Three-dimensional assessment of umbilical vein deviation angle for prediction of liver herniation in left-sided congenital diaphragmatic hernia

OBJECTIVES

To introduce a new sonographic marker of intrathoracic liver herniation in fetuses with left-sided congenital diaphragmatic hernia (CDH).

METHODS

In a consecutive series of fetuses with isolated CDH, an ultrasound volume of the fetal abdomen was acquired. On this volume, offline calculation of the angle formed by the midline of the abdomen (joining the center of the vertebral body to the abdominal insertion of the umbilical cord) and a second line joining the center of the vertebral body to the intra-abdominal convexity of the umbilical vein was carried out to give the umbilical vein deviation angle (UVDA). The UVDA was measured in a group of normal fetuses selected as controls. At follow-up, the presence of liver herniation was investigated in all cases of CDH. UVDA values were compared between the CDH group and controls, and between CDH 'liver-up' vs 'liver-down' cases. A receiver-operating characteristics (ROC) curve was constructed to identify a cut-off value of the UVDA with the highest accuracy in predicting liver herniation in the CDH group.

RESULTS

Between 2009 and 2015, 22 cases of left-sided CDH were included in the study group, of which nine cases had liver herniation. Eighty-eight normal fetuses were recruited as controls. The UVDA was significantly higher in the cases vs controls (15.25 ± 7.91° vs 7.68 ± 1.55°; P < 0.0001). Moreover, the UVDA was significantly increased in CDH fetuses with liver-up vs liver-down (21.77 ± 8.79° vs 10.75 ± 2.10°; P < 0.0001). On ROC curve analysis the UVDA showed good prediction of liver herniation (area under the ROC curve, 0.94; P < 0.0001) with the best cut-off of 15.2°, yielding a sensitivity of 89% and a specificity of 100% (P < 0.0001).

CONCLUSIONS

In fetuses with CDH, umbilical vein bowing may be quantified by measuring the UVDA using three-dimensional ultrasound. This sonographic marker seems to be an accurate predictor of liver herniation in left-sided CDH. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

[Surgery of congenital malformations in developing countries: experience in 13 humanitarian missions during 9 years]

The authors report their surgical experience concerning seriously impaired children due to congenital malformations or other non-congenital anomalies such as burns and traumas. All the patients were operated in one of 13 humanitarian missions undertaken in four developing countries. Throughout the "Third World" the demand for reconstructive surgery is extremely high due to the high birth rate and consequently large number of patients, as well as the shortage of both medical staff and supplies. In developing countries Primary Health Care has always been considered a priority and so hospitals, which are used mainly for emergency operations, are usually few in number and badly equipped; elective surgery is considered a luxury. Children with congenital diseases and/or other non-congenital anomalies who are fortunate enough to reach a hospital will often be treated by general surgeons lacking specific training; those children suffering from disabling conditions are often neglected and left to live with their anomalies for the rest of their lives. Our surgical missions have always been undertaken at the request of Catholic missionaries and/or secular organizations which contribute to the individual health schemes of each country. Highly experienced volunteer staff took part in the missions; medical teams are made up of 2 surgeons, one or two anaesthetists and two scrub nurses. The assistance and cooperation of local medical staff was essential in the preselection of cases to be operated while each single medical team provided all the necessary supplies for surgery, which took place in small but well-equipped missionary hospitals provided by the local authorities. A total of 1140 children were operated on during the 13 missions: 32% of these had routine procedures performed in day surgery and 54% underwent major plastic and reconstructive surgery for facial, uro-genital and anorectal malformations or for serious consequences of burns or traumas. The proportion of emergencies was only 3% as these were normally excluded because of the short duration of the missions. 26 patients had to be reoperated as a result of complications or surgical failure and long-term follow-up provided by either the local staff or as a part of later missions was given in over 70% of the major surgery performed. On the whole, the surgical results were highly satisfactory even if a final evaluation should be made taking the cultural factors and the socio-environmental conditions of each individual country into consideration. Such an evaluation should most importantly be made on the basis of the well-being of the patient, general satisfaction of the families involved and improved quality of life of these children.

