Effect of medial arch-heel support in inserts on reducing ankle eversion: a biomechanics study

Background  

Excessive pronation (or eversion) at ankle joint in heel-toe running correlated with lower extremity overuse injuries. Orthotics and inserts are often prescribed to limit the pronation range to tackle the problem. Previous studies revealed that the effect is product-specific. This study investigated the effect of medial arch-heel support in inserts on reducing ankle eversion in standing, walking and running.     

The anal sphincter force in the evaluation of postoperative imperforate anus.

Eight-four children, all of whom had imperforate anus, were evaluated by measuring the anal sphincter force (ASF). Sixty-three were boys, 46 of whom had a high imperforate anus and 17 of whom had the low anomaly. There were 7 girls with cloacal malformations, 7 girls with high type and 7 with low type of malformation. In all the boys with a high imperforate anus the ASF ranged from 50 to 300 g. Those boys with a low type had an average ASF of 513 g. Normal values vary from 480 to 600 g. Twenty-five of the boys with a high imperforate anus had undergone posterior sagittal anorectoplasty and none were clinically continent. Their ASF measurements were lower than in patients with spina bifida. Patients with a low anomaly, both boys and girls, were continent and had high ASF readings. The ASF is a simple, inexpensive, and objective measurement of fecal incontinence when this is the consequence of muscular inadequacy. A reproducible quantification is now available to compare results of different operations and different centres.     

苦楝化学成份的研究

从苦楝(Melia azedarach L.)果中分得苦楝新醇(Ⅰ),苦楝醇(Ⅱ)、苦楝酮(Ⅲ)、苦楝二醇(Ⅳ)、香草醛(Ⅴ)和香草酸(Ⅵ)。根据波谱(IR,MS,¹HNMR,¹³CNMR)分析和理化常数测定,确定了它们的结构。其中苦楝新醇(Ⅰ)为新化合物,对菜青小虫有一定的拒食活性。     

Twenty-one year experience with the pediatric gastric tube

From 1964 to 1985 inclusive, gastric tubes have been constructed in 36 infants and children to replace a congenitally defective esophagus or an esophagus with acquired irreparable damage. This report reviews our entire series to date covering a 21-year experience. There were 24 boys and 12 girls ranging in age from 3 months to 17 years. Twenty-two patients were operated on because of congenital esophageal defects and 14 for acquired lesions. A proximally based antiperistaltic tube was constructed in 32 instances, and a distally based isoperistaltic tube made in four. Thirty tubes were passed retrosternally, five through the chest (four with an anastomosis) and one subcutaneously. Twenty-nine infants and children had their tube construction staged, and the remaining seven had the entire procedure done in one stage. The spleen was removed in 23 early gastric tube operations. There were 19 extratube major complications. Twenty-four gastric tube neck anastomoses leaked (66%); all but one closed spontaneously within 3 months. There were 15 esophagogastric tube neck anastomotic strictures (41%), which were dilated; nine required resection. Thirty-two of the 36 infants and children have been followed for more than 1 year. Twenty-nine are swallowing normally, one is still being dilated, and one infant still does not swallow well. Mild sacculation or tortuosity of the gastric tube has been encountered only one. Growth was slow in four until the school years. One boy had his improperly made tube eventually discarded for a colon replacement. There were three deaths (tracheostomy complication, aspiration, gastric tube ulcer hemorrhage). Despite the above problems, the eventual outcome continues to be satisfactory and satisfying.(ABSTRACT TRUNCATED AT 250 WORDS)     

The pharmacological treatment of newborn diaphragmatic hernia — update 1987

Before the mid 1970s, neonates with diaphragmatic hernias (CDH) had a survival rate of 40%. Since then increased interest has been focused on the pulmonary artery and its hypertension (the persistent fetal circulation) and the pharmacologic treatment of this pathophysiology. Our initial pharmacologic experience left us with much information and even more unanswered questions. While other series were encouraging, they also showed a survival rate of about 50%. The following problems are associated with pulmonary vasodilator therapy: (1) there is no specific pulmonary vasodilator and the response is often unpredictable; (2) the pulmonary arterioles in these babies are abnormal and appear in many instances anatomically incapable of responding; (3) cardiac output may be affected secondary to inotropic or chronotropic side effects of vasodilators; and (4) the effect of a vasodilator on the pulmonary vasculature under hypoxic conditions is unknown. Moreover, we have yet to identify at birth which CDH babies require this treatment, and we must find improved pharmacologic agents that will more specifically dilate the constricted pulmonary vascular bed with minimal effect on the systemic circulation. Although some attempts at pharmacological manipulation of the pulmonary vascular bed continue in most centers, including ours, there are many other innovations in the perioperative management which require further evaluation, among them extracorporeal membrane oxygenation, high-frequency oscillation and possibly lung transplantation in the future. Offprint requests to: S. H. Ein