Prosthetic management of children in The Netherlands with upper limb deficiencies.

The aim of the study was to assess which children with congenital and acquired upper limb deficiencies were fitted with prostheses, what types of prostheses were prescribed as first, second and third prostheses, at what age prostheses were first prescribed and how long the children wore their prostheses. The design was a retrospective chart review at De Hoogstraat Rehabilitation Centre, Utrecht (The Netherlands). Medical files of all patients with congenital or acquired upper limb deficiencies who visited the outpatient clinic between 1972 and 1996 were reviewed, collecting data on patient characteristics, prosthesis prescription and use of prostheses. The group included 224 children, of whom 206 (92%) had congenital deficiencies. Of all children with unilateral congenital deficiencies, 54% had been fitted with prostheses, against 3% of all children with bilateral congenital deficiencies and 67% of all children with acquired deficiencies. In the congenital group, it was children with transverse defects of one-third or two-thirds of the forearm who had most frequently had prostheses fitted (85% of the children). Most of the children with unilateral congenital deficiencies had received passive prostheses as their first prostheses (80 of the 90 prescribed prostheses); children with acquired defects usually had active prostheses (8 of the 12 prescribed prostheses). Body-powered prostheses were most commonly prescribed as the second type of prosthesis. In the group of 119 children who had been seen before the age of 4 years and had been followed for at least three years, 63 had been fitted with one or more prostheses at a mean age of 2.6 (SD 2.5) years. Of the 46 children with congenital defects, 30 had been fitted with prostheses, and at the age of 12, two-thirds of them still used their prostheses (63%, 19/30). "De Hoogstraat" rehabilitation centre uses a restrained prosthesis prescription policy, depending on the type of deficiency and the expected functional benefits. Data on prosthesis use are encouraging, although a follow-up study is required to determine the functional outcome for prosthesis users and non-users.

Acute noncardiac chest pain in a coronary care unit. Evaluation by 24-hour pressure and pH recording of the esophagus.

Twenty-four-hour recording of esophageal pressure and pH was performed successfully in 41 patients admitted to the coronary care unit of a general hospital who had an episode of acute, prolonged retrosternal chest pain and who were initially suspected of suffering from coronary artery disease (severe angina pectoris, myocardial infarction), but in whom the pain was subsequently shown not to be of cardiac origin. The recordings were analyzed with fully automated techniques. A pain episode was considered to be related to abnormal esophageal motility when contraction amplitudes or durations in the pain episode exceeded the patient's upper limit of normal (97.5th percentile) or when the proportion of abnormal propagated contractions (simultaneous, nontransmitted) in the pain episode was significantly increased (chi 2 test). Thirty patients (73%) had one or more pain episodes (in total 63 pain episodes) during the 24-hour recording. Forty-three percent of the pain episodes was related to abnormal motility and 30% to reflux, and 27% was not related to esophageal function disturbance. Using the criterium that the symptom index had to be greater than or equal to 75%, it was found that the pain was related to reflux in 13 patients (43%) and to motor abnormalities in 10 patients (33%). It is concluded that in the majority of patients acutely admitted with noncardiac chest pain, esophageal motor abnormalities and reflux can be shown to be the likely cause of the symptoms.

[The value of ambulatory 24-hour esophageal manometry in the diagnosis of retrosternal pain of non-cardiac origin]. / De waarde van ambulante 24-uursslokdarmmanometrie bij de diagnostiek van retrosternale pijn van niet-cardiale origine.

The clinical relevance of a system of ambulatory 24-hour oesophageal pressure and pH recording with automated data analysis was investigated in 33 unselected patients with non-cardiac chest pain. After conventional manometry with edrophonium (Tensilon) provocation, 24-hour oesophageal pH and pressure monitoring was performed. In 17 patients conventional manometry, edrophonium provocation and 24-hour pH recording revealed an oesophageal origin of the symptoms: 6 patients had oesophageal motility disorders, 3 were positive responders to edrophonium and 8 had chest pain associated with gastro-oesophageal reflux. In none of the patients who had a pain attack during prolonged oesophageal pressure recording, was a new motility disorder detected.

Physiological suppression and attention.

On the Aulhorn phase-difference haploscope retinal rivalry was stimulated by using different optotypes for each eye. Physiological suppression could not elicited at will by changing attention from one eye to the other. The majority persons tested showed a preference for one eye.

Physiological gastroesophageal reflux and esophageal motor activity studied with a new system for 24-hour recording and automated analysis.

Gastroesophageal reflux and esophageal motility were studied for 24 hr in 32 ambulatory healthy volunteers (20-73 years old), using a newly developed system, consisting of a microprocessor-based data recorder and algorithms for fully automated data analysis. Physiological reflux was more extensive than expected on the basis of widely used normal values. The percentage of time with pH less than 4 and the duration of the reflux episodes increased with age. Of the more than 2000 esophageal contractions occurring per day, peristaltic contractions constituted 50.9 +/- 2.0%. Their amplitude was significantly lower between meals than during meals and during the night. The duration of the peristaltic contractions increased with age. Simultaneous contractions constituted 10.4 +/- 1.2% of the esophageal contractions. Their incidence increased with age. We conclude that continuous ambulatory 24-hr recording with automated analysis of esophageal motility and pH profile is feasible, that the upper limits of normal in ambulatory esophageal pH recording are higher than previously accepted, and that age, meals, and body position must be taken into account in the interpretation of both 24-hr esophageal pH and pressure data.

Microcomputer-based system for 24-hour recording of oesophageal motility and pH profile with automated analysis.

A system developed for long-term simultaneous recording of oesophageal motility and pH in the ambulant patient is described. The system consists of a microprocessor based data-acquisition and preprocessing device, a personal computer for postprocessing, report generation and data storage, a miniature two-sensor pressure catheter and a pH electrode. Identification and classification of oesophageal contractions are performed in separate steps, using online preprocessing software for identification and offline postprocessing software for categorisation, classification and report generation. Contractions are categorised as peristaltic, simultaneous or nontransmitte and classified according to their amplitude, duration and propagation velocity. The method described reduces the amount of data from 870 kbyte to approximately 40 kbyte per 24 hours in a multiparameter recording device, and offers the opportunity for offline postprocessing with different sets of criteria. The system has been found to be accurate and reliable in 24-hour studies in both healthy volunteers and patients with non-cardiac chest pain.

Physiological suppression demonstrated with the Aulhorn PDH.

Physiological suppression was studied in 25 subjects using the Aulhorn phase-difference haploscope (PDH). To control fixation the eye movements were registered by means of an infra-red reflection technique.

Electrical stimulation of bone growth with direct current.

Electrical stimulation of osteogenesis was studied in rabbit femora in: (A) a transcortical electric field with a cortex-depolarizing or hyperpolarizing orientation derived from an intramedullary electrode and a ring-shaped counter electrode encircling the femoral shaft; and (B) an electric field derived from an electrode located in the medullary canal and the counter electrode in the abdominal wall. Electrodes were made of platinum. A direct current of 20 microA was applied during six weeks. Contralateral femora with dummy electrodes served as controls. Results were analyzed by optical densitometry of roentgenograms and histomorphometry of histologic slides. Under the conditions of these experiments bone growth was not stimulated by applying a cortex-depolarizing electric field. Significant stimulation of bone growth was only observed at an intramedullary cathode, when the anode was placed at a distance.