A composite nasolabial flap for an entire ala reconstruction.

BACKGROUND: It is difficult to reconstruct an entire alar defect. We report a case of an entire alar reconstruction carried out in two stages with a composite nasolabial flap lined with retroauricular skin and supported with the attached conchal cartilage. OBJECTIVE: A composite nasolabial flap was applied for reconstruction of entire alar defect in this patient. METHODS: The lining skin for the flap was obtained from retroauricular region acceptable to the patient, and the conchal cartilage was used simultaneously for support and as the attachment for the lining skin. The flap was then replaced and secured. Half a year later, the flap was flipped and transferred to the alar defect as a second step. RESULTS: The final shape and texture were satisfactory. All procedures were performed under local anesthesia. CONCLUSION: Our design of composite flap has been successfully utilized to repair an entire alar defect with cosmetically and functionally good results, minimizing the donor area and the resulting operation scars. This composite nasolabial flap is thought to be the best choice of a flap for an entire alar defect reconstruction.     

An electron microscopic study of glomerular lesions in hereditary nephrotic mice (ICGN strain)

Summary Glomerular lesions in hereditary nephrotic mice (ICGN strain) were investigated by electron microscopy. The glomeruli of unaffected animals, which appeared normal by light microscopy, had developed an ultrastructural change in the glomerular capillary basement membrane (GCBM). There was a partial thickening of the GCBM with bilaminar splitting of the lamina densa and an electron-dense fibrillar material exhibiting cross-striations. In affected animals, light microscopy revealed a marked thickening of GCBM and an increase of mesangial matrix without cellular proliferaton. By electron microscopy, multilaminar splitting of the lamina densa in the thickened GCBMs and fusion of the epithelial foot processes were observed. In some severely affected animals, immune complex deposition was found in GCBM, but little if any was observed in other animals. In the end, the glomeruli were globally sclerosed. Our findings suggest that initial structural abnormalities in GCBM may play an important role in the onset and development of the disease, though subsequent events such as immune complex deposition would modify the disease.     

Successful treatment of hemochromatosis with renal tubular dysgenesis in a preterm infant

We report the first surviving case of neonatal hemochromatosis with renal tubular dysgenesis. Renal failure was treated with peritoneal dialysis. Although hepatic failure from neonatal hemochromatosis was progressive, repeated exchange transfusions improved jaundice and coagulopathy. The patient gained weight and received a liver transplantation from her father.     

Anaemia during pregnancy: impact on birth outcome and infant haemoglobin level during the first 18 months of life

To determine the effect of maternal anaemia on pregnancy outcome and describe its impact on infant haemoglobin level in the first 18 months of life, we conducted a prospective study of 617 pregnant women and their children in Benin. Prevalence of maternal anaemia at delivery was 39.5%, and 61.1% of newborns were anaemic at birth. Maternal anaemia was not associated with low birth weight [OR = 1.2 (0.6-2.2)] or preterm birth [OR = 1.3 (0.7-2.4)], whereas the newborn's anaemia was related to maternal anaemia [OR = 1.8 (1.2-2.5)]. There was no association between an infant's haemoglobin level until 18 months and maternal anaemia. However, malaria attacks during follow-up, male gender and sickle cell trait were all associated with a lower infant haemoglobin level until 18 months, whereas good infant feeding practices and a polygamous family were positively associated with a higher haemoglobin level during the first 18 months of life.     

