Plate fixation of talar neck fractures: preliminary review of a new technique in twenty-three patients.

OBJECTIVE: To describe an unreported technique of fixation for talar neck fractures. DESIGN: Retrospective review and telephone interview of patients with fractures of the talar neck (OTA 72-A1.2, 72-A1.3, 72-C2). SETTING: Level-one trauma center with six trauma surgeons. PATIENTS/PARTICIPANTS: Twenty-three patients treated with minifragment plates over a four-year period. Follow-up intervals were an average of twenty months. INTERVENTION: Talar neck fractures were stabilized with one or two 2.0 or 2.4 plates, with additional 2.0, 2.7, or 3.5 lag screws when necessary. Most fractures were approached through medial and lateral incisions. MAIN OUTCOME MEASURES: Union rates, pain, and incidence of complications. Functional outcome will be best determined by a further review with longer follow-up. RESULTS: Mini fragment plates were placed on the side with the most comminution, and all wounds and fractures healed uneventfully. Four patients underwent hardware removal. Two patients developed a mild extension malunion, but there was no evidence of varus malunion, as measured on Canale views. CONCLUSIONS: Initial review suggests that plate fixation of comminuted talar neck fractures is a successful technique, with low rates of complications compared with those discussed in the literature. A further review in a few years will allow functional assessment studies.

Seat belt fracture with late development of an enterocolic fistula in a child. A case report.

STUDY DESIGN: A case report of a 9-year-old boy treated at a pediatric trauma center for a flexion-extension spiral fracture with late development of an enterocolic fistula subsequent to a high-velocity motor vehicle accident. OBJECTIVES: To increase the awareness of possible delayed bowel complications associated with flexion-distraction injuries of the spine in children. SUMMARY OF BACKGROUND DATA: Flexion-distraction fractures of the spine in children wearing lap seat belts, so-called "Chance" fractures, are an increasingly common result of high-velocity collisions. This type of fracture, referred to as a seat-belt fracture, is often associated with duodenal or jejunal tears. Although such intra-abdominal injuries are common in such fractures secondary to this type of trauma, the occurrence of an enterocolic fistula has never been reported. METHODS: A review of all pediatric Chance fractures managed at the Children's Hospital of Eastern Ontario, as well as a literature review of all reported series of flexion-distraction injuries to the spine in children, were performed. RESULTS: The subtle and prolonged symptomatology of this lesion and its similarity to a cast syndrome is emphasized. CONCLUSION: Because the orthopedic surgeon is usually the primary care-giver for children with this type of seat-belt trauma, an appreciation of the possibility of a delayed onset enterocolic fistula with its symptomatology is essential to avoid prolonged morbidity.

Fine-needle aspiration biopsy of chondroblastic osteosarcoma of the vertebral column complicated by Corynebacterium infection: a case report.

We describe a case of chondroblastic osteosarcoma of the vertebral column in a 67-yr-old male in whom the preoperative diagnosis was made by fine-needle aspiration biopsy (FNAB). This diagnosis was subsequently confirmed in the T8 corpectomy specimen. Although the smears of the aspirate revealed only occasional markedly atypical spindle-shaped nuclei, the cell block was diagnostic of malignancy. It showed a well-preserved fragment of neoplastic cartilage populated by markedly atypical hyperchromatic cells and a crushed fragment of anaplastic spindle-shaped cells surrounded by opaque collagenous matrix reminiscent of osteoid. The surgically resected specimen exhibited comparable histological features as well as colonies of gram-positive bacilli within the necrotic tumor. Culture confirmed the presence of Corynebacterium species. It is likely that these skin organisms were introduced at the time of FNAB. This case demonstrates the value of FNAB in the diagnosis of primary bone tumors and reports a rare complication of this procedure.

[30 years later: children attending a counseling service up to 3 years of age]. / 30 Jahre später: Kinder, die im Alter von bis zu drei Jahren in einer Beratungsstelle vorgestellt wurden.

