Ten years later-scalp still a primary donor site in children.

UNLABELLED: Choice of the donor site for a split thickness skin graft depends on skin availability, possible complications and anticipated esthetic results. We selected the scalp to be the primary donor site at our institution. During a period of ten years (1998-2008), a group of 123 pediatric patients aged 4 months to 15 years (65% were below the age of 2; mean age 2.98 years) underwent skin grafting from this particular site. In 2 cases the same area was re-harvested. All donor sites healed by the 10th post-operative day. Donor site complications included: 2 microalopecia regions, 5 pressure sores in a close proximity, 1 hypertrophic scar and 1 visible mark on the forehead due to technical mistake in graft harvesting. All children started scar management of the recipient site with contact therapy using adhesive tape Hypafix (BSN Medical); subsequently moving on to silicone sheets or gel in selected refractory cases. We present results for 68 scars in 41 patients with the longest follow-up period. Scar quality was evaluated after minimum of 10 years and scored according to the Vancouver Scar Assessment Scale. Very good and good results were obtained in 55 scars (80.9%), satisfactory in 11 scars (16.2%) and unsatisfactory in 2 scars (2.9%). CONCLUSIONS: Our results confirm, that the scalp is a reliable donor site in children and contact therapy is an adequate form of scar prevention/treatment of the recipient site.

Expression of the insulin-like growth factor system in postpneumonectomy lung growth.

The insulin-like growth factors (IGF-I and IGF-II) may play an important role in postpneumonectomy compensatory lung growth by translating hormonal inputs and mechanical forces into cellular proliferation signals. We examined the mRNA abundance of IGF-I, IGF-II, and IGF binding proteins (IGFBPs) in lungs of rats on postoperative days 1, 2, 3, 5, and 7 following left pneumonectomy (PNX) or shamoperation (SC) and in normal animals (CON). There was no difference in the abundance of lung IGF-I mRNA (measured by Northern analysis) or serum IGF-I (measured by radioimmunoassay (RIA)) between SC and PNX animals. IGF-II mRNA abundance was initially decreased following PNX (73% decrease compared to SC animals on day 1, p < .05) and then rose to approach SC group values on subsequent days. Transcripts for IGFBP-2, -3, -4, -5, and -6 were decreased in both the SC and PNX groups compared to CON animals on the day following pneumonectomy, then rose back to baseline by postoperative day 2-3. Tissue IGFBPs, measured by ligand blot analyses, were not different in either the SC or PNX groups. In contrast, all serum IGFBP bands were increased on postoperative day 1 following either sham or PNX surgery. In addition, serum IGFBP-4 was increased in PNX animals compared to the SC group on days 1 and 2 (increase of 38% and 78%, respectively, p < .05). We conclude that the changes observed in lung IGF and IGFBP expression following pneumonectomy do not represent major.

Continuous administration of growth hormone does not prevent the decrease of IGF-I gene expression in zinc-deprived rats despite normalization of liver GH binding.

To determine the role of reduced liver GH binding (GHR) in the decreased IGF-I observed in zinc-deficient (ZD) animals, we investigated the effects of GHR restoration on growth, insulin-like growth factor I (IGF-I) and its binding proteins (IGFBPs) in ZD rats. Rats were fed for 4 weeks a zinc-deficient diet (ZD Zn, 0 ppm) or a Zinc-normal diet (pair-fed or PF; Zn, 75 ppm). ZD rats received continuous s.c. infusion of bovine growth hormone (bGH) (100 microg/d) for the 4 weeks or for the last week of the study. Compared with pair-fed rats, zinc deficiency produced attenuated weight gain (-43%, P < 0.001), lower serum IGF-I and liver IGF-I mRNA (-52%, P < 0.001 and -44%, P < 0.05), lower serum IGFBPs (IGFBP-3 -66%, IGFBP-4 -48%, 34-29 kDa IGFBP cluster -53%, P < 0.05), lower liver GHR and its mRNA (-20 and -34%, P < 0.05) and lower serum growth hormone binding protein (GHBP) and its mRNA (-56 and -48%, P < 0.05; all comparisons vs PF rats). Exogenous bGH given continuously normalized the liver GHR, serum GHBP and their liver mRNAs, as well as circulating IGFBPs. Despite restoration of GHR and GHBP to normal, growth, serum IGF-I and its liver mRNA were not stimulated by GH infusion in ZD rats, indicating that IGF-I synthesis requires the presence of zinc in addition to GH, and that the lack of growth-promoting action of GH in zinc-deprived rats results from a defect beyond GH binding to its liver receptors.

