Kinematic study of a reconstructed hip in paediatric oncology.

In 1997, a large portion of the femur of a four-year-old child affected by a Ewing's sarcoma was reconstructed with an innovative technique that used a massive bone allograft, in conjunction with a vascularised fibula autograft that was directly articulated within the acetabulum. The aim of the present study was to assess the kinematic behaviour of the reconstructed hip during flexion, once the acute remodelling process observed after the operation had ceased. A few additional CT slices of the hip joint region, in a flexed position, were taken at month 33 of the follow-up. The helical axes relative to the neutral-flexion motor action were estimated: their relative positions, with respect to the anatomical femoral heads, were compared, and the translation of the anatomical head centres was estimated. The angles spanned by the two femurs were almost equal, as were the translations along the respective helical axis. The main difference between the two femurs was the distance between the estimated femoral head centres and the relative helical axes. This resulted in a non-negligible translation of 2.9 mm of the fibula head inside the acetabulum during flexion, significantly higher than the 0.5 mm found for the intact contralateral femur. The results showed that, although the transplanted fibula grew and remodelled during the follow up, the action of the reconstructed hip joint still cannot be described as a ball-and-socket.

Ducts of the labral glands of Leptestheria dahalacensis (Crustacea: Branchiopoda: Spinicaudata).

Inside the labrum of Leptestheria dahalacensis are situated three types of large epidermal gland cells, whose ducts open onto the outer dorsal surface of the labrum. SEM revealed that the thin ducts of the A-type gland cells open out behind the epipharynx at the end of small, conically shaped protuberances, the two paired ducts of the B-type gland cells lead into the distal portion of the labrum, and the external opening of the single duct of the C-type gland cells lies on the dorsal lobe of the labrum. The ducts of the three different gland cell types have the same fundamental constitution, but vary in diameter. Each secretory unit consists of a pair of gland cells (A, B, or C) and a secretory duct. The duct is formed by ring-shaped folding of one anteroposteriorly elongated epidermal cell (duct cell), whose ends adhere closely to one another. A further ring-folded epidermal cell (accessory cell), but flattened in shape, is interposed, like a sleeve-connection, between the gland cells and the duct cell. The reservoirs of gland cells open into the lumen of the duct. Discontinuous deposits of highly electron-dense matter are present on the plasma membrane of the accessory cell delimiting the initial part of the duct lumen, while the plasma membrane of the duct cell facing the lumen is cuticularized. The cytoplasm of the accessory cell, on examination by TEM, appears quite similar to that of the duct cell, except for the different distribution and greater abundance of microtubules. Similarly organized tricellular tegumental glands also commonly occur in other Crustacea, both Malacostraca and non-Malacostraca. Possible functions of secretions from the three different types of gland cells present in the labrum of L. dahalacensis are discussed.

Nonnutritive sucking during heelstick procedures decreases behavioral distress in the newborn infant.

We investigated if nonnutritive sucking (NNS) during heelstick procedures alleviates behavioral distress in neonates. In our NICU, 26 neonates without severe complications (mean Minde score 0.8, range 0-3), undergoing heelstick procedures at least twice a day, in the first 2 weeks of life, were enrolled in the trial (mean gestational age 33.9 weeks, range 26-39 weeks, mean birth weight 1, 988.5 g, range 1,200-4,010 g, mean Apgar score at the first minute 6. 7, range 4-10, at the fifth minute 8.5, range 6-10). Two heelpricks were performed in each neonate with NNS randomly assigned. Behavioral states, transcutaneous oxygen tension (TcPO(2)), heart rate, and respiratory rate were monitored before, during and after the heelstick procedures. Heelstick procedures lasted for a mean of 109 s (range 50-230 s) with NNS, and a mean of 128.8 s (range 20-420 s) without NNS. Compared with baseline, heart rate and behavioral distress increased and respiratory rate decreased during heelstick and after heelstick. Oxygen tension did not change. Nonnutritive sucking had no effect on respiratory rate or transcutaneous oxygen tension, but reduced the time of crying and the heart rate increase during the procedure. In conclusion, NNS can be recommended to reduce distress in newborns undergoing invasive routine procedures. Further studies are needed to evaluate the effects of NNS on respiratory rate and blood gas levels.

