An intraluminal prosthesis may improve healing of a one-layer colonic anastomosis: an experimental study in pigs.

OBJECTIVE: To compare healing of one-layer colonic anastomoses with or without a soluble intraluminal prosthesis (* SBS-tube). DESIGN: Randomised, partly blinded controlled study. SETTING: University hospital, Denmark. SUBJECTS: 16 female Danish country strain pigs, of which 8 had the SBS tube inserted and 8 acted as controls. INTERVENTIONS: One-layer colonic anastomoses either hand-sewn (n = 8, controls) or hand-sewn onto an SBS tube (n = 8). MAIN OUTCOME MEASURES: Macroscopic evaluation, leakage test, breaking strength, histology, oxygen tension in and near the anastomosis peroperatively and 4 days postoperatively. RESULTS: Three quarters of the tubes (n = 8) dissolved in less than 2 hours. Histological examination showed significantly better structured layers and more mucosal epithelial covering in the SBS group. The other histological variables examined were: tissue gap (p < 0.08), inflammation (p < 0.10), breaking strength (p < 0.46) and amount of granulation tissue (p < 0.71), but the last findings were not significant. Oxygen tension at the anastomotic line was better in the SBS tube group, but not significantly so. CONCLUSIONS: We conclude that the SBS tube facilitates the sewing of the anastomosis and may improve healing, possibly because of better apposition of the cut ends and reduced tension in the sutures.

An epidemiological study of neonatal necrotizing enterocolitis.

OBJECTIVE: To study epidemiology including various risk factors incorporated in neonatal necrotizing enterocolitis in Kashmir. METHODS: A retrospective hospital based study on 3235 neonates admitted in Neonatal Intensive Care Unit of Sheri-Kashmir Institute, were evaluated. Forty two were diagnosed as cases of Neonatal Necrotizing Enterocolitis on the basis of various clinical and radiological parameters and grouped in 3 stages as per modified Bell's classification. The case records of these 42 babies and 303 of the control group were reviewed for the purported risk factors and recorded on pretested proforma and finally statistically analyzed. RESULTS: Over a period of 10 years, we documented necrotizing enterocolitis in 42 neonates, with an incidence of 1% of all Neonatal Intensive Care Unit admissions and 1% of all live births. Eighty one percent were less than 2000 gms and 76% less than 36 weeks of gestation. Twenty four percent had stage I disease, 33% had stage II, and 43% babies had stage III disease. Multiple risk factors were present in these babies, with significant differences among Necrotizing Enterocolitis and the control group of patients, particularly hypothermia (P < 0.001), respiratory distress (P < 0.05), polycythemia (P < 0.001) acidosis (P < 0.01), sepsis (P < 0.001), enteral feeding and asphyxia (P < 0.001). Of the 59 babies (< 2000 gms) with hypothermia (< 35 degrees C), 39% developed Necrotizing Enterocolitis, compared to 4% babies (11/278), who did not have hypothermia, statistically a significant finding. Mean birth weight and gestational age were lower than in control group (P < 0.05). The age of presentation was 5.2 +/- 4.0 days and majority (81%) presented during first week of life, most severe cases presenting earlier than the mild cases. Severity of Necrotizing Enterocolitis as per modified Bell's classification and mortality was inversely related to birth weight and gestational age. One hundred percent mortality was noted in the babies, with birth weight less than 1000 gms and gestational age less than 28 weeks. The overall mortality was 45%, for stage I, 20%; for stage II, 36% and 67% for stage III. Necrotizing Enterocolitis cases accounted for maximum mortality in Neonatal Intensive Care Unit than in control group (P < 0.001). CONCLUSION: Recognition of factors such as prematurity, low birth weight, hypothermia, asphyxia and their timely prevention would help in reducing morbidity and mortality due to Necrotizing Enterocolitis.

Restoration of sensation over the contact surfaces of the thumb-index pinch grip using the terminal branches of the superficial branch of the radial nerve.

In huge median nerve losses and in some brachial plexus lesions, absence of sensation over the pulps of the index finger and the thumb preclude their use without visual control. Currently, end-to-side anastomosis is a new option available (when the ulnar nerve is intact) but we have reviewed the results of 7 cases of nerve anastomosis between the sensory branches of the radial nerve and the collateral nerves of the thumb (ulnar) and index finger (radial). Palmar translocation of the donor nerve, as classically performed, was used in two cases and the technique was subsequently modified to provide a better nerve suture by dorsal transfer of the collateral nerves of the thumb and index. Two sequellae of brachial plexus lesions and 5 cases of extensive defects of the median nerve were reviewed at a mean follow up of 5 years. With the classical technique the two point discrimination was 15 mm in one case and more in the other; with the modified technique, 4 patients achieved a thumb discriminaTion of 9 mm, 12 mm (2 cases) and 13 mm.

Medical practitioners and their practices in acute diarrhea.