From 1953 through 1955 a total of 2364 individuals between o and 18 years were discharged from the Stockholm Child Guidance Clinics. Among these patients 125 (68 boys, 57 girls) were under the age of 3 years. A follow-up study was conducted 30 years later on this sample using records from psychiatric clinics and data from official registers of problematic behaviours. The majority of the infants when seen at the Child Guidance Clinics were judged to be mentally healthy or to have shown mild environmental reactions. However sixty per cent of these patients were identified in at least one of the registers during the follow-up period. Thus the initial evaluation was not prognostic of the future development. Boys developed mainly social maladjustment, whereas girls more often applied for psychiatric care during the follow-up. Significant prognostic factors in the 1950s were gender and parental psychiatric diagnosis.

An analysis of open reduction of irreducible supracondylar fractures of the humerus in children.

OBJECTIVES: To review experience with irreducible supracondylar fractures requiring open reduction in children, and to propose guidelines for an open approach to supracondylar fractures. DESIGN: A chart review. SETTING: The Children's Hospital of Eastern Ontario (CHEO), a pediatric centre with a large referral base. PATIENTS: Forty-one children (18 boys 23 girls, average age 7 years), who had open reduction of irreducible supracondylar fractures at the CHEO over a 10-year period (1985 to 1995). Of these 41 children, 7 were lost to direct follow-up. INTERVENTIONS: After closed reduction of displaced supracondylar fractures of the humerus failed, all patients underwent open reduction and percutaneous fixation in the operating room. Before operation, 6 had no radial pulse, 5 lost their pulse with flexion after reduction and 4 had unstable fracture patterns. MAIN OUTCOME MEASURES: Assessment of elbow range of motion and carrying angle, distal neurovascular status and radiographic measurement of the Baumann angle and the humerocapitellar angle. RESULTS: In 25 children, the humerus was found to have "buttonholed" through the brachialis muscle; 1 had entrapment of the common flexor muscle at its origin and 1 had entrapment of the triceps. In 15 children there was entrapment or tethering of the median nerve and radial nerve or brachial artery, or both, but this was not predictive of preoperative neurovascular deficit, which was recorded in 21 patients (fully recovered). At follow-up, the Baumann angle and the humerocapitellar angle differed by an average of 2 degrees and 5.3 degrees respectively compared with the unaffected arm. Range of motion was satisfactory in 94% of patients, and there was no significant cubitus varus. CONCLUSION: Open reduction of supracondylar fractures is a safe and effective procedure, for which orthopedists should should lower their threshold, given certain appropriate indicators.

Effects of physical training in a hypobaric chamber on the physical performance of competitive triathletes.

The effects of training in a hypobaric chamber on aerobic metabolism were studied in five high performance triathletes. During 3 weeks, the subjects modified their usual training schedule (approximately 30 h a week), replacing three sessions of bicycling exercise by three sessions on a cycle ergometer in a hypobaric chamber simulating an altitude of 4,000 m (462 mm Hg). Prior to and after training in the hypobaric chamber the triathletes performed maximal and submaximal exercise in normoxia and hypoxia (462 mm g). Respiratory and cardiac parameters were recorded during exercise. Lactacidaemia was measured during maximal exercise. Blood samples were drawn once a week to monitor blood cell parameters and erythropoetin concentrations. Training in the hypobaric chamber had no effect on erythropoiesis, the concentrations of erythropoetin always remaining unchanged, and no effect on the maximal oxygen uptake (VO2max) and maximal aerobic capacity measured in normoxia or hypoxia. Submaximal performance increased by 34% during a submaximal exhausting exercise performed at a simulated altitude of 2,000 m. During a submaximal nonexhausting test, ventilation values tended to decrease for similar exercise intensities after training in hypoxia. The changes in these parameters and the improved performance found for submaximal exercise may have been the result of changes taking place in muscle tissue or the result of training the respiratory muscles.

