Cleft lip and palate treatment of 530 children over a decade in a single centre.

OBJECTIVE: We sought to evaluate the process of care and the outcomes of cleft lip and palate operations carried by a multidisciplinary team at a centre of craniofacial anomalies with a high patients' volume. METHODS: A retrospective review of all cleft lips and/or palates cases treated in the centre from 1995 to 2007 was performed. Direct and long term complication rates, clinical, audiologic, speech intelligibility and dental arch assessments were analyzed. RESULTS: A total of 530 children have been operated this period in the centre (64 isolated cleft lip closures). A detailed presentation of the outcomes is performed in relation to the various types of cleft lip and palates. The majority of parents (70%) reported very good or excellent results 2-5 years after the lip closure with the Millard technique, although those with bilateral clefts were significantly less satisfied (P<0.002). Forty-two percent of children with cleft palate and otitis media with effusion were self-improved 2-8 months after palate reconstruction and 83.3% of children treated with the two flaps palatoplasty technique had a rather high or very high intelligibility score. Muscles' retropositioning had a significant effect on intelligibility (P=0.04). CONCLUSIONS: Children with cleft lips and palates have a variety of conditions and functional limitations even after the surgical correction of their problem that need to be evaluated and treated by several specialists. The treatment protocol utilized by the multidisciplinary team of our centre is efficient with a relative low percentage of complications and unfavorable results.

[Syndrome of inappropriate antidiuretic hormone secretion in non-differentiated small cell lung cancer]. / Syndrom neprimerené sekrece antidiuretického hormonu u nediferencovaného malobunecného karcinomu plic.

Hyponatraemia is one of the most frequent disorders of the electrolyte metabolism. One of the causes may be also the syndrome of inadequate antidiuretic hormone secretion. The cause of increased production of antidiuretic hormone can be not only a pathological condition affecting the hypothalamo-pituitary system but also ectopic production of antidiuretic hormone or peptide with the same effect on the distal portion of the nephron. A classical type of malignant tumour where the syndrome of inadequate antidiuretic hormone secretion develops is small cell lung cancer. It is also known that some pharmaceutical preparations stimulate the output of antidiuretic hormone or potentiate its effect.