Treatment of the Mayer-Rokitansky-Küster-Hauser syndrome in Bangladesh: results of 10 total vaginal replacements with sigmoid colon at a missionary hospital

PURPOSE

We report our experience with treating the Mayer-Rokitansky-Kuster-Hauser syndrome in a developing country. The operations were performed by a pediatric surgical team at a missionary hospital in Khulna, Bangladesh.

MATERIALS AND METHODS

From 1995 to 1998, 10 young women with the Mayer-Rokitansky-Kuster-Hauser syndrome underwent complete vaginal replacement. In 4 patients the abnormality was discovered after marriage at the initial sexual approach and, thus, the husband abandoned 3. In 4 of the 10 cases the diagnosis was suspected because of absent menstruation. A physician made the diagnosis in only 2 cases. Preoperatively abdominal ultrasound in 3 patients showed a hypoplastic uterus in all and a right solitary pelvic kidney in 1. In all 10 women a neovagina was created using a 14 cm. segment of sigmoid colon. Two weeks postoperatively patients were taught to dilate and irrigate the neovagina.

RESULTS

A minimum of 1 year of followup is available in 7 of the 10 patients. The vagina had a good appearing introitus. Mucous production significantly decreased 3 to 4 months after the operation. Two patients already had an active sexual life. The remaining 3 patients underwent surgery during the last mission and they had no complications 6 months postoperatively.

CONCLUSIONS

Our experience shows the feasibility of treating patients with a severe abnormality in a hospital with basic facilities in one of the poorest countries in the world.

Total vaginal replacement with sigmoid colon for partial testicular feminilizing syndrome in pediatric age

Full text is available as a scanned copy of the original print version.

Accessibility of primary care physicians' offices for people with disabilities. An analysis of compliance with the Americans With Disabilities Act

OBJECTIVE

To determine if primary care physicians are in compliance with the Americans With Disabilities Act of 1990 (ADA) and to what extent offices of primary care physicians are usable for persons with disabilities.

DESIGN

Cross-sectional survey.

SETTING

Members listed in the Harris County (Texas) Medical Society roster.

SUBJECTS

Sixty-two general practitioners, family practitioners, internists, and obstetrician-gynecologists.

MAIN OUTCOME MEASURE

A 15-page questionnaire with 57 items and 136 variables.

RESULTS

Eleven (18%) of the primary care physicians in this study were unable to serve their patients with disabilities in the last year for reasons that could be interpreted as noncompliant with the ADA. Two physicians (3%) had offices that patients with disabilities could not enter because of physical barriers, and 1 physician (2%) had inaccessible equipment. Fourteen physicians (22%) were improperly referring patients with disabilities although they generally treat such patients. In measuring the level of compliance with regard to structural features that enhance the accessibility of the physicians' offices, only 8 (13%) had a low level of compliance. Thirty-nine (63%) of the physicians supplied auxiliary aids and services to their patients with disabilities. The most common aid was printed materials.

CONCLUSIONS

A substantial portion of primary care physicians' offices are not in compliance with the ADA, and some informational tools will be required to inform physicians about the nondiscriminatory requirements of the statute.

Predicting acute denervation in carpal tunnel syndrome

OBJECTIVE

To determine which nerve conduction parameters can predict the presence of acute denervation in carpal tunnel syndrome.

SETTING

The electrodiagnostic laboratories of a hospital and a county hospital district.

DESIGN

A retrospective review.

PATIENTS

A total of 1,590 consecutive cases from January 1992 to June 1996, diagnosed as having median neuropathy at the wrist.

MAIN OUTCOME MEASURES

Evidence of acute denervation on needle electromyography of the abductor pollicis brevis and its relationship to patient age, gender, and parameters obtained from nerve conduction studies, including median sensory latency and amplitude, and median motor latency and amplitude.

