[Abdominal pain caused by herniation of the small intestine through the ligamentum latum uteri]. / Buikpijn als gevolg van dunnedarmherniatie door het ligamentum latum uteri.

A 47-year-old woman had experienced paroxysmal pain in the lower abdomen, nausea and vomiting for the last 12 hours. Laparoscopy revealed a 60-cm hernia of ileum through the ligamentum latum, which had led to ileal necrosis. After resection of a portion of the small intestine, the patient recovered. Defects in the ligamentum latum can arise from congenital or acquired causes. The most common congenital cause is the rupture of a cystic structure in the ligamentum latum. Acquired causes include surgical intervention, pelvic inflammatory disease and traumatic injury sustained during gravidity or parturition. These causes all lead to local weakening of or direct damage to the ligamentum latum.

Perfectionism and coping strategies as risk factors for the development of non-specific work-related upper limb disorders (WRULD).

BACKGROUND: The incidence of non-specific work-related upper limb disorders (WRULD) is rising throughout western society. Literature and our own WRULD file (>1200 patients) revealed that both physical and psychosocial work-related factors are major causes of non-specific WRULD. It also appeared that non-specific WRULD was more likely to develop in patients with neurotic-perfectionist personalities. AIM: To see if, alongside physical and psychosocial work-related factors, personality factors play an important role in developing non-specific WRULD. METHOD: This was a case-control study with two control groups, comparing 45 computer workers with non-specific WRULD with 45 computer workers free from upper limb disorder (first control group) and 42 chronic pain patients (second control group). Main questionnaires administered were: the Utrecht Coping List (UCL), measuring coping-styles; the Multidimensional Perfectionism Scale (MPS), measuring neurotic perfectionism; and the Symptom Check List (SCL-90), measuring general psychological complaints (psychoneuroticism). The SCL-90 was added because of its known high correlation with neurotic perfectionism. RESULTS: Logistic regression analysis revealed significant differences in SCL-90 scores (chi(2) = 17.2, P < 0.0001), thereby potentially negating the significance of the higher neurotic perfectionism in the non-specific WRULD group. A second control group of chronic pain patients, with prospective high score on the SCL-90, was added. Logistic regression showed that, after controlling for psychoneuroticism, non-specific WRULD patients had more neurotic perfectionist traits (chi(2) = 22.83, P < 0.0001). There were no significant differences in mean UCL scores (P > 0.05). CONCLUSION: Alongside physical and psychosocial work-related factors, psychoneuroticism and neurotic perfectionism appear to be important risk factors for developing non-specific WRULD.

[Gait analysis of 57 healthy children by measurement of ground reaction forces on an Adal treadmill]. / Analyse de la marche de 57 enfants sains par mesure de la réaction au sol sur tapis roulant Adal.

PURPOSE OF THE STUDY: The purpose of this study was to present a new treadmill proposed for evaluating gait in children. We analysed differences in ground reaction forces between boys and girls, and we calculated the symmetry index in healthy children. MATERIAL AND METHOD: Time and ground reaction forces of about 30 steps were measured using a new treadmill. The apparatus consists of 2 walking belts which function as two independent treadmills placed side by side, separated by 4 mm. The 2 treadmills were mechanically separated in order to allow independent measurement of the ground reaction forces induced by each lower limb during stance phase. The children (28 boys and 29 girls), all clinically healthy, were divided into three groups according to their height (between 105 and 150 cm). They walked at three different velocities (2.7 km/h, 3.6 km/h and 4.5 km/h according to their height). The graphs representing the subject's measurements were composed of fore-aft, medial-lateral, and vertical parameters. The analysis of these graphs considered stride, stance, double stance and nine specific points. We also calculated the symmetry index of each child. RESULTS: We determined the values of the symmetry index in healthy children. We did not find any significant difference in gait between girls and boys, except for Fz3 at 2.7 kg/h, where Fz3 was higher in girls than in boys. DISCUSSION: We compared our results with those reported in the literature and found that ADAL has a very important advantage in gait analysis in children because it is simple and easily accepted by children.