[A problem with qualifying for heart surgery for a patient with severe congestive heart failure in both ventricles in the course of left aortic stenosis]. / Problem kwalifikacji do operacji kardiochirurgicznej chorego ze skrajna niewydolnoscia obukomorowa serca w przebiegu zwezenia lewego ujscia tetniczego.

A case of a patient 62 years old with a severe congestive heart failure in the course of aortic stenosis and after myocardial infarction was presented. A concomitant mitral insufficiency, tricuspid insufficiency and pulmonary hypertension was also observed. An excellent improvement after aortic valve replacement was reached.

Mitral and aortic valve replacement in a patient with ectodermal anhydrotic dysplasia. A case report.

Ectodermal anhydrotic dysplasia is a rare, usually X-linked recessive malformation of ectodermal tissues and organs. The case of a 17-year-old boy with ectodermal anhydrotic dysplasia and concomitant combined mitral valve disease and aortic insufficiency is described. The surgical risk was considered to be high due to severe atrophia of the laryngo-pharyngeal mucosa complicating endotracheal intubation and the possibility of postoperative temperature control disturbances. Double valve replacement was performed late in the autumn, after laryngo-pharyngeal pharmacological treatment preparing for endotracheal intubation. The peri-operative course was managed without any complication related to the hereditary malformation. Our experience suggests that patients suffering from ectodermal anhydrotic dysplasia may undergo open heart surgery after appropriate preparation. Potential postoperative problems related to the hypohydrosis and impaired spontaneous temperature control could be prevented in our patient.

[Concurrent coronary artery disease and acquired rheumatic mitral valve disease]. / Wspólistnienie choroby wiencowej z nabyta, poreumatyczna wada zastawki mitralnej.

The aim of this study was to estimate coincidence of coronary artery disease (CAD) and rheumatic mitral valve disease in 264 patients treated in the National Institute of Cardiology (1976-1990). Severity of stenoses on coronary angiography with respect to age, sex, symptoms and risk factors were also estimated. Stenoses over 70% of artery lumen in relation to artery diameter before lesion and over 50% for left main coronary artery were stated as severe. There were 180 (68%) females and 84 (32%) males in the studied group; mean age was 52.5 year. Patients were divided into two groups: with angina--126 pts and without CAD symptoms--138 pts. 8 females (4%) had severe stenoses and 45 (25%) non-severe. Respectively 14 males (16.7%) had severe stenoses and 14 non-severe. Severe lesions were present in a group of females older than 50 years and in a group of males older than 45 years. Both in group with or without angina prevalence of coronary artery lesions was similar. Sensitivity and specificity of CAD clinical symptoms was low (less than 50%). Significantly more risk factors were present in pts with coronary stenoses than in pts free of CAD. No correlation between high pulmonary artery pressure and angina in patients without coronary stenoses occurred.

[Surgical treatment of bacterial endocarditis of the tricuspid valve]. / Bakteryjne zapalenie wsierdzia zastawki trójdzielnej leczone operacyjnie.

We present a rare case of bacterial endocarditis of tricuspid valve caused by temporary intracardiac pacing. The 48-year old male patient developed complete a-v block during the 1st day of acute inferior myocardial infarction. Intracardiac electrode was inserted for temporary pacing. After 4 days signs of bacterial endocarditis developed. Patient was markedly febrile, moderate tachycardia with gallop rhythm and systolic murmur of tricuspid valve insufficiency were present. Dullness to percussion was audible at the base of right lung. Hepato- and splenomegaly appeared during the second month of hospitalization. Laboratory tests revealed: elevated ESR, leukocytosis with a shift to the left, several blood cultures were positive to Staphylococcus aureus. On repeated chest X-ray patchy infiltrates with thin-walled translucent pools were visible. Transthoracic and transoesophageal++ echocardiography provided more precise informations. Bacterial vegetations were visualised on the tricuspid valve. Coronary angiography revealed proximal occlusion of the right coronary artery and 75-80% stenosis of the left circumflex artery. Antibacterial treatment guided by blood cultures was begun: vancomycin combined with netilmycin, then tienamycin and diflucan--after 10 weeks treatment was decided to be unsuccessful and the decision about surgical treatment was made. In extracorporeal circulation posterior left leaflet together with granular bacterial growths was excised. Septal and anterior leaflets were found normal. Cultures made of excised tissue were positive for Staphylococcus aureus and subsequent treatment with fluoroquinolones gave satisfactory result. Postoperative echocardiography revealed only small tricuspid valve insufficiency. Coronary by-pass surgery was performed later because of the high risk of simultaneous operation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Serotonin concentration in the rat fetal brain in experimental intrauterine dystrophy]. / Stezenie serotoniny w mózgu plodów szczura w doswiadczalnie wywolanej dystrofii wewnatrzmacicznej.