RESULTS

Logistic regression analysis identified gender, median motor latency, and median motor amplitude (all p < or = .008) as contributing to the prediction of denervation. Needle examination of the cases with a median motor amplitude <7 mV detected 95.3% (141/148) of all cases with denervation and could have spared 52% (708/1,362) of the population from a needle examination of the abductor pollicis brevis.

CONCLUSION

The median motor amplitude can predict the presence of acute denervation in the thenar muscles in median neuropathy at the wrist and possibly eliminate a painful needle examination of the median-innervated thenar muscles in over 50% of the cases.

Functional outcomes of patients on a rehabilitation unit after open heart surgery

BACKGROUND

Compared with predecessors, the modern-day patient who undergoes cardiac surgery is sicker, is older, has more diffuse disease, has poorer ventricular function, and is more likely to be a repeat surgery. Patients hospitalized after open heart surgery in the 1990s, therefore, may require increasingly comprehensive rehabilitation services before returning to the community; however, information documenting functional progress during, and outcome after, a hospital-based rehabilitation program is scarce.

METHODS

During a 14-month period, a consecutive sample of 44 patients who underwent cardiac surgery and were admitted to a rehabilitation unit in a tertiary acute hospital was studied. Thirty-one patients had coronary artery bypass graft, six had valvular surgery, and seven had both. Each patient's functional status on admission and discharge from the rehabilitation unit was assessed using the Functional Independence Measure. Other data studied included patient age and sex, premorbid medical problems, type of cardiac surgery, length of stay, and occurrence of medical complications in the acute and rehabilitation units.

RESULTS

The mean Functional Independence Measure scores at rehabilitation unit admission and discharge were 76.1 +/- 17.1 and 96.7 +/- 19.4, respectively, and this difference was significant (P < 0.0001). The most significant correlates (alpha = 0.05) of the discharge Functional Independence Measure were admission Functional Independence Measure (P < 0.00001) and length of stay in the acute care unit (P = 0.0072). Age and presence of medical complications were not significant.

CONCLUSION

Patients who undergo open heart surgery, many of whom have medical comorbidity, are able to demonstrate substantial functional improvement on an inpatient rehabilitation program before hospital discharge.

Analysis of gram negative recolonization of the neuropathic bladder among patients with spinal cord injuries

Over a 4 year period, 119 acute spinal cord injury (SCI) patients were enrolled in this study. The 101 males and 18 females had a mean age of 35.9 years (range 16-87). Sixty-two patients were tetraplegic and 57 were paraplegic. All patients had a urine specimen taken for culture, colony count and sensitivity once weekly while they were receiving intermittent catheterization. Of these, 22 patients (18.5%), none of whom had underlying genito-urinary (GU) pathology, developed recolonization by an organism of the same species and genus previously cultured. All 22 reached sterile-urine between colonizations after being treated with antibiotics for at least 7 days. The 16 males and six females had a mean age of 35.1 years (range 17-79). Sixteen were tetraplegic and six were paraplegic. Plasmid analysis (PA) was used to determine whether these recolonizations were from the same or from a different strain. In those instances where the bacteria harbored no plasmids or where the results of plasmid analysis were otherwise inconclusive, bacteria were also compared using restriction fragment length polymorphism (RFLP) analysis. Recolonization was caused primarily by E. coli and K. pneumoniae. While there was no significant difference between the two organisms with respect to the number of days when sterile urine occurred to the time when recolonization was observed, there were significant differences seen in both organisms with regard to the time lapse from one colonization to the next: the average number of days to recolonization with an identical organism was 10.3 days, whereas with a different strain it was 15.9 days (P < 0.04). When a different organism was cultured between the recolonizations, the mean recolonization interval was 17.9 days. When no intervening organism occurred, the interval was 9.5 days (P < 0.005). Both intervals measured the days from the first sterile urine after the first colonization to the next colonization. These data indicate the proclivity for two common Gram negative normal bowel inhabitants to recolonize the neuropathic bladder of spinal cord injured patients even after adequate treatment. PA and RFLP provide a means of discriminating between relapses by the same organism versus recurrences by a different organism of the same species and genus. Those with the same identity tend to recur sooner than those of different identities and may be suspected when relapse occurs within two weeks of cessation of 7 day course of antibiotics. While an intervening organism may delay the relapse (or recurrence), it does not prevent it and identical organisms can reappear even after adequate therapeutic regimens. Since none of the patients in this study had GU pathology, recolonization by an identical strain (relapse) does not necessarily warrant an extensive investigation for disease within the GU tract.

