Parental preferences regarding administration of an animal-derived versus a synthetic medication to newborn infants.

AIM: We examined the perceptions of parents with regard to animal-derived versus synthetic medications of comparable efficacy. We hypothesized that this issue is a concern in neonatal care and that the perceptions of parents from one geographical location would be similar to those of another. METHODS: A survey was distributed to parents of neonates admitted to a neonatal intensive care unit of a southeastern hospital. RESULTS: Of 153 parents surveyed, 150 (98%) responded. More mothers than fathers completed the surveys (113 vs. 34). Fifty-six percent of participants indicated a college or higher education; 40% had an income of $51,000/yr or higher. Thirty-four percent of parents had concerns about animal-derived medications, 41% preferred a synthetic medication of equivalent efficacy, and 69% would like to be informed if a medication was animal-derived. CONCLUSION: Parents have concerns about exposing neonates to animal-derived medication and wish to be informed if an animal-derived medication is being considered.

[Comparison of functional results with MRI findings after surgical treatment of transscaphoid perilunate fracture dislocations of the wrist: the role of scapholunate ligament lesions]. / Vergleich der funktionellen Resultate mit MRT-Befunden nach operativer Versorgung von transskaphoidalen perilunären Luxationsfrakturen: Die Rolle von skapholunären Bandläsionen.

PURPOSE: The aim of this study was to review the outcome of transscaphoid perilunate fracture dislocations by MRI to use the advantages of MRI to show the post-traumatic degenerative changes, the examination of cartilage, the integrity of the ligaments and the vascularisation of the carpal bones. A second aim of this study is to interpret the findings in correlation to the functional results and the individual perception of hand functionality (PRWE). PATIENTS AND METHODS: In this retrospective study, 20 patients (1 woman and 19 men), who were treated with open reduction and internal fixation at our institution, were reviewed at a mean of 67 (25-145) months postoperative. The mean age was 30 (12-73) years. The functional results were measured by range of motion (ROM), grip and pinch strength. The Mayo and Krimmer wrist scores were calculated and the SF-36 and the patient-rated wrist evaluation (PRWE) questionnaires were performed. Radiological findings included consolidation of the fracture and the radiological measures (revised carpal height, SL gap, SL and RL angle). An MRI, performed without a contrasting agent, was used to assess the degenerative changes of the joints, the vascularisation of the carpalia and the integrity of the SL ligament. Statistical data was calculated with SPSS. RESULTS: Range of motion and strength were reduced by 10-20% compared to the uninjured opposite side. Although the majority of the patients (85%) achieved good to very good results in the Mayo and Krimmer wrist scores, the MRI showed osteoarthritis in 95% of the cases in at least in 1 out of 5 patients evaluated intracarpal joints. MRI showed signs of complete SL ligament tears in 5 patients and a partial tear in 2 patients. The same group also showed the strongest degenerative changes. However, there was no correlation between patient satisfaction and imaging results. CONCLUSION: MRI findings, as well as X-ray findings, do not correlate with the subjective and objective functional outcomes after surgical treatment of transscaphoid perilunate fracture dislocations. It can be assumed that SL ligament lesions seen in MRI play a major role over the long term course.

Hemi-hamate autograft arthroplasty for acute and chronic PIP joint fracture dislocations.

BACKGROUND: Treatment of fracture dislocations of the PIP joint represents a hand surgical challenge. In hemi-hamate arthroplasty, the palmar joint surface is reconstructed using an osteochondral graft from the hamate and the immediate stability permits early movement. MATERIAL AND METHODS: We performed hemi-hamate reconstructions in 10 patients (mean age 34.9 years), who sustained fractures of the base of the middle phalanx of ≥50% surface and dorsal PIP dislocations. Outcomes were assessed by clinical exam and X-ray. Evaluation criteria were range of motion of PIP and DIP joints, grip strength, joint alignment, complications and donor site morbidity. Mean follow-up was 8.6 months (range 3-14). Fractures mostly involved the 4th and 5th fingers, all patients were male. Indications were subluxation and comminuition in acute cases of <6 weeks (5 patients) and chronic pain and morning stiffness in chronic cases (5 patients). RESULTS: Operative treatment was performed in average after 93 days (range 0-371 days) after injury. Average PIP motion was 71° (range 0-90); DIP motion was 54° (range 10-90) with a mean PIP flexion contracture of 6.5° (range 0-20). Grip strength averaged 95% of the opposite hand. 4 patients had revision surgery (2× arthrolysis PIP joint, 2× screw shortening, 1× neurolysis R. dorsalis N. ulnaris). CONCLUSIONS: Hemi-hamate autograft arthroplasty represents an effective procedure to address severe PIP joint fracture dislocations. It restores the comminuted articular surface in chronic injuries and in the acute injury it is a challenging but valuable alternative to extension block splinting. However, donor site morbidity and revision surgery have to be taken into account.

