Adopted children with cleft lip or palate, or both, require special needs cleft surgery

In recent years adoption of children with cleft lip, with or without cleft palate (CLP), and other birth defects has become more common. The aim of the present study was to describe the characteristics and initial care and treatment of adopted children with CLP. A total of 25 children were referred to our department between 2008 and 2010, 7 (28%) of whom had bilateral CLP and 16 (64%) had unilateral CLP. Two children had atypical clefts. Twenty of the patients (80%) had been operated on with a lip plasty in China before adoption. Most patients (n = 14) was seen by the cleft team within two months of arrival, and 13 were operated on within a month of the first visit at our department. In total, 22 primary palatoplasties, 6 lip plasties, and 1 lip adhesion were done. There were 5 fistulas (14%) three months after the palatoplasty. On arrival, 11 (44%) of the children were carriers of methicillin-resistant Staphylococcus aureus (MRSA). Adoption of children with CLP creates new challenges for the cleft teams, as we no longer have control over the overall treatment plan as regards preoperative and surgical treatment and timing of the operations. The patients are also often carriers of resistant bacteria, which create nursing challenges. In cases where the child is older than a year and has not been operated on, we advocate that the palatoplasty, or combined lip plasty and palatoplasty, is always given priority so that speech development is not compromised.     

Cardiac metabolism measured noninvasively by hyperpolarized 13C MRI.

Pyruvate is included in the energy production of the heart muscle and is metabolized into lactate, alanine, and CO(2) in equilibrium with HCO(3) (-). The aim of this study was to evaluate the feasibility of using (13)C hyperpolarization enhanced MRI to monitor pyruvate metabolism in the heart during an ischemic episode. The left circumflex artery of pigs (4 months, male, 29-34 kg) was occluded for 15 or 45 min followed by 2 hr of reperfusion. Pigs were examined by (13)C chemical shift imaging following intravenous injection of 1-(13)C pyruvate. (13)C chemical shift MR imaging was used in order to visualize the local concentrations of the metabolites. After a 15-min occlusion (no infarct) the bicarbonate signal level in the affected area was reduced (25-44%) compared with the normal myocardium. Alanine signal level was normal. After a 45-min occlusion (infarction) the bicarbonate signal was almost absent (0.2-11%) and the alanine signal was reduced (27-51%). Due to image-folding artifacts the data obtained for lactate were inconclusive. These studies demonstrate that cardiac metabolic imaging with hyperpolarized 1-(13)C-pyruvate is feasible. The changes in concentrations of the metabolites within a minute after injection can be detected and metabolic maps constructed.     

Functional evaluation of regenerated and misrouted low threshold mechanoreceptors and polymodal nociceptors in the skin of rat hindfeet after crush lesions to the sciatic nerve.

Tracer studies on motor axons after nerve crush injuries have indicated that misrouting may occur even when the endoneurium is intact. Misrouting of regenerated polymodal nociceptive C-fibres and low threshold mechanoreceptive axons have been studied functionally in 50 rats three months after unilateral crush lesions to the sciatic nerve. Two weeks before evaluation the tibial fascicle (or the peroneal fascicle) above the lesion was cut and tied off. In this way only functional regeneration of misrouted axons was tested. Misrouted low threshold mechanoreceptive axons and polymodal nociceptor C-fibres were found after regeneration in both glabrous and hairy skin. We conclude that functional misdirection of both myelinated and unmyelinated sensory axons innervating either glabrous or hairy skin can occur after a crush lesion to a peripheral nerve in rats.     

Prophylactic mesh placement to prevent parastomal hernia,early results of a prospective multicentre randomized trial

Purpose

Parastomal hernia (PSH) is a common complication after colostomy formation. Recent studies indicate that mesh implantation during formation of a colostomy might prevent a PSH. To determine if placement of a retromuscular mesh at the colostomy site is a feasible, safe and effective procedure in preventing a parastomal hernia, we performed a multicentre randomized controlled trial in 11 large teaching hospitals and three university centres in The Netherlands.

Methods

Augmentation of the abdominal wall with a retromuscular light-weight polypropylene mesh (Parietene Light?, Covidien) around the trephine was compared with traditional colostomy formation. Patients undergoing elective open formation of a permanent end-colostomy were eligible. 150 patients were randomized between 2010 and 2012. Primary endpoint of the PREVENT trial is the incidence of parastomal hernia. Secondary endpoints are morbidity, pain, quality of life, mortality and cost-effectiveness. This article focussed on the early results of the PREVENT trial and, therefore, operation time, postoperative morbidity, pain, and quality of life were measured.

