Early repair of inguinal hernia in preterm infants with oxygen-dependent bronchopulmonary dysplasia

Despite inguinal hernia being both common and problematic in a significant proportion of preterm infants with bronchopulmonary dysplasia (BPD), there has been a reluctance to intervene surgically for fear of exacerbating the underlying lung disease. We report our experience of early operation in 12 consecutive infants with varying degrees of oxygen-dependent BPD and investigate the effect of general anaesthesia and herniotomy on pulmonary function by measuring oxygen requirements prior to and following operation. Two infants who required oxygen in a concentration in excess of 95% failed to improve and died from the pulmonary disease 6 and 8 weeks following their operation. The remaining infants all showed a reduction in mean oxygen requirements in the weeks following operation. We conclude that, in the short term, hernia repair performed under general anaesthesia in infants with BPD of varying severity had no adverse effects on respiratory function, as determined by oxygen requirements. We suggest that in certain infants early repair may have been beneficial-potential mechanisms are explored.     

镍钛合金支架置入术治疗食管狭窄49例分析

目的 镍钛合金支架置入术治疗食管狭窄49例情况分析。方法 回顾性分析49例，52例镍钛支架植入术前，术后病例的临床资料，术后疗效观察3个月者39例，6个月者38例，12个月者20例，8例观察18个月。结果 49例病人支困全部顺利置放。病人吞咽困难均得到缓解，其中3例食管支气管瘘病人瘘口均得到封闭可解除呛咳和进食困难，治疗效果明显。支架置入术后6个月内易发生异物堵塞，6个月以上瘤体堵塞多见，均可经胃镜治疗缓解。结论 镍钛合金支架置入术治疗食管狭窄效果良好，以被覆镍钛合金支架为好。     

Magill versus Mallinckrodt tracheal tubes. A comparative study of postoperative sore throat

An attempt to assess the relative merits of Magill and Mallinckrodt tracheal tubes is described. One hundred patients scheduled for routine gynaecological operations were randomly allocated to one of two groups of 50; in one, Magill red rubber tubes were used and in the other, Mallinckrodt tubes. The incidence and severity of postoperative sore throat were assessed on the day after operation. Fifty percent of those intubated with Magill tubes suffered sore throats, compared with 28% with Mallinckrodt (p less than 0.05). In both groups, sore throat was more frequent in younger patients undergoing short operations: smokers intubated with Magill tubes had significantly more sore throat than smokers in whom Mallinckrodt tubes were used.     

Abnormalities of the neonatal brain: MR imaging. Part I. Intracranial hemorrhage

The authors prospectively evaluated 82 neonates, ranging in gestational age from 29 to 44 weeks postconception, with magnetic resonance (MR) imaging at 0.6 T. Twenty-two cases of hemorrhage in 15 infants were identified. Ultrasound (US) and computed tomography (CT) were superior to MR in the first few days after parenchymal hemorrhage, since at this time lesions were apparent on only T2-weighted images. After the first 3 days, MR was the single best modality because (a) hemorrhage on CT became imperceptible in the 2d week, whereas the high signal of hemorrhage on MR persisted for 2-11 weeks; (b) MR permitted rough dating of hemorrhage according to changes in signal intensity; and (c) MR was superior in identifying subdural or epidural hemorrhage. Because of the nonspecificity and restricted field of view of US and the inability of CT to depict hemorrhage after 7-10 days, the authors conclude that MR significantly improves the detection of intracranial hemorrhage in neonates.     

Selective posterior cerebral artery Amytal test for evaluating memory function before surgery for temporal lobe seizure

Selective testing for memory function with Amytal (amobarbital) in the posterior cerebral artery (PCA) is a promising modification of that test in the internal carotid artery (ICA). This new technique, performed with a Tracker catheter system, was completed successfully in 17 of 20 patients being examined before planned surgery for refractory temporal lobe seizure. The PCA test overcomes three major problems with the ICA technique. First, with the PCA technique, memory testing is begun immediately after injection, when the drug has its peak effect. Second, when the speech-dominant hemisphere is being tested with the PCA test, patients do not become aphasic. Third, injection into the PCA delivers the drug more effectively to the target, the ipsilateral hippocampal formation.     

Fetal rhombencephalon: normal US findings

Using ultrasound (US), the authors examined 25 embryos that were 8-10 menstrual weeks old for gestational age and the presence of a small cystic structure (3-4 mm) in the posterior aspect of the cranium. This structure was seen in all embryos. The US images of an in vitro embryo at 8 weeks menstrual age were also evaluated for anatomic correlation. Analysis of these US images determined that the cystic structure was the open rhombencephalon or hindbrain. Follow-up US studies or postpartum clinical examinations of the 25 in utero embryos demonstrated no abnormal posterior cranial cystic structures or neurologic deficits. This first-trimester structure should be considered a normal finding, since it develops into the normally proportioned fourth ventricle after the 11th menstrual week.