Craniofacial development in children with unilateral clefts of the lip, alveolus, and palate treated according to four different regimes. II. Mandibular and vertical development.

Lateral skull radiographs of 85 patients with unilateral clefts of the lip, alveolus and palate treated according to four different regimes were compared longitudinally, at three different ages, regarding mandibular and vertical facial development. It was found that there were no lasting differences in mandibular morphology resulting from regimes including primary or early secondary bone grafting. The non grafted group, however, showed increased mandibular length and anterior height. The jaw angle was increased and there was a more favourable sagittal jaw relationship. Regimes that included primary bone grafting were associated with reduced upper anterior facial height, which resulted in less harmonious facial proportions compared with treatment regimes including early secondary bone grafting done during the mixed dentition, or no bone grafting at all. Vertical development was greatest where bone grafting was excluded.     

Echocardiographic assessment of left ventricular function in left ventricular volume load and the immediate changes after operation

Cardiac function and changes following surgery was studied with computerized M-mode echocardiography in 12 patients with volume load of the left ventricle. Half of them had congenital lesions, the other half aortic regurgitation. Left ventricular (LV) shortening fraction and LV ejection time were significantly reduced postoperatively and came close to normal mean values. Also cardiac output and LV diameters normalized or at least started its normalization. The computerized values for rates of decrease and increase of left ventricular diameter were reduced postoperatively (p less than 0.01 and p less than 0.05 respectively) compared to elevated preoperative values. The study shows that relief of volume load on the left ventricle immediately leads to normalization of left ventricular function, especially if the myocardium was intact preoperatively.     

Rhabdomyoma of the heart with intrapericardial expansion

A rare case of a rhabdomyoma originating from the surface of the right atrium in a 20-year-old female is reported. The tumor showed electrical activity and caused both outflow obstruction and tamponade symptoms. It was successfully removed by a right-sided thoracotomy. The clinical course, diagnostic investigations, and the therapeutical approach of this rare lesion are discussed.     

Quantification of naturally occurring benzodiazepine-like substances in human breast milk

The possible occurrence of benzodiazepine-like substances in human breast milk was investigated in 35 healthy, newly delivered women who were known not to be taking benzodiazepines. Maternal blood samples and a sample of breast milk were obtained on the fifth post partum day. A radioreceptor technique (lower limit of detection 1.5 ng/ml; difference between duplicates at various concentrations <7%) was used for measuring benzodiazepine-like substances in blood and breast milk (with and without prior extraction). No benzodiazepine-like substances could be demonstrated in any of the blood samples taken from the 35 women. Measurable concentrations of benzodiazepine-like substances were demonstrated in all but 1 of the 35 breast milk samples. The mean concentration of benzodiazepine-like substances for all 35 women was 4.3±2.3 ng/ml (range 0–9.3 ng/ml) expressed as lorazepam. The corresponding value for extracted breast milk was 2.6±1.5 ng/ml (range 0–7.0 ng/ml). There was no association between concentrations of benzodiazepine-like substances in breast milk and maternal age, weight, height and body mass or parity, or the sex of the infant and infant birth weight. We suggest that non-detectable amounts of benzodiazepine-like substances in serum are concentrated in the mammillary glands and excreted in a higher concentration in breast milk. It is less likely that the relevant benzodiazepines are produced in the mammillary glands.     

The Effects of a Gastric Inhibitory Substance on Gastric Secretion in the Pylorus Ligated Rat1

An extract was prepared from juice secreted by vagally denervated isolated pouches of the gastric antrum in the dog, by dialyzing against water and lyophilization. This gastric inhibitory substance (GIS) was assayed in pylorus ligated rats. Three groups of rats served as controls. One group received no injections, while the two other were injected with saline (1 ml/100 g rat) intravenously (i.v.) or intraperitoneally (i.p.). Two different types of gastric secretion were studied: (a) basal or spontaneous gastric output, and (b) gastric acid response to exogenous gastrin. GIS lowered significantly the basal or spontaneous output of acid, but did not alter the basal output of pepsin significantly. When GIS was injected into animals stimulated by gastrin, there was a highly significant lower output of both acid and pepsin.     

Circadian rhythm of mitotic activity in the adult gull-tapeworm,Diphyllobothrium dendriticum (cestoda)

Summary The mitotic activity of Diphyllobothrium dendriticum reared in hamsters was studied. The hamsters were 1) fed ad libitum 2) fed in the evening only 3) fed in the morning only, and 4) starved for 24 hours. Starvation of the host drastically reduced mitotic activity in the worms. In all other experiments the mitotic activity showed a circadian periodicity with peaks at 22.00–2.00 hrs and minima at 10.00–18.00 hrs. Worms from hamsters fed in the morning only possibly had a second peak some time after feeding.In the group of hamsters fed in the morning, the mitotic activity of the intestinal mucosa was also investigated. No circadian rhythm was observed.Evidently, availability of nutrients is essential to keep the mitotic activity at a high level. It is assumed, however, that the circadian periodicity also depends on other conditions besides nutrition.This study was supported by Finnish State Council for Science.     

