Virtual reality modeling and computer-aided design in pediatric surgery: applications in laparoscopic pyloromyotomy

As a test of the applicability of modern bioengineering tools to pediatric surgery, we developed by computer-aided design (CAD) methods and evaluated a virtual reality (VR) model of laparoscopic pyloromyotomy (LP) and created a set of retractable hook instruments, called Pylorohooks. Our VR model of LP incorporated the infant's body wall, stomach, and hypertrophied pylorus as well as laparoscopic cannulas and two Pylorohooks. CAD software was used to design the 3-mm-diameter, retractable, double-pronged, minimally-traumatic hook instrument. A rapid prototype processor was employed to create a plastic model of the instrument. Surgical-grade stainless-steel prototypes were then manufactured and used in actual LPs. A working VR model was achieved. Following an initial correction in the angulation of the hooks, the instruments were successfully employed in nine consecutive LPs in infants weighing from 3.4 to 5.7 kg. VR and CAD thus proved instrumental in the development of a new LP approach. Because of increasing pressure to limit human and animal experimentation, computer-based bioengineering methods offer promising alternatives that are clearly applicable to pediatric surgery. Accepted: 13 March 2001     

Thymic carcinoma, systemic lupus erythematosus, and hypertrophic pulmonary osteoarthropathy in an 11-year-old boy: a novel association

Thymic carcinoma is exceptionally rare in children and it has never previously been associated with autoimmune disorders. The authors report the case of an 11-year-old boy with thymic carcinoma, hypertrophic pulmonary osteoarthropathy, and an autoimmune disease that resembled systemic lupus erythematosus. To their knowledge, this is the first case of such complex clinical findings. The tumor was of high grade histologically and the boy died after 1 year, in spite of chemotherapy and radiotherapy. A review is presented of the available medical literature on thymic malignancy in childhood.     

Idebenone treatment in paediatric and adult patients with Friedreich ataxia: Long-term follow-up

BACKGROUND: Antioxidant therapy is a new therapeutical approach for patients with Friedreich ataxia. AIMS: To assess the effectiveness of long-term idebenone treatment in Friedreich ataxia patients. METHODS: An open-labelled prospective study. Ten paediatric patients (age range 8-18 years) and 14 adults (age range 18-46 years) with genetic diagnosis of Friedreich ataxia were treated with idebenone (5-20mg/kg/day) for 3-5 years. Neurological evolution was evaluated using the International Cooperative Ataxia Rating Scale (ICARS), and cardiological outcomes using echocardiography. RESULTS: In paediatric patients, no significant differences were observed in ICARS scores and echocardiographic measurements when comparing baseline status and after 5 years of follow-up. Concerning adult cases, ICARS scores showed a significant increase in neurological dysfunctions during 3 years of therapy (Wilcoxon test, p=0.005), while echocardiographic measurements remained unchanged. CONCLUSIONS: Our results indicate that longer-term idebenone treatment prevented progression of cardiomyopathy in both paediatric and adult patients, whereas its stabilizing effect on neurological dysfunction was present only in the paediatric population, mainly before puberty. This suggests that the age at which idebenone treatment is initiated may be an important factor in the effectiveness of the therapy.     

腹壁牵引法与CO2气腹法腹腔镜幽门环肌切开术的比较

目的 比较腹壁牵引法与CO2气腹法两种幽门环肌切开术的优缺点,探讨腹壁牵引法幽门环肌切开术的应用价值.方法 回顾分析2006年3月至2007年9月,我院普外科收治先天性肥厚性幽门狭窄病例66例,其中21例行腹壁牵引法腹腔镜幽门环肌切开术,45例行CO2气腹法腹腔镜幽门环肌切开术,比较两组患儿术中血气分析及生命体征监测的各项指标、术后并发症、住院时间及治疗费用.结果 CO2气腹法组气腹10 min后,pH值、PCO2、HCO3-浓度较气腹前变化明显,差异有统计学意义(P<0.05),MBP、HR较术前有升高,但差异尤统计学意义(P0.05),SPO2改变不明显.腹壁牵引法组在Veress针穿刺10 min后各个指标较术前均无明显变化.两组比较手术用时及术后偶发呕吐比例差异无统计学意义(P0.05),术后进食时间、术后呼吸道感染发生比例、住院天数、治疗费用差异均有统计学意义(P<0.05).结论 腹壁牵引法腹腔镜幽门环肌切开术较传统气腹法腹腔镜手术更简便、经济,并发症相对少,有一定的应用价值.     