Pediatric surgical missions in Bangladesh

Bangladesh is one of the poorest countries in the world, with a population of more than 120 million people living in a territory of only 55,000 square miles. Pediatric surgery is not recognized as an independent branch of surgery: the Dhaka Shishu Hospital is the only pediatric hospital in the country. Sponsored by the World Organization for Pediatric Surgery in Emerging Countries and Azienda Ospedaliera di Parma, the authors performed four surgical missions in Bangladesh in the city of Khulna from 1991 to 1995. During these missions 395 operations were performed on children with general surgical urological, or maxillofacial problems. Besides the humanitarian significance of these missions, it is very edifying for a Western surgeon to observe the natural evolution of untreated congenital malformations.

Reported pressure ulcer prevention and management techniques by persons with spinal cord injury

OBJECTIVE

The purpose of this study was to identify factors that resulted in severe pressure ulcers in a community-based sample of 23 persons with spinal cord injury (SCI).

DESIGN

A correlational design was used.

SUBJECTS

Twenty men and three women, 57% with tetraplegia and 43% with paraplegia, participated. Adult participants with an ulcer of 12 weeks' duration or less were recruited from the plastic surgery clinic of a regional SCI center.

MEASURES

A structured survey assessed demographic, SCI and ulcer characteristics; detection method; immediacy and appropriateness of action; time from detection to clinic visit; number of prior ulcers; and knowledge and practice of ulcer prevention techniques. Ulcer characteristics (ie, location, size, and stage) were assessed by examination and compared with participants' descriptions of their ulcers.

RESULTS

Severe ulcers and ulcers that progressed in severity after initial detection were less accurately described by participants. Individuals who waited longer to come to the clinic presented with more severe ulcers. Taking immediate or appropriate action when an ulcer was detected was related to reported performance of more preventive behaviors. Contrary to expectation, immediacy and appropriateness of action, and knowledge and practice of preventive behaviors were unrelated to severity, progression of severity, and time from detection to the clinic visit. The findings suggest that educational programs should emphasize more strongly immediate visits to a physician upon detection of an ulcer. Furthermore, such educational models should be assessed for their effectiveness in reducing ulcers and preventing progression in severity once persons with SCI return to the community.

Alcohol and marijuana use in a community-based sample of persons with spinal cord injury

The prevalence of self-reported alcohol and marijuana use, along with alcohol abuse as measured by the Short Michigan Alcoholism Screening Test, was assessed for a community-based sample (n = 123) of persons with spinal cord injury (SCI). Correlates of alcohol and marijuana use and alcohol abuse also were examined, including demographic variables, measures of impairment, disability, and handicap, SCI medical complications, and measures of subjective assessment such as health rating, health maintenance behaviors, depression, life satisfaction, perceived stress, pain, and social support. Prevalence of alcohol use (59%) and marijuana use (16%) in persons with SCI was less than that of comparison groups in the general population. However, prevalence of alcohol abuse (21%) exceeded that of general population studies. Participants who abused alcohol shared the following criteria: (1) perceived their overall health as worse than those who did not abuse alcohol; (2) were more depressed; and (3) experienced more stress in their lives than those who did not abuse alcohol. Participants who used marijuana were younger at the time of the study and were younger at injury. They were also more depressed and more stressed. The indications of alcohol abuse in one in five persons with SCI living in the community mandates that screening, treatment, and referrals be part of any rehabilitation treatment program.

