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Muff JL, Guglielmetti LC, Gros SJ, Buchmüller L, Frongia G, Haecker FM, Holland-Cunz SG, de Trey T, Vuille-dit-Bille RN. Correction to: Failed preoperative vacuum bell therapy does not affect outcomes following minimally invasive repair of pectus excavatum. Pediatr Surg Int 2022; 38:779. [PMID: 35235017 PMCID: PMC8983503 DOI: 10.1007/s00383-022-05087-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- J. L. Muff
- grid.412347.70000 0004 0509 0981Department of Pediatric Surgery, University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
| | - L. C. Guglielmetti
- grid.452288.10000 0001 0697 1703Department of Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - S. J. Gros
- grid.412347.70000 0004 0509 0981Department of Pediatric Surgery, University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
| | - L. Buchmüller
- grid.412347.70000 0004 0509 0981Department of Pediatric Surgery, University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
| | - G. Frongia
- grid.5253.10000 0001 0328 4908Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - F.-M. Haecker
- grid.414079.f0000 0004 0568 6320Department of Pediatric Surgery, Children’s Hospital of Eastern Switzerland, St. Gallen, Claudiusstrasse 6, 9006 St. Gallen, Switzerland ,grid.6612.30000 0004 1937 0642Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - S. G. Holland-Cunz
- grid.412347.70000 0004 0509 0981Department of Pediatric Surgery, University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
| | - T. de Trey
- grid.412347.70000 0004 0509 0981Department of Pediatric Surgery, University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
| | - Raphael N. Vuille-dit-Bille
- grid.412347.70000 0004 0509 0981Department of Pediatric Surgery, University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
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Frongia G, Dostal F, Ziebell L, Vuille-Dit-Bille NR, Müller T, Schenk JP, Mehrabi A, Günther P. Delayed Surgery for Perforated Appendicitis is Feasible in Children Without Compromising the Outcome in Selected Cases. World J Surg 2022; 46:1980-1986. [PMID: 35445826 DOI: 10.1007/s00268-022-06561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM The relationship between time to surgery and risk of postoperative complications and re-intervention has not been conclusively investigated in pediatric perforated appendicitis (PA). The aim of this study was to determine whether time to appendectomy (TTA) is a risk factor for postoperative complications and re-intervention in a cohort of children undergoing appendectomy for PA. METHODS A total of 254 children (age: 8.7 ± 3.7 years) undergoing appendectomy for PA were retrospectively evaluated and stratified into Group I-III according to the Clavien-Dindo classification for postoperative complications (Group I n = 218, 86%; Group II n = 7, 3%; Group III n = 29, 11%). RESULTS The TTA was comparable between all groups (group I: 8.8 ± 9.2 h; group II: 7.8 ± 5.3 h; group III: 9.5 ± 9.6 h; overall: 8.8 ± 9.1 h; p = 0.885). A C-reactive protein (CRP) value at admission of ≥128.6 mg/l indicated a higher risk for developing Grade II complications with no need for re-intervention (OR: 3.963; 95% CI: 1.810-8.678; p = 0.001) and Grade III complications with the need for re-intervention (OR: 3.346; 95% CI: 1.456-7.690; p = 0.004). This risk was independent of the TTA (OR: 1.007; 95% CI: 0.980-1.035; p = 0.613). CONCLUSIONS Appendectomy can be delayed by an average time delay of about 9 h in children with PA without increasing the risk of postoperative complications and re-intervention, also in patients at high risk defined by the initial CRP level ≥ 128.6 mg/l. This data may support the correct risk-adjusted scheduling of surgical interventions in times of limited capacity.
