Repair of congenital diaphragmatic hernia on extracorporeal membrane oxygenation - observations of a paediatric surgeon.

Introduction: Congenital diaphragmatic hernia (CDH) is a defect involving herniation of the abdominal organs into the pleural cavity through an incompletely closed diaphragm. This defect is also accompanied by various types of pulmonary and bronchial hypoplasia and serious anomalies in the pulmonary vascular bed and pulmonary hypertension. Extracorporeal membrane oxygenation (ECMO) is used in extreme cases resistant to standard treatment. There are no reports clearly indicating the optimal time to make a decision about the repair of CDH in paediatric patients on ECMO. In high-risk neonates (with severe hypoplasia and pulmonary hypertension), this repair procedure is postponed until the cardiopulmonary parameters are stabilized and pulmonary pressure reduced. Aim: To present the experience of paediatric surgeons regarding congenital diaphragmatic hernia repair in neonates on extracorporeal membrane oxygenation. Material and methods: CDH was surgically repaired in 17 neonates, and of these 7 were on ECMO. Results: Surgical problems were encountered intraoperatively: positioning of the patient forced by the cannulae inserted in the carotid vessels, significant generalized oedema, significant capillary bleeding from the surgical wound, difficulties with closing the abdominal cavity. The most common postoperative complications included bleeding from various areas. Conclusions: Each surgery in a neonate with CDH on ECMO is a challenge for the whole medical team involved in the procedure.

Unexpected Rearrangement of Dilithiated Isoindoline-1,3-diols into 3-Aminoindan-1-ones via N-Lithioaminoarylcarbenes: A Combined Synthetic and Computational Study.

The reaction of 2-aryl-3-hydroxyisoindolin-1-ones with the s-BuLi·TMEDA system in THF at -78 °C, affording a series of diastereomeric 3-aminoindan-1-ones via a novel rearrangement of the isoindolinone scaffold, is reported. It is proposed that α-elimination of LiOH from the transient N,O-dilithiated hemiaminal carbenoids leads to the formation of singlet carbenes followed by their trapping via an intramolecular C-H insertion. An alternative explanation based on an intramolecular Mannich reaction seem much less probable. A mechanistic-type study that combines spectroscopic data of the products and calculation results, with a special focus on the diverse lithiated intermediates that are most likely to engage in the title process (particularly those with internal Li bonds), is presented. The MP2 approach, including the NPA and QTAIM data, provided insight into structures and properties of all these species. Two reaction routes A and B appeared to be possible for the postulated carbene mechanism. An unusual metamorphosis of the CCN atom triad, from a near sp 1-azaallene-type in more stable noncarbene Li enolates to a roughly sp2 type in their carbene keto tautomers, is recognized in one of these pathways (route B). Dominant forms of resonance structures for the aforementioned tautomeric systems that have seven-membered quasi rings stabilized by Li+ ions bridging the N and carbonyl O atoms are indicated. Large computational difficulties arising from a huge impact of internal Li+ complexation on conformational preferences and electronic properties of carbonyl group-bearing lithium derivatives are also discussed. The new γ-keto carbene species under study belong to a subclass of acyclic aminoarylcarbenes.

Congenital cystic adenomatoid malformation - diagnostic and therapeutic procedure: 8-year experience of one medical centre.

INTRODUCTION: Congenital cystic adenomatoid malformation (CCAM) is a rare anomaly. The mechanisms and the time at which the abnormality develops are still unclear. The malformation is characterized by the presence of single large or multiple but smaller cysts. AIM: To present the experience of our medical centre, the Polish Mother's Memorial Hospital - Research Institute. MATERIAL AND METHODS: We analysed the medical records of 32 neonates hospitalized in 2008-2017 at the Department of Paediatric Surgery and Urology ICZMP due to pre- or postnatally diagnosed congenital cystic adenomatoid malformation. RESULTS: In 2008-2017 32 children were hospitalized at our department due to prenatally diagnosed CCAM. An intrauterine procedure of thoracoamniotic shunting was performed in 13 fetuses. All newborns had chest computed tomography. Surgery had been performed in 21 children. Histopathological analysis of specimens prepared from the resected lung tissue confirmed type 1 CCAM in 4 cases, type 2 CCAM in 11 cases and type 3 CCAM in 1 case. Four patients were diagnosed with a bronchogenic cyst and one with extralobar pulmonary sequestration. CONCLUSIONS: Postnatal management of CCAM depends on the clinical status of the newborn. Newborns without clinical symptoms require radiological diagnostics to confirm the presence of malformation. Surgical treatment is recommended before the age of 10 months. Resection of the malformed lung fragment in patients with CCAM is the first-line treatment. It should be emphasized that despite the tremendous advances in diagnostic imaging, the final diagnosis of CCAM is made based on histopathological findings.

