Visual development in infants: visual complications of periocular haemangiomas.

UNLABELLED: Periocular haemangioma of childhood can severely impact visual development. OBJECTIVE(S): To review our experience with 20 periocular haemangioma patients; to review infant ocular development in the context of periocular capillary haemangioma; to identify early clinical warning signs that may precede devastating visual outcomes in the absence of timely management and to review our experience with surgical debulking for the treatment of selected periocular haemangioma. DESIGN: Retrospective case series. INTERVENTIONS: Twenty children with congenital periocular haemangiomas received care by a multidisciplinary team consisting of doctors from the specialties ophthalmology, plastic surgery, paediatrics and dermatology. The patients were separated by age at presentation to our centre (1 year). Based on consensus amongst the team, certain patients were considered to be at high risk for development of amblyopia, permanent cortical visual change or blindness. These patients were scheduled for urgent surgical excision or debulking. The effect of treatment on visual development over time was evaluated. RESULTS: Patients presenting to our centre after 1 year of age were more likely to have amblyopia (75% vs. 0% if presenting at

Closed reduction internal fixation rates and procedure times for metacarpal fractures treated in a minor surgery area before and after the introduction of a mini C-arm unit.

BACKGROUND: Mini C-arm units are compact, mobile, fluoroscopic imaging systems designed for real-time imaging of the extremities. They deliver the lowest possible radiation exposure to the patient and physician while minimizing operator effort and inconvenience. METHODS: A retrospective chart review was undertaken for consecutive metacarpal fractures requiring internal fixation treated in the minor surgery centre before (n=100) and after (n=100) the introduction of the mini C-arm. Open versus closed approach, procedure time and total operating room time were recorded. RESULTS: Before the introduction of the mini C-arm, the percutaneous rate was 48% and the average procedure and total operating room times were 55 min and 102 min, respectively. After mini C-arm implementation, the percutaneous rate increased to 59% and the average procedure and total times were 36 min and 78 min, respectively. CONCLUSIONS: The use of a mini C-arm increased the rate of successful closed reduction internal fixation and reduced the procedure time for metacarpal fractures treated in the minor surgery area.

Autotransplantation of epithelial cells in the pig via an aerosol vehicle.

A new method of delivery of epithelial suspensions with use of an aerosolization apparatus was examined in the pig. Full-thickness pig skin was harvested, and an epithelial suspension was created using standard techniques of dispase and trypsin. Twenty-four hours after skin harvest, four full-thickness wounds were created on the flanks of the pig. The control wound was sprayed with a solution without epithelial cells. The three experimental wounds were sprayed with epithelial cell suspensions (integral 10(6) cells/suspension). Weekly evaluation with photographs, biopsies, and tracings were done for 4 weeks. At 10 weeks, the entire process was repeated with new wounds on the pig's back. Thirty-five wounds in five pigs were evaluated: 10 control (5 flank, 5 back) and 25 experimental (15 flank, 10 back). Control wounds healed by contraction alone, with epithelium at the edges only. After 4 weeks, an open area remained. Central epithelial islands developed in experimental wounds at 2 weeks. These islands coalesced to close the wounds by 4 weeks. Histology at 1 week showed groups of epithelial cells deeply embedded in granulation tissue. These groups became immature epithelial layers on the surface by 2 weeks, and all layers of epithelium were present by 4 weeks. Overall, flank experimental wounds epithelialized sooner, but contracted at the same rate as control wounds. In conclusion, epithelial cells can be delivered by an aerosolization apparatus and remain viable and proliferative in a pig model.

Regulation of collagen synthesis and mRNA expression in normal and hypertrophic scar fibroblasts in vitro by interferon-gamma.

Development of hypertrophic scarring (HTS) is a major problem for patients who survive extensive thermal injuries. HTS and other fibroproliferative disorders are associated with excessive accumulation of collagen and other extracellular matrix proteins. Recent in vitro and in vivo studies have demonstrated that proteins of the interferon family have an inhibitory effect on collagen production by fibroblasts in some fibroproliferative disorders. This study investigated the effects of interferon-gamma (IFN-gamma) on cell proliferation, collagen production, and expression of types I and III procollagen mRNA in human postburn HTS fibroblasts. Paired fibroblast cultures were established from explants of biopsies obtained from HTS and normal skin (matched for location and skin tension) in five patients recovering from thermal injuries. Thus, normal dermis from each patient was used as a paired control. Administration of IFN-gamma (1000 U/ml) to proliferating fibroblast cultures for 5 days resulted in 51% reduction (P < 0.05) in HTS cell proliferation. Using hydroxyproline as an index for collagen production, a 34% reduction (P < 0.05) in collagen synthesis was observed in HTS fibroblast culture media after treatment with IFN-gamma (1000 u/ml) for 48 hr. Northern blot analysis demonstrated 55 and 36% reductions (P < 0.05 for each) in type I and type III procollagen mRNA levels, respectively, after treatment for 12 hr with IFN-gamma (1000 u/ml). The effect of IFN-gamma on each of these parameters was at least as pronounced in HTS fibroblasts as their normal controls.(ABSTRACT TRUNCATED AT 250 WORDS)