Satisfaction with hand appearance in children with index pollicization for thumb hypoplasia.

Although the primary aim of pollicization is to augment function, aesthetic improvement is an important secondary aim. Satisfaction with hand appearance in children with index pollicization for thumb hypoplasia was evaluated in 18 patients at an average of 7.5 years after surgery. Patients and their parents rated the appearance of their operated hand using a 10-point visual analogue scale (VAS). Four independent surgeons and 16 non-surgeon observers also rated the hands after reviewing standardized photographs of each child. The median patient-reported and parent-reported scores were 9 for both groups (IQR: 7-10) with a trend for children 12 years and older, to report lower satisfaction with appearance. The non-surgeon group assessments varied more for a given hand than the surgeons' assessments, though when scores were averaged within these groups for each hand, there was a high degree of correlation between the two groups. Surprisingly, the patient's own assessment showed a trend towards negative correlation when compared with the average rating of the non-surgeon assessors, suggesting that patients' own assessment of their hand's appearance is more affected by subjective factors than the objective physical outcome.

Toe to hand transfer in children: ten year follow up of psychological aspects.

Our previous study found positive psychosocial effects from hand reconstruction in children, by microsurgical toe transfer. The aim of the current study was to determine whether these are enduring at ten years or more postoperatively. Twenty-five patients with congenital (n=21) or post-traumatic (n=4) hand anomalies underwent transfer of either one or two toes. (Nineteen of the patients had taken part in the previous study while six had not.) All families had undergone preoperative counselling. Ten years or more after surgery, the patients and their parents underwent review to assess the long-term psychosocial outcome of the surgery. As in the previous study, a high level of satisfaction was reported, in terms of function, appearance, donor site, psychosocial well-being and the reactions of others. This was true regardless of the gender of the child. Patient and parent responses were more similar to each other than they had been in the earlier study. It was concluded that the positive effects of toe transfer surgery are enduring at long-term follow-up.

The application of n-butyl 2-cyanoacrylate to repair CSF fistulas for 221 patients who underwent transsphenoidal surgery.

BACKGROUND: The adequate repair of intraoperative CSF leaks during transsphenoidal surgery remains a challenge. The authors describe the application of N-butyl 2-cyanoacrylate (cyanoacrylate) tissue glue for repair of CSF fistulas during transsphenoidal surgery. METHODS: The authors retrospectively reviewed the records of 221 consecutive patients who underwent transsphenoidal surgery during 1998-2007. Among these patients, 52 (24%) experienced detectable intraoperative CSF leakage. The CSF fistulas were graded on a scale of 1-3, according to the amount of CSF loss and extent of diaphragmatic disruption. 39 patients who had an average leak scale of 1.28 received cyanoacrylate glue to seal the floor. The remaining 13 patients who were not part of this report received other dura sealant substitutes, including Tisseel and Dura Seal, or fat/cartilage grafts without any additional glue material. RESULTS: 4 of 221 patients (2%) who underwent surgery had postoperative CSF fistula. Of the 39 patients who underwent repair of their fistula using fat graft, cartilage/bone buttress and cyanoacrylate reconstruction, 2 (5.13%) developed postoperative CSF fistulas without any other side effects. The average intraoperative leak grade in these 2 patients was 2.00. CONCLUSIONS: The authors used cyanoacrylate glue for intraoperative repair of higher grade CSF fistulas. As an adjunct to careful sellar reconstruction, cyanoacrylate glue appears to be effective and safe in preventing postoperative CSF leakage after transsphenoidal surgery.

Pre- and postoperative developmental attainment in sagittal synostosis.

AIMS: To investigate whether sagittal synostosis (SS) has consequences for children's mental and psychomotor development, and whether surgery has any impact on this. METHODS: The study involved 28 children with SS who underwent corrective surgery at a mean age of 8.0 (SD 7.16) months, and 28 normal controls. All the children with SS were assessed pre- and postoperatively using the Griffiths Mental Development Scales. The controls were assessed on one occasion, at an age matched with individuals in the patient group at the time of the preoperative assessment. A further control group consisted of 13 children with SS, who had received developmental assessment on two or more occasions without surgical intervention. RESULTS: The data indicated that children with SS have significantly poorer gross locomotor function than the normal controls. Following surgical intervention the deficit was shown to have resolved; consistent with this a lesser improvement in eye-hand coordination and performance skills was shown. Overall developmental attainment also improved postoperatively. The children with SS who did not receive surgery did not show any improvement in development. CONCLUSIONS: The study shows improved developmental attainment following surgical correction of SS, which may therefore be more than a cosmetic procedure.