Development of a stereotaxic device for low impact implantation of neural constructs or pieces of neural tissues into the mammalian brain.

Implanting pieces of tissue or scaffolding material into the mammalian central nervous system (CNS) is wrought with difficulties surrounding the size of tools needed to conduct such implants and the ability to maintain the orientation and integrity of the constructs during and after their transplantation. Here, novel technology has been developed that allows for the implantation of neural constructs or intact pieces of neural tissue into the CNS with low trauma. By "laying out" (instead of forcibly expelling) the implantable material from a thin walled glass capillary, this technology has the potential to enhance neural transplantation procedures by reducing trauma to the host brain during implantation and allowing for the implantation of engineered/dissected tissues or constructs in such a way that their orientation and integrity are maintained in the host. Such technology may be useful for treating various CNS disorders which require the reestablishment of point-to-point contacts (e.g., Parkinson's disease) across the adult CNS, an environment which is not normally permissive to axonal growth.

The prevalence of falls and their relation to visual and hearing impairments among a nation-wide cohort of older Poles.

Falls are a geriatric syndrome which affects the physical and psychological well-being of the aged. So far, in Poland there have not been any population-based data on the prevalence of falls among the elderly. The aim of this analysis was to assess the prevalence of falls, their circumstances and consequences in the Polish population aged 65 years and older in comparison to younger respondents aged 55-59 years, and the relation of falls to visual and hearing deficits. Mean age of the 4920 elderly subjects (51.6% men) was 79.4±8.7 years. Falls in the past year were reported by 10.4% of the younger and 19.1% of the older subjects. In both groups falls occurred more frequently in women (11.9% vs. 8.7%, p=0.03 in the younger and 22.7% vs. 13.2%, p<0.001 in the older group). In the group of older subjects falls occurred most often during walking (66.7% vs. 50.7% in the group of 55-59 years old), p=0.005), while the younger more often fell while practicing sports (5.48% vs. 0.8% in the group 65+, p<0.001) and risky activities (respectively: 13.7% vs. 4.9%, p=0.002). A similar percentage of younger and older fallers reported one (44.0% and 46.1% respectively) or more falls (56.1% and 53.9%; p=0.6). The percentage of recurrent fallers grew with increasing age (Cc=0.177; p<0.001). The prevalence of injurious falls was similar in the younger and older groups (45.4% and 42.8%, p=0.53). In both genders fall-related injuries were more frequent in younger elderly (65-74 years old) and in subjects 90 years old and older. In the non-standardized analysis and after adjustment for age and gender visual and hearing impairments and its degree were associated with falls but both relations lost statistical significance after adjustment for a set of explanatory variables. Despite somewhat lower estimates, falls in older Poles are no less an important factor influencing overall health than in other populations. The higher prevalence of multiple falls should draw attention of the health-care policy makers. Sensory impairment may add to the risk of falls and should be adequately taken care of, however the priority in the future fall prevention initiative should be given to stronger factors, such as age, type of activity, overall health, cognitive function and functional status.

The gait pattern in post-menopausal women. Pilot study.

