Posterior sternoclavicular joint dislocation in children-role of spiral computed tomography

Traumatic posterior dislocation of the sternoclavicular joint is an uncommon injury in children. It is not normally well seen on plain films. We report 2 cases where spiral computed tomography with intravenous contrast confirmed the clinical suspicion of sternoclavicular joint dislocation and also allowed assessment of the adjacent mediastinum for possible complications. Emergency physicians should be aware that the use of spiral computed tomography is the procedure of choice in posterior sternoclavicular joint dislocation. This is particularly helpful in allowing multiplanar reconstruction to show complications arising in the mediastinum.

Modern trends for external fixation of fractures in children: a critical review

There is considerable controversy about the use of external fixation to manage children's fractures. The indications for external fixation are examined in the light of the available evidence in the literature. A general overview of surgical considerations, including the type of fixator, pin placement, and duration of treatment, is given with an assessment of possible complications. External fixation offers a safe and effective management option and may perhaps be the subject of randomized controlled trials in the future.

Staging laparotomy for Hodgkin's disease in children

Experience with staging laparotomy in twenty-one children has produced minimal immediate postoperative morbidity. Sepsis in two patients after discharge has prompted the long-term use of penicillin. Confirmation or revision of clinical staging by laparotomy has proved to be an accurate means of determining therapy and prognosis in children.

Circular esophageal myotomy simulating a pulmonary or mediastinal pseudocyst

Circular esophageal myotomy of the upper pouch in infants with esophageal atresia is an effective means of reducing anastomotic tension. This report describes two patients who developed marked postoperative dilatation of the proximal esophagus at the myotomy site. On radiographs, the dilated, air-filled esophagus simulated a pneumomediastinum or intrathoracic cyst-like structure.

An investigation into the etiology of irritable hip

A prospective review has been made of 111 children who presented with acute hip pain to determine it's etiology and assess the need for multiple investigations at presentation. There was no clinical hematological, serological or bacteriological evidence to identify positively patients with an irritable hip, neither was there good correlation with a history of infection. An effusion was diagnosed by ultrasound in 71% but there were no factors, either clinically or by investigation, to differentiate between patients with or without an effusion. We conclude that multiple investigations to find a source of infection in patients with irritable hip are not warranted as they are rarely positive, seldom affect management and are of no help in investigating the etiology of irritable hip.

Limb reconstruction in Ollier's disease

We present our experience of lengthening and correction of complex deformities in the management of patients with Ollier’s dysplasia (multiple enchondromatosis) from 1985 and 2002. All patients were under 18 years with a minimum follow-up time of 2 years (mean 9.6 years, range 2–15 years). There were a total of ten patients of which seven were male and three female. The mean age at presentation was 10.7 years (range 5–17 years; SD 3.7 years). The total length gain was 42.3 mm (range 30–110 mm; SD 28.9 mm). The number of days in external fixation was 164.8 days (range 76–244 days; SD 42.9 days). The bone healing index was 32.5 days/cm (18–50 days/cm; SD 10.3 days/cm). Patients with Ollier’s disease have limb length inequality and angular deformities and require multiple reconstructive procedures owing to a high incidence of recurrence. We identified a tendency for the osteotomy to prematurely consolidate and advise the latency period after surgery to be 4–5 days and for distraction to proceed at a faster rate.

Characterization of the Methoxy Carbonyl Radical Formed via Photolysis of Methyl Chloroformate at 193.3 nm

This study investigates two features of interest in recent work on the photolytic production of the methoxy carbonyl radical and its subsequent unimolecular dissociation channels. Earlier studies used methyl chloroformate as a photolytic precursor for the CH3OCO, methoxy carbonyl (or methoxy formyl) radical, which is an intermediate in many reactions that are relevant to combustion and atmospheric chemistry. That work evidenced two competing C-Cl bond fission channels, tentatively assigning them as producing ground- and excited-state methoxy carbonyl radicals. In this study, we measure the photofragment angular distributions for each C-Cl bond fission channel and the spin-orbit state of the Cl atoms produced. The data shows bond fission leading to the production of ground-state methoxy carbonyl radicals with a high kinetic energy release and an angular distribution characterized by an anisotropy parameter, beta, of between 0.37 and 0.64. The bond fission that leads to the production of excited-state radicals, with a low kinetic energy release, has an angular distribution best described by a negative anisotropy parameter. The very different angular distributions suggest that two different excited states of methyl chloroformate lead to the formation of ground- and excited-state methoxy carbonyl products. Moreover, with these measurements we were able to refine the product branching fractions to 82% of the C-Cl bond fission resulting in ground-state radicals and 18% resulting in excited-state radicals. The maximum kinetic energy release of 12 kcal/mol measured for the channel producing excited-state radicals suggests that the adiabatic excitation energy of the radical is less than or equal to 55 kcal/mol, which is lower than the 67.8 kcal/mol calculated by UCCSD(T) methods in this study. The low-lying excited states of methylchloroformate are also considered here to understand the observed angular distributions. Finally, the mechanism for the unimolecular dissociation of the methoxy carbonyl radical to CH3 + CO2, which can occur through a transition state with either cis or, with a much higher barrier, trans geometry, was investigated with natural bond orbital computations. The results suggest donation of electron density from the nonbonding C radical orbital to the sigma* orbital of the breaking C-O bond accounts for the additional stability of the cis transition state.

