Free flap monitoring: A review of current practice

Individual techniques for the postoperative monitoring of free flaps vary considerably. In order to establish the currently preferred protocols, a survey was conducted among micro-surgeons in North America using a mailed questionnaire. Data were received from 95 centers for the monitoring of 2,825 free flaps performed during 1994. Results indicate that rates for flap salvage and overall success with free tissue transfer are closely related to surgical experience (number of cases performed per month). Ninety percent of microsurgeons routinely use monitoring devices, with external and laser doppler having achieved greatest popularity. An account is given of the preferred postoperative regimens for flap surveillance, and the overall results are discussed. © 1995 Wiley-Liss, Inc.     

Schlaganfallverbund Essen

Modern stroke care is now comparable to the care for cardiac ischemia. Although there are 100 stroke units in Germany, only a few patients can be treated with all the options available with evidence-based medicine. The stroke network in Essen is based on a concept, which optimizes all elements of stroke care, from the acute onset to rehabilitation. The Essen manual on stroke summarizes all results of the local round table talks. Logistics for acute situations, recommendations for prehospital care, and requirements at admission are explained in detail. With networks for stroke, patient care can be optimized and costs can be saved.     

Genetic and environmental influences on cord blood serum IgE and on atopic sensitisation in infancy

It has recently been reported that cord blood serum IgE (CBsIgE) concentrations in a black Third-World cohort were significantly higher than those in a similar cohort of white and coloured newborns, and were not influenced by an atopic family history (aFH). This study reports on the 1-year follow-up of these newborns carried out to determine whether statistical differences in median CBsIgE values at birth could be found between infants in each ethnic group who subsequently developed clinical atopy in the first year of life and those who remained healthy. The infants were seen at 3, 7 and 12 months of age. At each visit a detailed history was taken from the mothers, the infants were examined clinically for the presence of atopic disease and blood was taken for immunological assay (total serum IgE by paper-disc radio-immunosorbent testing, and radio-allergosorbent testing for egg-white, cow's milk and Dermatophygoides pteronyssinus). A combination of clinical and immunological variables was assessed in order to categorise the infants into 'atopic' or 'not atopic' groups at the end of the 1-year follow-up period. The black infants who completed the study had the lowest incidence of aFH (16%), but 64% of them developed atopic disease during infancy. The median CBsIgE values for the black infants who became atopic were lower than, but not statistically different from, those for the group who remained non-atopic (P = 0.57). The white and coloured infants who completed the study had 81.6% and 30.4% incidences of aFH respectively, with 47.4% and 58.7% respectively developing atopic disease during infancy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Anterior lumbar instrumentation improves correction of severe lumbar Lenke C curves in double major idiopathic scoliosis

Fifteen skeletally immature patients with double major adolescent idiopathic scoliosis with large lumbar curves and notable L4 and L5 coronal plane obliquity were retrospectively studied. Seven patients who underwent anterior release and fusion of the lumbar curve with segmental anterior instrumentation and subsequent posterior instrumentation ending at L3 were compared with eight patients treated with anterior release and fusion without anterior instrumentation followed by posterior instrumentation to L3 or L4. At 4.5 years follow-up (range 2.5-7 years), curve correction, coronal balance and fusion rate were not statistically different between the two groups; however, the group with anterior instrumentation had improved coronal plane, near normalangulation in the distal unfused segment compared with the group without anterior instrumentation. In cases involving severe lumbar curvatures in the context of double major scoliosis, when as a first stage anterior release is chosen, the addition of instrumentation appears to restore normal coronal alignment of the distal unfused lumbar segment, and may in certain cases save a level compared with traditional fusions to L4.     

Crigler-Najjar Syndrom Typ I infolge segmentaler paternaler Isodisomie 2

Ohne Zusammenfassung     

Morbidität nach Herztransplantation

The morbidity in the long-term course following heart transplantation in childhood is mainly determined by the morbidity of the transplanted graft, by side effects caused by immunosuppression and by psychosocial morbidity due to the special situation of life and growing up with a transplanted heart. Transplant vasculopathy as a specific disease of the transplanted organ itself, is a common complication following heart transplantation and is an important factor of morbidity and mortality, considerably limiting the long-term prognosis. Progressive disturbance of renal function and cumulative incidence of malignant tumors is a further factor limiting prognosis caused by the side effects of immunosuppression.     

Randomised controlled trial of the efficacy of a metered dose inhaler with bottle spacer for bronchodilator treatment in acute lower airway obstruction.

BACKGROUND: Inhaled bronchodilator treatment given via a metered dose inhaler (MDI) and spacer is optimal for relief of bronchoconstriction. Conventional spacers are expensive or unavailable in developing countries, but there is little information on the efficacy of low-cost spacers in young children. OBJECTIVE: To compare the response to bronchodilator treatment given via a conventional or a low-cost bottle spacer METHODS: A randomised controlled trial of the efficacy of a conventional spacer compared with a bottle spacer for bronchodilator treatment in young children with acute lower airway obstruction. Bronchodilator treatment was given from an MDI via an Aerochamber or a bottle spacer. Clinical score and oximetry recording were carried out before and after 15 min of treatment. MDI-spacer treatment was repeated up to three times, depending on clinical response, after which nebulisation was used. The primary outcome was hospitalisation. RESULTS: 400 children, aged (median (25th-75th centile)) 12 (6-25) months, were enrolled. The number of children hospitalised (n = 60, 15%) was identical in the conventional and bottle spacer groups (n = 30, 15% in each). Secondary outcomes including change in clinical score (-2 (-3 to -1)), oxygen saturation (0 (-1 to 1)) and number of bronchodilator treatments (2 (1 to 3)) were similar in both groups. Oral corticosteroids, prescribed for 78 (19.5%) children, were given to a similar number in the conventional (37 (18.5%)) and bottle spacer groups (41 (20.5%)). CONCLUSION: A low-cost bottle spacer is as effective as a conventional spacer for bronchodilator treatment in young children with acute obstruction of the lower airways.