A family-based paradigm to identify candidate chromosomal regions for isolated congenital diaphragmatic hernia.

Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm that causes high newborn mortality. Isolated or non-syndromic CDH is considered a multifactorial disease, with strong evidence implicating genetic factors. As low heritability has been reported in isolated CDH, family-based genetic methods have yet to identify the genetic factors associated with the defect. Using the Utah Population Database, we identified distantly related patients from several extended families with a high incidence of isolated CDH. Using high-density genotyping, seven patients were analyzed by homozygosity exclusion rare allele mapping (HERAM) and phased haplotype sharing (HapShare), two methods we developed to map shared chromosome regions. Our patient cohort shared three regions not previously associated with CDH, that is, 2q11.2-q12.1, 4p13 and 7q11.2, and two regions previously involved in CDH, that is, 8p23.1 and 15q26.2. The latter regions contain GATA4 and NR2F2, two genes implicated in diaphragm formation in mice. Interestingly, three patients shared the 8p23.1 locus and one of them also harbored the 15q26.2 segment. No coding variants were identified in GATA4 or NR2F2, but a rare shared variant was found in intron 1 of GATA4. This work shows the role of heritability in isolated CDH. Our family-based strategy uncovers new chromosomal regions possibly associated with disease, and suggests that non-coding variants of GATA4 and NR2F2 may contribute to the development of isolated CDH. This approach could speed up the discovery of the genes and regulatory elements causing multifactorial diseases, such as isolated CDH.

[Glomangiomatosis on the hand. A case report]. / Glomangiomatose der Hand. Ein Fallbericht.

Glomus tumours are solitary benign lesions most frequently located subungually on fingers and toes. In the rare case of a glomangiomatosis, the typical glomus cells are found on the altered vessel wall of the angiomatosis. Due to the rarity of this disease, no therapeutic golden standard has been mentioned in the literature, and a conservative treatment is usually adopted. The case of a 20-year-old craftsman with congenital, painful glomangiomatosis on his left dominant hand, progressively limiting the functionality of this limb, is reported. Two years after unsuccessful partial tumour resection, a surgical treatment based on radical tumour resection in terms of a finger amputation was performed. The 1-year follow-up showed no signs of pain for the patient.

Physiologic implications of helium as a carrier gas for inhaled nitric oxide in a neonatal model of Bethanecol-induced bronchoconstriction.

OBJECTIVE: To compare heliox to nitrogen-oxygen (nitrox) as a carrier gas for inducible nitric oxide (iNO) in the presence of pharmacologically inhaled bronchoconstriction. We hypothesized that respiratory resistance and gas exchange would improve when iNO is delivered with heliox. DESIGN: Interventional laboratory study. SETTING: An academic medical research facility in the northeastern United States. SUBJECTS: Sedated, ventilated newborn piglets. INTERVENTIONS: Newborn piglets (n = 16; 2.3 +/- 0.1 kg) were placed on a flow-controlled ventilator and given intravenous Bethanecol (2 x 1 mg/kg followed by 1 mg/kg/hr) to induce bronchoconstriction. Piglets were randomized to heliox or nitrox (Fio2 = 0.3) and given 80 ppm iNO. MEASUREMENTS AND MAIN RESULTS: Hemodynamics, blood chemistry, and pulmonary mechanics were recorded at 30-min intervals for 2 hrs. Bethanecol dosing increased inspiratory respiratory resistance (cm H2O/L/min; p < .01) and decreased respiratory compliance (mL/cm H2O/kg; p < .01). Following carrier gas assignment, hemodynamics and respiratory compliance were similar between groups and respiratory resistance decreased (p < .01) in the heliox group. Over 2 hrs with iNO therapy, Paco2 increased (p < .01) whereas blood pH decreased (p < .01) in the heliox group. Respiratory resistance trended downward, oxygenation index improved (p < .01), and blood methemoglobin levels trended higher for nitrox compared with heliox. CONCLUSIONS: The INOvent was effective for controlling heliox delivery of iNO. Despite marked reduction in respiratory resistance with heliox gas ventilation in a neonatal model of pharmacologic bronchoconstriction, nitrox might perform better as a delivery vehicle for iNO.

