High proportion of type I fibres in thigh muscle of young dancers.

A previous study showed that adult female dancers have a high percentage of type I fibres in vastus lateralis, similar to that of endurance-trained female runners or female cross-country skiers. It is not known if dancers already at an early age are characterized by a high percentage of type I fibres or develop a high percentage of type I fibres as a consequence of dance training. Furthermore, the muscle fibre composition of male dancers has not previously been studied. Therefore the aim of the study was to analyse skeletal muscle fibre characteristics in 10-year-old and 20-year-old dancers of both sexes. Age-matched boys and girls whose physical activity was average for their age groups served as controls. Muscle biopsies for histochemical analysis were obtained from vastus lateralis using the percutaneous needle technique. The major finding of the present study was that the vastus lateralis of young dancers of both sexes had a higher percentage of type I fibres than that of controls. Moreover, the higher type I percentage was seen not only in 20 year olds, but also in 10 year olds, who had begun their dance training at a professional level only a few weeks earlier. No significant difference in this respect was found between female and male dancers. In conclusion, the muscle fibre type composition in young dancers of both sexes differs from that of the average individual of the same age and is characterized by a high percentage of type I fibres.

Gray-scale sonography in torsion of the testicular appendages.

The reliability of gray-scale ultrasonography in diagnosing torsion of the testicular appendages was studied in a series of 54 boys with acute non-traumatic scrotal pain. All boys were operated upon, and the appendages extirpated irrespective of their appearance at exploration; the final diagnosis was based on histological examination. Forty-two boys had appendicular torsion, 2 had testicular torsion and 10 had other diagnoses. Using the sign of appendicular torsion--an echogenic extratesticular structure situated between the head of the epididymis and the upper pole of the testis--as the criterion, 37 displayed a true positive, 9 a true negative, 3 a false positive and 5 a false negative diagnosis. Thus, the sensitivity was 88%, the specificity 75% and the positive predictive value 93% respectively. The echogenic mass varied in size from 3 to 17 mm in diameter. In 34 of the 42 cases of appendicular torsion extratesticular fluid was present, and 19 patients showed enlargement of the head of the epididymis. It is concluded that gray-scale sonography is an accurate and valuable tool in diagnosing torsion of the testicular appendages.

[30 years of urethral valve treatment in Sweden]. / 30 Jahre Urethralklappenbehandlung in Schweden.

To achieve the best possible late results in valve treatment we think the following procedure would be mandatory: 1. Immediate transfer to a specialised hospital. 2. Acute diagnostics with correction of the water and electrolytes balance. 3. Suprapubic procedure is preferable over the transurethral approach if the catheter is expected to remain indwelling for a length of time. 4. The obstructing urethral valve is the primary object. 5. Resection is done only in 12 o'clock position in dorsosacral (lithotomy) position. 6. In rare cases with a severely constricted neck of the bladder it may be necessary to perform resection after Turner-Warwick. 7. In most cases it is possible to avoid surgical intervention at the upper urinary tract. 8. Regular follow-up checks are urgently recommended (sonography, x-ray, endoscopy, urodynamics).

Skiing injuries in children: lower leg fractures.

A study was made of 113 children who sustained a lower leg fracture during downhill skiing. The age distribution showed a peak between 4 and 7 years in both sexes, and boys had another peak in their teens. Three of four patients were beginners. To a large extent, they had had their bindings adjusted in ski shops. Three of four bindings did not release at the time of the accident. Spiral fractures in the shaft or distal metaphysis of the tibia predominated (73%); the incidence of concomitant fibular fracture was low. The degree of malalignment was generally small. The results of treatment, which was generally conservative, were good, 7% of the patients having minor sequelae 1-3 years after the accident. To reduce the risks in children's downhill skiing, the following measures seem important: intensified training during the beginner stage; increased supervision by parents and in ski schools; development of children's release bindings and testing methods; and adequate instruction of personnel in ski shops.

Skiing safety in children: adjustment and reliability of the bindings.

One-hundred children were picked at random from ski lift queues and were questioned as regards their skiing ability, experience, and ski equipment. Around 40% of the skiers had not made any adjustment and/or setting of the bindings. The lateral toe release and recentering forces were recorded. We found, irrespective of to which reference system our results were correlated, a very low percentage of bindings with acceptable setting, lower than has been reported for adults. Sixty percent of the bindings did not have any space between the sole of the boot and the slip plate. After correction of the space, the lateral toe release torque decreased significantly. Only 20% of the bindings displayed a recentering force. Our results indicate the need for several improvements regarding children's release bindings, including factors such as mechanical function, adjustment, and testing. The IAS reference system is recommended as the best of the existing reference systems.

Urinary incontinence in children: treatment with free autogenous muscle transplantation.

Free autogenous muscle transplantation has now been carried out in 13 patients with anal incontinence and 16 patients with urinary incontinence. In anal incontinence the results have been excellent; all patients were improved and 12 out of 13 reached an acceptable level of continence. In 10 patients with urinary incontinence the results were good, with increase of functional bladder capacity and abandonment of nappies during the day. Two patients were improved and 4 were failures. Cinematographic studies in both anal and urinary incontinence clearly demonstrated the muscular activity of the transplants and confirmed the existence of a reinnervation process. The longest postoperative observation time is now 7-years in the anal patients and 6 years in the urinary patients.