Hemostasis for the Ramstedt procedure: Use of a fibrin adhesive

Pre- and postoperative blood counts were retrospectively compared between patients with no hemostatic management (group A,n = 30) and patients with a fibrin adhesive (Beriplast P) applied to the cut edges (group B,n = 8) when pyloromyotomy was performed for hypertrophic pyloric stenosis. Postoperative red blood cell count, hematocrit, and hemoglobin were significantly decreased in group A (P <0.01) while there was no significant change in group B. It has been stated that the Ramstedt operation does not require any special hemostatic management. However, as postoperative peritoneal bleeding is suspected, hemostatic management with a fibrin adhesive applied to the incised region of the serosa and muscle layer is recommended.     

Resolution of Neonatal Hypertrophic Cardiomyopathy in an Infant with an Affected Mother

Hypertrophic cardiomyopathy (HCM) in infancy has been described in association with many medical disorders. The genetic location and mode of transmission of HCM in families also has been reported extensively. We present an infant with nonobstructive hypertrophic cardiomyopathy whose mother also had HCM. Regression of septal hypertrophy was documented in this patient by 1 year of age despite a positive family history.     

巨噬细胞、T淋巴细胞在增生性瘢痕组织中的分布研究

为了解巨噬细胞、Ｔ淋巴细胞在不同时期增生性瘢痕组织内的浸润及分布情况，探讨免疫细胞在增生性瘢痕发生、发展过程中的作用。利用巨噬细胞、Ｔ淋巴细胞的单克隆抗体对实验收集的不同时期增生性瘢痕组织（４１例）进行免疫组织化学染色。结果在正常皮肤组织中，巨噬细胞、Ｔ淋巴细胞浸润很少；在增生性瘢痕组织中，巨噬细胞、Ｔ淋巴细胞浸润有明显的阶段性变化，１～３个月时期瘢痕组织中分布广泛、密度高，６个月以后细胞浸润逐渐减轻，在增生性瘢痕发展至１２个月时期时组织内这两种免疫细胞的浸润较少。提示巨噬细胞、Ｔ淋巴细胞在瘢痕早期组织内的丰富浸润与瘢痕成纤维细胞增殖旺盛及细胞外间质过度沉积有着密切联系。     

Hypertrophic neuropathy — neurosurgical and neuropathological aspects

Summary Three cases of hypertrophic peripheral neuropathy are presented and their different aetiology is discussed. Hypertrophic peripheral neuropathy involving spinal nerve roots may act as a space occupying lesion mimicking tumors especially neurinomas. Therefore the neurosurgical approach may have a therapeutic as well as a diagnostic value.

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Zusammenfassung Drei Fälle von hypertrophischer peripherer Neuropathie werden beschrieben und ihre unterschiedliche Aetiologie wird diskutiert. Bei Beteiligung spinaler Nervenwurzeln an der hypertrophischen peripheren Neuropathie kann eine Raumforderung entstehen, die einen Tumor, insbesondere ein Neurinom, vortäuschen kann. Ein neurochirurgisches Vorgehen kann in diesem Falle neben der diagnostischen Bedeutung auch von therapeutischem Nutzen sein.

     

A study of 11,003 patients with hypertrophic pyloric stenosis and the association between surgeon and hospital volume and outcomes

Aim

The availability of large clinical databases allows for careful evaluation of surgical practices, indicators of quality improvement, and cost. We used a large clinical database to compare the effect of surgeon and hospital volume for the care of children with hypertrophic pyloric stenosis (HPS).

Methods

Patients with International Classification of Diseases-9 codes for HPS and pyloromyotomy were selected from the 1994 to 2000 National Inpatient Samples database. Multiple and logistic regression models were used to evaluate the risk-adjusted association between provider volume and outcomes.

Results

Postoperative complications occurred in 2.71% of patients. Patients operated on by low- and intermediate-volume surgeons were more likely to have complications compared with those operated on by high-volume surgeons (95% confidence interval [CI], 1.25-3.78 and 95% CI, 1.25-2.69, respectively). Patients operated at low-volume hospitals were 1.6 times more likely to have complications compared with those operated at intermediate- or high-volume hospitals (95% CI, 1.19-2.20). Procedures performed at high-volume hospitals were less expensive than those at intermediate-volume hospitals by a margin of $910 (95% CI, $443-$1377).

Conclusions

These data represent the largest study to date on the epidemiology, complication rate, and cost for care for HPS. Patients treated by both high-volume surgeons and at high-volume hospitals have improved outcomes at less cost.     

Studies on the immunologic aspects of keloids and hypertrophic scars

Summary A significant difference between keloids and hypertrophic scars could be demonstrated by means of acid elution of lymphoid blood cells and immunofluorescence studies. A total of 20 patients (13 patients with keloids and seven with hypertrophic scars) were investigated.All the 13 patients with keloids revealed in the eluates antinuclear antibodies belonging to one or more of the five main classes and directed mainly against fibroblasts. On the other hand, there were no antinuclear antibodies detectable in the eluates of the seven patients with hypertrophic scars and in over 40 healthy controls.