[Digestive disorders and self medication observed during a competition in endurance athletes. Prospective epidemiological study during a championship of triathlon]. / Troubles digestifs et automédication constatés en compétition chez les sportifs d'endurance. Enquête epidémiologique prospective sur une saison sportive de triathlon.

Gastro-intestinal disorders were described during long lasting exercise. However, no systematic evaluation was done before the study of the French Medical Society of Triathlon, which realized an epidemiologic analysis during the French triathlon championship in 1989. The aims of this study were to evaluate the prevalence and the nature of different gastro-intestinal symptoms, to precise the severity and the consequences of these disorders, and to evaluate the self-medication. This study concern 25,640 competitors of the 101 meetings of the French triathlon championship 1989 (75 category A, 19 category B and 7 category C). Two thousand two hundred and seventy four competitors had gastric symptoms like nausea, epigastgric pain or vomiting (8.9%); 2,046 competitors had intestinal troubles like diarrhea or abdominal pain (8%). These results confirm the suffering of the gastro-intestinal tract during a long lasting exercise like a triathlon. These disorders are well known, so self-medication was used for gastric symptoms (0.7%) or intestinal disturbances (18.2%).

Low field magnetic resonance imaging of the central nervous system in 15 children with autistic disorder.

Fifteen children, 10 boys and 5 girls, with autistic disorder, were studied with low field magnetic resonance imaging (MRI). The age ranged from 2.7-13.1 years, with a mean of 8.3 years. All patients but one (who refused) had a normal CT scan of the C.N.S. The MRI investigation was performed during anaesthesia with a low field magnetic resonance imager. The cerebrum, cerebellum, and brain stem were examined. No pathological changes were found in any of the patients studied.

Mortality and aggressiveness in a 30-year follow-up study in child guidance clinics in Stockholm.

The mortality rate and aggressiveness in a cohort of 2364 former patients of the child guidance clinics in Stockholm were studied during a 30-year follow-up period; 106 died during this observation period. This frequency is significantly higher than the calculated mortality rate in a reference population. In all, 82% of the total deaths were caused by suicide, accidents, or abuse of alcohol or drugs. Among the patients that died of suicide and abuse, more mental disorders, abuse and criminality were found in their parents during the initial evaluation. Significantly more males than females died as a result of accidents and alcohol or drug abuse. Aggressive feelings and acts, both against oneself and others, were overrepresented in the initial contacts with the child guidance clinics. To prevent these deaths, an alternative approach during the first contact with a child psychiatric centre is discussed, as well as more extensive help and intervention at an early stage.

Circulatory monitoring of children during anaesthesia in low-field magnetic resonance imaging.

Anaesthesia for patients in a Magnetic Resonance Imaging (MRI) scanner provides some problems for the design of both the anaesthetic and the monitoring equipment. This report presents a technique for continuously displaying the heart rate during anaesthesia for children in an MRI scanner. The monitoring system used light to detect differences in skin capillary circulation, and the light was transferred to and from the patient via fiberoptic cables. After amplification, the signal was displayed "on line" on a cardioscope, thus continuously presenting heart rate and, in part, a qualitative view of the skin vascular resistance.

Long-term effect on mother-infant behaviour of extra contact during the first hour post partum. V. Follow-up at three years.

Primiparous mothers and their infants who had had an extra 15-20 minutes skin-to-skin and suckling contact (P+) during the first hour after delivery behaved differently, had a longer duration of breast-feeding, and expressed different opinions on child rearing practices at follow-ups 36 hours, 3 and 12 months after delivery as compared with a control group (P) of primiparous mothers and their infants, who were given routine care immediately after birth. The present report is based on parts of the results of the follow-up at 3 years. Asked in retrospect more P mothers found the time together with their infants immediately after delivery to have been insufficient. More P+ children were reported to have been earlier continent during the day and also earlier stubborn than the children in the P group. The Denver Developmental Screening Test showed similar results in both groups. Catecholamine levels in the urine of extra contact mothers and their boys were found to be slightly higher than those of routine care mothers and boys. Two separate analyses of video-tapes of free play showed that mothers and children in the P+ group were smiling/laughing more often than P mothers and children. The P+ mothers were more encouraging and instructing towards their children than the P mothers. Articulated conflicts were more common in the P+ group. Regardless of the type of conflict, more conflicts in the P+ group were solved. As in earlier parts of this longitudinal study differences related to type of neonatal care were more pronounced for boy-mother than for girl-mother pairs.