Early bladder training in patients with spina bifida.

A bladder training programme was applied in 43 children with myelomeningocele and complete urinary incontinence. In one group the training was commenced before the age of 3 years (mean age 1.3 years) and in another group between the ages of 3 and 13 years (mean age 5.8 years). The results as regards continence were better in the group with an early start of training, girls showing significantly better results than boys. Pharmacotherapy and cautious urethral surgery were valuable complements in selected cases. Vesico-ureteral reflux disappeared during treatment in 60% of the patients. Patients not showing significant improvement should be candidates for clean intermittent catheterization and/or cholinergic drugs, if detrusor hyperactivity is present.

Skiing injuries in children and adults: a comparative study from an 8-year period.

The investigation is a retrospective analysis of 2756 skiing injuries from two centers in a Swedish skiing area during the years 1972 to, and including, 1979. The relative frequency of lower extremity injuries successively diminished, while a corresponding increase of upper extremity injuries was found. The relative frequency of ankle and foot injuries declined, while the frequency of knee injuries did not change, knee injuries still being the most common skiing injury. The relative frequency of fractures of the lower leg showed a statistically significant decrease, but, in children, constituted 16% of all injuries at the end of the investigation period. Further studies, with special regard to the children's prerequisites, seem to be necessary to define the desired characteristics of an optimally functioning safety binding for children.

Piperacillin in paediatric surgery.

23 infants and children, aged 1 month - 15 years, were treated with piperacillin, a new semi-synthetic penicillin with a broad spectrum of activity. The indications were perforated appendicitis with peritonitis or abscess formation (12 patients), urinary tract infection due to congenital anomalies (3 patients), miscellaneous infections (3 patients) and peroperative prophylactic treatment (5 patients). The clinical response was good. Few adverse reactions were noted. The drug seems to be effective and safe.

Aspects on the treatment of omphalocele and gastroschisis. Twenty years' clinical experience.

Sixty-one patients with abdominal wall defects (omphalocele 37; gastroschisis 24) were treated during a twenty-year period according to different therapeutical principles. An analysis showed that good results were obtained by means of primary radical closure, large lesions included. The silo-technique appeared to be less successful. The use of central vessels for infusion probably contributed to a negative outcome, while total parenteral nutrition (in peripheral veins) and postoperative assisted ventilation had positive effects. With the exception of the antenatal type of gastroschisis, our experience indicates that the vast majority of cases with omphalocele or gastroschisis can be successfully treated by means of radical primary repair.

Experience of the Cohen method for ureteral reimplantation in complicated cases.

Thirty-seven infants and children (41 ureters), a majority with complicating factors (low age, neurogenic bladder, duplication, reoperative surgery), were treated with ureteral reimplantation according to Cohen. The results were good in 90% of the cases. Minor deviations from the original technique, i. e. Dexon instead of chromic catgut as suturing material, catheter splinting of ureter in only 40% and short length of submucosal tunnel in some cases, did not seem to have a negative influence on the results. The method, which is easy and safe to perform, is recommended, particularly in complicated cases.

Urodynamic studies in boys with disorders of the lower urinary tract. V. Posterior urethral folds. A pre- and postoperative study.

Urodynamic investigation was performed in 21 boys with posterior urethral folds. An abnormal micturition pattern characterized either by varying degree of obstruction during the course of a micturition or by constant obstruction of "stricture type" was found in nine cases. The obstruction was generally of moderate degree. No micturition pattern specific for posterior urethral folds could be shown. Ten boys had enuresis. They did not differ from the other boys in regard to urodynamic variables. On the basis of clinical indications, 16 of the boys were operated on. Postoperative urodynamic follow-up indicated definite improvement or complete normalization in most of them, though urethral resistance was slightly increased postoperatively in three cases. Patients with posterior urethral folds probably should be treated by transurethral resection only if urodynamic investigation reveals an obstruction.

Free autogenous muscle transplantation in 5 children with urinary incontinence.

Five children with urinary incontinence were operated with a new method involving free autogenous muscle transplantation. Before transplantation a skeletal muscle (extensor brevis of the foot) is denervated and, 2 weeks later, it is transplanted and placed as a U-sling around the urethra in close contact with normally innervated muscles, which act as reinnervation sources. All patients showed improvement of continence and increasing bladder capacity from about 2 months after transplantation. Postoperative cine-micturition studies clearly demonstrated the functional properties of the transplanted muscle and estimation of urinary flow rate showed no signs of infravesical obstruction.

A new treatment of anal incontinence in children: free autogenous muscle transplantation.

A new method is presented for the treatment of anal incontinence in children, including free autogenous muscle transplantation. The primary step is denervation of a skeletal muscle, which 2 wk later is transplanted and placed as a U-sling around the rectum, imitating the position and function of the puborectalis muscle. The transplant is placed in close contact with innervated muscles, which act as reinnervation sources. The results in five consecutive patients are highly promising. An early sign of improvement is the occurrence of a sensation of rectal fullness. All the patients reached an acceptable degree of continence, including abandonment of the use of napkins, 4-12 mo after surgery.