The role of primary health care in patient education for diabetes control

The major components of diabetes management are dietary therapy, exercise and drug treatment. Therefore, education of people with diabetes is the cornerstone of management. The aim of the present work was to study the role of primary health care (PHC) in patient education for diabetes control in Alexandria. Accordingly, the knowledge and perception concerning diabetes and its management of all 88 PHC physicians and 104 nurses working in the two rural health centers and two randomly chosen urban health centers of Alexandria governorate were assessed by pre-designed self-administered questionnaire. All diabetic patients over 20 years of age attending the study health facilities over a period of two months were assessed for their knowledge and attitude concerning diabetes and self-management and asked about their degree of satisfaction with the provided PHC services by a pre-designed interview questionnaire. They amounted to 560 diabetic patients. The results revealed that the PHC physicians had sufficient knowledge about causes and complications of the disease, but insufficient knowledge about diagnosis and management, as only 10.2% & 4.5% of the physicians recognized the importance of regular exercise and patient education for diabetes management. Some misconceptions and false beliefs were observed among PHC nurses, as many of them considered diabetes a contagious disease or primarily caused by stress; that liver failure, hearing impairment and splenomegaly are among the complications of diabetes and that young age and immunodeficiency disorders are among the risk factors for developing diabetes. Moreover, most of them believed that the amount of carbohydrates given to diabetic patients should be reduced or even completely restricted; that vitamins are essential for all diabetic patients and that hot-water bottles are good for providing warmth to the diabetic feet. They also disagreed on the use of artificial sweeteners as sugar substitutes. Most of the diabetic patients had poor knowledge about diabetes and its management (85.7%) and a negative attitude towards self-management (61.6%) and only 23.6% of them were satisfied with the services provided by the PHC facilities for diabetes control. They were mainly dissatisfied with the role of PHC physicians in patient education. Some misconceptions and false beliefs were also recognized among diabetic patients. Many of them considered diabetes a contagious disease or primarily caused by stress. They didn't know the importance of regular exercise in diabetes control. They also believed in the efficacy of herbal therapy in diabetes control; that vitamins are essential for all people with diabetes; that water intake should be decreased when passing large amounts of urine, that anti-diabetic drugs should be stopped during associated illnesses and that patients on insulin treatment can't be shifted to oral drugs. Moreover, they believed that the amount of carbohydrates in diet should be reduced or even restricted and that the amount of proteins should not be reduced. They also refused the use of artificial sweeteners as sugar substitutes. Thus, it may be concluded that there is a serious gap in the provision of basic educational services to the majority of diabetic patients attending PHC facilities in Alexandria.     

Commotio Cordis Presenting as a Temporary Complete Atrioventricular Block in a 2-Year-Old Girl With Congenitally Corrected Transposition of the great Arteries

This report describes a 2-year-old girl with congenitally corrected transposition of the great arteries (ccTGA) who presented with transient complete atrioventricular (AV) block after a mild chest blow. Running around the house with her older sister, she fell to the floor. Her sister also fell and landed on her. The girl became cyanotic and pale and experienced a transient loss of consciousness. At arrival to the emergency department, she had regained consciousness, but she remained pale. An electrocardiogram (ECG) demonstrated complete AV block with a heart rate of 78 beats per minute (bpm). The ECG after admission showed a Wenckebach-type second-degree AV block. Day 2 after admission, a 12-lead ECG showed significant ST and T-wave abnormalities in the precordial leads, but the girl had no chest pain and a normal physical examination. Echocardiography demonstrated normal contractility of the systemic right ventricle. The first-degree AV block and the ST and T-wave abnormalities on the 12-lead ECG improved gradually without abnormal Q-waves. This is the first report of ccTGA in which a transient complete AV block naturally recovered after a presentation with commotio cordis.     

Use of LMA Stonebreaker as an intracorporeal lithotrite in the management of ureteral calculi

BACKGROUND AND PURPOSE: LMA Stonebreaker is a new type of ballistic intracorporeal lithotrite that does not need external electric power or access to compressed air. It is small and portable. This study aims to evaluate the efficacy, safety, and cost-effectiveness of this lithotrite in the management of ureteral calculi. MATERIALS AND METHODS: A total of 110 patients with ureteral calculi necessitating intracorporeal lithotripsy were prospectively included in the study. The size of the stone, position of the stone, number of shocks needed to fragment the stone to effect complete clearance, and degree of retropulsion were documented in each case, and any evidence of urothelial trauma was noted. RESULTS: All stones were fragmented, and all patients were rendered stone free. The mean number of shocks needed to fragment the stones was eight. The incidence of retropulsion was 6.36%. There was no evidence of urothelial trauma noted in any patient. CONCLUSION: LMA Stonebreaker is a safe, effective, cost-effective, robust, and portable device for intracorporeal lithotripsy.     

Development of a Direct Mechanical Left Ventricular Assist Device for Left Ventricular Failure

Abstract: We have developed a direct mechanical left ventricular assist device (DMLVAD) for severe left ventricular failure. The DMLVAD was attached to the left ventricle and compressed the heart by a pneumatic driving unit. In a mock circulation model with an extracted non-beating heart, a cardiac output (CO) of 1.93 L/min was obtained at a driving pressure of 200 mm Hg. In a canine left ventricular failure model induced by injection of sodium hydroxide into the myocardium, the systolic arterial pressure, systolic left ventricular pressure, maximum LV dP/dt, peak flow, and CO increased by 21, 24, 58, 144, and 37%, respectively. The mean left atrial pressure also decreased by 15% when the DMLVAD was driven. These effects were most prominent when the mean left atrial pressure was over 15 mm Hg, and the driving pressure was over 100 mm Hg. Compression at late systole was more effective in obtaining greater CO. We suggest that the DMLVAD could be an optional circulatory assist device for patients with left ventricular failure awaiting heart transplantation.