Cholestasis in newborn infants with perinatal asphyxia.

OBJECTIVE: The aim of this study was to characterize the liver involvement in infants who have both neonatal asphyxia and neonatal cholestasis. METHODS: We describe four asphyctic newborn infants (three born at term) who developed early (age 3.8 +/- 2.1 days) intrahepatic neonatal cholestasis and in whom tests for causes of neonatal liver damage were negative. RESULTS: The clinical picture and course were benign and similar to that of sporadic "idiopathic" neonatal hepatitis. Clinical signs and abnormal liver function tests tended to normalize within the first year of life in all. Conjugated bilirubin became normal at 6 months after the onset of cholestasis, while liver enzymes tended towards normal values thereafter, within 1 year of follow-up. Liver biopsy (taken in one patient) showed a typical picture of giant cell hepatitis; ultrastructure was nonspecific. SIGNIFICANCE: Our results suggest that isolated asphyxia should be taken into account as a potential causal factor in term or pre-term asphyctic newborns who develop early "idiopathic" neonatal cholestasis.

[The birth of a neonate with a congenital malformation]. / La nascita di un neonato con malformazione congenita.

The birth of a neonate with congenital malformation for the parents determines often a process of adaptation with a phase of shock, a phase of incredibility and scare and, at last, one of adaptation and equilibration. The reactions of the parents and the difficulties they meet in the relation with the child depend mostly on the characteristics of the malformation and on the explanations and support they receive. The Health care personnel knows well that the communication of a diagnosis of a congenital malformation to the parents is frustrating. Both the Pediatrics and the Gynaecologist have to considerate seriously and consciously this relational question, considering that the communication is a interpersonal relationship and therefore flexible and changeable in every case. After this previous statement we consider it useful to report advises taken from the literature: the parents have to be informed at once the diagnosis is confirmed, possibly at the same time and in presence of the infant; the communication should be done both from the Pediatrics and the Gynaecologist, possibly at the same time; the communication should take place in a private atmosphere and with plenty of time.

Rubella embryopathy after maternal reinfection.

Reinfection with rubella is possible. The real risk for fetus and newborn is not known, as are the incidences of rubella reinfection during pregnancy and congenital rubella infection after maternal reinfection.

Differences between male and female protogonia in chick embryos before sex differentiation of the gonads.

The sex of chick embryos is diagnosed by cyto-karyological methods on skin fragments of 2-7 days' incubation before gonadal sex differentiation. In 44 males and 42 females statistical analyses have been made of the number and dimension of the germ cells, and of the volume of the gonadal primordia. Moreover an ultrastructural study has been made on the germ cells colonizing the genital ridges (70-hours of incubation). Early differences between the sexes have been found regarding: earlier numerical increase of CGs in the left gonadal primordium of the females; larger primordial germ cells in the female; the same cytological characteristics at ultrastructural level.

[Non-nutritional sucking in the preterm neonate]. / La suzione nonnutritiva nel neonato pretermine.

The authors briefly review the available data on nonnutritive sucking (NNS) in preterm infants focusing mainly on NNS as a form of intervention and on the relationship of NNS with cardiorespiratory control. The previous studies on the positive effects of NNS on weight gain and oxygenation called for deeper investigation on the mechanism involved. The authors report the main results of their work on this field. The effects of NNS on transcutaneous oxygen tension, heart rate and respiration were studied sequentially in 14 sleeping preterm infants breathing room air. Transcutaneous oxygenation tension increased during NNS in infants between 32 and 35 weeks postconceptional age, but not in those between 36 and 39 weeks. This response was not associated with a change in respiratory rate or sleep state, although heart rate tended to increase. A subsequent study however, demonstrated a small and transient increase of respiratory rate during NNS bursts. Although further longitudinal studies will be needed these data offer further support for the beneficial effects of NNS in preterm infants.