Timing of Therapeutic Hypothermia for Inborn and Outborn Infants with Neonatal Encephalopathy.

Therapeutic hypothermia is now the standard of care for infants with moderate to severe hypoxic ischaemic encephalopathy. Sixty-three infants received therapeutic hypothermia at Cork University Maternity Hospital (CUMH) from 2010-2014. Median gestational age was 40 weeks. Eighteen (29%) infants were Sarnat grade 3, 41(65%) grade 2 and 4(6%) grade 1. Nineteen outborn infants arrived in CUMH at a median (IQR) age of 310 (270, 420) minutes. Four (21%) outborn infants were within the target temperature range on arrival. Median (IQR) time (minutes) from birth to achieve target temperature was 136 (90, 195) for inborn and 300 (240, 360) for outborn infants (p < .01). Overall, 35 (56%) infants had electrical seizures, 42 (74%) had a normal MRI at a median (IQR) age of 7(6,9) days and the median(IQR) length of stay was 9 (7,11) days. Although no difference in seizures or MRI findings was seen, passive cooling does not achieve consistent temperature control for outborn infants.

Trisomy 21--incidence and outcomes in the first year, in Ireland today.

Incidence of Trisomy 21 in Ireland, 1:546 live births, is the highest in Europe. This project aimed to define the incidence of T21 amongst liveborn infants at Cork University Maternity Hospital (CUMH), and to describe neonatal outcomes and progress in their first year. Infants were identified from Social Work department records. A retrospective review of the neonatal inpatient database, outpatient letters and medical charts was performed. Forty three infants with T21 were born in CUMH in 2010 and 2011. Incidence of T21 was 1:411. Antenatal diagnosis was uncommon at 14% (6). 34 (79%) were admitted to the neonatal unit. Co-morbidities included congenital heart disease 22 (51%) and duodenal atresia 2 (5%). Thirty four were followed-up in CUMH outpatient department. Of these, 34 (100%) had thyroid function testing, 29 (85%) ophthalmology and audiology referral, and 7 (21%) were referred for hip review. Mortality rate was 9% (4). Readmission to hospital in the first year of life was 42% (18).

Image quality associated with the use of an MR-compatible incubator in neonatal neuroimaging.

OBJECTIVES: MRI in the neonate poses significant challenges associated with patient transport and monitoring, and the potential for diminished image quality owing to patient motion. The objective of this study was to evaluate the usefulness of a dedicated MR-compatible incubator with integrated radiofrequency coils in improving image quality of MRI studies of the brain acquired in term and preterm neonates using standard MRI equipment. METHODS: Subjective and objective analyses of image quality of neonatal brain MR examinations were performed before and after the introduction of an MR-compatible incubator. For all studies, the signal-to-noise ratio (SNR) was calculated, image quality was graded (1-3) and each was assessed for image artefact (e.g. motion). Student's t-test and the Mann-Whitney U-test were used to compare mean SNR values. RESULTS: 39 patients were included [mean gestational age 39 weeks (range 30-42 weeks); mean postnatal age 13 days (range 1-56 days); mean weight 3.5 kg (range 1.4-4.5 kg)]. Following the introduction of the MR-compatible incubator, diagnostic quality scans increased from 50 to 89% and motion artefact decreased from 73 to 44% of studies. SNR did not increase initially, but, when using MR sequences and parameters specifically tailored for neonatal brain imaging, SNR increased from 70 to 213 (p=0.001). CONCLUSION: Use of an MR-compatible incubator in neonatal neuroimaging provides a safe environment for MRI of the neonate and also facilitates patient monitoring and transport. When specifically tailored MR protocols are used, this results in improved image quality.

[Relationship of the flexor hallucis longus and flexor digitorum longus tendons in the plantar midfoot. An anatomical cadaver study]. / Spojení slach m. flexor hallucis longus a m. flexor digitorum longus na plante: anatomická studie na kadaverech.