Intrathecal baclofen: does tolerance occur?

Concern over the development of tolerance in patients on continuous intrathecal baclofen therapy has arisen as this new form of treatment for spasticity has gained wider use. We have studied time-dose relationships in 18 spinal cord injured patients who have undergone intrathecal baclofen infusion pump implantation since February 1988 in our facility. Our data show that there was a significant increase in baclofen dosage needed to control spasticity during the first 12 months post implantation. After 12 months, however, no significant changes in dosage requirement was detected. In addition, there was no significant difference between completely and incompletely spinal cord injured patients with regard to both the initial dose and the tolerance trend.

Hypotensive anesthesia for scoliosis surgery in Jehovah's Witnesses

Hypotensive anesthesia has been advocated in spinal surgery for the purpose of diminishing operative blood loss. This study evaluated its effectiveness in 12 Jehovah's Witnesses undergoing Harrington instrumentation and fusion who refused transfusion. Previous series from this institute did not use deliberate hypotension because of routinely low blood loss. Compared with matched controls operated on under normotensive anesthesia, the Jehovah's Witness patients had lower absolute blood loss but also shorter operative time. Applied linear-regression analysis demonstrated that the diminished blood loss was associated with shorter operative time (P = 0.0002) rather than lower blood pressure. The majority of blood losses in spinal instrumentation with fusion occurs with decortication. This rapid bleeding occurs at venous pressures which are unaffected by arterial blood pressure manipulation. The authors conclude that spinal surgery is possible in Jehovah's Witnesses without transfusion and that operative technique is the single most important determinant of blood loss.

Diagnostic problems in a Wilms' tumour of the horseshoe kidney

The authors report on a case of Wilms' tumour in a horseshoe kidney in a child with correct preoperative diagnosis. They emphasise the superiority of the ultrasound and CT scan studies. A brief discussion of the surgical approach in the different presentations is made. The authors suggest, because of the predisposition of the horseshoe kidney to develop Wilms' tumour to perform, an annual ultrasound study for its surveillance.

Clonidine effect on spasticity: a clinical trial

Clonidine was used as an adjunct to baclofen in 55 patients with spasticity due to spinal cord injury. Dosage was held at the minimum effect amount for those who responded. No effect was seen in 24 patients (44%), although 31 (56%) benefitted from the drug. Patients were grouped as quadriplegics or paraplegics, having complete or incomplete lesions. Of all quadriplegics, seven of 11 complete (64%) and 17 of 25 incomplete patients (68%) responded; among the paraplegics, six of 15 complete (40%) and one of four incomplete patients (25%) improved. Side effects were limited to postural hypotension necessitating reduction in dosage in three patients that were successfully treated; in the unsuccessfully treated group, one patient had insomnia, one had dizziness, and one had drowsiness.

Vocational development following severe spinal cord injury: a longitudinal study

Vocational development of individual with spinal cord injury was studied from shortly after injury to two years after discharge from inpatient rehabilitation. Objectives included examining differences in the course of vocational development by level of functional independence, and predicting vocational outcomes two years after injury. Thirty-three spinal cord injury patients (17 quadriplegics, 16 paraplegics) were followed during the study. The Goldberg Scale of Vocational Development was used to measure changes in vocational development over time. The Barthel Index was used to measure level of functional independence. Results revealed that vocational development was markedly depressed during initial inpatient rehabilitation and for six months after injury. Gradual improvement occurred after six months, but two years after discharge the level of vocational development remained lower than that before injury. Changes in vocational development over time did not differ significantly by level of functional independence. Best predictors of successful vocational outcomes were educational attainment, educational plans made before injury, and origin of interests in work.

