Evaluation of cardiac arrhythmias by electrocardiographic markers in pediatric patients who have tuberous sclerosis without cardiac rhabdomyoma.

BACKGROUND: Tuberous sclerosis (TS) is an autosomal dominant and hereditary disorder. Cardiac rhabdomyoma and arrhythmias are the most deleterious risk factors linked to TS. Although arrhythmias in pediatric patients with TS who have cardiac rhabdomyoma have been frequently reported, arrhythmia in patients who have TS without rhabdomyoma is rarely reported in the literature. The study aimed to assess the susceptibility of pediatric patients who have TS without cardiac rhabdomyoma to cardiac arrhythmia using electrocardiographic (ECG) markers. METHODS: This prospective study included 10 patients who had TS without cardiac rhabdomyoma. The control group was made up of 30 healthy children of the same age and sex as the patient group. P wave, P wave dispersion, QT dispersion, QTc dispersion, TP-e interval, and TP-e interval dispersion were calculated on 12-lead surface ECGs for each patient in both groups and compared. RESULTS: P wave, P wave dispersion, QT dispersion, and QTc dispersion were found to be significantly higher in the patient group (P<0.001). Furthermore, patients had a greater Tp-e interval and Tp-e interval dispersion than healthy children (P<0.001). CONCLUSION: Pediatric patients with TS without cardiac rhabdomyoma might be prone to atrial and ventricular arrhythmias according to their prolonged ECG markers. Our findings suggest that patients with TS without cardiac rhabdomyoma need close monitoring for atrial and ventricular arrhythmias.

[Allergy to nickel, chromium and cobalt after osteosynthesis]. / Alergia na nikiel, chrom i kobalt po zespoleniu kosci za pomoca laczników metalowych.

Metals are known as a common cause of contact allergies. The prevalence of sensitisation to the composite metals makes for a potential risk of osteosynthesis complications in patients suffering from long bones fractures. In the study the prevalence of delayed allergy to nickel sulphate, potassium dichromate and cobalt was estimated as well as the relation to the osteosynthesis complications. The atopy prevalence was estimated too. Persons under examination were divided into 3 groups. I--treated with osteosynthesis without complications (n = 20), II--treated with osteosynthesis with synostosis complications (n = 16) and III--negative controls (n = 34). We estimated 5% prevalence of delayed allergy to nickel in group I, 6.25% in group II and 5.8% in group III. In patients exposed to chromium we observed delayed allergy prevalence of 5.8% in group I and 3% in group III. No allergy to chromium in group II was revealed. No allergy to cobalt in all groups was revealed. The prevalence of atopy in group II was rare (6.35%) when in group I it was 45% and in controls 32%. The more frequent occurrence of type IV allergy to metals in atopic patients was not confirmed. There was no difference between the prevalence of delayed allergy to metals in groups I and II. Only one case of secondary allergy to chromium was observed.

A new procedure in the surgical treatment of large incisional ventral hernias with the use of Dexon Mesh.

A new procedure in the surgical treatment of large incisional ventral hernias is described. It is based on the use of enlarged relaxation incisions of the abdominal fascia on both sides of the hernia to perform a direct suture of the posterior and superficial fascial layer of the hernia defect without tension. Extensive fascial defects after enlarged side relaxation incisions should be reinforced to prevent a weakness of the ventral abdominal wall. The best material may be a resorbable knitted mesh.

[Intraoperative staining of tissues]. / Sródoperacyjne wybarwienie tkanek organizmu.