Shear does not necessarily inhibit bone healing.

Interfragmentary shear has been perceived as inhibitory to bone healing. We think this is because of inadequate balance between stimulatory and disruptive interfragmentary displacement magnitudes in the shear direction. We hypothesized that pure shear is not necessarily detrimental to bone healing. This was investigated by comparing bone healing under interfragmentary torsional shear, axial compression, and no applied motion. Applied motion was controlled carefully with similar interfragmentary principal strain magnitudes found to stimulate healing under axial compression. The observation period was 8 weeks. Torsional rotation stimulated intercortical mineralized callus formation with greater area than the group without applied motion, and led to a stiffness and rate of bony bridging similar to that of the no motion group. Axial compression stimulated less intercortical mineralized callus of a lower density than the no motion group, and there also was little bridging. These results support the hypothesis that interfragmentary shear does not necessarily inhibit bone healing.

Ehrlichiosis humana: ehrlichia trombocítica en sangre periférica / Human ehrlichiosis: tromboytic ehrlichia in peripheral blood

Ehrlichia, pequeña bacteria Gram-negativa intracelular obligatoria, reside dentro de vacuolas en el citoplasma de células sanguíneas de animales y humanos. Se multiplica por fisión binaria, formando un agregado o microcolonia ("mórula), visible en frotis sanguíneo al microscopio óptico. Transmitida por garrapatas, causa una enfermedad llamada Ehrlichiosis. En Estados Unidos se ha decrito Ehrlichia monocitotrónica en el año 1987, y Ehrlichia granulocitotrópica en 1994 y 1999. En Venezuela no fue sino hasta 1994 que por primera vez se identificó un agente de Ehrlichia con característica trombocitotrópica en frotis de sangre humana. Se presenta una casuística de un grupo de individuos que por diferentes motivos solicitaron la realización del examen. Se revisaron 182 frotis sanguíneos (periférica y capa blanca) coloreados con Wright. Se identificaron mórulas intraplaquetarias de Ehrlichia en 68 de los 182 (37,36 por ciento) sujetos estudiados

John Dalton and the aesthetics of molecular representation.

This paper examines the negative response to Dalton's symbolism in the context of the representational system of affinity tables. When situated in an iconoclastic scientific culture that rejected overt speculation, affinity tables reflected a functionalist empirical aesthetic, while Dalton's symbols embraced a deductive aesthetic suggestive of alchemical iconography.

[The use of urea carbon 14 in breath tests as diagnostic method for Helicobacter pylori infections]. / Uso del test úrea carbono14 en el aliento como método de diagnóstico de infección por Helicobacter pylori.

The Helicobacter Pylori has been indicated as a pathologic agent in the pathogenesis of antral gastritis, gastric and duodenal ulcers and probably in gastric cancer. Due to the high incidence of this infection in our place, we decided to look for a diagnostic method quick to perform, sensitive, reliable and no invasive. The breath test of 14C urea, based in the production of urea by the H. Pylori, represents this alternative. We have found, using does of 1 microCi, a high correlation with the diagnosis of H. Pylori by biopsies. We determined as negative less than 100 DPM, doubtful between 100 and 200 DPM and positive more than 200 DPM. The high pick of the curve keeps tight relation with the degree of infection. We checked this when we suppressed the H. Pylori with bismuth subsalicylate. The breath 14C Urea test showed high sensitivity (100%) and specificity (85.71%). We conclude that this breath test is an alternative way of diagnosing and follow up for H. Pylori infections. It is highly sensitive, reproducible and no invasive.