Brown-Séquard syndrome in a 11-year-old girl due to penetrating glass injury to the thoracic spine.

Injuries in children are one of the most frequent causes of high morbidity and mortality, and they present a challenge to the treating physician. Fortunately, spinal trauma in pediatric patient is relatively rare. Brown-Séquard syndrome is a rare form of incomplete spinal cord injury consisting of ipsilateral upper motor neuron paralysis (hemiplegia) and loss of proprioception with contralateral pain and temperature sensation deficits resulting from hemisection or lateral injury to the spinal cord. A 11-year-old girl was admitted to our Pediatric Trauma Emergency Department after she had suffered a penetrating back injury. Neurological examination demonstrated left lower extremity paresis and moderate spastic paralysis of the right lower extremity. The examination showed loss of temperature sensation contralateral to and below the lesion. The examination of the pain sensation was difficult because the patient was in pain shock, but it was diminished on the side opposite to the damage. Multislice spiral computed tomography (MSCT) demonstrated a triangular foreign body in spinal canal at the level of the Th11-Th12. After a Th11-L2 laminectomy and retrieval of foreign bodies, dura repair was performed. Patient was discharged from the hospital with partial recovery. Operative decompression of the neural elements in case of spinal canal compromise is the treatment of choice. Indication for surgical intervention in existing cerebrospinal fluid fistula includes closure of the dura and reducing neural elements compression and lowering the risk of infectious complications by removing bone or foreign body fragments. Patients with Brown-Séquard syndrome have good prognosis for functional recovery.

[Correction of angular deformity of the knee in growing children by temporary hemiepiphyseodesis using the eight-plate]. / Die kniegelenksnahe Achskorrektur im Wachstumsalter durch temporäre Hemiepiphyseodese mit der eight-Plate.

AIM: Angular deformities of the lower extremity are considered as prearthrotic factors. Osteotomy is regarded as a way of corrective treatment. But this intervention is considered as complex and requires a special after-treatment. During childhood and with remaining growth, guided growth offers an elegant solution for this problem. Resulting in a temporary hemiepiphyseodesis, the eight-Plate offers an alternative technique besides the Blount staples and the definitive epiphyseodesis. We evaluated the effect of this device on the correction of angular deformities in children with different diagnoses and at different ages. METHOD: Since 04/2006 22 patients with angular deformities of the lower extremities due to different diagnoses were treated at our department with the eight-Plate (42 eight-Plates). In this study we evaluated the outcome of 13 patients (26 eight-Plates) until the completed angular correction and removal of the eight-Plate. A special treatment after plate removal was not applied. RESULTS: All patients improved their mechanical leg axis. The average age at implantation was 9.4 years (2.3-13.7 years). The average time until plate removal was 10.7 months (6-34 months). No hardware failures, extrusions, growth arrests, wound infections or other complications were observed. Two patients did not achieve the desired axis correction because of insufficient remaining growth potential. An additional surgical intervention was realised. The average correction of the study group regarding the mechanical axis deviation (MAD) was 22 mm (6-43 mm) and 10.6 degrees (5-27 degrees) regarding the angular correction of the mechanical lateral distal femoral angle (mLDFW). The mechanical medial proximal tibial angle (mMPTW) changed by 8.0 degrees (3-15 degrees). CONCLUSION: In our opinion the eight-Plate seems to be a safe and reliable device for guided growth of angular deformities around the knee. The technique is easy to learn and the complication rate low compared to the staple technique. A special after-treatment is not needed and there is only minor operative trauma. At present there are only few data on long-term follow-up after plate removal until skeletal maturity. The definition of the ideal point in time for plate removal is still open.

[Partial physeal growth arrest with increasing genu varum deformity caused by a cortical enchondroma--a case report]. / Partielle epiphyseale Brückenbildung mit zunehmendem Genu varum bei kortikalem Enchondrom--ein Fallbericht.

