Standardized delivery room management for neonates with a prenatal diagnosis of congenital heart disease: A model for improving interdisciplinary delivery room care.

Precise characterization of cardiac anatomy and physiology through fetal echocardiography can predict early postnatal clinical course. Some neonates with prenatally defined critical congenital heart disease have anticipated precipitous compromise during perinatal transition for which specialized, diagnosis-specific delivery room care can be arranged to expeditiously stabilize cardiopulmonary hemodynamics. In this article, we describe our institutional approach to the delivery room care of neonates with prenatally diagnosed congenital heart disease, emphasizing our diagnosis-specific care pathways for newborns with critical disease.

Postoperative complications following the Fontan procedure: the role of aprotinin.

OBJECTIVE: To determine how the anti-inflammatory properties of aprotinin impact on postoperative complications in children undergoing the Fontan procedure. METHODS: We included all patients between 14 months and 18 years (n=56) undergoing a Fontan operation at our institution between January 2005 and June 2009. The study group (n=29) included patients from January 2005 through December 2007 all of whom received aprotinin. The control group (n=27) included all patients from January 2008 through June 2009 who did not receive aprotinin. We reviewed all medical records and collected preoperative, intraoperative and postoperative data. Duration and volume of chest tube drainage were the primary outcome measures. RESULTS: Of the 20% of patients who had postoperative arrhythmias, multivariate logistic regression analysis demonstrated only aprotinin was associated with significantly decreased postoperative arrhythmias (P=0.01). Renal function and fenestration or Fontan thrombosis did not differ significantly; there was no statistically significant difference in volume or duration of chest tube drainage. Median duration of chest tube drainage was 7 days in the aprotinin group and 8 days for patients who did not receive aprotinin (P=0.36). CONCLUSION: The anti-inflammatory properties of aprotinin may be protective against postoperative arrhythmias. Aprotinin does not confer increased risks of prolonged chest tube drainage, renal dysfunction or thrombosis in patients undergoing the Fontan procedure.

Anatomical partitioning and nerve branching patterns in the adult rabbit masseter.

The masseter muscle is functionally heterogeneous with a complex architecture consisting of multiple tendons and a multipennate arrangement of muscle fibers. In this study, the anatomical partitioning of the rabbit masseter is described on the basis of the tendons of origin and insertion, general partition orientation relative to the zygomatic arch, motor endplate descriptions, and primary nerve branches that innervate these partitions. This work refines previous descriptions of the rabbit masseter and describes 13 anatomical partitions, each with a unique tendinous attachment. In addition, 14 naturally occurring primary nerve branches were identified and found to innervate different regions of the muscle. After correlating the anatomical partitions and the associated neural innervation pattern, it was determined that simple branch order will not adequately define all the neuromuscular compartments in the rabbit masseter.

Aneurysmal bone cyst of the capitate.

Aneurysmal bone cysts are uncommon in the hand. An aneurysmal bone cyst in the capitate of a 16-year-old girl is presented, and 32 previously recorded cases are discussed.

Acetabular erosion: a comparison between the Austin Moore and Monk hard top prostheses.

Primary prosthetic replacement has become the method of treatment for acute subcapital fractures of the femur and is now widely accepted as a treatment for elderly patients. This paper presents the incidence of acetabular erosion by Monk (hard top) hip prostheses for subcapital fractures as compared with that by Austin Moore prostheses.

Isolated palsy of the nerve to flexor pollicis longus.

Two cases of isolated paralysis of the nerve to flexor pollicis longus are described, both of which recovered after division of constricting fibrous bands. Anatomical considerations and treatment are described.

Total knee replacement in osteoarthritis and rheumatoid arthritis.

Between 1974 and 1983, 187 total knee replacements were performed in 163 patients at four East Kent district general hospitals. With few exceptions pain was the most common indication for the operation and it produced complete or almost complete relief in 90% of cases. The most frequently used prostheses were the Attenborough, Stanmore and Geomedic.

Treatment of early breast cancer: a report after ten years of a clinical trial.

A controlled clinical trial has been carried out to compare radical mastectomy with wide excision (extended tylectomy) in the treatment of early breast cancer. Only patients aged 50 and over were included and 370 entered the trial during a period of 10 years. Postoperative radiotherapy was given in each case. In patients with clinically involved axillary nodes there was a significantly higher incidence of local and distant recurrence in those having a wide excision, and the survival of these patients was significantly less than those who had a radical mastectomy. In patients with clinically uninvolved nodes, although there was a significantly higher incidence of local recurrence in those having a wide excision, there was no increased incidence of distant recurrence and the survival rate was similar to those having a radical mastectomy.