Does the diurnal pattern of enteric methane emissions from dairy cows change over time?

Diet manipulation and genetic selection are two important mitigation strategies for reducing enteric methane (CH4) emissions from ruminant livestock. The aim of this study was to assess whether the diurnal pattern of CH4 emissions from individual dairy cows changes over time when cows are fed on diets varying in forage composition. Emissions of CH4 from 36 cows were measured during milking in an automatic (robotic) milking station in three consecutive feeding periods, for a total of 84 days. In Periods 1 and 2, the 36 cows were fed a high-forage partial mixed ration (PMR) containing 75% forage, with either a high grass silage or high maize silage content. In Period 3, cows were fed a commercial PMR containing 69% forage. Cows were offered PMR ad libitum plus concentrates during milking and CH4 emitted by individual cows was sampled during 8662 milkings. A linear mixed model was used to assess differences among cows, feeding periods and time of day. Considerable variation was observed among cows in daily mean and diurnal patterns of CH4 emissions. On average, cows produced less CH4 when fed on the commercial PMR in feeding Period 3 than when the same cows were fed on high-forage diets in feeding Periods 1 and 2. The average diurnal pattern for CH4 emissions did not significantly change between feeding periods and as lactation progressed. Emissions of CH4 were positively associated with dry matter (DM) intake and forage DM intake. It is concluded that if the management of feed allocation remains constant then the diurnal pattern of CH4 emissions from dairy cows will not necessarily alter over time. A change in diet composition may bring about an increase or decrease in absolute emissions over a 24-h period without significantly changing the diurnal pattern unless management of feed allocation changes. These findings are important for CH4 monitoring techniques that involve taking measurements over short periods within a day rather than complete 24-h observations.

Nitrous oxide emissions from cattle excreta applied to a Scottish grassland: effects of soil and climatic conditions and a nitrification inhibitor

Dung and urine excreted onto grasslands are a major source of nitrous oxide (N2O). These N2O emissions stem from inefficient utilisation of nitrogen (N) ingested by ruminants, and the inability of pasture to utilise the deposited N. Predicted growth in dairy and meat consumption means that there is a requirement to quantify N2O emissions, and investigate emission reduction mechanisms. Three 12 month 'seasonal' experiments were undertaken at Crichton, SW Scotland, where N2O emissions were measured from applications of cattle urine, dung, artificial urine and urine+a nitrification inhibitor (NI), dicyandiamide (DCD). The three application timings were 'spring', 'summer' and 'autumn', representative of early-, mid- and late grazing seasons. N2O emissions were measured from static chambers for 12 months. The aim was to quantify emissions from cattle excreta, and determine their dependence on the season of application, and the respective contribution of dung and urine to total excreta emissions. Measurement from NI amended urine was made to assess DCD's potential as an emission mitigation tool. Emissions were compared to the IPCC's default emission factor (EF) of 2% for cattle excreted N. Mean annual cumulative emissions from urine were the highest when applied in summer (5034 g N2O-N ha(-1)), with lower emissions from spring (1903 g N2O-N ha(-1)) and autumn (2014 g N2O-N ha(-1)) application, most likely due to higher temperatures and soil moisture conducive to both nitrification and denitrification in the summer months. Calculated EFs were significantly greater from urine (1.1%) than dung (0.2%) when excreta was applied in summer, and EFs varied with season of application, but in all experiments were lower than the IPCC default of 2%. These results support both lowering and disaggregating this EF into individual EFs for dung and urine. Addition of DCD to urine caused no significant reduction in emissions, suggesting that more research is required into its use as a mitigation option.

An experience with total parenteral nutrition in children

Total parenteral nutrition has been used in the treatment of more than 100 children with gastrointestinal illnesses, including 90 under the age of 6 months. The incidence of complications has been reduced markedly as experience was acquired. Total parenteral nutrition has been especially valuable in patients with intractable diarrhea syndrome and it has been used successfully in the management of infants with overwhelming systemic infections.

Bilateral scaphoid exostoses

We report a case of bilateral symptomatic scaphoid exostoses associated with osteoarthritis of the wrist. These were treated by surgical excision with good short-term results.

Perthes disease affecting three female first-degree relatives

Perthes disease has an incidence of 1 in 4,750 live births (1 in 3,000 boys, but only 1 in 11,800 girls). Although there is evidence for a genetic predisposition to Perthes disease, more than two family members are rarely affected. We report the first recorded case of Perthes disease affecting three female first-degree relatives.