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Affiliation(s)
- G Frongia
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
| | - F Dostal
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - L Ziebell
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - N R Vuille-Dit-Bille
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, Switzerland
| | - T Müller
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - J P Schenk
- Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - A Mehrabi
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - P Günther
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
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Muff JL, Guglielmetti LC, Gros SJ, Buchmüller L, Frongia G, Haecker FM, Holland-Cunz SG, de Trey T, Vuille-Dit-Bille RN. Failed preoperative vacuum bell therapy does not affect outcomes following minimally invasive repair of pectus excavatum. Pediatr Surg Int 2021; 37:1429-1435. [PMID: 34272597 PMCID: PMC8408062 DOI: 10.1007/s00383-021-04963-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE It is unknown if failed preoperative vacuum bell (VB) treatment in patients undergoing minimally invasive repair of pectus excavatum (MIRPE), delays repair and/or affects postoperative outcomes. METHODS A retrospective data analysis including all consecutive patients treated at one single institution undergoing MIRPE was performed between 2000 and 2016. Patients were stratified into preoperative VB therapy versus no previous VB therapy. RESULTS In total, 127 patients were included. Twenty-seven (21.3%) patients had preoperative VB treatment for 17 months (median, IQR 8-34). All 27 patients stopped VB treatment due to the lack of treatment effect. Eight (47.1%) of 17 assessed VB patients showed signs of skin irritation or hematoma. VB treatment had no effect on length of hospital stay (p = 0.385), postoperative complications (p = 1.0), bar dislocations (p = 1.0), and duration of bar treatment (p = 0.174). Time spent in intensive care unit was shorter in patients with VB therapy (p = 0.007). Long-term perception of treatment including rating of primary operation (p = 0.113), pain during primary operation (p = 0.838), own perspective of look of chest (p = 0.545), satisfaction with the procedure (p = 0.409), and intention of doing surgery again (p = 1.0) were not different between groups. CONCLUSIONS Failed preoperative VB therapy had no or minimal effect on short-term outcomes and long-term perceptions following MIRPE.
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Affiliation(s)
- J L Muff
- Department of Pediatric Surgery, University Children's Hospital of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - L C Guglielmetti
- Department of Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - S J Gros
- Department of Pediatric Surgery, University Children's Hospital of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - L Buchmüller
- Department of Pediatric Surgery, University Children's Hospital of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - G Frongia
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - F -M Haecker
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St.Gallen, Claudiusstrasse 6, CH-9006, St.Gallen, Switzerland.,Faculty of Medicine, University of Basel, 4056, Basel, Switzerland
| | - S G Holland-Cunz
- Department of Pediatric Surgery, University Children's Hospital of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - T de Trey
- Department of Pediatric Surgery, University Children's Hospital of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Raphael N Vuille-Dit-Bille
- Department of Pediatric Surgery, University Children's Hospital of Basel, Spitalstrasse 33, 4056, Basel, Switzerland.
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Frongia G, Majlesara A, Saffari A, Abbasi DS, Gharabaghi N, Okun JG, Thiel C, Günther P, Vianna R, Mehrabi A. P2.59: Simultaneous Serial Transverse Enteroplasty (STEP) in Size Mismatch Small Bowel Transplantations. Transplantation 2019. [DOI: 10.1097/01.tp.0000576104.71684.c6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Frongia G, Janosi C, Mehrabi A, Schenk JP, Günther P. Long-term outcome in displaced lateral humeral condyle fractures following internal screw fixation in children. Acta Orthop Belg 2016; 82:889-895. [PMID: 29182135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The aim of this study was to investigate the long-term clinical outcome following open reduction and internal screw fixation of displaced lateral condyle fractures (LCFs) of the distal humerus and compare the outcome of primary and secondary LCFs. METHODS The clinical outcome in 31 children (mean age 5.8±2.4 years) operated for primary or secondary LCFs was retrospectively analyzed by standardized clinical examination and compared using the Mayo score, Morger score, and Patients Satisfaction score. RESULTS The scores did not differ significantly between the primary and secondary displacement groups (Mayo score: 99.3±3.3 vs. 100±0, p=0.852; Morger score: 3.8±0.5 vs. 3.9±0.3, p=0.852; Patients Satisfaction score: 3.7±0.6 vs. 3.9±0.3, p=0.546). Deficits in range of motion and joint axis deviation were minor (< 10°) and no elbow instabilities were observed. CONCLUSIONS Surgical treatment of a secondary displaced LCF with open reduction and internal screw fixation leads to a favorable long-term outcome. The long-term outcome is similar between primary and secondary displaced LCFs.
