[The coxopodopatellar syndrome]

Characteristic features of the coxopodopatellar syndrome are patellar hypoplasia, pelvic skeletal anomalies and morphologic abnormalities of the front of foot. Fifteen cases with variable degrees of anomaly were observed in one family. Since a world-wide literature review failed to demonstrate any perfectly identical observation it was considered that this triple lesion constitutes an original syndrome worth reporting in detail.

A comparative analysis of newborn outcome in a hospital-based birthing center

Medical records of babies born in a hospital-based birthing center were reviewed to determine whether a birthing center alternative to traditional hospital care of the newborn is safe and cost-effective. A cohort of 123 hospital-based birthing center low-risk deliveries was compared to 100 control low-risk deliveries born in the traditional setting at the medical center during the same time period. Morbidity was assessed using the Hollister Classification as reference and was based on treatment need. The analysis of the babies' status at birth, 24 hours, and 72 hours revealed no difference in immediate morbidity. Cost of hospitalization was reduced by $340.00 per cohort baby. These data suggest that this alternative can be safe and cost-effective. This study applies only to hospital-based birthing centers, because the safety of free-standing birthing centers has not been established and because screening for low risk can not eliminate morbidity.

The effect of nitrous oxide on the oxyhaemoglobin dissociation curve

The influence of nitrous oxide on the oxyhaemoglobin dissociation curve (ODC) was studied using blood from twenty healthy patients. When the blood samples were exposed to 50 per cent N2O during the determination of the ODC, a left shift was observed and the P50 was decreased by 1.06 kPa (8 mmHg). This shift cannot be explained by temperature, pH, PCO2, or 2,3-DPG effects. Following exposure of the blood to N2O-free gases, the shift disappeared rapidly, and a normal P50 (3.46 kPa) (26 mmHg) was reobtained. In keeping with this reversibility, blood samples taken before and during 45 minutes of N2O-curare anaesthesia showed identical dissociation curves to those which had been obtained during the in vitro N2O exposure experiment.

Reversion to fetal circulation in congenital diaphragmatic hernia: a preventable postoperative complication

A review of 26 patients with congenital diaphragmatic hernia, diagnosed in the first 24 hours of life, supports the hypothesis that the postoperative fetal circulation syndrome is an iatrogenic complication, due to the rapid expansion of both lungs, when they are severely hypoplastic. This complication is preventable, when no aspiration of air from the chest cavity is done, and when no tube attached to an underwater seal is inserted. When assisted ventilation is necessary, small volumes at a rapid rate allows satisfactory gaseous exchanges, without pulmonary overinflation.

Survival of autotransfused red blood cells recovered from the surgical field during cardiovascular operations

The survival of autologous red blood cells (RBCs) collected during operation from the surgical field and processed immediately by the Haemonetics Cell Saver was compared to the survival of autologous nonprocessed RBCs obtained by venipuncture in nine patients undergoing reconstructive vascular operations and four patients undergoing coronary artery bypass. A double isotope technique (Cr-51 and In-111) was used to determine the survival of the different cell populations. Seven patients undergoing coronary artery bypass served as controls to characterize the isotopes by labeling the same population of RBCs with each radionuclide. Comparison of the data in all groups failed to show any significant difference in either the immediate or long-term survival between autotransfused (Cell Saver--processed) blood and nonprocessed RBCs. This study indicates that shed blood collected and processed at operation with the Haemonetics Cell Saver can be autotransfused and that the in vivo survival of these cells is not significantly different from the survival of nonprocessed blood.

Comparison between a clinical short-cut method and a precise laboratory estimation of intrapulmonary shunt and A-aDO2

This study shows the application to 20 patients of a very simple formula to estimate A-aDO2 and intrapulmonary shunt, from data commonly available in patients with oxygenation disorders. The values obtained by the "clinical short cut" method and the more sophisticated one are in statistically significant correlation.

Measurement of serum free thyroxine by RIA in various clinical states

A radioimmunoassay for quantitatively measuring the serum concentration of free thyroxine is described. This method does not require equilibrium dialysis, and is rapid and reproducible. The serum values obtained by this radioimmunoassay and by equilibrium dialysis are similar in normal subjects, hyperthyroid and hypothyroid patients, pregnant women, "sick euthyroid" patients, and euthyroid patients with hereditary TBG abnormalities. The method also provides a total serum thyroxine concentration in the same assay procedure.

[Tricipital and subscapular skinfold thickness: normal values for boys and girls between 4 and 19 1/2 years of age from Western Switzerland]

Application of profile analysis (4) to skinfold thickness (tricipital ; subscapular) experimentally shows that when data are collected under strict control of the measuring technique, the fluctuations ascribale to observers, to left or right body sides, and to replications may be almost entirely eliminated.

Anaesthesia for separation of conjoined twins

We have presented the anaesthetic technique used during the separation of two female pygopagus conjoined twins. The twins were three months old and weighed 9.2 kilograms on the day of the operation. The main problem during the operation was to evaluate blood volume lost by each patient and a close monitoring of all cardiovascular parameters was necessary to attain this aim. The little pygopagus recuperated well and left the hospital at six months old.