Correction of camptodactyly with an external fixator

Camptodactyly is a flexion deformity of the proximal interphalangeal joint. Because of unsatisfactory results, treatment is not recommended for mild deformities, and in severe deformities surgery has been disappointing. A specially designed external fixator providing gradual distraction was used in a severe case. With this mildly aggressive method, an acceptable result was obtained. Received: 5 June 1997/Accepted: 2 February 1998     

Extracorporeal Septoplasty Combined with Open Rhinoplasty

Extracorporeal septoplasty is a radical solution for the severely deviated nose. The major problems associated with this procedure are fixation of the septal cartilage graft and dorsal irregularities. Extracorporeal septoplasty was performed in combination with open rhinoplasty in 17 patients with severe nasal deformities. In this technique septum was totally removed through the columellar incision of open rhinoplasty, corrected outside, and replaced as a free ``L' shaped cartilage graft. The cartilage graft was fixated to the upper lateral cartilages to restore the natural relations of the anatomical structures. Additional rhinoplastic manipulations were also performed. The follow-up period was up to 18 months. The overall result was successful in all patients. Nasal deviation did not recur and secondary revisions were not needed for any patient during follow-up.     

An algorithm for deciding alternative grafting materials used in secondary rhinoplasty.

Severe middle vault deformity with disturbed nasal form and function is one of the most challenging procedures to correct in a secondary rhinoplasty. Reconstructing the deformity with autologous septal cartilage would be the primary choice of most surgeons, if it were always available. However in certain cases the lack of a sufficient quantity of autologous cartilage has forced surgeons to explore other viable options. This paper discusses our experience with the combined use of spreader and dorsal onlay grafts from various materials in the reconstruction of severe middle vault deformity in 110 patients. In follow up, (between 6 and 42 months; mean 21 months) all patients were noted to have improved in both aesthetics and function with no major complications noted. In summary, this study proposes that any engrafting material can be used safely when the proper surgical principals and technique are employed.     

Determinants of blood flow and ultrafiltration in continuous arteriovenous haemodiafiltration: theoretical predictions and laboratory and clinical observations

In continuous arteriovenous haemofiltration (CAVH) or haemodiafiltration (CAVHD), it is important to obtain an adequate blood flow through the haemofilter to minimise the risk of excessive haemoconcentration and clotting. In this study we determined the resistance to blood flow of the extracorporeal device as well as the hydraulic permeability of the filter membrane is intensive care patients treated with CAVHD. Data were obtained for CAVH catheters and Scribner shunts and for a polyacrylonitrile (AN-69) plate filter, an AN-69 capillary filter and a polysulphone (PS) capillary filter. In accordance with recent literature we also predicted the resistance to flow by using Poiseuille's law and a formula for the estimation of blood viscosity. Although with all three filters an adequate blood flow was usually obtained, the resistance to blood flow was 2-3 times greater than the predicted value. With continued use of the filter, resistance to blood flow remained largely unchanged. When, in the laboratory, the AN-69 capillary filter was perfused with saline and with a viscous sucrose solution, the resistance to flow was only 1.4 time the predicted value, a difference that might result from small deviations of the capillary diameter. When perfused with blood, the resistance was 2.6 times greater than the predicted value. This was largely explained by gross underestimation of blood viscosity in these patients. By combining laboratory data on filter resistance during saline perfusion and a more accurate estimation of blood viscosity, a reasonably accurate prediction of blood flow rate would be feasible. In the clinic the hydraulic permeability of the filters decreased with time.(ABSTRACT TRUNCATED AT 250 WORDS)     

Correlation of P-selectin and lipoprotein(a), and other lipid parameters in preeclampsia

Preeclampsia is a pregnancy specific disorder and is thought to be associated with generalized endothelial dysfunction. P-selectin, an adhesion molecule, mediates the interaction of monocytes, platelets, and endothelial cells. Increased P-selectin levels and altered lipid and lipoprotein metabolism were reported in preeclampsia and during pregnancy. In order to investigate the relationship between serum P-selectin and lipoprotein(a), and other lipid parameters, 28 preeclampsia [13 severe (group I) and 15 mild preeclampsia (group II), 15 healthy pregnant (group III) and 20 non-pregnant (group IV)] women were investigated. Serum P-selectin, lipoprotein(a), total cholesterol, triglyceride, and high density lipoprotein cholesterol were measured and low-density lipoprotein cholesterol was derived. Serum P-selectin concentrations were consistently and significantly higher in the severe preeclampsia group than in the mild preeclampsia, healthy pregnancy, and non-pregnant control groups (P<0.0001, for all). The mild preeclampsia group also had increased serum P-selectin concentrations compared with the healthy pregnancy group and non-pregnant controls (P<0.05 and P<0.0001, respectively). Serum P-selectin and lipoprotein(a) levels revealed a significant and linear increase with the severity of preeclampsia. There were also significant (in groups I and II) and borderline (in groups III and IV) correlations between P-selectin and total cholesterol. The present study suggests that P-selectin may be an additional risk marker for preeclampsia, and may be useful in distinguishing women with mild and severe preeclampsia and normal pregnancy. Received: 9 November 2001 / Accepted: 6 February 2002     

Urinary factors of kidney stone formation in patients with Crohn's disease

Summary An increased frequency of kidney stone formation is reported in patients with inflammatory bowel disease. In order to investigate its pathogenesis, the concentrations of factors known to enhance calcium oxalate stone formation (oxalate, calcium, uric acid) as well as of inhibitory factors for nephrolithiasis (magnesium, citrate) were determined in the urine of 86 patients with Crohn's disease and compared with those of 53 metabolically healthy controls. Six patients with Crohn's disease already had experienced calcium oxalate nephrolithiasis. Patients with Crohn's disease had significantly higher urinary oxalate and lower magnesium and citrate concentrations. Among all patients magnesium and citrate were significantly lower in those with a positive history of kidney stones. Our results demonstrate that the increased propensity for renal stone formation in patients with Crohn's disease is a result not only of increased urinary oxalate, but also of decreased urinary magnesium and citrate concentrations.Abbreviations CDAI Crohn's disease activity index Dedicated to Professor Dr. N. Zöllner on the occasion of his 65th birthday