Intussusception complicated by bowel perforation during hydrostatic reduction.

Most perforations of the bowel during attempt at hydrostatic reduction of intussusception occur in an area of localised infarction in the normal transverse or left colon. An animal model of intussusception was used to find indications for the cause of this phenomenon. We submitted the intussuscipiens of 10 strangulated intussusceptions in 6 dogs to a histological examination. In 6 of 10 intussusceptions we found ischaemic changes in the mucosa of the intussuscipiens. In 3 cases these lesions were multiple. All lesions were found in locations where there was a close contact between the intussusceptum and the intussuscipiens. We did not find signs of impaired circulation of the whole intussuscipiens. We conclude that our findings give an indication that perforation of the intussuscipiens during attempt at hydrostatic reduction occurs through areas of localised ischaemic infarction on the basis of direct pressure by the intussusceptum.

Intussusception: factors related to treatment.

To provide guidelines for the choice of treatment of intussusception, 10 factors that are known to be related to the outcome of treatment were studied in a series of 146 children with intussusception. The length of history, vomiting, rectal bleeding, small bowel obstruction, ileoileocolic intussusception, and the presence of a leading point were all significantly related to failure of hydrostatic reduction. Only 'rectal bleeding' and 'duration of symptoms of more than 48 hours' contributed significantly to the prediction of failure of hydrostatic reduction by logistic regression analysis. We believe that as well as the generally accepted contraindications--signs of peritonitis or bowel perforation--the presence of rectal bleeding when symptoms have lasted more than 48 hours is a contraindication to hydrostatic reduction.

Atypical characteristics of a group of children with intussusception.

We describe the characteristics of a group of 140 children with intussusception. They differed strikingly from the classical picture of intussusception given in textbooks and in publications concerning large series. We found a low incidence of intussusception especially in infants and young children. There were far more children of older ages, the delay in diagnosis was significantly longer and there was a very high percentage of leading points. These factors explained our low hydrostatic reduction rate. The weight of most children was under the fiftieth percentile. The percentage of small bowel intussusceptions was somewhat higher. These differences are important in the light of early diagnosis and evaluating the results of treatment.

Conservative treatment of ingrowing toenails.

A combination of conservative measures was used to treat 105 patients with 119 ingrowing toenails. The method proved to be simple and cheap, but time consuming. Post-treatment discomfort and the time taken to return to normal activities were acceptable; the cosmetic result was good. Two-year follow-up revealed that the success rate of the method in less advanced cases (stages I and II) was high (96 per cent), although in the long term there was a tendency to recurrence in stage II cases. The failure rate in advanced cases (stage III) was high (up to 62 per cent). Conservative treatment can be used successfully in mild cases of ingrowing toenails.

Chronic intussusception in children.

Nine children presented with intussusception lasting for 14 days or more. Their mean age was 8.5 years. Diagnosis of intussusception was delayed considerably, probably due to an unusual presentation. Compared with acute intussusception, symptoms consist of infrequent attacks of abdominal pain, sporadic vomiting and no, or small, changes in defecation. Marked weight loss and an abdominal mass assume diagnostic significance, in contradiction to bloody stools. Ultrasonography can be of diagnostic value. An attempt at hydrostatic reduction is often unsuccessful. A high frequency of organic lesions precipitating intussusception warrants early surgical intervention.

Intussusception in children 5-15 years of age.

Twenty cases of intussusception in children between the ages of 5 and 15 years were compared with intussusception in infancy and early childhood. They accounted for 18.5 per cent of all 108 children treated for intussusception in two large hospitals from 1964 to 1984. Diagnosis of intussusception was delayed, probably due to an unusual presentation. Fifty-five per cent had a definite predisposing factor precipitating the intussusception and 45 per cent had a small bowel intussusception, which warranted early surgical intervention. In the absence of contraindications no child should be disqualified from an attempt at hydrostatic reduction. After hydrostatic reduction careful follow-up is required to exclude an organic lesion, possibly by a small bowel follow-through meal. Surgery is indicated after hydrostatic reduction in case of chronically recurrent abdominal complaints.