PURPOSE OF THE STUDY: To verify, in cadaver specimens, the precise anatomic structure of cross-connection between the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendons and to identify its position in relation to orientation points in the foot in view of the surgical technique for tendon transfer, including the necessity of subsequent tendon suture. MATERIAL AND METHODS: A hundred cadaver legs (50 cadavers of 29 men and 21 women, all Caucasians) were dissected by an extensive medio-plantar approach. The anatomical relationship of the FHL and FDL tendons was studied. The distances measured were as follows: between the first metatarsophalangeal joint line and the FHL origin of a tendinous slip; between the slip and the calcaneal tubercle; and the total distance between the first metatarsophalangeal joint line and the calcaneal tubercle. RESULTS: In all cadaver legs, a cross-connection between the FHL and FDL tendons was present in the plantar midfoot. There was always a tendinous slip branching from the FHL tendon and running lateral and distal to the FDL tendon. The slip was attached to the FDL tendon distal to its branching for the toes; it either attached to only the FDL tendon for the second toe or it split to attach to the FDL tendon branches for the second and the third toe. The two configurations were referred to as type II and type II,III, respectively. Type II was found in both legs of 31 cadavers (62 %), and type II,III in 14 cadavers (28 %). In five cadavers (10 %) attachment was different in the right and the left foot. Expressed in absolute numbers, there were 67 type II attachments (two-thirds of the findings) and 33 type II,III attachments (one-third of the findings). The average distance between the first metatarsophalangeal joint line and the origin of an FHL tendinous slip was 7.3 (± 0.9 ) cm, the average distance between the origin of an FHL tendinous slip and the calcaneal tubercle was 9.2 (± 1.1) cm and the average distance between the first metatarsophalangeal joint line and the calcaneal tubercle was 16.5 (± 1.6) cm. DISCUSSION: Various presentations of the anatomical relationship between the FHL and FDL tendons in the midfoot are found in the literature. Some describe it as a mere cross-connection between the tendons; others report certain forms of attachment. Only two papers on this issue have recently been available in the international literature and their findings markedly differ from our observations made on a significantly higher number of specimens. CONCLUSIONS: The FHL and FDL tendons in the midfoot are cross-connected with a tendinous slip branching proximal to the FHL tendon to be attached to the FDL tendon distal to its branching for the second or the third toe. Transfer of the FHL and FDL tendons is often used in the treatment of tibialis posterior muscle dysfunction, extensive inveterated ruptures of the Achilles tendon and, less frequently, posterior foot balancing in neuromuscular foot deformities. The anatomic pattern of a tendon cross-connection in relation to orientation points in the foot varies to such an extent that, during surgery, it is impossible to keep strictly to the recommended halves of the distances between the calcaneal tubercle and the first metatarsophalangeal joint. The length of a FDL graft is limited by the level of tendon branching for the toes; it is not necessary to cut through the slip. Because of the anatomical structure of tendon cross-connection, we consider it necessary to suture the distal stump of one tendon to the other tendon to retain their correct function.

[Precise, computed-assisted leg angle correction with open-wedge high tibial osteotomy]. / Präzise computergestützte Beinachsenkorrektur mit öffnender valgisierender Tibiakopfosteotomie.

AIM: This prospective study investigates open-wedge high tibial osteotomy performed with the aid of a kinematic computer-guided navigation system. After the X-ray control the osteotomy was stabilized by internal LCP fixation. The aim of the study was to demonstrate the accuracy of the navigation system and to prove the reliability of the LCP fixation. METHOD: A total of 39 patients were operated between 2002 and 2003 following this method. The outcomes were evaluated at least 2 years after the surgery clinically and radiologically; 21 females (1 female underwent bilateral osteotomy) and 18 males were included in the study sample. RESULTS: Prior to the osteotomy, the mean anatomic lateral tibiofemoral angle (aLTFA) was 181.1 degrees . The desired 4 degrees "overcorrection" of valgus (aLTFA 170 degrees) was found on X-rays postoperatively in all cases. The mean correction was 11.1 degrees. The correction achieved was stable during the 2-year follow-up period. The osteotomy healed in all cases after 4 months. The full range of motion remained after the surgery in all cases. All patients were satisfied with their results. The Lysholm score was 55 points before and 82 points after the osteotomy (27 points difference). CONCLUSION: The computer-assisted open-wedge high tibial osteotomy with tricortical grafts stabilized by LCP fixation gives exact and reproducible results without loss of correction.

[Minimally invasive and navigated implantation for total knee arthroplasty: X-ray analysis and early clinical results]. / Minimal-invasive und navigierte implantation von knietotalendoprothesen: radiologische analyse und frühe klinische ergebnisse.

Total knee arthroplasty (TKA) alignment is one of the most important factors in long-term prosthesis survival. Minimally invasive surgical (MIS) procedures are becoming more common. There may be an increased overall complication rate, especially component malpositioning, due to poor visualisation. The disadvantage of restricted visualisation in the less invasive technique can be compensated by a navigation system. This combined procedure is described in this paper. A total of 40 Search Evolution TKAs were implanted using OrthoPilot navigation in the standard manner, and 40 TKAs were implanted using MIS via a subvastus approach. Primary osteoarthritis of the third or fourth degree, without severe valgus deformity, was the indication. These patients were then selected at random as they came to the institution. The results were evaluated radiologically and clinically.Pain, range of motion, gait and function, and the entire clinical score 10 days after the operation were significantly better in the MIS-group. At 6 and 12 weeks postoperatively, these results were no longer statistically significant. Ideal radiological results were obtained in all cases. No differences in limb axis and component alignment were found after the operation between the navigated groups. MIS is technically very demanding. That is why it should be used only in carefully selected cases. Its advantages occur in the first weeks after the surgery. The long-term results must still be determined.

The relationship between the onset of electrographic seizure activity after birth and the time of cerebral injury in utero.

In the fetal lamb model of hypoxic-ischaemic injury, the insult is followed by EEG depression, after which seizures emerge at 7-13 hours. We explored the relationship between the emergence of electrographic seizures and our estimate of the time of the cerebral injury in nine babies who underwent continuous video-EEG monitoring from soon after birth. Babies with prelabour insults had their first seizures before 12 hours of age, whereas those whose insult was peripartum had seizure onset at 18-20 hours of age. EEG seizure onset time could have important clinical and medico-legal applications, and be related to the time or severity of the insult, or both.