Mothers' postpartum psychological adjustment and infantile colic.

BACKGROUND: Infantile colic is a common problem of early infancy. There is limited data on the relation between postpartum maternal psychological problems and colic. AIM: : To investigate whether infantile colic is associated with postpartum mood disorders or insecure adult attachment style of the mother. METHODS: Seventy eight mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened with Edinburgh Postpartum Depression Score (EPDS) and maternal anxiety was assessed with State-Trait Anxiety Inventory (STAI). The Adult Attachment Scale was used to determine the attachment style of the mother. Infantile colic was defined according to Wessel criteria. RESULTS: Infantile colic was present in 17 infants (21.7%); 12.9% of the mothers had an EPDS > or =13. The mean EPDS of the mothers whose infants had infantile colic (10.2+/-6.0) was significantly higher than that of the mothers of infants without colic (6.3+/-4.0). Among infants with infantile colic, 62.5% had mothers who had insecure attachment style, whereas only 31.1% of mothers had insecure attachment when the infant did not have infantile colic. CONCLUSION: Postpartum maternal depressive symptoms and insecure attachment style are associated with infantile colic. Screening and early intervention of postpartum depression might promote the health of both the mother and infant.     

Sagittal spinopelvic parameters in children with achondroplasia: identification of 2 distinct groups

Imatinib mesylate has become the treatment of choice for gastrointestinal stromal tumors (GISTs) and has made a revolutionary impact on survival rates. Bone marrow necrosis is a very rare adverse event in malignant GIST. Bone metastases are also rarely encountered in the setting of this disease. The authors report on a patient with malignant GIST who developed a bone lesion, mimicking spinal metastasis on both MR imaging and FDG-PET/CT. Corpectomy and anterior fusion was performed, but the pathology report was consistent with bone marrow necrosis. Radiological and clinical similarities made the distinction between metastasis and bone marrow necrosis challenging for the treating physicians. Instead of radical surgical excision, more conservative methods such as percutaneous or endoscopic bone biopsies may be more useful for pathological confirmation, even though investigations such as MR imaging and FDG-PET/CT indicate metastatic disease.     

Effects of granulocyte-macrophage colony-stimulating factor on incisional wound healing in an experimental diabetic rat model

The exact nature of poor wound healing in diabetes is uncertain. Neutrophils play a critical role in the host defense mechanism, and it is suggested that impaired neutrophil functions cause healing difficulties with or without infections in diabetic patients. Granulocyte-macrophage colony-stimulating factor (GM-CSF) is used clinically when given systematically to increase the circulating neutrophils, but its wound-healing effects have not been systematically studied. This study was undertaken to examine the effects of GM-CSF on incisional wound healing in an experimental diabetic rat model. Forty rats were randomly divided into three groups, group I receiving saline as control, diabetes-induced group II receiving saline and diabetes-induced group III receiving GM-CSF. The anesthetized rats in all groups were wounded 21 days after diabetes induction by streptozotocin. Blood neutrophil counts and neutrophil fractions were also determined three days after wounding. Tensile strengths of wounded skin and the hydroxyproline (hyp) level of the wound were determined and wound healing processes were evaluated by light and electron microscopy, fourteen days after wounding. Neutrophil counts and phagocytosis were significantly increased in group III and neutrophil counts decreased in group II (p < 0.05). Although the hydroxyproline level of wound tissue significantly decreased in group II as compared with group III (p < 0.05), there was no differences of tensile strength between group II and III (p < 0.05). Wound score in group II was less than that in groups I and III (p < 0.05). It is concluded that PMN may have a role in modulating wound healing. GM-CSF may be useful for creating better wound healing healing. GM-CSF may be useful for creating better wound healing in risky patients such as diabetics.     

Tensile strength of ligaments after thermal shrinkage depending on time and immobilization: in vivo study in the rabbit

The effects of immobilization on healing collagenous tissue treated with thermal shrinkage are investigated in an in vivo rabbit model. Thermal shrinkage was performed on 45 of 50 medial collateral ligaments in 25 mature New Zealand rabbit knees. In half of the knees, the joints were immobilized. Animals were killed at 0, 3, 6, and 9 weeks postoperatively. Failure loads of ligaments were determined, and morphologic changes were evaluated by electron microscopy. The failure load of shrunken ligaments was significantly lower than that of the intact ligaments on the day of operation (P<.05). Shrunken ligaments reached their highest failure loads in the third week within the first 9 weeks. The immobilized ligaments remained weaker than the mobile group, but this difference was statistically significant only in the ninth week (P<.05). Immobilization seems to have negative effects on the healing ligament. Ideal timing for remobilization is still controversial, and abandoning immobilization protocols for longer than 3 weeks should be considered.     

The role of L-arginine and neutrophils on incisional wound healing.