[Intraluminal diverticulum of the duodenum]

A case of intraluminal duodenal diverticulum associated with partial situs inversus in a 15 year-old girl is reported. Etiopathogenicity is discussed. The pathological characteristics explain that surgery associated with upper digestive endoscopy had to be performed and why endoscopic excision was not possible in this case.

Postdischarge outcomes for ventilator-dependent quadriplegics

Based on data contributed to the National Spinal Cord Injury Data Base between the years 1975 and 1981, outcomes were assessed for 34 patients who had been injured approximately a year earlier and who were ventilator dependent when discharged from inpatient rehabilitation. Their outcomes were compared with those of 196 patients who required mechanical respiration some time during acute care or rehabilitation, but who were free of such assistance at discharge. Statistically significant differences were obtained between the groups in levels of spinal cord injury, duration of acute care hospitalization, duration of total hospitalization, extent of self-care capability, hours/week of hired attendant care, and hours of actual physical assistance/day. The groups did not differ significantly in terms of duration of inpatient rehabilitation, duration of rehospitalization, and vocational or prevocational status at follow-up.

Results of a survey of 201 polio survivors

We present the results of a survey on the late effects of poliomyelitis in 201 persons. The most common new problems were fatigue, weakness in previously affected and unaffected muscles, muscle pain, and joint pain. The median time from poliomyelitis to onset of new problems ranged from 30 to 40 years. Factors at onset of polio most strongly associated with development of these late effects of polio were (1) hospitalization (P less than 0.00001), (2) age greater than 10 years (P less than 0.00001), (3) ventilator use (P less than 0.0029), and (4) paralytic involvement of all four limbs (P less than 0.0240). The differential diagnosis of these new problems, implications for treatment, and areas for future research are discussed.

[Gastro-esophageal reflux in childhood. When to operate?]

Gastroesophageal reflux has been well described in children as the cause of a variety of symptoms from nutritional to respiratory problems. If the regurgitation and vomiting are very common symptoms in newborns, their persistence after the first months of life will result in pathological entity leading to complications as esophagitis, failure to thrive, respiratory problems. The purpose of this article is to point out the functional and anatomical implications maintaining gastroesophageal reflux in children and the correct indications for surgery.

New problems in old polio patients: results of a survey of 539 polio survivors

Presented are the results of a questionnaire survey on new health problems in 539 polio survivors. The most common new problems were fatigue, weakness in previously affected and unaffected muscles, muscle pain, and joint pain. The median time from polio to the onset of these problems ranged from 30 to 40 years. Factors at onset of polio most strongly associated with developing these new health problems were: being hospitalized, being over 10 years old, being on a ventilator, and having paralytic involvement of all four limbs. The differential diagnoses of these new problems, implications for treatment and areas for future research are discussed.

[Varicocele in childhood]

The Authors analyze 20 cases of left varicocele, treated surgically, in boys from 10 to 16 years with the mean age of 12 years. During the operation a testicular biopsy was carried out alternatively in both testicles, showing, mostly, a growth arrest of the spermatogenesis. A blood sample from the left internal spermatic vein was taken for the measurement of the testosterone. The Authors discuss the results and emphasize an early correction of the varicocele.

[Conservative treatment of splenic injuries in childhood]

From 1978 to 1983, 11 children with splenic traumas were observed at the Pediatric Surgery of Parma. The diagnosis was confirmed by splenic scintigraphy with 99m Technetium. Those patients whose condition was stable with intravenous fluids or blood transfusions were not operated on. Emergency laparotomy was necessary only in 3 cases of 11 patients, when the general conditions were unstable.

[Traumatic intramural hematoma of the duodenum. Description of a case]

The traumatic intramural hematoma of the duodenum is the result of contusion of the retroperitoneal portion of the duodenum. This lesion occurs most frequently in children and can result in complete obstruction of the second and third portion of the duodenum.