The concentration of serotonin (5-hydroxytryptamine, 5-HT) was determined in the brain of fetal rats with experimental intrauterine growth retardation (IUGR). IUGR was induced using the procedure of Wigglesworth. On the 17th day of gestation, the uterine artery supplying one uterine horn was ligated. The artery of the opposite uterine horn was left untouched (control). On the 22nd day the fetuses were delivered by C-section. 5-HT was determined by fluorometric method. Statistical analysis employed the paired Student t-test. The average body weight of the IUGR fetuses was 3.15 g, whereas control fetuses 4,50 g. The mean concentration of 5-HT was 10,4% lower in IUGR fetal brains. The mean 5-HT brain concentration in IUGR was 155 micrograms/g of tissue, whereas in control the mean concentration was 173 micrograms/g of tissue. The difference between these brain concentrations was significant (p less than 0,005). We conclude that reduction in maternofetal blood flow in the 3rd trimester of gestation results in decreased concentration in the brain of 5-HT.

[Serotonin concentration in the placentas in experimental intrauterine growth retardation]. / Stezenie serotoniny w lozyskach w doswiadczalnie wywolanej dystrofii wewnatrzmacicznej.

A number of investigators have shown that 5-hydroxytryptamine (5-HT) administration to pregnant animals produces changes in the placenta and leads to death of the fetuses. It has been well known that 5-HT is the most potent umbilical-placental vasoconstrictor and that its administration affects the nutritional function of the placenta. In view of these results it seemed desirable to determine 5-HT concentration in the placenta in experimental intrauterine growth retardation. IUGR was induced on the 17th day of gestation in pregnant rats by ligating the uterine artery of one horn as described by Wigglesworth with the opposite horn left untouched (control). On day 22, fetuses were delivered by C-section. 5-HT was determined by a fluorometric method. Statistical analysis employed the paired Student t-test. Average weight of IUGR fetuses was 3,05 g, whereas control fetuses 4,48. The mean concentration of 5-HT was 11% higher in IUGR fetal placentas. The mean placental concentration in IUGR was 247 micrograms/g of tissue, whereas in control the mean concentration was 222 micrograms/g of tissue. The difference between these placental concentrations was significant (p less than 0,01). We conclude that decreased blood supply to the pregnant rat uterus results in increased concentration in the placenta of 5-HT.

Homocysteic acid: an examination of its possible growth hormone-like activity.

Hypophysectomized rats were injected intraperitoneally for 4 days with various doses of homocysteic acid or growth hormone. The effects of these compounds on epiphyseal cartilage thickness and circulating somatomedin activity levels were evaluated in an attempt to repeat the results of Clopath, Smith, and McCully, who reported that this compound had growth hormone-like activity. DNA polymerase activity in livers of animals treated with growth hormone or with 10 mg/day of homocysteic acid was also measured. Using larger number of animals and including higher doses of homocysteic acid than those previously employed, we did not observe an increase of epiphyseal cartilage thickness in homocysteic acid treated hypophysectomized rats. Growth hormone significantly increased cartilage thickness. DNA polymerase levels in homocysteic acid treated hypophysectomized rats were not substantially increased although a larger, dose-dependent increase was observed with pGH and hGH. Neither homocysteic acid nor GH increased circulating somatomedin activity under the conditions used in this investigation. These observations demonstrate that homocysteic acid was not a substance with growth hormone-like activity in our hands and cast doubt on its possible future usefullness as a substitute for GH in clinical situations.

Intrauterine growth retardation in renal insufficiency: an experimental model in the rat.

Experiments described here with partially nephrectomized pregnant rats with pair-fed controls and controls fed at will indicate that decreased maternal food intake is a major factor in the intrauterine growth retardation associated with moderate renal insufficiency during the last trimester of gestation. Although renal disease in human pregnancy is often associated with vascular insufficiency, the possibility that maternal undernutrition may also play a contributory role in the fetal growth failure associated with certain cases of human renal compromise merits further study.