Possibilities of vital dyeing to determine blood supplied from non blood supplied tissues are subject of many years' investigations. They may play an important role in traumatology, reconstructive and septic surgery. In acute traumatic changes one of the methods known is the so called immediate surgical treatment with delayed operation. In chronic and septic pathological changes there exists a great difficulty distinguishing necrotic parts of bone or soft tissues, which are the cause of long lasting inflammation and external fistulas. This process can last for months or even years if not treated by a proper and precise surgical procedure. Very helpful may be vital dying of tissues which was introduced by K. Klemm in 1970 for the surgical treatment of septic bone necrosis using the Disulphine Blue, produced by Imperial Chemical Industries Limited, Pharmaceuticals, Division, Macclesfield Cheshire, G. B. The tissue dyes are used widely for subcutaneous injections in lymphography, i.e. in about 30,000 patients in USA yearly. Disulphine Blue is a water soluble and partly spirit soluble powder giving a blue solution, which can be sterilized in autoclave. After an intravenous application of 0.25-0.5 ml/kg body of 6.2% solution a green colour of skin and conjunctivas appears in 5 minutes. The dye can appear in bile, bronchial tree, feces and in intestine secretions. It is evacuated with urine. Green colour of the skin disappear after 36 hours in children and after 48 hours in adults. This dye has been used as a direct visual test to investigate normal blood-supplied and necrotic soft and bone tissues. This phenomenon can have a special significance for defining the vitality in inflammation of bone tissue, in burns and in necrosis of soft tissues a.a. of the Achilles tendon. A demonstrative case report. Patient K. J., 32 years old, a worker and sportsman was hospitalized in our clinic because of chronic inflammation and purulent fistulas 10 weeks after two operations in one of hospitals because of traumatic right Achilles tendon rupture. During the first operation the tendon was sutured and the leg immobilized for a period of 6 weeks. After that time the plaster dressing was removed and during the rehabilitation was stated a secondary Achilles tendon rupture. The tendon was resutured. The course after the operation was complicated with haematoma and purulent fistulas. Antibiotics were used but without effect. In our Clinic 10 weeks after the primary injury and unsuccessful local treatment we performed a subsequent operation after slow intravenous injection of 10 ml Disulphine Blue.(ABSTRACT TRUNCATED AT 400 WORDS)

[Contact lenses permeable to gas. Literature review]. / Gazopronitsaemye kontaktnye linzy. Obzor.

Some medical-technical requirements concerning ophthalmic contact lenses were formulated. A whole series of scientific descriptions of contact lenses was analysed. A short characterization of lenses was given on the basis of PMMA (polymethacrylate of methyl), silicon rubber, poly-2-methacrylic cellulose and cellulose acetate-butyrate; the properties of contact lenses made of materials achieved through a modification of the above-mentioned ones as well as made of new materials were also examined. The problems of transmission of gases of contact lenses were described and the calculations necessary for a minimum of the gas transmittance were mentioned, starting from partial oxygen to the eye cornea. Some ways of solving the problems concerning the insertion of therapeutic substances into contact lenses are described together with prevention of the accumulation of lacrimation fluid protein on their surfaces.

[Local treatment of burn injuries and traumatic wounds with a hydrogel Geliperm dressing]. / Miejscowe leczenie ran oparzeniowych i urazowych hydrozelowym opatrunkiem Geliperm.

Hydrogel Geliperm dressings of BYK Goldbin - Konstanz and Geistlich Sons Ldt. firms were used in patients in case of skin burns and some traumatic wounds. During a four-year observation it was discovered that those materials are safe for the patient, their removing is painless and their are fully useful in the treatment of burns and traumatic wounds in surgical departments and in the ambulatory treatment. Geliperm does not have allergic action. Because of its physicochemical and biological properties Geliperm may have also usage for example in the treatment of leg ulcerations, of bed-sores and of radiation skin defect.

[Sutureless reconstruction of the extensor tendon in mallet finger]. / Nahtlose Rekonstruktion der Strecksehne bei Hammerfinger.

Good functional results can be obtained with early conservative treatment of lacerations or ruptures of the terminal portions of the finger extensor tendons. If the injury is not treated or followed closely, the typical deformity can be seen after several months. If the appearance and the functional disturbance are severe, operative reconstruction is indicated. In these cases, the ruptured or avulsed tendon generally heals spontaneously in three months in a lengthened position. This observation has been the impetus to the investigation of a very simple operative procedure. Observations on the healing and shortening of tendon ends in loose approximation can be applied to acute tendon ruptures. For this reason, ruptures of the extensor tendons are treated by pinning the distal interphalangeal joint in slight hyperextension with a Kirschner wire. This operation has been performed on 80 patients with good functional and aesthetic results.

