Flexible intramedullary nailing as fracture treatment in children.

To correct angulation and to avoid plaster immobilization in diaphyseal fractures in childhood, intramedullary nailing with flexible titanium pins is an easy and safe method. Under radiographic control, fractures of femur, tibia, and humerus are stabilized with two crossing pins. Forearm fractures are splinted with a single pin each in the radius and the ulna. Even displaced fractures of the radial neck can be corrected with a distally introduced titanium pin. This method is safe in elective trauma surgery and will especially be useful in polytraumatized children in whom multiple fractures should be stabilized with minimal x-ray exposure in a short time.

Isolated hyperthermic perfusion with mitoxantrone of melphalan in malignant melanoma of the limb.

BACKGROUND: Melphalan administered by isolated hyperthermic perfusion of the affected limb is an accepted treatment for malignant melanoma of the extremities. In contrast, pharmacologic and phase I studies suggest that, because of its high uptake, mitoxantrone may give even better local control, but data on survival, onset of metastases, and local and systemic toxicities have not yet been reported. METHODS: A matched-pairs comparison was performed to examine differences in the tolerability and effectiveness of isolated hyperthermic extremity perfusion with mitoxantrone (n = 44) and melphalan (n = 44) in high risk and locoregionally (P < 0.41) metastatic malignant melanoma. Criteria evaluated were local and systemic complications, and recurrence-free and overall survival. RESULTS: Local complications, such as delayed wound healing, were more frequent in the mitoxantrone (27.9%) than in the melphalan group (9.8%) (P < 0.05). Systemic toxicity, in particular bone marrow toxicity, was also more severe with mitoxantrone (78.6% versus 15.4%, P < 0.001). Hepatotoxic effects were more frequent among patients in the melphalan group who were older and has lower tissue perfusion temperatures (P < 0.05). There was no difference between the two groups in overall or recurrence-free survival (P < 0.41). CONCLUSIONS: Local and systemic toxicity seem to be higher with mitoxantrone. Survival rates were similar with both drugs. The data obtained suggest a randomized phase II study with an appropriate number of patients.

Hemodialysis via the Scribner shunt in childhood: a surgical evaluation.

From 1973 to 1988, 105 children with renal failure (average age, 6.5 years; range, 5 days to 16.2 years) were treated with hemodialysis via surgically implanted Scribner shunts (n = 120). The average duration of dialysis was 16 days (range, 1 to 194 days). Twenty-three patients died during treatment or during the hospital stay because of the underlying disease; no patient died because of shunt complications. The treatment was initially successful for 82 children, but 14 of them died within several months of discharge. Among the initially surviving 82 patients, the shunt was the only means of access for dialysis in 52. In the other 30, the primary Scribner shunt was unsuccessful; it required replacement, or the type of dialysis had to be changed. The shunts were implanted in the forearm in 23%, the groin in 40%, and the ankle in 37%. Early complications were local bleeding (17%) after an average of 37.3 days, shunt occlusion (34%) after an average of 47.3 days, infections (9.3%) after an average of 43.9 days, and decreased blood flow (8.5%) after an average of 47.7 days. Vessels were reconstructed after discontinuation of dialysis in 28 cases, in which the Scribner shunt had been implanted in the groin. No patient experienced immediate ischemic problems. Long-term follow up results were obtained for 60% (n = 40) of the surviving 68 children after an average of 7 years (range, 2.1 to 15.2 years). We found no evidence of arterial or venous complications at the former shunt site.(ABSTRACT TRUNCATED AT 250 WORDS)

Membrane versus bubble oxygenator in hyperthermic regional perfusion: a prospective randomized clinical study.

In a prospective randomized clinical study a routinely used bubble oxygenator (Bentley-5) was compared with a hollow fiber membrane oxygenator (D 701 Masterflo 34) during hyperthermic isolated extremity perfusion. This was done to find out whether there were differences between the two oxygenators in hemolysis, cellular damage, oxygenation and temperature achieved during extremity perfusion. In 30 perfusions blood samples were obtained at defined times: plasma hemoglobin (Hb), serum lactate dehydrogenase (s-LDH), number of erythrocytes, mean corpuscular volume (MCV), hemoglobin and bilirubin were determined for hemolysis, leukocyte count (neutrophils, lymphocytes, monocytes) and platelets as a check for cellular damage, and PO2, PCO2, O2 saturation and pH to define blood oxygenation and CO2 elimination. Maximal increase in temperature after 30 min and perfusion time until maximum tissue temperature were also recorded. The membrane oxygenator yielded better results from the aspect of hemolysis: s-LDH and plasma Hb were significantly different (p < 0.001). Cellular damage was less with the membrane oxygenator: platelet differences were significant (p < 0.01). Oxygenation and hyperthermia were obtained more quickly and were better controllable in membrane oxygenator. Further advantages for the patient were the smaller volume of blood needed for priming in a membrane oxygenator (750 vs. 1,200 ml) and improved safety resulting from a 'closed' perfusion system. On the basis of the clinical prospective randomized trial conducted, we conclude that membrane oxygenators must be adopted as the new standard in isolated hyperthermic extremity perfusion.

Factors that influence the level of activities in persons with lower extremity amputation.

This study explored the problems of prosthesis use in four dimensions of activity in 122 males and 9 females, aged 24 to 90 years, with lower extremity amputations. Comparisons were made between persons with above-the-knee amputation and those with below-the-knee amputation. A four-dimensional prosthetic problem inventory scale developed by the investigators was used. Results of this study provide a framework for identifying and addressing problematic areas in the use of prostheses.

Rhinebothrium biorchidum n. sp., a tetraphyllidean cestode from a yellow-spotted stingray, Urolophus jamaicensis, in Jamaica.

Rhinebothrium biorchidum n. sp. (Tetraphyllidea: Phyllobothriidae) is described from the spiral valve of the yellow-spotted stingray, Urolophus jamaicensis, from Jamaica. It was most similar to R. spinicephalum Campbell 1970 but differed by having fewer proglottids (15 to 26 vs. 36 to 49), smaller peduncle (110 to 146 vs. 330 to 470) and pedicels (100 to 180 vs. 170 to 370), fewer transverse septa (6 to 8 vs. 16 to 17), fewer total loculi per bothridium (22 to 30 vs. 32 to 34) and larger ovarian lobes (148 to 310 vs. 88 to 176). A key to bitestate species of Rhinebothrium is included.

Ascarops talpa sp. n. (Nematoda: Spirocercidae) from the formosan mole, Talpa micrura insularis, in Taiwan.

Ascarops talpa sp. n. (Nematoda: Spirocercidae) is described from the small intestine of the Formosan mole, Talpa micrura insularis, from Taiwan. It is most similar to A. kutassi (Shul'ts, 1927) and A. tuvensis Sulimov, 1961. Ascarops kutassi differs by having a smaller ratio of left to right spicule length (1:4 vs. 1:5.5), no caudal alae, by its preanal papillae that are not equidistant from one another, and in its area rugosa which extends 1.25 mm anterior to the anus. Ascarops tuvensis differs by having a smaller ratio of left to right spicule length (1:3.8 vs. 1:5.5), by its preanal papillae that are not equidistant from one another, and in its area rugosa which covers only the ventral tip of the tail.