INTRODUCTION: Trauma or infectious diseases can cause destruction of the epiphyseal region of the knee with premature partial bridging of the physis and deviation of length and axis. There is only little information about tumorous lesions as pathogenetic factor for these deviations. We have been searching for an approach to take advantage of the particular growth potential in order to avoid further complex procedures. METHOD: We report the case of a 6-year-old girl with progredient varus deformity of the left knee and reduction of walking distance. The X-ray and MRI investigations have shown a benign lesion like osteofibroma of the mediodistal femur with an affection of the medial physis. Because of the early and rapidly progredient deformity we planned an operative intervention, including the following two steps: 1) resection of the benign lesion and arthroscopically assisted resection of the bony bar with fat-patch interposition; 2) lateral hemiepiphyseodesis with an eight-plate. The histological examination revealed a cortical enchondroma, which had caused the above-mentioned growth disturbance. During follow-up (clinical and radiological examinations every 3 months) we saw a nearly normal growth of the mediodistal femoral physis with consecutive correction of the axial deviation. RESULTS: With surgical intervention (resection and temporary lateral hemiepiphyseodesis) we achieved a complete deformity correction in reference to the opposite side within one year post operation. Removal of the eight-plate has already been accomplished. Follow-up will be continued until completion of growth. CONCLUSION: In cases of rare partial bridging of the physis induced by a benign bone tumour one can achieve early correction of axial deviation during growth with resection, interposition of a fat patch and temporary hemiepiphyseodesis. With the help of such a procedure it is possible to prevent further progression of a pre-existing deformity and later aggressive surgical intervention.

Air-facilitated three-phase contact formation at hydrophobic solid surfaces under dynamic conditions.

The paper presents results documenting the mechanism of facilitation of the three-phase contact (TPC) formation due to gas entrapped during immersion of hydrophobic (Teflon) plates into distilled water and n-octanol solutions. Collisions, bouncing, the time scale of the TPC formation, and bubble attachment to Teflon plates of different surface roughness were studied using a high-speed camera. Processes occurring during the microscopic wetting film formation at the Teflon plates were monitored using the microinterferometric method (Scheludko-Exerowa cell). A strong relation between the time necessary to form a stable TPC and the roughness of the Teflon was observed. The higher the Teflon roughness was the shorter the time for the TPC formation. This effect can be attributed to two factors: (i) local differences in the thickness of the thinning intervening liquid layer (quicker attainment of rupture thickness at pillars of rough surface) and/or (ii) the presence of gas at the hydrophobic surface. Experimental findings, that (i) prolongation of the plate immersion time resulted in quicker TPC formation, (ii) white irregular and disappearing spots (air pockets) were recorded during the wetting film formation, and (iii) high n-octanol concentration caused prolongation of the time of the TPC formation, show that attachment (TPC formation) of the colliding bubble to hydrophobic surfaces was facilitated by air entrapped at the Teflon plates (and re-distributed) during their immersion into water phase. Thus, on collision instead of solid/gas wetting liquid film a thin gas/liquid/gas foam film was formed which facilitated the TPC formation.

The activity of exoglycosidases in the synovial membrane and knee fluid of patients with rheumatoid arthritis and juvenile idiopathic arthritis.

OBJECTIVE: To determine the activities of the five exoglycosidases that catabolize glycoconjugates (proteoglycans, glycoproteins, and glycolipids) in the synovial membrane and knee joint fluid of patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). METHODS: The following exoglycosidases were analysed with the p-nitrophenyl derivatives of appropriate sugars as substrates: hexosaminidase (HEX) and its isoenzymes A and B, beta-glucuronidase, beta-galactosidase, alpha-mannosidase, and alpha-fucosidase. RESULTS: Our results show that the activity of all exoglycosidases tested in the synovial membrane of patients with RA and JIA was significantly higher than in synovial fluid. We demonstrated that only the enzymatic activity of HEX was significantly higher in the tissue of patients with inflammatory diseases in comparison to the activity in the control group. CONCLUSION: These data support the concept that the synovial cells of patients with RA and JIA are the main source of exoglycosidases, which catabolize glycoconjugates of cartilage.

Using temperature gradient gas chromatography to determine or predict vapor pressures and linear solvation energy relationship parameters of highly boiling organic compounds.

An isothermal chromatographic method allowing determination of sigmabetaH2 and sigmaalphaH2 descriptors of the linear solvation energy relationship (LSER) was tested and results obtained are presented. This method is based on the use of four stationary phases of various polarity. On the other hand, it was demonstrated that the temperature gradient chromatography may be successfully used to determine LSER descriptors. Results of piH2, sigmabetaH2 and log L16 determination are reported. This approach opens new possibilities of precise and rapid determination of LSER descriptors of high boiling compounds using a small number of phases. It was demonstrated that the log L16 descriptor may be used to estimate vapor pressures of high boiling organic compounds with a better accuracy than those usually obtained with chromatographic methods.

Characterization of crude oils by inverse gas chromatography.