Although arginine plays an important role in many aspects of inflammation and wound healing, the mechanism is not clear. We aimed to evaluate the effect of L-arginine administration on wound healing and neutrophil activity and on the interaction of these effects. Sixteen rats were divided into two groups: control group and L-arginine group. L-arginine was given intraperitoneally. The rats underwent incisional wounding and were killed on the 7th day of wounding. Blood neutrophil counts, neutrophil adhesivity index, tensile strengths and hydroxyproline level of skin were determined, histopathological and electron microscopical evaluation of healing was performed. Wound scores in the control group were significantly lower (p < 0.05). Hydroxyproline and collagen levels of skin were significantly increased in the L-arginine group (p < 0.05). Blood neutrophil counts and neutrophil adhesivity index in the L-arginine group were significantly increased (p < 0.05), as were the inflammatory cells in the skin. L-arginine may be used during the first phase of healing to induce inflammation in high risk patients.     

Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty

Background  Cord retethering and other postoperative complications can occur after the surgical untethering of a first-time symptomatic tethered cord. It is unclear if using duraplasty vs. primary dural closure in the initial operation is associated with decreased incidence of either immediate postoperative complications or subsequent symptomatic retethering. It is also unclear if different etiologies are associated with different outcomes after each method of closure. We reviewed our pediatric experience in first-time surgical untethering of symptomatic tethered cord syndrome (TCS) to identify the incidence of postoperative complications and symptomatic retethering after duraplasty vs. primary closure. Materials and methods  We retrospectively reviewed 110 consecutive pediatric (<18 years old) cases of first-time symptomatic spinal cord untethering at our institution over a 10-year period. Incidence of postoperative complications and symptomatic retethering were compared in cases with duraplasty vs. primary dural closure use. Results  Mean age was 5.7 ± 4.8 years old. “Complex” etiologies included lipomyelomeningocele or prior lipomyelomeningocele repair in 22 (20%) patients, prior myelomeningocele repair in 35 (32%), and concurrent lumbosacral lipoma in 18 (16%). “Noncomplex etiologies” included fatty filum in 26 (24%) and split cord malformation in five (4%). Seventy-five (68%) cases underwent primary dural closure vs. 35 (32%) with duraplasty. Twenty-nine (26%) patients experienced symptomatic retethering at a median [interquartile range (IQR)] of 30.5 [20.75–41.75] months postoperatively. There was no difference in incidence of postoperative cerebrospinal fluid leak, surgical site infection, or median [IQR] length of stay in patients receiving primary dural closure [4 (5%), 7 (9%), and 5 (4–6) days, respectively] vs. duraplasty [3 (9%), 3 (9%), and 6 [5–8] days, respectively], p > 0.05. Complex etiologies were more likely to retether than noncomplex etiologies after primary closure (33.6% vs. 6.6%, p = 0.05) but not after duraplasty (13.7% vs. 5.4%, p = 0.33). Duraplasty graft type (polytetrafluoroethylene vs. bovine pericardium) was not associated with pseudomeningocele or retethering. Conclusion  In our experience, the increased rate of symptomatic retethering observed with complex pediatric TCS (pTCS) etiologies after primary dural closures was not observed when duraplasty was instituted. Expansile duraplasty may be valuable specifically in the management of patient subgroups with complex pTCS etiologies.     

Tension band wiring of unstable transverse fractures of the proximal and middle phalanges of the hand

Twenty-three isolated, unstable and closed transverse middle and proximal phalangeal shaft fractures in 23 patients were treated by tension band wiring. The tension band was applied with two transverse Kirschner wires that did not cross the fracture line. All of the fractures united and achieved satisfactory functional outcomes. No patient required either physiotherapy or tenolysis or capsulotomy surgery.     

Effect of acute alcohol intake on prostate tissue and serum PSA-like protein levels in rats

OBJECTIVE: To investigate both the possible changes induced by acute alcohol intake on prostate tissue at the ultrastructural level and its effect on serum prostate-specific-antigen (PSA)-like protein levels in rats. MATERIALS AND METHODS: 44 male Wistar rats were included in the study in four separate groups; 7 treatment and 4 control animals were selected for each group. The treatment group received 40% ethanol (6 g/kg) while the control group was injected with the same dose of intraperitoneal isotonic saline. The first group was sacrificed after 3 h, the second group after 24 h, the third group after 72 h and the fourth group on day 7. Samples were examined by light and Jeol-100 electron microscope. Total serum PSA-like protein levels were determined by a Tosoh immunoenzymometric analyzer AIA 600. RESULTS: In groups 1-3, electron microscopy showed dilatations in the endoplasmic reticulum cisternae of prostatic acinar cells, disarrangements in apparent Golgi complex and apertures belonging to the basal labyrinth. It was also observed that there was a mass of debris cells inside the acinar lumen, and the secretory epithelium was detached from the basal membrane in some places. No pathology was found in group 4 by light and electron microscopy. In group 1, significant levels of increased serum total PSA-like protein were found compared to controls and other treatment groups (p = 0.006). CONCLUSIONS: The fundamental effect of acute alcohol intake on prostate tissue was observed in intermediate stages participating in the exocrine secretion process in the cellular organelles. At the same time, this influences the levels of serum PSA-like protein.