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Abstract
PURPOSE Assessment of risk factors for postoperative complications following surgical treatment of pediatric perforated appendicitis (PA) is necessary to identify those patients in need of closer monitoring. In this study, we have investigated the impact of different risk factors on the occurrence of complications after an appendectomy in children with PA. MATERIAL AND METHODS The study was a retrospective, single-centre analysis of all pediatric PA conducted over a 10-year period. Preoperative clinical and laboratory results, intraoperative findings, and postoperative complications were analyzed. Risk factors were defined and a risk score was determined for postoperative complications and reinterventions. RESULTS Surgical treatment for appendicitis was performed in 840 pediatric patients during the observation period. 163 of the included patients were diagnosed with PA (mean age 8.9 ± 3.6 years). 19 (11.7%) patients developed postoperative complications, 17 (10.4%) of which required complication-related intervention. We identified five predictors of postoperative complications: the C-related protein value at admission, purulent peritonitis, open appendectomy (primary, secondary, or converted), placement of an abdominal drain, and administration of antibiotics not compliant to results from the subsequent antibiogram. The determined risk score was significantly higher in the complication group (p < .0001) and reintervention group (p < .001). CONCLUSIONS Postoperative complications following pediatric PA can be predicted using specific preoperative, intraoperative, and postoperative risk factors. In the high-risk group, an active prevention, detection, and intervention of any occurring complication is necessary and we present a new specific pediatric risk score to define patients at risk for complications.
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Affiliation(s)
- G Frongia
- a Division of Pediatric Surgery, Department of General , Visceral and Transplantation Surgery
| | - A Mehrabi
- b Department of General , Visceral and Transplantation Surgery
| | - L Ziebell
- a Division of Pediatric Surgery, Department of General , Visceral and Transplantation Surgery
| | - J P Schenk
- c Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology , University Hospital of Heidelberg , Heidelberg , Germany
| | - P Günther
- a Division of Pediatric Surgery, Department of General , Visceral and Transplantation Surgery
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Mehrabi V, Mehrabi A, Jamshidi SH, Pedram MS, Sabagh MS, Jaberansari N, Fonouni HR, Sharifi AH, Malekzadeh R, Frongia G. Modified Spiral Intestinal Lengthening and Tailoring for Short Bowel Syndrome. Surg Innov 2015. [DOI: 10.1177/1553350615596639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. The spiral intestinal lengthening and tailoring (SILT) procedure is a new surgical technique for autologous intestinal reconstruction in patients with short bowel syndrome. The aim of this work is to present a first description of a modified SILT technique by which the mucosal layer is left intact to possibly reduce the severe postoperative complications of intestinal leakage and abdominal abscess formation. Materials and Methods. The modified SILT technique was performed on a 10-cm-long intestinal segment in 2 pigs to determine the technical feasibility. Thereafter, the short-term clinical feasibility was monitored clinically in 2 dogs by gastrointestinal X-ray series at postoperative day 4 and by relaparotomy postoperative day 10. Results. It was technically feasible to lengthen the intestinal segment from 10 cm to 20 cm and tailoring it from 3 cm to 1.7 cm in diameter, while leaving the intestinal mucosal layer intact. The postoperative course was uneventful for both dogs. The gastrointestinal X-ray series showed an inconspicuous intestinal transit time without any signs of stricture, perforation, or leakage. In the relaparotomy, the initially achieved lengthening and tailoring extents were preserved and the operated intestinal segment was well perfused with no early signs of necrosis, stenosis, or leakage. Conclusions. Leaving the mucosal layer intact during SILT is technically and clinically feasible in the short term in a large animal model. Further studies are needed to fully assess the impact of this technical modification on the long-term outcome of larger series.