Emergency treatment options for pediatric traumatic brain injury

Traumatic brain injury is a leading killer of children and is a major public health problem around the world. Using general principles of neurocritical care, various treatment strategies have been developed to attempt to restore homeostasis to the brain and allow brain healing, including mechanical factors, cerebrospinal fluid diversion, hyperventilation, hyperosmolar therapies, barbiturates and hypothermia. Careful application of these therapies, normally in a step-wise fashion as intracranial injuries evolve, is necessary in order to attain maximal neurological outcome for these children. It is hopeful that new therapies, such as early hypothermia or others currently in preclinical trials, will ultimately improve outcome and quality of life for children after traumatic brain injury.

Leg lengthening for short stature in Turner's syndrome

We describe ten patients with Turner's syndrome (karyotype 45, XO) who had leg lengthening for short stature. A high incidence of postoperative complications was encountered and many patients required intramedullary fixation as a salvage procedure. We discuss the reasons for this and highlight the differences between our findings and those of a similar series recently reported. In view of the considerable difficulties encountered, we do not recommend leg lengthening in Turner's syndrome.

Periosteal stripping in achondroplastic children. Little effect on limb length in 10 cases

We present a prospective study of the results of periosteal stripping and division in 10 achondroplastic children. A single limb (femur and tibia) was operated on and the change in actual length of each bone and the percentage change in growth compared to that of the non-operated limb was measured by scanogram. The mean absolute increase in growth was small, measuring 3 mm for the femur and 2 mm for the tibia. There was no measurable growth difference after 18 months. This method of increasing limb length in achondroplastic children prior to definitive and extensive lengthening procedures is not recommended.

Effects of photoperiod on reproductive development of peanut (Arachis hypogaea L.) in a cool subtropical environment. I. Field studies

The effects of photoperiod on reproductive development and yield of two Virginia, one Spanish and one Valencia peanut (Arachis hypogaea L.) cultivar were investigated in the field at Kingaroy, Australia. The objective was to assess the importance of photoperiod as a limitation to post-flowering reproductive development in a cool subtropical environment. A total of five experimental sowings were made between the 1986/87 and 1988/89 growing seasons. Treatments consisted of either natural photoperiods (ranging from 11 to 14 h, depending on sowing date and growth stage) or long (16 h) photoperiods during a range of phenological stages, both pre- and post-flowering. Long photoperiods were achieved by using low intensity light from incandescent bulbs with equal extension periods in both morning and evening. Different sowing dates and seasons were used to produce a range of natural photoperiods, radiation and temperature regimes, while shadecloth was used to alter incident irradiance during the 1988/89 experiments. Photoperiod responses were significant in only one experiment (S2, 1986/87), and were due to effects of treatment during the immediate post-flowering period. Numbers of flowers, pegs and pods were reduced under long photoperiods in cv. Robut 33-1, and to a lesser extent, in cv. White Spanish. The Virginia cv. Uf 781 14-5 was unaffected. The effects of long photoperiods during this 30 day post-flowering treatment were not expressed until after the treatment period. Effects were relatively small and reproductive (pod) yields at maturity were not significantly reduced. The lack of strong photoperiod responses in the reportedly sensitive Valencia cv. NC17090 and the occurrence of the strongest response in the relatively insensitive cv. Robut 33-1 were unexpected. Analysis of climatic data from these experiments, and others reported in the literature, suggested interactions between photoperiod and temperature, with photoperiod effects being only significant at higher temperatures, i.e. in our studies, when mean daily temperature during the treatment period was 26-0�C. This finding is of considerable significance in assessing the importance of photoperiod sensitivity for cultivar adaptation to long day/subtropical environments. A subsequent paper in this series examines photoperiod x temperature interactions more closely under controlled environment conditions.

The role of adenosine during the period of delayed cerebral swelling after severe traumatic brain injury in humans

Cerebrovascular failure with an increase in cerebral blood volume or hyperemia contributes delayed cerebral swelling after severe traumatic brain injury (TBI) in humans. One mediator that could be involved in this process is adenosine, which stimulates a concurrent reduction in cerebral metabolic rate and an increase in cerebral blood flow (CBF). We hypothesized that during the delayed phase after TBI in humans: 1) CSF adenosine concentration is associated with uncoupling of CBF and CMRO2, and 2) adenosine formation is driven by mediator-stimulated cAMP production in injured brain. We serially measured CBF and AVDO2, and CSF adenosine, lactate and cAMP after severe TBI in 13 humans. After 6-18 h, global CBF was increased and AVDO2 was reduced vs all other time periods, defining the uncoupling phase as the period between 18 h and 5 days. CSF adenosine concentration was negatively associated with AVDO2 and strongly associated with death (both p < 0.05), CSF lactate peaked during the initial 18 h, but remained increased for 5 days. CSF cAMP concentration was not increased (vs normal). The association between CSF adenosine concentration and death, and the correlation between uncoupling of CBF and oxidative metabolism and CSF adenosine concentration support our first hypothesis. In contrast, the low levels of cAMP in CSF observed in these patients, but persistently increased CSF lactate, refute our second hypothesis. We speculate that hyperglycolysis or occult ischemic foci are possible sources of ATP breakdown and adenosine formation, and that adenosine is playing a neuroprotective role.