Reflexes of the external urethral sphincter in children

The electromyographic responses in the external urethral sphincter to electrical stimulation of the pudendal nerve and stretch of the external sphincter were analyzed in a pediatric population; the population included a group with recurrent urinary tract infections and a group with complete or almost complete upper spinal cord lesions. Electrical stimulation produced a response of reflex nature mediated in the sacral spinal cord, frequently beginning with two components that could be individually characterized and that behaved similarly to a flexor reflex. The response produced by stretch appeared to be similar to that produced by electrical stimulation.     

Complex repetitive discharges in the external urethral sphincter in a pediatric population

Complex repetitive discharges (CRDs) were seen in 26 patients undergoing urodynarnic studies. Eleven patients had myelodysplasia, 12 patients had urinary incontinence and/or urgency and/or recurrent urinary tract infections without evident neurologic abnormality, and 3 patients had spinal cord tumors. All exhibited abnormalities on urodynamic evaluation, either upper or lower motor neuron in type. Six girls with incontinence and CRDs had positive family histories, and these features define a possible genetic syndrome of delayed maturation of control over micturition.     

Successful use of venovenous extracorporeal membrane oxygenation in accidental hypothermic cardiac arrest

Cardiopulmonary bypass is usually used for rewarming and for providing cardiac support in patients with severe hypothermia and cardiovascular instability. We report the first case of accidental severe hypothermia associated with prolonged cardiac arrest that was successfully managed by venovenous extracorporeal membrane oxygenation.     

A comparison of radiographic signs of pulmonary inflammation during ECMO between silicon and poly-methyl pentene oxygenators

INTRODUCTION: The inflammatory response caused by extracorporeal membrane oxygenation (ECMO) is clearly visible within the first 24 h of cannulation. The inflammatory process affects all areas of the lung, even areas previously spared by the primary disease. OBJECTIVE: To compare the change in the radiographic signs of inflammatory response to ECMO between poly-methyl pentene and silicon oxygenators. STUDY DESIGN: Retrospective review of neonates and adults pre- and post-replacement of silicon oxygenators with poly-methyl pentene devices. Data were collected from Extracorporeal Life Support Organisation (ELSO) registry forms and patient records. Results were analysed by quantitative and semi-quantitative methods. RESULTS: There was a significant reduction in the radiographic signs of inflammatory response to ECMO, and a reduction in the time taken to revert to pre-ECMO state in the neonatal poly-methyl pentene group compared to silicon. However, there was no significant reduction in the duration of ECMO runs and the percentage survival between these groups in the neonates. In adults, there was no difference in severity of radiographic signs between groups. However, the inflammatory changes were relatively delayed in the adult poly-methyl pentene group. CONCLUSION: Polymethyl pentene (Medos) oxygenators have reduced the host's response phenomenon 'white out' in neonates, and caused a delayed response in adults. This is most likely a consequence of smaller blood contact surface area combined with the effect of heparin coating of the oxygenator membrane. However, recovery was not a function of the type of gas exchange device used.     

Age-Related Functional Decline Following Total Knee Arthroplasty: Risk Adjustment is Mandatory

Background

Patient-reported outcome measures (PROMs) are being used increasingly to determine the success of total knee arthroplasty (TKA). Our goal is to investigate whether advanced age is associated with lower PROM scores.

Bariatric Surgery Prior to Total Joint Arthroplasty,Does it Decrease the Risk of Obesity Related Perioperative Complications?

Purpose of Review

The purpose of this review paper is to provide an overview of the relationship between obesity, osteoarthritis, arthroplasty outcomes, and the potential use of bariatric surgery to improve these outcomes.

Recent Findings

Unfortunately, the findings in the currently available literature evaluating the role of bariatric surgery prior to arthroplasty surgery largely rely on retrospective data and their results are somewhat conflicting.

Summary

Future prospective studies are needed to further evaluate whether or not bariatric surgery prior to arthroplasty surgery may be of benefit for patients. Additional research is needed to identify other methods to minimize complications that obese patients are particularly prone to developing following arthroplasty surgery.

     

The Ideal Total Hip Replacement Bearing Surface in the Young Patient: A Prospective Randomized Trial Comparing Alumina Ceramic-On-Ceramic With Ceramic-On-Conventional Polyethylene: 15-Year Follow-Up

Background

The optimum bearing surface for total hip arthroplasty remains debatable. We have previously published our outcome at 10 years and this represents the 15-year follow-up.

The teratogenicity of anticonvulsant drugs

BACKGROUND: The frequency of major malformations, growth retardation, and hypoplasia of the midface and fingers, known as the anticonvulsant embryopathy, is increased in infants exposed to anticonvulsant drugs in utero. However, whether the abnormalities are caused by the maternal epilepsy itself or by exposure to anticonvulsant drugs is not known. METHODS: We screened 128,049 pregnant women at delivery to identify three groups of infants: those exposed to anticonvulsant drugs, those unexposed to anticonvulsant drugs but with a maternal history of seizures, and those unexposed to anticonvulsant drugs with no maternal history of seizures (control group). The infants were examined systematically for the presence of major malformations, signs of hypoplasia of the midface and fingers, microcephaly, and small body size. RESULTS: The combined frequency of anticonvulsant embryopathy was higher in 223 infants exposed to one anticonvulsant drug than in 508 control infants (20.6 percent vs. 8.5 percent; odds ratio, 2.8; 95 percent confidence interval, 1.1 to 9.7). The frequency was also higher in 93 infants exposed to two or more anticonvulsant drugs than in the controls (28.0 percent vs. 8.5 percent; odds ratio, 4.2; 95 percent confidence interval, 1.1 to 5.1). The 98 infants whose mothers had a history of epilepsy but took no anticonvulsant drugs during the pregnancy did not have a higher frequency of those abnormalities than the control infants. CONCLUSIONS: A distinctive pattern of physical abnormalities in infants of mothers with epilepsy is associated with the use of anticonvulsant drugs during pregnancy, rather than with epilepsy itself.