Early parental experiences of obstetric brachial plexus palsy.

Early parental experiences of having a child with obstetric brachial plexus palsy were examined to determine whether there were any areas of dissatisfaction and, if so, whether these resulted from their distress and a need to blame someone, or from problems in the communication of bad news. A high level of dissatisfaction was reported with similar levels of dissatisfaction found in a mildly injured group that did not require surgery, and a severely injured group that did. This suggests either that degree of dissatisfaction is not related to degree of disability, or that dissatisfaction was due to factors other than a reaction to their child having a problem. Support was found for the latter as the parents reported details of problems in communication, particularly the giving of inaccurate and misleading information.

The introduction of a paediatric anaesthesia information leaflet: an audit of its impact on parental anxiety and satisfaction.

BACKGROUND: A paediatric anaesthesia information leaflet was produced to address preoperative parental anxiety and to facilitate informed parental consent. METHODS: An audit was undertaken to assess the impact of introducing the leaflet. This addressed the information needs and expectations of parents of children undergoing anaesthesia, parental satisfaction with information provision and parental preoperative anxiety. RESULTS: The audit revealed that parents expect to be provided with information, although not necessarily in written form. However, the majority who received the information leaflet concluded that verbal information alone would not have been sufficient. The information leaflet was found to be accessible, informative and useful and those who received it reported greater satisfaction with information provision than a control group. Many parents perceived that it resulted in lower levels of preoperative anxiety CONCLUSIONS: A decision was therefore undertaken that routine use of the leaflet would continue on all of the paediatric surgical wards. However, the study also indicated that leaflets should not replace verbal communication with nursing and medical staff, who remain important sources of information.

Developmental and behavioural outcome in obstetric brachial plexus palsy.

Forty-four children with obstetric brachial plexus palsy were assessed for both developmental attainment and behavioural problems. Analysis of the resulting data revealed developmental and behavioural problems previously not identified, particularly in those with more severe injuries. These effects were independent of the general condition of the child at birth, as indicated by their Apgar scores. Further studies are required to provide clarification of these children's difficulties, the mechanisms by which they occur and effective strategies to address them.

Psychological aspects of toe to hand transfer in children. Comparison of views of children and their parents.

Thirty-seven children with congenital (n = 32) or post-traumatic (n = 5) hand anomalies underwent unilateral or bilateral toe transfers. All had undergone preoperative counselling. After rehabilitation and more than 1 year after surgery, the children and their parents were reviewed by a clinical psychologist to assess the psychosocial outcome of the surgery. A high level of satisfaction was reported with regard to the surgery, in terms of function, cosmesis, donor site, psychosocial wellbeing and the reactions of others. This was true regardless of the gender of the child. However, there was a tendency for the children to be more positive in their responses than their parents.

Toe to hand transfer in children. Part 2: Functional and psychological aspects.

Forty children with congenital (85%) or acquired hand disorders underwent transfer of one or two toes to one hand. The children were reviewed with their parents and assessed for functional and psychosocial performance. There was some evidence that the older the child at the time of transfer, the better the range of motion. The passive range of motion was on average 60 degrees more than the active range of motion despite subsequent procedures such as tenolysis. All transfers recovered protective sensibility and the majority recovered good levels of two point discrimination and light touch perception. Almost all transfers were naturally incorporated into the use pattern of the limb for some or most of the time. Most parents and patients reported a very positive effect of this surgery on the child's psychosocial functioning.

Patterns of sleep disorders and sedative hypnotic use in seniors.

Adequate sleep is required for good physical and psychological health. Sleep disturbance is common and its prevalence increases with advancing age. Physiologically, sleep in elderly adults differs from that in younger adults, both in terms of quantity and quality. Sleep disturbance in old age may be associated with many physical and psychological conditions, and less commonly can occur as a primary disturbance. It must be distinguished from the understandable but unrealistic expectations of many elderly people that they will sleep for as long and as soundly as when they were younger. The evaluation of a patient with a sleep disorder requires full medical psychiatric and social histories, mental state and physical examinations and appropriate investigations. If present, an underlying condition should be treated. Management strategies for sleep disorders include attention to sleep hygiene, behavioural treatment and hypnotics. Ideally, a hypnotic should be prescribed for a limited period and then in the smallest effective dose.