The interaction between the infant and the environment: the importance of mother-child contact after delivery.

Birth is more than just the physical beginning of a new life--it is also the start of the psychosocial development of the newborn infant together with its family. Immediately after delivery parents and infants can start to exchange signals that maybe are of major importance for this development. The early post partum period has been regarded to have great potentials and especially the mother has been regarded to play a very powerful role, whereas the infant's contribution has been accorded little discussion. The individual reactive capacity of the newborn baby and its influence on the environment can be illustrated in a number of ways. In recent years studies of fetal movements have been made by means of ultra sound registration and it has been discussed whether these are precursors of later behavior in the neonate-infant. The transition at birth can be considered either to be continuous or dis-continuous, the outcome of this discussion has great bearing on the importance of early neonate-environment interactions. Short and long term outcome of different routine care procedures around the time of delivery and transition are controversial subjects. Although several studies support the importance of early post delivery interaction, other studies do not seem to find correlations between early experiences and later developmental outcome measurements. In this paper several of these aspects will be discussed, examples from the literature given and possible clinical applications suggested, as well as their impact on the care of healthy and sick newborns and their families.

Maternal age and transition to motherhood: prenatal and perinatal assessments.

The purpose of this short-term longitudinal study was to document the contents and consequences of the timing of first birth to two groups of Swedish mothers in respect to biomedical, behavioral, psychological and social variables. Fifty-one primiparous women participated in the study during pregnancy through the first 4 months postpartum. Women were assigned to group dependent upon age: those 20-29 years of age in Group 1; and those 30-39 years of age in Group 2. Methods included standard ethnographic procedures, semi-structured open-ended interviews and pre-coded questionnaires. Infant assessments included the Brazelton examination and the Neonatal Perception Inventory. Results indicated group specific maternal behavioral patterns. Group 2 mothers were more anxious during pregnancy and more likely to regard certain aspects of their transition to motherhood as problematic (e.g. breastfeeding). Additional findings included biomedical variance between groups of infants: the Group 2 infants weighed less and were less healthy than the infants born to younger mothers. Results are discussed in respect to medical precedents and psychological impact as well as the cultural patterning of motherhood.

Left-side preference in holding and carrying newborn infants. A three-year follow-up study.

Observation of maternal infant holding was made during the postnatal week. Among 264 observed mothers 37 were right-holding and 35 could be traced 3 years later. They were matched with 35 left-holding mothers. The right-holding mothers had more contact with the district nurses and Child Health Centres during the 3-year follow-up period, although their children were equally healthy. Other between group differences were also found illustrating a greater need for support and more anxiety about their children among right-holding mothers. Maternal parity seemed to have a stronger correlation to maternal anxiety about her child than did side preference for holding during the lying-in period.

Transfer of terbutaline into breast milk.

Terbutaline has been determined in milk and plasma from 4 nursing mothers treated with Bricanyl tablets (2.5 or 5 mg, 3 times daily) because of obstructive lung disease. Both doses produced milk concentrations of terbutaline in the range 2.5-4.6 ng/mL, which were similar to or higher than the concentrations found in plasma. The highest milk:plasma concentration ratios (up to 2.9) were observed at the beginning and end of the dosage interval. The infants in this study were estimated to have ingested about 0.4-0.6 micrograms/kg/day of terbutaline base, which corresponds to 0.2-0.7% of the daily dose per kg taken by the mothers. Terbutaline was not detectable in plasma when samples were taken from one of the infants and no symptoms of beta-adrenoceptor stimulation could be found in any of the babies.