[Proposal for difficult nursing in neonatal Hirschsprung's disease]

Often the Hirschsprung's disease presents severe neonatal manifestations: enterocolitis, intestinal occlusion. The authors experienced a conservative treatment in 3 patients with Hirschsprung's disease using elemental diets. This behaviour avoided the colostomy, otherwise necessary with a normal nursing.

[Gastric acidity and serum levels of pepsinogen I and gastrin in children with primary duodenal ulcer]

A population of 8 children aged 7 to 13 and radiologically and/or endoscopically diagnosed of duodenal ulcer is compared with another made up of 12 normal children of similar ages and weights. In both groups gastric secretion, basal and after pentagastrin stimulation, and serum levels of gastrin and pepsinogen I, basal and after pentagastrin stimulation, and serum levels of gastrin and pepsinogen pepsinogen basal and after pentagastrin stimulation, and serum levels of gastrin and pepsinogen I, basal and after proteic meal, were studied. BAO, MAO and PAO were significantly higher in ulcer patients. Gastrinemia, both basal and stimulated, were rather similar in both groups. Serum pepsinogen I was always higher in ulcer patients in the basal state than in their healthy counterparts (greater than ng/ml vs. 30-50 ng/ml), but was not modified by proteic meal in either group. The fact that all ulcer children had a familial history and a basal pepsinogen I elevated, aside with the secretory response to stimulation, suggests that ulcer can be result either of an increased mass or of a higher sensitivity of gastric parietal cells that could be related to genetic factors.

[Clinical approach to constipation: proposal of a diagnostic and therapeutic protocol]

A study concerning constipation in children has been carried out in the University Department of Pediatrics and in the Division of Pediatric Surgery of Parma with the aim of reaching an homogeneus approach: it has been applied to 20 children up to now observed for such a problem. According to clinical and anamnestic criteria, children were divided into 3 groups on the basis of different degree of constipation: 1) moderate, 2) mild, 3) severe. Children belonging to the 2nd and 3rd group underwent barium enema and rectal manometry; two cases of ultrashort Hirschprung's disease and 7 cases of functional megarectum were diagnosed. Different treatment have been employed for each group and good results were observed in 18 cases. The AA. briefly discuss the different aspects concerning constipation and its therapy in childhood including diet, drugs, psychotherapy and surgical treatment.

Effects of somatostatin in a case of severe hypoglycemia due to nesidioblastosis

The Authors have studied the effects of somatostatin (SRIF) treatment in an infant affected by hypoglycemia due to nesidioblastosis. During iv infusion with SRIF we observed a marked increase of blood glucose levels; concomitantly insulin secretion was almost completely suppressed. In contrast, during treatment with protamine zinc-somatostatin (PZ-SRIF), a long acting SRIF preparation, the blood glucose levels did not rise and insulin concentrations were inappropriately elevated. Therefore in this case the long term treatment of hypoglycemia due to nesidioblastosis with PZ-somatostatin was unfeasible.

[A middle esophageal ring]

The Authors, having observed a case of middle oesophageal web giving rise to severe dysphagia, discuss the aetiopathogenesis, the diagnosis and therapy of these rare oesophageal lesions. Because of its pathological feature, the reported case was succesfully treated by surgical resection of the ring, using a transthoracic approach.

Judgments of the potential benefits of rehabilitation research

A critical step in a project to develop a benefit-cost approach to evaluating proposed rehabilitation research has been to specify the potential benefits of such research in a reasonably systematic and comprehensive manner. The purposes of this study were: (1) to assess the contemporary relevance of 46 benefit factors yielded by a 1973 survey: (2) to acquire judgmental data to reduce these factors to fewer and more generic 2nd-order factors: (3) to compare 7 different rehabilitation role groups in terms of how the potential benefits of rehabilitation research are valued. "Hierarchical clustering" analyses of similarity judgments by 96 participants yielded 18 2nd-order benefit factors. A number of reliable differences were identified among the role groups regarding the value placed upon specific potential benefits of rehabilitation research.