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Affiliation(s)
| | | | | | | | - M. S. Sabagh
- Tehran University of Medical Science, Shariati, Iran
| | | | | | - A. H. Sharifi
- Tehran University of Medical Science, Shariati, Iran
| | - R. Malekzadeh
- Tehran University of Medical Science, Shariati, Iran
| | - G. Frongia
- Heidelberg University, Heidelberg, Germany
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Frongia G, Weih S, Romero P, Mehrabi A, Holland-Cunz S, Günther P. Surgical intervention does not affect short-term plasma citrulline levels in infants: implications for citrulline as a marker of postoperative intestinal complications. Eur Surg 2015. [DOI: 10.1007/s10353-015-0312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Weih S, Nickkholgh A, Kessler M, Frongia G, Hafezi M, Golriz M, Fard N, Holland-Cunz S, Mehrabi A. Models of short bowel syndrome in pigs: a technical review. ACTA ACUST UNITED AC 2013; 51:66-78. [PMID: 24081112 DOI: 10.1159/000354806] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 08/05/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Short bowel syndrome (SBS) is still a life-threatening disease in both children and adults. Although the therapeutic options are improving, challenges still remain, and to overcome these challenges is a major focus of SBS research today. In order to simulate anatomical and physiological conditions similar to those in humans for research, porcine models of SBS are often used. Various approaches for generating SBS models have been described in the literature. METHODS/RESULTS In this work, we present a review of different types of porcine models of SBS and outline the differences between those models regarding types of animals, surgical procedures, monitoring, and methods of assessment. CONCLUSION The aim of this study was to select the most suitable SBS model regarding the purpose of the research.
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Affiliation(s)
- S Weih
- Department of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany
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Piancino MG, Comino E, Talpone F, Vallelonga T, Frongia G, Bracco P. Reverse-sequencing chewing patterns evaluation in anterior versus posterior unilateral crossbite patients. Eur J Orthod 2011; 34:536-41. [DOI: 10.1093/ejo/cjr109] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Romero P, Frongia G, Wingerter S, Holland-Cunz S. Prospective, randomized, controlled trial comparing a tissue adhesive (Dermabond™) with adhesive strips (Steri-Strips™) for the closure of laparoscopic trocar wounds in children. Eur J Pediatr Surg 2011; 21:159-62. [PMID: 21283958 DOI: 10.1055/s-0030-1270458] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND 4 methods are used in pediatric laparoscopic surgery to close trocar wounds. While tissue adhesives or adhesive strips have been shown to produce fewer wound complications and a better cosmetic result compared to trans- or only subcutaneous sutures, the choice of technique is still often based on the surgeon's personal experience. Thus, the objective of this trial was to assess the impact of tissue adhesives (Dermabond™) compared to adhesive strips (Steri-Strip™) on potential complications of wound healing, wound pain, cosmetic outcome, and patient satisfaction after laparoscopic appendectomy in children. METHODS 49 patients undergoing laparoscopic appendectomy were enrolled in this prospective randomized trial. In every patient, two 5-mm and one 10-mm port-site incision was closed either with Dermabond™ or Steri-Strip™ after placing subcuticular absorbable sutures (4-0 Vicryl™). Postoperative complications, pain, and patient satisfaction with scars were evaluated at follow-up on day 10 and day 90 after the operation using a questionnaire and a visual analogue scale (VAS). Photographs of scars taken on day 90 were evaluated on a VAS by 2 pediatric surgeons blinded to the closure method used. RESULTS According to the surgeons' evaluation of the cosmetic outcome, a significant difference between the 2 groups with regard to the cosmetic score was found on day 90 of follow-up, favoring Steri-Strip™ wound closure (p < 0.05). On day 10 and 90 there were no statistical differences between the 2 methods as regards the result of patient evaluations (p > 0.05). Only one wound infection (4%) was observed in the Steri-Strip™ group (n = 25) on day 10. At follow-up on day 90 two patients (9.1%) in the Dermabond™ group and one (4.8%) in the Steri-strip™ group complained of wound pain (p = 0.52). CONCLUSIONS Both tissue adhesives and adhesive strips are excellent "no needle" alternatives for the closure of laparoscopic port-site incisions in children. As regards cosmetic outcome, Steri-Strip™ wound closure seems to be the most suitable and is also the less expensive technique.
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Affiliation(s)
- P Romero
- Department of Surgery, Section Pediatric Surgery, University of Heidelberg, Heidelberg, Germany.