Effects of naloxone on newborn infant behavior after maternal analgesia with pethidine during labor.

Infants born to mothers receiving 100 mg of pethidine during labor, were randomly given either 100 micrograms of naloxone (n = 14) or 0.25 ml 0.9% NaCl (n = 13) one hour post partum. Infant behavior was assessed with the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) and the Broussard Neonatal Perception Inventory (NPI). No differences in cluster scores on the BNBAS were found between the two groups. Both groups improved scores over time in 4 out of 7 clusters. On the NPI, mothers assessed naloxone infants as having less optimal behavior than did the control mothers. The results of this study on the effects of naloxone on infant behavior and maternal perception of newborn behavior do not warrant administration of naloxone after maternal analgesia with pethidine in the absence of clinical evidence of respiratory depression in the newborn.

Long-term effect on mother-infant behaviour of extra contact during the first hour post partum. III. Follow-up at one year.

The present prospective study examined, one year after delivery, the possible effects of early extra contact during the first hour following delivery. An extra skin-to-skin contact and suckling contact was allowed 22 primiparous mothers and their infants (P + group). One control group of 20 primiparous mothers and their infants were given routine care immediately after birth (P group). During observation of a physical examination of the infant, 'extra contact mothers' held and touched their infants more frequently and more often talked positively to their infants than did mothers given routine care. 'Extra contact mothers' had returned to their professional employment outside the home to a lesser extent than had routine care mothers. A greater proportion of 'extra contact' infants slept in a room of their own. In the P+ group, mothers who had returned to gainful employment were also able to have their babies sleep in a room of their own--no such correspondence was found in the P group. The Gesell Developmental Schedules revealed that, in four parts out of five, infants with extra contact immediately after birth, were ahead of those in the control group. On the other hand, the Vineland Social Maturity Scale and the Cesarec Marke Personality Scheme did not reveal any major differences between the two groups. Mothers with early extra skin-to-skin contact and suckling contact breast-fed their infants on an average for 2 1/2 months longer than did routine care mothers. No other differences in feeding habits were found. The influence of extra contact was more pronounced in boy-mother than in girl-mother pairs.

Fluoride in human milk.

Reported contents of fluoride (F) in human milk vary considerably. The aim of this study was to determine the F content in human milk under different levels of F intake using a siliconfacilitated microdiffusion technique, which had a good accuracy and precision. The mean F concentration of colostrum from mothers in a 1.0 ppm and a 0.2 ppm F area was 0.36 +/- 0.02 mumol/l (+/- SEM) and 0.28 +/- 0.02 mumol/l, respectively. The mean F concentration of mature milk from a 1.0 ppm F area was 0.37 +/- 0.04 mumol/l. Within the 1.0 ppm F area, the intra- and interindividual differences in F concentration were very small. No statistically significant difference in milk F concentration between the two areas was found. Consequently, breastfed infants living in a 1 ppm or a 0.2 ppm F area will have an approximately equal F intake of 5-10 micrograms per day, in spite of great differences in F intake among the nursing mothers.

Left-side preference for holding and carrying newborn infants. Parental holding and carrying during the first week of life.

Four groups of adults were studied: new mothers, new fathers, fathers with older children, and males without children of their own. Nearly 80 per cent of all newly delivered mothers and fathers held their newborn infant against a point to the left of the body midline. Handedness and parity did not influence this preference, nor did the sex of the infant. The present study also demonstrates that new fathers during the neonatal period, as well as fathers with older infants, display a significantly greater preference for holding the infant to the left than males without own children and with or without experience of other children. Individual mother-father pairs held the infant on the same side of the body in the majority of couples studied. The pattern of infant-carrying showed no significant in-between group differences. The possible significance of these observations and their relation to other parental behavior are discussed.