.     

Total anomalous pulmonary venous drainage. Seventeen-year surgical experience

Between 1968 and 1985, 80 children underwent correction of total anomalous pulmonary venous drainage. There were 47 boys and 33 girls whose ages ranged from 3 days to 16 years (median 2 months, interquartile range 5 years). Seventy (87.5%) were less than 1 year of age at operation. Fifty-eight (72.5%) weighed less than 5 kg, the range being 1.6 to 42 kg (median 3.7 kg, interquartile range 2.4 kg). Forty-five (56%) patients had supracardiac, 14 (17.5%) cardiac, 15 (19%) infracardiac, and 6 (7.5%) had mixed total anomalous pulmonary venous drainage. Follow-up was complete in 78 (97.5%) and ranged from 6 to 189 months (median 58 months, interquartile range 59 months). There were 14 (17.5%) early and six (7.5%) late deaths. Analysis by various factors revealed year of operation as the only factor to affect survival at the 5% level of significance. Early mortality was 29% between 1968-1977 and 11% between 1978-1985 (p = 0.04). Postoperative pulmonary venous obstruction occurred in five (6%) patients between 6 weeks and 3 months after operation. All 5 died, three after reoperation. Five (6%) other children had reoperations, four for residual shunts and one for superior vena caval obstruction.     

Disposition of oral and intravenous pravastatin in MRP2-deficient TR- rats.

The aim of this study was to characterize the role of the efflux transporter Mrp2 (Abcc2) in the pharmacokinetics of orally and intravenously administered pravastatin in rats. Eight Mrp2-deficient TR- rats and eight wild-type rats were given an oral dose of 20 mg/kg pravastatin. Four TR- animals and four wild-type animals were studied after intravenous administration of pravastatin (5 mg/kg). The TR(-) rats showed a 6.1-fold higher mean area under the plasma concentration-time curve (AUC) of pravastatin (p < 0.001) after oral administration and a 4.7-fold higher AUC (p < 0.01) after intravenous administration of pravastatin as compared with the wild-type animals. The mean systemic (total) clearance of pravastatin was 4.6-fold higher (39.2 versus 8.50 l/h/kg, p < 0.001) and the mean V 4.3-fold higher (14.1 versus 3.29 l/kg, p < 0.01) in the wild-type rats. The mean renal clearance of pravastatin in the TR(-) rats was 16.5-fold increased as compared with the wild-type animals (0.695 versus 0.042 l/h/kg, p < 0.05). The increased systemic exposure to oral pravastatin in the TR- rats was associated with a greater inhibitory effect on 3-hydroxy-3-methylglutaryl CoA reductase, as shown by smaller lathosterol to cholesterol concentration ratios. These results suggest that the reduced biliary pravastatin excretion in the Mrp2-deficient TR- rats is partly compensated for by increased urinary excretion of pravastatin. Furthermore, intestinal Mrp2 does not appear to play a major role in the oral absorption of pravastatin in normal rats.     

Fortschritte in der systemischen Therapie des metastasierten Magenkarzinoms

In spite of a reduced rate of new occurrence, gastric cancer is still one of the most common causes of cancer related mortality. Crucial to the value of systemic therapy are the 50% of patients who already have metastasizing or locally advanced stages at first diagnosis which are not surgically curable. In comparison to merely supportive therapy, controlled studies have shown the unmistakable value of chemotherapy. Recently, cisplatin and infused 5-fluorouracil (5-FU) based combination treatments have become the therapeutic standard. The internationally best studied scheme is the “ECF” combination. The taxane and irinotecan group has limited value as monotherapy and is used in combination studies, as are oral fluoropyrimidine and oxaliplatin, with other substances. With the introduction of numerous, new, effective cytostatics, a whole series of combinations are being tested. The main aims of these studies are, on the one hand, lowered toxicity or ease of use with equivalent effectiveness, and on the other hand, higher effectiveness without significantly increased toxicity.     

Quantification of naturally occurring benzodiazepine-like substances in human breast milk

The possible occurrence of benzodiazepine-like substances in human breast milk was investigated in 35 healthy, newly delivered women who were known not to be taking benzodiazepines. Maternal blood samples and a sample of breast milk were obtained on the fifth post partum day. A radioreceptor technique (lower limit of detection 1.5 ng/ml; difference between duplicates at various concentrations <7%) was used for measuring benzodiazepine-like substances in blood and breast milk (with and without prior extraction). No benzodiazepine-like substances could be demonstrated in any of the blood samples taken from the 35 women. Measurable concentrations of benzodiazepine-like substances were demonstrated in all but 1 of the 35 breast milk samples. The mean concentration of benzodiazepine-like substances for all 35 women was 4.3±2.3 ng/ml (range 0–9.3 ng/ml) expressed as lorazepam. The corresponding value for extracted breast milk was 2.6±1.5 ng/ml (range 0–7.0 ng/ml). There was no association between concentrations of benzodiazepine-like substances in breast milk and maternal age, weight, height and body mass or parity, or the sex of the infant and infant birth weight. We suggest that non-detectable amounts of benzodiazepine-like substances in serum are concentrated in the mammillary glands and excreted in a higher concentration in breast milk. It is less likely that the relevant benzodiazepines are produced in the mammillary glands.     

Editorial

Ohne Zusammenfassung     

Gait analysis in patients with total hip endoprosthesis. Part II: Pre- and postoperative gait analysis]

35 patients have been examined before the implantation of a total hip replacement, about 7 days postoperatively and again after 12 weeks by means of the electro-ichnograph EKIG-3 of the Riga Institute of Orthopaedics and Traumatology. Before the hip-joint substitution the normal values could not approximately be attained. The step duration has postoperatively increased, and it has decreased to pre-operative values by the time of the follow-up examination. The best results were obtained concerning the change of the trunk deviation in the frontal plane. The hip mobility measured passively was remarkably better after the operation and almost reached normal values. Regarding the results it should above all be taken into consideration, that the most important fact for the patient is the alleviation and elimination of pain, respectively.     

Metastases in Cases with Hepatocellular Carcinoma in Relation to Clinicopathologic Features of the Tumour An autopsy study from a low endemic area

In order to study clinicopathologic features of hepatocellular carcinoma (HCC) and their relation to metastatic growth, all autopsied cases with confirmed HCC (n = 490) from a period with a high autopsy frequency in a well-defined population were analyzed. Cirrhosis, usually of micronodular type, was found in 72%. The gross appearance of the tumour was predominantly massive (46%) or multinodular (42%). The tumour involved both liver lobes in 72% or the right lobe alone in 20%. Histologically, trabecular growth (79%) and grade II of differentiation (52%) prevailed. Vascular invasion was noted in 56%, whereas involvement of the biliary tract was unusual (4%). Metastases especially involved lymph nodes (42%), lungs (18%) and skeleton (17%). Increased weight of the liver, multinodular appearance, involvement of both liver lobes, low grade of differentiation and vascular invasion were significantly associated with presence of metastases.     

Interstitial deletion of 10q: Clinical features and literature review

We report on a patient with interstitial deletion of 10q and compare her to 8 previously described patients, 2 of whom have chromosomal breakpoints similar to our patient. Minor anomalies including broad forehead, hypertelorism, strabismus, prominent philtrum, and “dysplastic” pinnae are present in our patient. Psychomotor retardation and hypotonia are universal findings in 10q interstitial deletion. Growth retardation, not present in our patient, is seen in some. These clinical findings are sufficiently distinct to suggest early chromosome studies. © 1992 Wiley-Liss, Inc.