Results

Outcomes represent results after 3 months of follow-up. A total of 150 patients were randomized. Mean operation time of the mesh group (N = 72) was significantly longer than in the control group (N = 78) (182.6 vs. 156.8 min; P = 0.018). Four (2.7 %) peristomal infections occurred of which one (1.4 %) in the mesh group. No infection of the mesh occurred. Most of the other infections were infections of the perineal wound, equally distributed over both groups. No statistical differences were discovered in stoma or mesh-related complications, fistula or stricture formation, pain, or quality of life.

Conclusions

During open and elective formation of an end-colostomy, primary placement of a retromuscular light-weight polypropylene mesh for prevention of a parastomal hernia is a safe and feasible procedure.The PREVENT trial is registered at: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2018.

     

Psychosocial aspects of road traffic trauma--benefits of an early intervention?

PURPOSE: To assess the psychosocial consequences of traffic accidents, and to evaluate the effect of an intervention programme to reduce the occurrence and extent of psychosocial residual states. MATERIAL AND METHODS: A telephone interview was conducted with 314 individuals, 1(1/2)-2 years after the accident in 1994-1995. The effect of the intervention programme was studied for inpatients, 68 in the study group, and 89 in the control group. The structured follow-up form included the Impact of Event Scale (IES). RESULTS: Half of those injured had residual physical complaints with negative effects on their work- and economic-situation. An influence on housing or the need for practical assistance was reported by 1-7%. Mental effects were reported by 4/5. IES demonstrated that 1/5 suffered a high degree of intrusion, and this occurred twice as often among females as among males. Situational anxiety occurred more often in the intervention group than in the control group, p=0.02. More individuals in the intervention group than in the control group were satisfied with the medical certificate to the insurance company, p=0.058. CONCLUSIONS: Females were afflicted by mental effects considerably more than males. The intervention programme did not appear to reduce the psychosocial sequelae. The methods within this area need to be further developed.     

Multiple neuroectodermal abnormalities in pheochromocytoma patients

A series of 80 consecutive pheochromocytoma patients operated on from 1956 to 1985 were investigated for other neuroectodermal abnormalities. Such abnormalities were found in 23 (29%) patients. Medullary thyroid carcinoma was the most common associated neuroectodermal abnormality followed by von Recklinghausen's neurofibromatosis. Other abnormalities were intracranial tumors, midgut carcinoid, and parathyroid hyperplasia. All 6 patients with multiple pheochromocytomas had other neuroectodermal abnormalities. In the total series, the 14 patients with hereditary disease had multiple neuroectodermal abnormalities (MNA). Hypertension occurred significantly less often in MNA patients (p<0.05). All the MNA patients had benign adrenal pheochromocytoma. In 7 of 9 normotensive patients, pheochromocytoma was suspected because of the presence of other neuroectodermal abnormalities. None of these 9 patients had any cardio- or cerebrovascular complications, but these occurred in 22% of the hypertensive patients. No patient in the series died from pheochromocytoma, but 4 of 5 deceased MNA patients died as a result of their associated neuroectodermal disease. During the last decade, 40% of the pheochromocytoma patients had MNA diagnosed compared to 20% during the previous period. An increased observation for other neuroectodermal abnormalities in pheochromocytoma patients and for pheochromocytoma in patients with neuroectodermal abnormalities should lead to earlier diagnosis and a better prognosis for the patients concerned.

