Neonatal subgaleal haematoma: Associated risk factors, complications and outcome

Objective : To describe the obstetric and perinatal factors, in particular the method of delivery, associated with development of a subgaleal haematoma (SGH) and to determine the outcome of survivors with this type of birth trauma. Methodology : Perinatal and obstetric data were retrospectively reviewed for 37 infants admitted to the neonatal unit of the sole tertiary paediatric referral hospital in Western Australia with an SGH, over a 24 year period from 1970 to 1993. These data were compared to data for all Western Australian births. The long-term outcome was obtained through medical and private paediatric records for 26 of these infants. Results : All except one of the neonates had instrumental deliveries; 89% had a vacuum extractor applied to the head at some stage of delivery compared to 10% of the general population of births in Western Australia. There was also a significantly increased risk of failure of attempted vacuum extraction. Of the cases where a vacuum extraction was attempted, 45% also had forceps applied to the head. Coagulopathy was associated with the severity of the SGH. There was also a high frequency of occurrence (40%) of associated head trauma such as intracranial haemorrhage, skull fracture and cerebral oedema, as well as neonatal encephalopathy (73%). The occurrence of these associated features did not correlate significantly with the severity of SGH. Minor complications of SGH included jaundice and facial bruising. There was an excess mortality associated with SGH; however, the long-term outcome for neonatal survivors with this disorder was good. None of the cases studied subsequently developed cerebral palsy or intellectual disability, and minor neurological sequelae only were documented in four infants. Conclusions : SGH is an uncommon type of birth trauma, and is associated with delivery or attempted delivery by vacuum extraction. The most commonly associated clinical problems were hypovolaemia and coagulopathy. The long-term outcome for neonates with this condition is good.     

Electromyographic biofeedback can improve subjective and objective measures of fecal incontinence in the short term

Electromyographic biofeedback therapy has demonstrated subjective improvement in patients with fecal incontinence that is comparable to surgery. We assessed the efficacy of biofeedback therapy in a consecutive heterogeneous group of patients using both subjective and objective assessment criteria. These 28 patients with fecal incontinence were studied retrospectively. Patients were assessed using a qualityof-life questionnaire (QOL), the Vaizey and Wexner incontinence scoring systems, and anorectal manometry for efficacy of treatment, before and after biofeedback therapy. Eighty-six percent of patients completed the study. Median follow-up was 18 months. Eighty percent of patients demonstrated significant improvements in their Vaizey and Wexner scores (P < 0.001 and P < 0.001, respectively). The mean QOL score improved from 62 to 77 (P < 0.01). Significant improvements were also demonstrated in the mean resting pressure (P < 0.01), peak amplitude of squeeze (P < 0.01), and the duration of squeeze pressure (P < 0.05). The deferred 15-minute evacuation time also significantly increased (P < 0.001). This study reported significant short-term improvement in fecal incontinence with electromyographic biofeedback therapy using validated subjective and objective scoring systems. Similarly, this treatment also significantly improved anorectal manometric findings. Our data confirm the role of biofeedback therapy in the multimodality approach to patients with fecal incontinence. Presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Florida, May 19–21, 2003 (oral presentation).     

Effects of taper on endurance cycling capacity and single muscle fiber properties

PURPOSE: It was hypothesized that metabolic adaptations in single muscle cells after a taper period are fiber type (I and II) specific and protocol regimen dependent. METHODS: After 7-wk intensive endurance training, 22 male cyclists (VO2max=4.42 +/- 0.40 L.min(-1)) were randomly assigned to one of three 7-d taper groups: the control group (CON, N=7) continued weekly training, the first experimental group (INT) maintained training intensity but reduced duration (N=7), and the second experimental group (DUR) maintained training duration but reduced exercise intensity (N=8). Each cyclist completed a simulated 40-km time trial (40TT) before and after tapering on a set of wind-loaded rollers using their own bicycle. Muscle biopsies were taken immediately before the 40TT both before and after tapering, and analyzed for mATPase, succinate dehydrogenase (SDH), cyctochrome oxidase (CYTOX), alpha-glycerolphosphate dehydrogenase (alpha-GPD), and beta-hydroxyacyl CoA dehydrogenase (beta-HOAD) in Type I and II fibers, separately, using quantitative histochemistry. RESULTS: The results showed significant (P< or =0.05) increases in SDH (Type I) and mATPase, CYTOX, beta-HOAD, and SDH (Type II fibers) in the INT group, and significant increases in CYTOX (Type I) and beta-HOAD (Type I and II fibers) in the DUR group. Regression analysis showed that the change (posttaper minus pretaper) in simulated 40-km endurance time was correlated with the change in CYTOX and SDH activity for all groups combined (r2=0.62-0.72). CONCLUSION: These results demonstrated that the metabolic properties of different fiber types are altered with tapering, that the type of taper protocol used influences their physiological adaptation, and that improvements in simulated 40-km endurance time were related to changes in metabolic properties of the muscle at the single fiber level.