It was shown that the flocculation onset of asphaltenes in crude oils could be predicted on the basis of the inverse gas chromatography characterization of the crude oil properties. Hildebrand's solubility parameters of four crude oils were calculated from inverse chromatography data and compared with values obtained from the onset of asphaltene flocculation measurements. A good agreement was observed with three crude oils of different origin. A relation between Hildebrand's solubility parameter and linear solvation energy relationship descriptors was established and it was demonstrated that the solubility parameter of a crude oil is determined mainly with dispersion interactions and the hydrogen bond basicity. A large basicity lowers the oil solubility parameter, and increases its stability in respect to flocculation.

Experimental determination and prediction of the gas-liquid n-hexadecane partition coefficients.

Experimental methods based on gas-phase chromatography were tested with a view to determine the gas-liquid n-hexadecane partition coefficients, log L16 of non-volatile compounds at 298.2 K. It was demonstrated that reliable values of log L16 of compounds more volatile than n-docosane can be obtained using either capillary, or packed columns. The main limitation of both methods is the column stability at high temperatures. Here we propose a new method based on the temperature gradient mode, to obtain log L16 of high-boiling compounds. A group contribution model is also presented in view to predicting log L16 values of non-volatile compounds.

Synthesis and properties of two new liquid crystals: an analytical and thermodynamic study.

Synthesis, analytical performances, thermodynamic and surface properties of two new liquid crystals substituted with poly(ethylene oxide) chains are described. The first of them is N,N'-diphenyl-[4-[2,3,4-tri[2-(2-metoxyethoxy)ethoxy]benzylidene]i mine]piperidine (LC1) and the second is 2-hydroxy-3-methyl-4-[4-[2-(2-butoxyethoxy)ethoxy]] 4'-[4-[2-(2-butoxyethoxy)ethoxy]styryl]azobenzene (LC2). The nematic ranges of the two liquid crystals, determined by differential scanning calorimetry do not interfere. The analytical and thermodynamic studies of LC1 and LC2 in the solid, nematic and liquid state were done using a series of appropriate solutes. Comparison of the analytical performances shows a better efficiency in the nematic state.

Self-assembly of chlorophenols in water.

In saturated solutions of some di- and trichlorophenols, structures with complex morphologies, consisting of thin, transparent sheets often coiling into helices and ultimately twisting into filaments, were observed under the optical microscope. Freeze-fracture electron microscopy, x-ray diffraction, phase diagrams, and molecular modeling were performed to elucidate the observed phenomena. Here, we present evidence that the chlorophenols studied, when interacting with water, self-assemble into bilayers. The fact that some chlorophenols form the same supramolecular structures as those described previously for structurally nonrelated surfactants sheds light on the mechanisms of self-assembly.

Familial patterns of thoracic aortic aneurysms.

HYPOTHESIS: To provide evidence that genetic factors contribute to the development of thoracic aortic aneurysms (TAA) by demonstrating familial patterns of the disease. DESIGN: Retrospective review. SETTING: University hospital. PATIENTS AND METHODS: We sought to identify familial patterns of TAA from a database of 598 patients evaluated or treated for TAA at the Yale Center for Thoracic Aortic Disease, New Haven, Conn, from January 1985 to August 1998. Of the 598 patients, 45 patients had a diagnosis of Marfan syndrome and 553 patients had no known history of any collagen vascular disorder. Of the 553 patients in the latter category, 398 patients had confirmed TAA, 66 had TAA with concomitant aortic dissections, and 89 had aortic dissections. From the group of 464 patients with TAA with or without concomitant aortic dissections, 2 interviewers attempted to contact 150 randomly selected patients for telephone screening to determine the presence of familial patterns of aortic disease. Fifteen of these patients were lost to follow-up. Complete medical and family histories of the remaining 135 patients (85 men, 50 women) were reviewed. Of the 135 individuals screened, 26 (18 men, 8 women) (19.3%) were found to belong to multiplex pedigrees. These 26 patients with familial nonsyndromic TAA were compared with the remaining 109 patients with sporadic TAA and the 45 patients with Marfan syndrome-associated TAA. MAIN OUTCOME MEASURES: Groups were examined for statistical differences in age and aortic size at the time of diagnosis, growth rates of TAA, and rates of concomitant diseases. Nonsyndromic family pedigrees were analyzed and potential modes of inheritance were determined. RESULTS: The mean age at presentation for patients with familial nonsyndromic TAA (56.8 years) was significantly younger than the mean age of presentation in sporadic cases (64.3 years, P< or =.03), and significantly older than that of patients with Marfan syndrome (24.8 years, P< or =.001). Patients with a family history of aortic aneurysms had faster growth rates (0.22 cm/y) compared with patients with sporadic TAA (0.03 cm/y) (P< or =.001) and patients with Marfan syndrome (0.10 cm/y) (P< or =.04). Familial nonsyndromic TAA in patients with a concomitant aortic dissection had a growth rate of 0.33 cm/y, which was greater than that of patients with sporadic TAA (0.10 cm/y) and patients with Marfan syndrome (0.08 cm/y) with associated aortic dissection. This growth of 0.33 cm/y was significantly faster than the overall growth rate estimate of aneurysms in patients with aortic dissection (0.14 cm/y) (P< or =.05). Ten pedigrees (38.5%) showed direct father to son transmission, consistent with an autosomal dominant mode of inheritance. Six family pedigrees (23.1%) suggested an autosomal dominant or X-linked mode of inheritance. Seven pedigrees (26.9%) suggested a recessive mode of inheritance; 2 an autosomal recessive mode, and 5 an X-linked recessive or autosomal recessive mode. The remaining 3 pedigrees displayed more complex modes of inheritance. CONCLUSIONS: This study supports the role of genetic factors influencing familial aggregation of TAA. Thoracic aortic aneurysms in association with multiplex pedigrees represent a new risk factor for aneurysm growth. Pedigree analysis suggests genetic heterogeneity. The primary mode of inheritance seems to be autosomal dominant, but X-linked dominant and recessive modes are also evident.