Pharmacological approach to acute pancreatitis

The aim of the present review is to summarize the current knowledge regarding pharmacological prevention and treatment of acute pancreatitis （AP） based on experimental animal models and clinical trials. Somatostatin （SS） and octreotide inhibit the exocrine production of pancreatic enzymes and may be useful as prophylaxis against Post Endoscopic retrograde cholangiopancreatography Pancreatitis （PEP）. The protease inhibitor Gabexate mesilate （GM） is used routinely as treatment to AP in some countries, but randomized clinical trials and a meta-analysis do not support this practice. Nitroglycerin （NGL） is a nitrogen oxide （NO） donor, which relaxes the sphincter of Oddi. Studies show conflicting results when applied prior to ERCP and a large multicenter randomized study is warranted. Steroids administered as prophylaxis against PEP has been validated without effect in several randomized trials. The non-steroidal anti-inflammatory drugs （NSAID） indomethacin and diclofenac have in randomized studies showed potential as prophylaxis against PEP. Interleukin 10 （IL-10） is a cytokine with anti-inflammatory properties but two trials testing IL-10 as prophylaxis to PEP have returned conflicting results. Antibodies against tumor necrosis factor-alpha （TNF-α） have a potential as rescue therapy but no clinical trials are currently being conducted. The antibiotics beta- lactams and quinolones reduce mortality when necrosis is present in pancreas and may also reduce incidence of infected necrosis. Evidence based pharmacological treatment of AP is limited and studies on the effect of potent anti-inflammatory drugs are warranted.     

Shoulder pain after stroke – experiences,consequences in daily life and effects of interventions: a qualitative study

Purpose: To describe experiences of shoulder pain after stroke, how pain affects daily life and perceived effects of interventions.

Method: A qualitative interview study including 13 community-dwelling persons (six women; median age 65?years) with persistent shoulder pain after stroke.

Results: Three categories emerged from the content analysis. In “Multiple pain characteristics” an insidious pain onset was reported. The pain existed both day and night and could be located around the shoulder girdle but also have radiation to the arm and hand. An explanation of the pain was seldom given. In “Limitations caused by the pain” it was described how the pain negatively influenced personal care, household activities and leisure, but also could lead to emotional reactions. In “Multiple pain interventions with various effects” a variety of interventions were described. Self-management interventions with gentle movements were perceived most effective. A restraint attitude to pain medication due to side effects was reported.

Conclusions: Shoulder pain after stroke can lead to a variety of pain characteristics. As the pain is complex and may affect many important areas in a person’s life, multidisciplinary rehabilitation interventions are important.

• Implications for rehabilitation

• Shoulder pain after stroke can lead to a variety of pain characteristics with radiation to the arm and hand

• Shoulder pain often influence personal care, household activities and leisure negatively, which may lead to emotional reactions

• Self-management interventions with gentle movements are perceived most effective

• As the shoulder pain after stroke is complex, interventions by a multidisciplinary team may be needed

     

A longitudinal three-center study of craniofacial morphology at 6 and 12 years of age in patients with complete bilateral cleft lip and palate

In this longitudinal study, the craniofacial morphology and evaluated soft tissue profile changes, at 6 and 12 years of age in patients with complete bilateral cleft lip and palate (CBCLP) were compared. Lateral cephalograms from 148 patients with CBCLP, treated consecutively at three European cleft centers, Gothenburg (n (A) = 37), Nijmegen (n (B) = 26), and Oslo (n (C) = 85), were evaluated. Eighteen hard tissue and ten soft tissue landmarks were digitized. Paired t test, Pearson's correlation coefficients, and multiple regression models were applied for statistical analysis. ANOVA and Tukey-B, as a post hoc test, were used to evaluate the increments and compare centers. Hard and soft tissue data were superimposed using the generalized Procrustes analysis. For Nijmegen, the increments of the variables SNA, ANB, SN-NL, SN-ML, NL-ML, Snss, and Snpg were significantly different than the two other centers (p = 0.041 to <0.001). SNPg increments were significantly different between Nijmegen and Oslo (p = 0.002). The three cleft centers followed different treatment protocols, but the main differences in craniofacial morphology until 12 years of age were the growth pattern and the maxillary and upper incisor variables. Follow-up of these patients until facial growth has ceased, which may elucidate components for improving treatment outcome.