BACKGROUND: Aging brings about a number of degenerative changes in the body. The aging process in-creases its pace after the menopause. Women notice functional limitations in their daily lives, including mobility problems, as early as in their forties. Gait is one of the most reliable parameters reflecting the body's overall function and condition. The aim of this study was to determine the effect of menopause on gait patterns in healthy women. MATERIAL AND METHODS: The study involved a group of 48 healthy women (divided into Group A of pre-menopausal women and Group B of post-menopausal women). Gait parameters were acquired by a DynaPort MiniMod accelerometer. The pre- and post-menopausal women's gait data, including spatio-temporal parameters, gait cycle phases and the variability, were analysed. RESULTS: There were no significant differences between Group A and B in walking speed, step length, cadence, and gait phase duration. Significant differences were only noted in gait cycle phases with regard to the onset of single-support of the right limb, the 1st double-support of the right limb and the 2nd double-support of the left limb. Gait variability did not show any significant differences between the groups. CONCLUSIONS: 1. A prolonged stance phase during the gait cycle observed in the post-menopausal women in this study is a typical finding in aged people. 2. However, stride-to-stride variability of gait was not affected in the study.

Experimental and theoretical electron-density study of three isoindole derivatives: topological and Hirshfeld surface analysis of weak intermolecular interactions.

A combined experimental and theoretical study of three isoindole derivatives was made on the basis of a topological analysis of their electron-density distributions. Experimental electron densities were determined from high-resolution X-ray diffraction data sets measured with synchrotron radiation at 100 K, whereas theoretical calculations were performed using DFT methods at the B3LYP\6-311++G(3df,3pd) level of approximation. Both experimental and theoretical models are in good agreement with each other. Since the analysed structures possess a variety of hydrogen-bonding interactions, weak intermolecular contacts of C-H···C(π), C,N(π)···C,N(π) and H···H types were subject to our special interest and are discussed in detail. They were characterized quantitatively and qualitatively by topological properties using Bader's Atoms in Molecules theory and by mapping the electron-density distribution, electrostatic potential and a geometric function on the Hirshfeld surface. This way the forces and directions of intermolecular interactions as present on the molecular surfaces were depicted and described. These interactions not only guide crystal packing, but are likewise important for recognition processes involving (aza)isoindole fragments in a biological environment.

[Ileus due to adhesions as a consequence of abdominal surgery in childhood - analysis of 94 cases]. / Niedroznosc zrostowa jelit po operacjach brzusznych u dzieci - analiza 94 przypadków.

INTRODUCTION: Ileus due to adhesions is a common postoperative complication. However, there are only rare reports of this condition occuring in children. The aim of this study was to determinate the risk of incidence of intestinal adhesion ileus in children after abdominal operations. MATERIAL AND METHODS: Retrospective studies were carried out on a group of 94 children operated in the Department of Pediatric Surgery and Urology of the Polish Mother's Memorial Hospital - Research Institute in Lódz in the years 1996-2005, in whom adhesions were found on relaparotomy. The following parameters were analysed:indication for operation age at first laparotomy, timeintervalbetweenl aparotomyandrelaparotomy, localization and extent of adhesions, complications after adhesiolysis, indications for relaparotomy. RESULTS: Among 1987 children in whom laparotomy was performed, in 94 intestinal adhesions were found. The majority of relaparatomies were performed in the first 6 months after the primary operation. CONCLUSIONS: Adhesive bowel obstruction is a frequent and serious complication after laparotomy especially in the neonatal period. It occurs most frequently in the 6 months after the primary operation.

Association of atrial fibrillation and focal neurologic deficits with impaired cognitive function in hospitalized patients >or=65 years of age.

Atrial fibrillation (AF) is a risk factor for cerebrovascular diseases and can manifest as impaired cognitive function (ICF). ICF may be accompanied by various focal neurologic deficits (FNDs). This study evaluated cognitive function and the risk for ICF in patients aged >or=65 years hospitalized for any reason and grouped according to the presence of AF and/or FNDs. Data on 2,314 conscious patients aged >or=65 years (1,506 women) were analyzed. Physical examination, electrocardiography at rest, and the Mini-Mental State Examination were performed at admission. The median Mini-Mental State Examination score was 25 in patients without AF or FNDs (63.4%), 23 in those with AF alone (23.6%), 21 in those with FNDs alone (8.9%), and 18 in those with AF and FNDs (4.1%). On multivariate logistic regression (adjusted for age and gender), the risk for ICF was increased in patients with AF alone (p <0.0001), in those with FNDs alone (p <0.0001), and in those with AF and FNDs (p <0.0001). In conclusion, hospitalized patients aged >or=65 years with AF and/or FNDs at admission are at increased risk for ICF. The influences of AF and FNDs on the risk for ICF are independent of each other.