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Piancino MG, Roberi L, Frongia G, Reverdito M, Slavicek R, Bracco P. Computerized axiography in TMD patients before and after therapy with 'function generating bites'. J Oral Rehabil 2008; 35:88-94. [PMID: 18197841 DOI: 10.1111/j.1365-2842.2007.01815.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The study evaluates the temporomandibular joint (TMJ) movements of patients with signs and symptoms of temporomandibular disorders (TMD) before and after therapy with the functional appliances of the 'function generating bite' (FGB) type. Thirty subjects suffering from TMD were selected and divided into two groups: group A (young patients: four males, nine females, mean age +/- standard deviation: 13.3+/-1.5 years); group B (adults: three males, 14 females, mean age +/- standard deviation: 23.2+/-4.4 years). A control group comprised 13 healthy subjects with perfect normal occlusion, TMD-free, was matched for age and sex with patient groups and was examined at T0 and after 12 months (T1). Computerized axiography was performed before and after therapy (average 13 months) with FGBs to evaluate any difference in condyle border movements. Results showed a statistically significant improvement after treatment, for groups A and B, in length, clicks, tracings with normal morphology, superimposition, deviations, regularity and return to starting position and speed (statistical analysis: chi-squared test) except for the symmetry of tracings which was significantly improved only for the young patient group. No statistically significant differences at time T0/T1 were found in the control group. In conclusion, the study shows that the TMJ tracings of TMD patients before and after therapy with 'FGB' significantly improve especially in young patients. FGB may be a useful appliance to improve TMJ function in young and adult TMD patients requiring orthodontic treatment.
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Affiliation(s)
- M G Piancino
- Chair Department of Orthodontics and Gnathology-Masticatory Function, University of Turin, Turin, Italy
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Lombardi E, Sly PD, Concutelli G, Novembre E, Veneruso G, Frongia G, Bernardini R, Vierucci A. Reference values of interrupter respiratory resistance in healthy preschool white children. Thorax 2001. [DOI: 10.1136/thx.56.9.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUNDInterrupter respiratory resistance (Rint) is reported to be useful in evaluating lung function in poorly collaborating patients. However, no reference values are available from large samples of preschool children using the standard interrupter method. The aim of this study was to define reference Rint values in a population of healthy preschool children.METHODSRint was assessed without supporting the cheeks in children with no history of wheeze from six kindergartens. To evaluate the effects of upper airway compliance on Rint in healthy children, an additional group of preschool children with either no history of wheeze or no respiratory symptoms at the time of testing underwent Rint measurements in our lung function laboratory with and without supporting the cheeks. Short term (about 1 minute apart) and long term (mean 2.5 months apart) repeatability of Rint measurements (2 SDs of the mean paired difference between measurements) was also assessed in children referred for cough or wheeze.RESULTSA total of 284 healthy white children (age range 3.0–6.4 years) were evaluated. Mean inspiratory and expiratory Rint (Rinti and Rinte) did not differ significantly in boys and girls. Age, height, and weight showed a significant inverse correlation with both Rinti and Rinte in the univariate analysis with linear regression. Multiple regression with age, height, and weight as the independent variables showed that all three variables were significantly and independently correlated with Rinti, whereas only height was significantly and independently correlated with Rinte. Supporting the cheeks had no significant effect on Rinti (n=29, median 0.673 v0.660 kPa/l.s, p=0.098) or Rinte (n=39, median 0.702v 0.713 kPa/l.s, p=0.126). Short term repeatability was 0.202 kPa/l.s for Rinti (n=50) and 0.242 kPa/l.s for Rinte (n=69). Long term repeatability was 0.208 kPa/l.s for Rinte (n=26).CONCLUSIONSWe have reported reference Rint values in preschool white children and have demonstrated the usefulness of this technique in assessing lung function in this age group.