[Diagnosis and treatment of injuries of the brachial plexus in our experience]. / Wlasne doswiadczenia w diagnostyce i leczeniu urazów splotu ramiennego.

The subject of the paper is an analysis of the pathomechanism of injuries and results of multispecialist diagnostic investigations and surgical treatment in 74 cases of traumatic brachial plexus injuries observed in a period of 5 years. The observations of the authors suggest the following conclusions: Direct injury to the brachial plexus requires emergency or delayed emergency surgical intervention. In indirect and secondary traumatic injuries of the plexus the best results are obtained by possibly early reconstructive operation carried out after establishing indications to surgical treatment. The optimal time for full diagnosis of brachial plexus injury and its surgical treatment is between 3 and 6 months after trauma. The full diagnosis of brachial plexus injury should include: radiological examination of the cervical spine with radiograms in flexion and extension (if necessary) and contrast investigations (myelography) of the vertebral canal for determining canal patency and cerebrospinal fluid changes and dynamics. Electromyography is one of the principal elements of the diagnostic procedures used for the localization of plexus damage and for evaluation of the return of function after surgery. It would be indicated to organize in Poland special hospital departments or centres for systematic diagnostic investigations and surgical treatment of patients with brachial plexus injury.

[Experimental studies of Dallon vascular prostheses after superficial alkaline hydrolysis]. / Badania doswiadczalne protez naczyniowych Dallon po powierzchniowej hydrolizie alkalicznej.

Within the research on improving polyester vascular prostheses DALLON there was made a superficial alkaline hydrolysis in the manufactured product, which greatly enhanced the prostheses wettability without lowering their resistance parameters. In preliminary laboratory research and in biological studies in vitro, made with model prostheses and with those having been hydrolyzed, the results were better for hydrolized ones. Biological studies in vivo were made on piglets by implanting the prostheses into surgical defects of the thoracic aorta. In the course of the operations it was found that the prostheses were, apart from having better wettability, far more tight intraoperationally, as compared to the model ones. Pathomorphological studies, carried out 3 and 6 months after the operation, showed that, besides the hydrolized prostheses being less calcified, there were no significant qualitative and quantitative changes in the tissues around the implanted prostheses.

[Microsurgical fascicular neurorrhaphy. Our method]. / Mikrochirurgische faszikuläre Nervennaht. Eigene Methode.

The author holds the microsurgical fascicular neurorrhaphy superior to the classical epineural suture. Microsurgical technique is more time-consuming and requires greater experience, moreover the application of autologous nerve grafts is often necessary. In secondary reconstructive operations of peripheral nerves a strong epineurium was found and in cases of small defects a surgical procedure was devised which permitted immediate microsurgical nerve suture without autologous nerve grafts. By isolating the epineurium it was possible to suture it initially on one side of the nerve, giving relaxation of the fascicle groups for direct repair.

[Multiple post-traumatic neuromas of the cervical plexus with atypical symptoms]. / Mnogie nerwiaki pourazowe splotu szyjnego o nietypowej symptomatologii.

The report presents a patient in whom a direct trauma to the neck caused development of multiple painful neuromas of the cervical roots C2 and C4 with peculiar and rarely observed symptoms. Reconstructive operation was carried out 10 years after the injury and disappearance of persistent neurologic manifestations was obtained.

Reconstructive operation of large incisional hernias.

During the last 18 years we have treated few hundreds of patients with large incisional hernias. In more than the half of the cases our surgical procedure followed 3, 4 or even 5 previous surgical operations. In about 160 patients the hernia was connected with obesity, and in 25 females with pendulous abdomen. Our results were good due to anatomic and plastic reconstruction of the abdominal wall, and in case of the tension in the suture line--the application of decompression sutures or the implantation of knitted nets.