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Resumen Una serie de 80 pacientes con feocromocitoma operados entre 1956 y 1985 fueron investigados para establecer la presencia de otras anomalías neuroectodérmicas, las cuales fueron halladas en 23 pacientes (29%). La más frecuente fue el carcinoma medular de tiroides, seguida de neurofibromatosis de von Recklinghausen. Otras anomalías encontradas fueron tumores intracraneales, carcinomas del intestino medio, e hiperplasia paratiroidea. La totalidad de los 6 pacientes con feocromocitomas múltiples poseían otras anomalías neuroectodérmicas. Los 14 pacientes con enfermedad hereditaria presentaban también anomalías neuroectodérmicas múltiples (ANM). La hipertensión se presentó con incidencia significativamente menor en los pacientes con ANM (p<0.05). Todos los pacientes con ANM tenían feocromocitoma adrenal benigno. En 7 de los 9 pacientes normotensos se sospechó el feocromocitoma por la presencia de otras anomalías neuroectodérmicas. Ninguno de los 9 pacientes exhibió complicaciones cardiovasculares o neurovasculares, pero éstas ocurrieron en 22% de los pacientes hipertensos. Ningún paciente de la serie falleció por causa de su feocromocitoma, pero 4 de los 5 pacientes fallecidos con ANM murieron como resultado de la enfermedad neuroectodérmica asociada. En el curso del último decenio, 40% de los pacientes con feocromocitoma tuvieron diagnóstico de ANM, contra 20% en el período previo. La creciente conciencia sobre la posibilidad de otras anomalías neuroectodérmicas en pacientes con feocromocitoma y de feocromocitoma en pacientes con anomalías neuroectodérmicas debe resultar en diagnósticos más tempranos y mejor pronóstico en estos pacientes.

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Résumé Chez 80 patients consécutifs porteurs de phéochromocytome, opérés de 1956 à 1985, on a recherché des signes d'autres anomalies neuroectodermiques. On en a trouvé chez 23 patients (29%). L'anomalie associée la plus fréquente était le cancer médullaire de thyroïde, puis venait la neurofibromatose de von Recklinghausen. Les autres anomalies retrouvées étaient les tumeurs intracrâniennes, les tumeurs carcinoïdes de l'intestin moyen et l'hyperplasie parathyroïdienne. Les 6 patients ayant des phéochromocytomes multiples avaient des anomalies neuroectodermiques associées. Quatorze patients avec une maladie héréditaire avaient des anomalies neuroectodermiques multiples associées (ANM). Il y avait significativement moins d'hypertension parmi les patients avec des ANM (p<0.05). Tous les patients présentant une ANM, avaient aussi un phéochromocytome surrénalien bénin. Chez 1 patient parmi les 9 patients normotensifs, on a soupçonné un phéochromocytome en raison de l'association d'anomalies neuroectodermiques. Parmi ces 9 patients, il n'y a pas eu de complications cardio- ou cérébrovasculaires, mais celles-ci se sont produites chez 22% des patients hypertendus. Aucun patient dans cette série n'est mort de son phéochromocytome, mais 4 sur 5 patients avec une ANM sont morts de leur maladie neuroectodermique associée. Pendant ces 10 dernières années, on a fait le diagnostic d'ANM chez 40% des patients avec un phéochromocytome, alors qu'au cours des 10 précédentes années, ce diagnostic n'a été fait que chez 20%. Une recherche approfondie des anomalies neuroectodermiques associées chez le patient avec phéochromocytome ainsi que la recherche de phéochromocytome chez le patient présentant des anomalies neuroectodermiques devraient aider à poser le diagnostic plus précocément et ainsi à améliorer le pronostic.

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Presented at the International Association of Endocrine Surgeons in Paris, France, September, 1985.

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Supported by grants from the University of Göteborg, the Göteborg Medical Society, and the Swedish Medical Research Council (B87-17X-06534-05A).     

Fatigue fracture morphology in human lumbar motion segments

The fatigue behavior of 17 fresh lumbar spine motion segments was examined during cyclic, axial, compressive loading. The loading frequency and magnitude were chosen to simulate vigorous physiological loading conditions. The average failure occurred after 318 such loading cycles. Two main types of failure occurred and both involved the endplate and the adjacent subchondral spongy bone of the vertebral body. A tendency was observed toward a relation between the degree of disk degeneration and fracture type. Location of the fatigue fractures corresponded to the location of earlier detected microcalluses of the spongy trabeculae in the vertebral body. The findings further demonstrated that, under repetitive physiological loading, the weakest part of the lumbar motion segment was the endplate and the adjacent spongy bone.     

Lack of hepatitis B virus DNA sequences in sera from patients with acute and chronic liver diseases diagnosed as non-A, non-B-hepatitis

The sera of 15 individuals with transfusion-associated acute or chronic non A, non B hepatitis, which lacked hepatitis B virus markers, were tested for hepatitis B virus DNA by dot blot hybridization test. Three sera of two patients positive in this test, however, also gave positive results when the labeled plasmid was used as probe instead of labeled HBV-DNA, indicating false positive results in the initial test. In conclusion, the data indicated that sera of patients with confirmed non A, non B hepatitis do not contain DNA-sequences in the serum hybridizing with HBV-DNA.