PIP: A study conducted in the Pediatric Outpatient Department of the Institute of Medical Sciences in Srinagar, India, assessed the acute diarrhea management strategies of various categories of health care practitioners. Of the total of 1030 infants enrolled at private clinics or other health units, 71.7% were treated by general practitioners and chemists, 11.6% saw hospital residents, and 16.7% were treated by pediatricians. Antidiarrheal and antispasmodic preparations were given to most infants, either alone (46.8%) or in conjunction with oral rehydration therapy (ORT) (45.4%). Only 4.1% of infants received ORT alone. 87.2% of pediatricians selected a combination of drugs and ORT. Both qualified and unqualified practitioners provided drugs such as lopermaide (57.9%), pipenzolate (2.1%), metoclopramide (13.7%), and steroids (2.5%). All categories of health workers prescribed marketed ORT preparations containing insufficient sodium; only 23.7% of cases received home-made sugar-salt solution. Parents in India express a preference for the use of drugs and parenteral fluids in acute diarrhea, and most practitioners appear to gear their practices to this preference. Education of both parents and health professionals about the adequacy of ORT in most cases of acute diarrhea is needed to prevent electrolyte imbalances, iatrogenic hazards, and the emergence of multidrug-resistant strains of microorganisms.^ieng

Serum lipid profile in Kashmiri children.

314 normal children in the age group of 5-14 years including 169 boys and 145 girls, were studied for their blood lipids and lipoprotein levels. Mean total cholesterol (Tch) of 172.8 mg/dl, triglycerides (TG) of 66.4 mg/dl, high density lipoprotein (HDLc) of 71.2 mg/dl, low density lipoprotein (LDLc) of 88.9 mg/dl and very low density lipoprotein (VLDLc) of 13.3 mg/dl was obtained. Lipid profile did not show any significant correlation with age and sex. Serum Tch and LDLc were higher in upper socio-economic group (P < 0.01). Tch and LDLc were higher in children taking high percentage of calories from fat and consuming more animal fats (P < .01) while HDLc value had an inverse relationship to these dietic rations.

[Validity of clinical signs and provocative tests in carpal tunnel syndrome]. / Validité des signes cliniques et des manoeuvres provocatrices dans le syndrome du canal carpien.

The relevance of EMG study was assessed to ascertain the diagnosis of carpal tunnel syndrome in cases of positivity of clinical signs and provocative tests. A prospective study was conducted in 60 patients presenting 85 symptomatic hands. Correlation between 11 signs and tests (isolated or associated) was performed with EMG used as "standard". None of the signs or tests reached an acceptable level of sensitivity, specificity or predictive value. This exam was positive in only 62 per cent of cases. EMG seems to mandatory before deciding on surgical release of the carpal tunnel syndrome.

Parental awareness and practices in acute diarrhea.

PIP: In 1992, in Srinagar, India, the Pediatric Outpatient Department of the Institute of Medical Sciences interviewed the parents of 1600 infants with acute diarrhea to learn their awareness and practices in infantile diarrhea. The parents were divided into two groups: Group A (physicians, engineers, teachers, professors, lawyers, clerks, and educated business professionals; N = 660) and Group B (all others and uneducated parents; N = 940). Most infants with acute diarrhea were boys (66.2%) and aged 6-9 months (58.7%). Only 15% of all parents knew the definition of diarrhea (3 loose stools/day) with Group B parents being more likely to know it than Group A parents (18.5% vs. 10%; p .001). 81.9% of all parents incorrectly considered frequent stools as constituting diarrhea. The parents considered weaning, maternal diet, and teething to be the major causes of diarrhea (58.1%, 42.5%, and 34.4%, respectively). Group A parents were more likely than Group B parents to report infections (27.4% vs. 9.5%) and formula and dirty feeds (7.6% vs. 2%) to be causes of diarrhea (p .001). Group B parents were more likely have no knowledge about the danger signs of diarrhea than Group A parents (30.2% vs. 9.1%; p .001). Group B parents were more likely to treat infantile diarrhea with antidiarrheal and antispasmodic drugs than Group A parents (77.7% vs. 22.7%; p .001). Group A parents were more likely to use both these drugs and oral rehydration therapy (ORT) than Group B parents (65.2% vs. 7.9%; p .001). Few parents (.6%) administered only ORT. Group A parents were much more likely than Group B parents to know the composition of various ORT brands, reconstitution of the solution, and their utility in diarrhea (65.6% vs. 7.7%; p .001). Group B parents preferred complete dietary restrictions during a diarrheal episode than Group A parents (28.7% vs. 6.2%; p .001). These findings reflect limited parental knowledge about diarrhea and its treatment.^ieng

[Carpal tunnel syndrome. Can it still be a controversial topic?]. / Le canal carpien. Peut-il être encore sujet de controverse?