[Treatment of neonatal respiratory distress syndrome with Alveofact--results of a prospective observational study]. / Behandlung des neonatalen Atemnotsyndroms (ANS) mit Alveofact--Ergebnisse einer prospektiven Anwendungsbeobachtungsstudie.

AIM: After registration of the bovine Surfactant Alveofact (Fa. Thomae) for treatment of neonatal respiratory distress syndrome (RDS) an observational study was performed in 47 german neonatal departments to register indication, effectivity, mode of administration and unexpected side effects. METHODS: 680 ventilated preterm infants (gestational weeks 29.5 +/- 2.9; birth weight 1359 +/- 507 g) were enrolled in an uncontrolled clinical study with study-protocol, prospectively defined outcomes and covariates, manual of operation, central control system, biometrical control. RESULTS: Surfactant was applicated at a postnatal age of 2 hours 56 minutes (median). Only 2.9% of newborn infants got the first surfactant doses < 6 min postnatally, 19.4% between 6 ... 60 min and 77.7% > 60 min postnatally. Following 1338 instillations in 76% an improved lung function, in 21% no change and in 3% a worsening was observed. During the study the total dose of surfactant increased. Safety considerations determined by the rate of pulmonary and extrapulmonary complications were similar to data of the literature: pneumothorax 12%, pulmonary interstitial emphysema 11.6%, secondary pneumonia 20.4%, broncho-pulmonary dysplasia 27%, pulmonary hemorrhage 2.1%, peri/intraventricular hemorrhage (degree III/IV) 27.9%, ductus arteriosus persistens 24.4%, sepsis/meningitis 12.4%. During the study the mortality reduces from 31% (first period) to 18% (third period) the mean was 20%. In 44 infants (6.5%) a disturbed ventilation (airway obstruction, overdystension of pulmonary areas, atelectasis) after surfactant administration was observed. CONCLUSION: In RDS the surfactant Alveofact is preferably used therapeutically (rescue mode), it is effective but not free of risk. Its administration needs for a clear indication. New unknown side effects of Alveofact were not observed.

EPR and Mössbauer spectroscopy investigations on the metal ion contents of Sendai virus components.

EPR and Mössbauer spectroscopy indicate that Sendai virus contains iron ions in paramagnetic states. Spectral data show that the iron ions are in an oxidized form (Fe3+), having low and high spin states (S = 1/2 and S = 5/2). On enrichment of Sendai virus with 57Fe, the concentration of Fe3+ ions substantially increases in the virus preparations. The Fe3+ ions in the high spin state appear to be tightly bound to the virus components; they are not significantly removed by dialysis. The five main proteins separated by SDS gel electrophoresis from 57Fe-enriched Sendai virus contain the signal corresponding to the presence of Fe3+ ions in the high spin state. The concentration of Fe3+ ions is, however, about five times higher in the HN polypeptide than in the other four components. It is suggested that Fe3+ (5/2) ions might be a structural component of the Sendai virus HN polypeptide.