Severe secondary peritonitis following upper stomach perforation in a full-term mature newborn infant]

A perforation of the stomach is relatively seldom during the newborn period and the first year of life. A wide spectrum of causes has to be considered. The prognosis is determined by prematurity, basic illnesses and combined injuries and essentially by the time of an operation. We report on a mature newborn. At the fourth day a stomach perforation was closed by an operation. A serious diffuse peritonitis and a partial suture insufficiency complicated the postoperative course and necessitated a four-weekly respirator therapy, complete parenteral nutrition for 30 days as well as chemotherapy for several weeks. Altogether a programmed peritoneal lavage has been carried out for 10 times. After 62 days the child could be discharged home in a good condition.     

General practitioners' satisfaction with and attitudes to out-of-hours services

Background  

In recent years, Dutch general practitioner (GP) out-of-hours service has been reorganised into large-scale GP cooperatives. Until now little is known about GPs' experiences with working at these cooperatives for out-of-hours care. The purpose of this study is to gain insight into GPs' satisfaction with working at GP cooperatives for out-of-hours care in separated and integrated cooperatives.     

Comparative study on the shaping ability and cleaning efficiency of rotary Mtwo instruments. Part 1. Shaping ability in simulated curved canals

AIM: To compare the shaping ability of Mtwo instruments with K3 and RaCe instruments. Part 1 of this two-part report describes the efficacy of these nickel-titanium instruments in simulated curved root canals. METHODOLOGY: Simulated canals with 28 degree and 35 degree curves in resin blocks were prepared with Mtwo instruments using a single length technique and with K3 and RaCe instruments using a crowndown preparation technique (n = 20 canals in each case). Pre- and post-instrumentation images were recorded and assessment of canal shape was completed with a computer image analysis program. Material removal was measured at 20 measuring points, beginning 1 mm from the endpoint of preparation. Incidence of canal aberrations, preparation time, changes of working length and instrument failures were also recorded. The data were analysed statistically using ANOVA and Student-Newman-Keuls test. RESULTS: On an average, canals prepared with Mtwo instruments remained better centred compared with those enlarged with K3 or RaCe instruments. Six RaCe instruments, four K3 files and none of the Mtwo instruments fractured during preparation (P > 0.05). In both of the canal types, Mtwo was significantly faster (P < 0.001). It was possible with all types of instruments to control working length as well. CONCLUSIONS: Mtwo instruments prepared curved canals rapidly, respected original canal curvature well and were safe to use.     

Treatment of proximal fibular tumors with en bloc resection

Proximal fibular tumor resection has always been a challenge to an orthopedic surgeon due to the proximity of two major structures; the peroneal nerve and anterior tibial artery. Extra-articular resection of the proximal tibiofibular joint, sacrificing of peroneal nerve and split resection of lateral tibial wall are major points of debate. Malawer described two types of resection for aggressive benign and malignant tumors of the proximal fibula, type I for benign and type II for malignant tumors. Between 1992 and 2002, nine male patients with proximal fibula tumors were treated by en-bloc resection as described either by Malawer and or by one of two new resection techniques. Of the nine tumors, six were diagnosed as giant cell tumor (one of them recurrent), two as osteosarcoma and one as benign fibrous histiocytoma. The mean age of the patients was 23.6 (20–48) years. The mean follow up period was 42.8 months (15–117). There were no complications leading to a secondary surgical procedure+no local recurrence. Tumor volume was over 250 ml in two GCT cases, so the deep peroneal nerve was sacrificed to provide a wide margin. Iatrogenic peroneal nerve palsy developed in two patients. Late tendon transfers were performed for the management of drop foot. Our results indicate that if tumor is recurrent or has a large volume, wide resection (including deep peroneal nerve) should be done. Despite satisfactory tumor management, functional outcomes turned out to be variable, therefore precise ligament and muscle reconstruction is recommended.     

Heart rate variability--physiology, methods of registration and application in pediatric sleep laboratory

Heart rate variability (HRV) has become the focus of interest of a multitude of investigations being a parameter that can easily be recorded. Accepted clinical indications in adults include evaluation of diabetic neuropathy and prediction of prognosis after myocardial infarction in adults. In children, HRV is regularly being registered in the pediatric sleep laboratory in sleep related breathing disorders, after apparent life threatening events, or in infants with assumed increased risk for sudden infant death syndrome. However, uniform interpretation criteria have not been established in these situations, at least partially due to insufficient understanding of physiology and pathophysiology of HRV in this age group. In this overview, current knowledge on HRV in infants and children is summarized and its clinical relevance discussed. In addition, technical requirements and methods of analysis which have a major impact on calculated parameters are being presented.     

Deleterious effects of irradiation and bone marrow transplantation therapy in the genetically anemic an/an mouse

The efficacy and outcome of bone marrow transplantation therapy following lethal irradiation were examined in syngeneic mice that had a hereditary macrocytic anemia (an/an) or were genotypically normal (+/+). Successful RBC and WBC replacement, based on blood cell parameters and donor genetic markers, were observed in all combinations of transplant therapy. Nevertheless, the an/an mice died prematurely several months after treatment, whether they received +/+ or an/an marrow cells. In contrast, the +/+ recipients of either +/+ or an/an marrow cells survived for at least 1 year after transplantation. Premature death of the an/an mice was associated with lymphopenia, anemia, kidney lesions, and severe pathogen-free pneumonitis. On the basis of our results, we hypothesize that the premature deaths of an/an mice are caused by a kind of chronic irradiation damage to which an/an mice are especially susceptible.     

Specificity of autoantibodies in autoimmune thrombocytopenia

In 42 patients with autoimmune thrombocytopenia (AITP) and a positive direct platelet suspension immunofluorescence test (PSIFT), the antigenic specificity of the autoantibodies was studied. Because the autoantibodies were often not detectable in the serum and additional HLA antibodies may disturb the reaction pattern with the platelet panel, we used eluates prepared from the patients' platelets for this study. Thirty-five patients had antibodies equally reactive with normal platelets, irrespective of their antigenic make-up, but not with the platelets from two Glanzmann's disease patients. Absorption and elution experiments in two patients showed that his was probably not due to the presence of a combination of anti-Zwa and anti-Zwb antibodies. Thus, the majority of autoantibodies against platelets seems to be directed against antigenic determinants not present on Glanzmann's disease platelets, but perhaps located on the platelet-membrane glycoproteins IIb and/or IIIa. In ten patients, antibodies of no, or still unknown, specificity were detected. Three of these had additional antibodies not reactive with the platelets of the two Glanzmann patients.