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Lombardi E, Sly PD, Concutelli G, Novembre E, Veneruso G, Frongia G, Bernardini R, Vierucci A. Reference values of interrupter respiratory resistance in healthy preschool white children. Thorax 2001; 56:691-5. [PMID: 11514689 PMCID: PMC1746135 DOI: 10.1136/thorax.56.9.691] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Interrupter respiratory resistance (Rint) is reported to be useful in evaluating lung function in poorly collaborating patients. However, no reference values are available from large samples of preschool children using the standard interrupter method. The aim of this study was to define reference Rint values in a population of healthy preschool children. METHODS Rint was assessed without supporting the cheeks in children with no history of wheeze from six kindergartens. To evaluate the effects of upper airway compliance on Rint in healthy children, an additional group of preschool children with either no history of wheeze or no respiratory symptoms at the time of testing underwent Rint measurements in our lung function laboratory with and without supporting the cheeks. Short term (about 1 minute apart) and long term (mean 2.5 months apart) repeatability of Rint measurements (2 SDs of the mean paired difference between measurements) was also assessed in children referred for cough or wheeze. RESULTS A total of 284 healthy white children (age range 3.0-6.4 years) were evaluated. Mean inspiratory and expiratory Rint (RintI and RintE) did not differ significantly in boys and girls. Age, height, and weight showed a significant inverse correlation with both RintI and RintE in the univariate analysis with linear regression. Multiple regression with age, height, and weight as the independent variables showed that all three variables were significantly and independently correlated with RintI, whereas only height was significantly and independently correlated with RintE. Supporting the cheeks had no significant effect on RintI (n=29, median 0.673 v 0.660 kPa/l.s, p=0.098) or RintE (n=39, median 0.702 v 0.713 kPa/l.s, p=0.126). Short term repeatability was 0.202 kPa/l.s for RintI (n=50) and 0.242 kPa/l.s for RintE (n=69). Long term repeatability was 0.208 kPa/l.s for RintE (n=26). CONCLUSIONS We have reported reference Rint values in preschool white children and have demonstrated the usefulness of this technique in assessing lung function in this age group.
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Affiliation(s)
- E Lombardi
- Paediatric Allergy and Pulmonology Centre, "Anna Meyer" Children's Hospital, Department of Paediatrics, University of Florence, 50132 Florence, Italy.
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de Martino M, Veneruso G, Gabiano C, Frongia G, Tulisso S, Lombardi E, Tovo PA, Galli L, Vierucci A. Airway resistance and spirometry in children with perinatally acquired human immunodeficiency virus-type 1 infection. Pediatr Pulmonol 1997; 24:406-14. [PMID: 9448232 DOI: 10.1002/(sici)1099-0496(199712)24:6<406::aid-ppul5>3.0.co;2-e] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Airway resistance was measured by the interrupter technique in 54 children [aged 63.8 months (range: 9.1-131.6 months)], with perinatal human immunodeficiency virus-type 1 (HIV-1) infection and in a control group of 315 gender, height, and race-matched healthy children. In addition, 14 HIV-infected children, aged 75-131 months, had spirometry performed. Resistance was significantly higher in infected children than in controls (0.84 +/- 0.3 vs 0.64 +/- 0.08 kPa x l(-1) x s; t = 9.991; P < 0.0001). Resistance decreased with age in controls (r = -0.95; P < 0.001), but not in infected children (r= -0.22; P = 0.105). Resistance did not correlate with mothers' intravenous drug addiction, perinatal data, T-cell subset numbers, treatment, clinical course, or presence of respiratory complications. Resistance was higher (t = 3.103; P < 0.003) in p24 antigen-positive than in negative children. Thirty-nine children underwent a second evaluation 12.3 months (range 11.1-14 months) after the first. Resistance was higher (t = 3.960; P < 0.0001) at the second evaluation compared to the first. Eight of 14 children had abnormal spirometric measurements. We conclude that perinatal HIV-1 infection is associated with increased airway resistance and often abnormal spirometry. The degree of abnormalities in resistance depends on the duration of the infection rather than on HIV-1-related respiratory complications.
