Sialoblastoma and hepatoblastoma in a newborn infant

We report a case of a newborn infant who had simultaneous sialoblastoma and hepatoblastoma tumours at birth. The diagnoses were made on post mortem examination. Both of these are rare tumours in the neonatal period. Pediatr Blood Cancer 2009;52:883–885. © 2009 Wiley‐Liss, Inc.     

Neonatal Pleural Effusion

A case of neonatal pleural effusion with asphyxia neonatorum is reported. This condition should be considered in the diagnosis of respiratory distress in the newborn, for early recognition and treatment can be life-saving. As a massive effusion may be seen in early life, it is likely to have been present before birth and trauma at birth does not adequately explain its occurence.     

Shear Bond Strengths of One-Bottle Adhesives to Moist Enamel

Abstract: Purpose: This study evaluated bond strengths of six one-bottle bonding agents and a control (primer plus unfilled resin) to moist enamel.
Materials and Methods: One-hundred and five bovine teeth were randomly assigned to seven groups of 15. Enamel was etched for 15 seconds with 35% phosphoric acid. Etched enamel was rinsed, and excess water was blotted with tissue paper. Following application of the adhesive, composite resin was bonded using a gelatin capsule technique. Shear bond strengths to enamel were determined using a universal testing machine (Instron Corp., Canton, Massachusetts).
Results: Mean bond strengths ranged from 21.9 MPa for OptiBond Solo (Kerr Corp., Orange, California) to 29.6 MPa for Prime & Bond 2.1 (Dentsply/Caulk, Milford, Delaware). Prime & Bond 2.1 had a significantly higher mean bond strength than the other adhesives.
CLINICAL SIGNIFICANCE: The results of this study suggest that all of the one-bottle systems tested should provide clinically acceptable bonding to moist enamel.     

Visualization of a looped and knotted epidural catheter with a guidewire

PURPOSE: To describe the management of a looped and knotted epidural catheter after analgesia for labour and delivery. CLINICAL FEATURES: Obstetrical epidural pain relief was provided for a 37-yr old woman in early labour. A 20-gauge Portex catheter was inserted at the L2-L3 interspace. Six centimetres of catheter was left in the epidural space. After vaginal delivery the catheter could not be removed. The catheter was left in situ for 24 hr. Repeated attempts at removal were again unsuccessful. The epidural catheter was not visible with fluoroscopy and it was impossible to inject radiopaque dye into the catheter. However, we successfully advanced a 0.016 inch guidewire through the epidural catheter and radiologically demonstrated a knot and part of a loop. The catheter was removed by an orthopedic surgeon using blunt dissection under local anesthetic from the soft tissue just lateral to the interspinous ligament. CONCLUSIONS: A knot can be a rare cause of a trapped epidural catheter. A suggested approach to the trapped lumbar epidural catheter: 1) Gentle traction on the catheter with the patient in various positions and in various degrees of lumbar flexion. 2) Test for catheter patency by injecting sterile, preservative-free, normal saline through the catheter. 3) Radiological imaging to determine if a knot is present and to determine its location, using radiopaque contrast for patent catheters or a guidewire for occluded catheters. 4) The approach to definitive management is based on the position of the knot. This can range from excision under local anesthetic to consultation with a surgical specialty for more invasive retrieval.     

Psychometric properties of the Pediatric Motor Activity Log used for children with cerebral palsy

The Pediatric Motor Activity Log (PMAL) is a parent-report measure of the use, by children with hemiplegic cerebral palsy (CP), of their affected upper limb in everyday activities. The aim of this study was to examine the psychometric properties of both scales of the PMAL ('How Often' and 'How Well' scales) using Rasch measurement modelling. Sixty-one parents of children with hemiplegic CP completed the PMAL and 31 completed it again 3 weeks later. The mean age of children was 4 years 6 months (SD 1y 9mo); 35 males, 26 females. Children were at Gross Motor Function Classification System (GMFCS) levels I (83%) and II (17%), and Manual Ability Classification System levels I (35%), II (52%), and III (14%). The original scales were found to have disordered rating scale structure. Further Rasch modelling with collapsed rating scale structures resulted in both scales conforming to the expectations of the Rasch model, yielding strong evidence for construct validity and reliability. One item from the How Often scale failed to conform to Rasch expectations and was deleted in subsequent analyses. Test–retest reliability of both scales was high (the intraclass correlation coefficient for the How Often scale was 0.94, and for the How Well scale 0.93). The revised scales possess good psychometric properties, specifically a logical item hierarchy, evidence of unidimensionality, adequate rating scale structure, and good test–retest reliability. We conclude that the revised PMAL has the capacity to yield valid and reliable scores except for children at the extremes of upper limb ability.     

Identification of perioperative risk factor by laser‐doppler spectroscopy after free flap perfusion in the head and neck: A prospective clinical study

The aim of this study was to evaluate perioperative flap perfusion using noninvasive monitoring with a laser‐Doppler flowmetry and spectrophotometry unit (O2C) and identify whether perioperative blood flow, velocity, hemoglobin level (Hb), and oxygen saturation (SO₂) measured could be used as indicators of free flap success. Measurements of blood flow, velocity, Hb, and SO₂ were performed in 196 microvascular flaps, which had been transferred into the oral cavity to reconstruct ablative defects after surgery for oral cancer. The values were calculated superficially on the skin surface and at a depth of 8 mm. The results showed that perioperative absolute values measured were not associated with an increased rate of microvascular revisions or free flap failure. Independent predictors of microvascular revisions at the first postoperative day were the development of a falling trend in superficial and deep blood flow, and velocity in comparison with baseline values of variables measured. On day 2, all superficial and deep values of Hb, flow, and velocity were independent prognostic factors (P < 0.01), demonstrated as a downward trend were associated with a need for revision. The superficial and deep values of SO₂ (P = 0.59 and 0.43, respectively) were not associated with ultimate free flap failure. This is the first clinical study to demonstrate that during early free flap integration to the recipient site different parameters of perfusion and oxygenation play an important role at different points of time. Within the first two postoperative days, changes in these parameters can help influence the decision to revise microvascular anastomoses. © 2013 Wiley Periodicals, Inc. Microsurgery 34:345–351, 2014.     

Innovations in community health nursing: Examples from practice

Cusack L, Smith M, Byrnes T. International Journal of Nursing Practice 1997; 3: 133–136
Innovations in community health nursing: Examples from practice
The Ottawa Charter for Health Promotion is cited internationally as an appropriate conceptual framework for healthcare service delivery yet the literature reveals minimal evidence of nursing services interpreting and applying the Ottawa Charter strategies into nursing practice. Nurses with the community services of Noarlunga Health Services and the Drug and Alcohol Services Council of South Australia, however, do use the strategies to plan and implement their services. The Ottawa Charter strategies of developing personal skills; creating supportive environments; strengthening community action; building healthy public policy; and re-orienting services in the interest of health can be used as a tool to assist nurses to identify the purpose of their interventions and select a comprehensive range of nursing actions which address the needs of individuals while acknowledging the broader determinants of health. This article presents a nursing analysis of the Charter and provides examples of how the strategies are used to influence nursing practice in both organizations. The examples provided from the two different nursing services also demonstrate the adaptability and relevance of the strategies to diverse community nursing practice settings.