[Symptoms of severe digoxin intoxication in patients hospitalized in geriatric wards]. / Objawy ciezkiego przenaparstnicowania u pacjentów hospitalizowanych w oddziale geriatrycznym.

Digoxin is a drug commonly used in geriatrics. The purpose of the study is to present cases of elderly patients hospitalized on the Geriatric Ward of the Provincial Neuro-Psychiatric Hospital "Dziekanka" in Gniezno with extremely high level of digoxin in the blood serum. The study was based on the case history of patients hospitalized on the ward from July 1998 to June 2003. During that time 83 patients (age: 77.4 +/- 8.1 years old, 60 females and 23 males) were suspected to suffer from digoxin intoxication on the basis of their morbid states, and their digoxin level in serum was measured. Furthermore, medical documentation of four patients with extremely high digoxin level was profoundly analyzed. Such is regarded, the level which exceeds by 100% the upper limit of concentration believed to be therapeutic (2 ng/ml) which is 4 ng/ml. The paper also includes a profile of clinical conditions of the patients at the time of their admission to the ward. While analyzing the patients' states, careful attention was drawn to the symptoms that might be caused by digoxin intoxication (changes in the ECG, central nervous system and gastrointestinal tract disturbances). However, because of typical for geriatrics polypathology and not clear characteristic clinical symptoms of majority of pathological syndromes, even severe intoxication may turn out to be impossible to diagnose. In the paper, coexistence of risk factors predisposing to appearance of toxic symptoms such as kidney failure, hypoproteinemia, dehydration, hypoxia, electrolyte abnormalities, drug interactions, and a possibility of improper taking medication were pointed out. It was concluded that lack of specific signs of severe digoxin intoxication among the elderly results in the fact that every worsening in a patient's state of health of an unknown reason treated with digoxin should be suspected as digitalis' glycosides intoxication.

[Impaired cognitive function as an independent risk factor for the in-hospital mortality in the elderly with chronic heart failure]. / Sprawnosc funkcji poznawczych jako czynnik ryzyka smiertelnosci wewnatrzszpitalnej starszych chorych z niewydolnoscia serca.

Heart failure (HF) and impaired cognitive function are frequent causes of hospitalization in elderly patients. Independently, both clinical syndromes are associated with increased mortality. The aim of the study was to evaluate the influence of impaired cognitive function on in-hospital mortality in old patients with HF. A modified Mini-Mental State Exam (MMMSE) was performed in 598 consecutive patients (65-102 years old; 355 female) with heart failure. All patients were stratified into low (6.3 +/- 1.2 points), medium (19.7 +/- 4.7 points) or high (29.1 +/- 2.1 points) tertile group according to MMMSE results. Total in-hospital mortality was 52.0% in the lowest, 34.2% in the medium and 15.1% in the highest tertile (Pearson Chi-square p < 0.0001 for trend). The comparison of in-hospital mortality between tertiles of MMMSE was done with the use of logistic regression adjusted to age, sex, and the presence of diabetes mellitus, renal failure and anemia. Comparison of in-hospital mortality between patients from the lowest tertile of MMSE with the highest one revealed that odds ratio was 5.93 (95% CI: 3.58-9.80; p < 0.0001) whereas it was 2.67 (95% CI: 1.60-4.67; p = 0.0002) for patients from the medium tertile. The obtained results show that the worse cognitive function is, the worse in-hospital prognosis can be observed in older patients with HF. Moreover, it also suggests that impaired cognitive function may be an independent risk factor for mortality in elderly HF patients.