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Affiliation(s)
- M de Martino
- Department of Medicine, University of Chieti, Italy
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Novembre E, Frongia G, Lombardi E, Resti M, Zammarchi E, Vierucci A. The preventive effect and duration of action of two doses of inhaled furosemide on exercise-induced asthma in children. J Allergy Clin Immunol 1995; 96:906-9. [PMID: 8543748 DOI: 10.1016/s0091-6749(95)70227-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Exercise-induced asthma can be prevented by treatment with inhaled furosemide. OBJECTIVE In this study we evaluated the effect and duration of action of two doses (15 and 30 mg) of inhaled furosemide in prevention of exercise-induced asthma in children. METHODS Ten children with exercise-induced asthma (8 boys and 2 girls, aged 6 to 13 years) were included in the study. Each patient was tested with three treatment regimens (placebo, 15 mg of furosemide, and 30 mg of furosemide) in random order on 3 separate days. Patients performed exercise challenges on a treadmill at 20 minutes and 1, 2, 3, and 6 hours after each treatment. Pulmonary function, urinary output, and fluid intake were monitored. RESULTS Both doses of furosemide had a significantly greater protective effect than placebo, but there was no significant difference between the two doses of furosemide. The higher dose of furosemide was associated with increased urinary output and had a longer duration of action. CONCLUSION A 30 mg dose of furosemide is more effective for treatment of exercise-induced asthma in terms of duration but has a significant diuretic effect.
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Affiliation(s)
- E Novembre
- Department of Pediatrics, Ospedal A. Meyer, Florence, Italy
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17
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Novembre E, Frongia G, Lombardi E, Veneruso G, Vierucci A. The preventive effect of nedocromil or furosemide alone or in combination on exercise-induced asthma in children. J Allergy Clin Immunol 1994; 94:201-6. [PMID: 8064072 DOI: 10.1016/0091-6749(94)90041-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Recent evidence suggests that inhaled nedocromil and furosemide are effective in preventing asthma by ultrasonically nebulized distilled water, allergen, and exercise. There are, however, no studies that compare the effects of these two drugs. The aim of this study was to investigate the effect of inhaled furosemide (30 mg), nedocromil (4 mg), the combination of these two drugs, and placebo aerosol in preventing exercise-induced asthma. METHODS Twenty-four children with exercise-induced asthma, aged 6 to 16 years, performed a treadmill test before and 20 minutes after a single dose of drug(s) in a double-blind trial. Lung function measurements were taken before drug administration, before the exercise test (20 minutes after drug administration), and then 2, 4, 6, 8, 10, 15, 20, and 30 minutes after the exercise test. RESULTS Both active drugs performed significantly better than placebo. In fact, the exercise challenge resulted in a mean maximum fall in forced expiratory volume in 1 second of 28.46% +/- 13.84% after administration of placebo, but of only 15.42% +/- 8.35% after administration of nedocromil (p < 0.001) and of 11.37% +/- 9.14% after administration of furosemide (p < 0.001). When the two drugs were given together, there was a statistically significant additive effect because the mean maximum fall in forced expiratory volume in 1 second was 5.75% +/- 3.57% (nedocromil vs nedocromil + fluorsemide: p < 0.001; furosemide vs nedocromil + furosemide: p < 0.01). CONCLUSION This study suggests that nedocromil and furosemide provide a comparable effect in preventing exercise-induced asthma in children. The combined administration of the two drugs significantly increases the protective effects, suggesting a potential therapeutic use.
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Affiliation(s)
- E Novembre
- Department of Pediatrics-Ospedale A. Meyer, Florence, Italy
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Abstract
The surgical management of ptosis is reported in seven patients suffering from the ocular fibrosis syndrome. Satisfactory results were obtained with bilateral Crawford type brow suspension with autologous fascia lata in six patients and bilateral Fox type brow suspension with stored fascia lata in a young child. As patients with ocular fibrosis syndrome usually exhibit little or no Bell's phenomenon, corneal exposure can become a problem after brow suspension. It was recommended that the lids are left just closed on the operating table at the end of the operation. None of the patients required a subsequent procedure to lower an overcorrection of the ptosis. The routine prescription of ocular lubricants for 2 months after ptosis correction is advocated. Urgent brow suspension in young children using non-autologous materials should only be considered if there is a risk of amblyopia.
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Affiliation(s)
- C Liu
- Lid Clinic, Moorfields Eye Hospital, London
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Biavasco F, Manso E, Giovannini A, Frongia G, Scaglia M, Lupidi R, Giovanetti E, Tittarelli R, Steele AD, Visvesvara GS. Bilateral acanthamoeba keratitis. Clin Infect Dis 1994; 18:661-2. [PMID: 8038336 DOI: 10.1093/clinids/18.4.661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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