Use and satisfaction of the internet in obtaining information on brachial plexus birth palsies and its influence on decision-making.

The purpose of this study was to determine the influence of the Internet on parents regarding decisions for children with brachial plexus birth palsies (BPBP). A power analysis was performed to determine the appropriate sample size needed for estimating proportions in the general BPBP population. At least 100 surveys were needed for appropriate data analysis and 122 surveys were collected (100% response rate). Each participant filled out a 32-item survey on demographics, questions on Internet usage, and the influence of the Internet on care decisions. It is evident that parents commonly access the Internet. Of 122 participants, 108 (89%) searched the Internet for general BPBP information. Topics commonly researched include causes (76%), symptoms (70%), treatment/surgical options (84%), choice of physicians/surgeons (60%), and choice of hospitals/clinics (60%). Our study reveals that over half of the Internet users make clinical decisions based on their research and 98% report satisfaction with the outcome of their decisions. It is clear that parents of children with BPBP frequently use the Internet for information and available options regarding care for this rare condition.

Measuring surgeons' treatment preferences and satisfaction with nerve reconstruction techniques for children with unique brachial plexus birth palsies.

BACKGROUND: This study surveyed microsurgeons on treatments chosen for infants with brachial plexus birth palsies who have had failure of antigravity biceps and/or triceps function due to nerve surgery or natural history. METHODS: Questionnaires were sent to surgeons participating in a prospective multicenter brachial plexus birth palsy study. With a response rate of 82 percent, the sample comprised 22 surgeons with extensive experience in treating brachial plexus birth palsy. The survey gathered collective information on two unique clinical groups: (1) infants with no antigravity biceps function but intact antigravity deltoid and radial nerve function and (2) infants with no antigravity radial nerve function (wrist and digital extension, triceps) but intact antigravity biceps and deltoid function. Analysis of data and age-based trends was performed using the Fisher's exact test. RESULTS: With failure of biceps recovery, surgeons preferred microsurgery for children 6 to 18 months old and tendon transfers for children older than 18 months. Both procedures were preferred over observation alone (p < 0.001). With regard to microsurgery techniques, with increasing age, surgeons used nerve transfers more than resected neuroma and grafting. With tendon transfers, regional transfers were performed more than 90 percent of the time at all ages. For patients with no antigravity radial nerve function, most cases at all ages were managed by observation rather than microsurgery or tendon transfers (p < 0.001). CONCLUSIONS: The authors' data indicate a general consensus in treatment choices for the two cases of microsurgical failure in infants with brachial plexus birth palsies as well as in satisfaction among experienced surgeons in using these treatments.

Surfactant copolymers prevent aggregation of heat denatured lysozyme.

We investigated the ability of certain triblock copolymer surfactant poloxamers of the form polyethylene oxide-polypropylene oxide-polyethylene oxide (PEO-PPO-PEO), to prevent formation of stable aggregates of heat denatured hen egg lysozyme. Differential scanning calorimetry (DSC) and synchrotron small angle x-ray scattering (SAXS) experiments were performed to study the thermodynamics and solution structures of lysozyme at temperatures between 20 and 90 degrees C in the presence and absence of poloxamers with various molecular weights (8.4-14.3 kDa), but similar hydrophile/hydrophobe (PEO:PPO) ratio of 80%. Poloxmer 188 was found to be very effective in preventing aggregation of heat denatured lysozyme and those functioned as a synthetic surfactant, thus enabling them to refold when the conditions become optimal. For comparison, we measured the ability of 8 kDa polyethylene glycol (PEG) to prevent lysozyme aggregation under same conditions. The results of these studies suggest that poloxamers are more efficient than PEG in preventing aggregation of heat denaturated lysozyme. To achieve equivalence, more than an order of magnitude higher concentration of PEG concentration was needed. Apparently, the presence of a hydrophobic segment in the poloxamers increases their ability to target the hydrophobic region of the unfolded proteins and protect them from self association. Given their biocompatibility and the low concentrations at which they effectively facilitate refolding of denatured proteins, they may be useful in the treatment of burns and other conditions resulting in the denaturation of proteins.

Percutaneous reduction of incipient malunion of phalangeal neck fractures in children.

PURPOSE: In this article we describe our treatment of partially healed malaligned fractures of the phalangeal neck in children. METHODS: This was a retrospective study of 8 pediatric patients with phalangeal neck fractures who presented late for care to Children's Hospital in Boston. All patients were diagnosed clinically and radiographically with advanced partial healing of their fracture in a malunited position of extension. The 8 patients were followed up until fracture healing and restoration of normal motion and function were achieved. RESULTS: A K-wire was inserted into the fracture site through the dorsal callus and used to mobilize the fracture fragment by breaking down the fracture callus and partially healed bone. The wire then was used as a lever arm for fracture reduction. A separate wire was used to pin the fracture percutaneously. CONCLUSIONS: This treatment corrects the loss of flexion that occurs with a malunion in the phalangeal subcondylar fossa. It is a minimally invasive procedure that avoids the soft-tissue dissection of an open procedure.