The authors studied two aspects of the carpal tunnel syndrome. As far as the diagnosis is concerned, clinical signs and provocative manoeuvres compared to the accepted standard of electrophysiological studies proved to be insufficient to settle a surgical indication in 85 carpal tunnel syndromes. When surgery is needed, post-operative course is frequently bothered by pillar pain and decreased strength postponing return to manual activities. The authors performed a prospective randomized study of 3 techniques in 251 carpal tunnel releases: classical technique, Agee endoscopic technique and anterior ligamentoplasty. Strength was only improved by the last technique. The only advantage for the endoscopic technique was greater post-operative comfort.

Identification of several human urinary metabolites of 6-benzoyl benzoxazolinone by gas chromatography/mass spectrometry.

The biotransformation of 6-benzoyl benzoxazolinone (6-BB), a non-narcotic peripheral analgesic, was studied in eight healthy volunteers after oral administration of a single dose of 1 g. Urinary metabolites were extracted either with ethyl acetate at different pH values or by percolating at pH 5 through Amberlite XAD 2 ion-exchange resin. Eluates were concentrated under vacuum, purified by thin-layer chromatography and analysed by gas chromatography/mass spectrometry or direct insertion probe mass spectrometry. Metabolites were identified with reference to the mass spectra of various synthesized compounds assumed to be metabolites of 6-BB, as N-methylated or monohydroxylated compounds. Another metabolic pathway was cleavage of the benzoxazolinone heterocycle giving 2-amino-5-benzoyl phenol after hydrolysis and decarboxylation. N-methyl, N-acetyl and hydroxylated metabolites having an amino-5-benzoyl phenol structure were also found.

Poisoning in children.

This study is a retrospective analysis of 670 cases of poisoning (including phenothiazine toxicity) admitted to this hospital in the past six years, accounting for 0.9% of all pediatric admissions. Nearly half (45%) of the cases were in the age group of 1-4 years. Medicines and chemicals were the commonest agents (53%), followed by pesticides (15%), kerosene (11.2%), plant poisons (9.4%), food poisoning (3.9%) and corrosives (1.9%). Accidental poisoning was the commonest (70%) followed by iatrogenic (29.6%) and suicidal (0.4%). Overall mortality was 1.8%. Stress is laid on judicious use of phenothiazines as antiemetics and replacing them with drugs of lesser toxicity.

Indications and results of skin flaps in painful digital neuroma.

Of the many procedures for treating painful neuromas, resection and proximal translocation are the most usual techniques, but these can decrease distal sensibility increasing deafferentation pain. In cases of intricate pain (nociception plus deafferentation), certain types of flaps allow the treatment of both components of the pain. We have used 30 such flaps in 28 patients: local flaps (exchange, advancement or lasso island flaps) and distant flaps (free "custom-made" toe flaps). The results of the different techniques provides 86.6% excellent or good results.

[Neuritis and neuroma of the sensory branches of the radial nerve. Apropos of 44 cases]. / Névrites et névromes des branches sensitives du nerf radial. A propos de quarante-quatre cas.

The authors present a series of 44 cases of sensory disorders in the radial nerve territory. Eighteen cases of pure painful neuromata gave, excellent results according to Herndon criteria in 11 cases with various techniques. Wartenberg neuritis (22 cases) was found to respond favorably to conservative treatment in the majority of cases (19 cases). A legal problem can arise from association with De Quervain disease if the condition has not been recognized before surgical release of the first compartment. Finally 9 cases are presented with intricate pathology of neuroma plus neuritis. Treatment addressing both conditions provided good results.

[Role of orthosis in the treatment of stiffness of the hand]. / Le rôle de l'orthèse dans le traitement des raideurs de la main.

The statistical analysis of results obtained with splinting treatment of finger and hand stiffness, and derived from a series of 635 motion range measurements taken on 249 hand joints, provided us with sufficient data to identify the various factors likely to have an impact on the therapeutic outcome. A mean increase of 25.8% in the range of movements is enough to justify the use of orthosis, although this figure actually varies substantially with the patient's age, the duration of the stiffness, the latter's degree and origin, the joint involved, and the duration of the orthotic treatment. An analysis of the time factor enabled us to establish the date beyond which changes for recovery are quite limited, whereby allowing to schedule surgical mobilization.

Exercise after myocardial infarction: a controlled trial.

Six weeks after acute myocardial infarction, 303 men were randomly divided into exercise and control groups. The exercise group attended the hospital gymnasium twice weekly for a three-month supervised exercise course. Both groups were exercise tested before and after the course and at subsequent follow-up. The exercise group increased their physical fitness greatly compared with the control group. Eight per cent of the exercise group died during the period of follow-up, compared with 14 per cent of the control group; this difference is not significant. There was an apparent improvement in mortality in those with inferior MI who completed the exercise course, which was not seen in those with MI in other sites. For many patients after MI progressive exercise is safe, improves physical fitness and may reduce mortality for those after inferior MI.