Safety and Feasibility of Skin-to-Skin Contact in the Delivery Room for High-Risk Cardiac Neonates.

Early skin-to-skin contact (SSC), beginning in the delivery room, provides myriad health benefits for mother and baby. Early SSC in the delivery room is the standard of care for healthy neonates following both vaginal and cesarean delivery. However, there is little published evidence on the safety of this practice in infants with congenital anomalies requiring immediate postnatal evaluation, including critical congenital heart disease (CCHD). Currently, the standard practice following delivery of infants with CCHD in many delivery centers has been immediate separation of mother and baby for neonatal stabilization and transfer to a different hospital unit or a different hospital altogether. However, most neonates with prenatally diagnosed congenital heart disease, even those with ductal-dependent lesions, are clinically stable in the immediate newborn period. Therefore, we sought to increase the percentage of newborns with prenatally diagnosed CCHD who are born in our regional level II-III delivery hospitals who receive mother-baby SSC in the delivery room. Using quality improvement methodology, through a series of Plan-Do-Study-Act cycles we successfully increased mother-baby skin-to-skin contact in the delivery room for eligible cardiac patients born across our city-wide delivery hospitals from a baseline 15% to greater than 50%.

The extensor tendon splitting approach to the proximal interphalangeal joint: do we need to reinsert the central slip?

Current approaches to the proximal interphalangeal (PIP) joint have potential complications and limitations. We present a dorsal approach that involves splitting the extensor tendon in the midline, detaching the insertion of the central slip and repairing the extensor tendon without reinserting the tendon into the base of the middle phalanx. A retrospective review of 16 digits that had the approach for a PIP joint arthroplasty with a mean follow up of 23 months found a postoperative PIP active ROM of 61 degrees (range 25-90 degrees). Fourteen digits had no extensor lag, while two digits had an extensor lag of 20 degrees and 25 degrees. This modified approach is fast and simple and does not cause an extensor lag.

Metastatic lymphadenopathy from ENT carcinoma: role of diagnostic imaging.

Problems concerning the use of different imaging modalities in N staging of the neck are dealt with. The peculiar features, findings, sensitivity, specificity and diagnostic accuracy of each modality in the diagnosis of nature of cervical lymphadenopathy are described, as reported in most recent reports of literature, and according to the personal experience. CT/MRI criteria commonly used to establish whether a lymph node is metastatic or benign/reactive are related to the size, morphology, density (CT), signal intensity (MRI), evidence of central necrosis and extracapsular spread. Color Doppler US is a reliable method in the diagnosis of cervical metastatic lymphadenopathy even if no parameter is highly predictive; the combination of different findings, especially cortical thickening and structural inhomogeneity with thin, compressed, displaced or non visualized hilum makes the procedure significantly sensitive and specific. Intranodal hilar vascularization on color Doppler, with high resistance arterial flow (PI > 1.5), enhances the predictive value of findings of bi-dimensional sonography. Extracapsular spread impacts on survival as well as on the number of recurrences, which increases in patients with extracapsular spread; the disease-free interval is less in these patients. The identification and definition of extracapsular spread is based on some CT/MRI criteria as: 1) lymph nodes with spiky, irregular margins; 2) loss of adipose cleavage planes around the node and thickening of adjacent fascia; 3) apparent invasion of an adjacent structures or muscles. Similarly to CT/MR, sonographic findings of extracapsular spread can be: 1) blurred margins and irregular contours; 2) invasion of an adjacent structure or muscle.