Academic Achievement in School-Aged Children with Single Suture Craniosynostosis Over Time.

Introduction: Children with single suture craniosynostosis (SSC) are at risk for neurocognitive problems. The reported magnitude of differences between children with SSC and their normative peers on standardized tests of academic and intellectual ability are small. Evaluation of real-world academic outcomes of these children and its impact on educational resources have not been conducted. Methods: A retrospective cohort study of academic outcomes of children with SSC was conducted using the data from Ontario's Education Quality and Accountability Office (EQAO) standardized provincial reading, writing and mathematics tests. The need for special education was identified by documentation of the child's need for an Identification, Placement, and Review Committee (IPRC). Results: Of 296 eligible children, 42 participated in the study. Half of the children had sagittal synostosis, while the remaining were 10 (24%) unicoronal, 9 (21%) metopic, and 2 (5%) lambdoid synostosis. Thirty-six (86%) underwent operative management. The EQAO scores of operated children with SSC met the provincial academic standards on the Grade 3 and 6 EQAO scores across the 3 academic subjects. Converted grade-matched EQAO scores decreased in reading and writing over time, while math improved. Of the 21 patients with special education data, one child required an IPRC in Grade 3, while an additional four (24%) required an IPRC in Grade 6. Conclusions: Operated children with SSC had average academic performance, however, their needs appeared to change over time. Future studies are needed to evaluate academic difficulties and special education needs as these children progress through grade school.

Introduction: Les enfants ayant une craniosynostose simple (CSS) sont à risque de troubles neurocognitifs. Selon les tests standardisés des capacités scolaires et intellectuelles, les enfants ayant une CSS présentent des différences légères par rapport à leurs homologues en bonne santé. Les résultats scolaires concrets de ces enfants n'ont pas été évalués, ni leurs répercussions sur les ressources pédagogiques. Méthodologie: Les chercheurs ont effectué une étude de cohorte rétrospective des résultats des enfants ayant une CSS aux examens de lecture, d'écriture et de mathématique au moyen des données provinciales standardisées de l'Office de la qualité et de la responsabilité en éducation de l'Ontario (OQRÉO). Les besoins en éducation spécialisée étaient indiqués par un avis du comité d'identification, de placement et de révision (CIPR) au dossier de l'enfant. Résultats: Des 296 enfants admissibles, 42 ont participé à l'étude. La moitié des enfants présentaient une synostose sagittale (scaphocéphalie), tandis que dix (24 %) avaient une synostose unicoronale, neuf (21 %), une synostose métopique (trigonocéphalie), et deux (5 %), une synostose lambdoïde. Au total, 36 (86 %) ont été opérés. Les scores de l'OQRÉO des enfants opérés à cause d'une CSS respectaient les normes scolaires provinciales pour la 3e et la 6e années dans les trois matières scolaires. Les scores de l'OQRÉO convertis en fonction du degré ont diminué en lecture et en écriture au fil du temps, mais se sont améliorés en mathématiques. Des 21 patients sur qui les chercheurs possédaient des données en éducation spécialisée, un enfant a eu besoin d'un avis du CIPR en 3e année, et quatre (24 %), en 6e année. Conclusions: Les enfants opérés à cause d'une CSS avaient une performance scolaire moyenne, mais leurs besoins semblaient évoluer au fil du temps. D'autres études devront être réalisées pour évaluer les problèmes scolaires et les besoins d'éducation spécialisée des enfants au primaire.

Secondary Effects of Radiation Therapy to the Hand for Benign Conditions.

Background: Emerging literature introduces radiation therapy for benign hand conditions. However, hand surgeons are wary recommending radiation therapy for nonmalignant conditions. In our practice, we have used radiation therapy for patients who present with infiltrative or recurrent giant cell tumor of the tendon sheath (GCTTS) since 1998. The purpose of this study is to examine the secondary effects of radiation to the hand through the critical lens of a hand surgeon. Methods: A case series of patients who received radiation therapy for GCTTS were reviewed. The Radiation Oncology/Toxicity Grading Late Radiation Morbidity Scoring Schema was used, and patients were questioned about symptoms and examined for physical findings involving their irradiated digits. Results: A total of 8 patients with GCTTS presented for follow-up. The average patient age was 59.1 years, and the average time since radiation therapy was 5.4 years. Patients had an average of 2.3 surgeries on the affected digit prior to receiving radiation therapy. The average Disabilities of the Arm, Shoulder, and Hand score was 8.1. The most common sign of radiation was nail changes. All patients complained of sensibility changes, although only 2 of the 8 patients had abnormal moving 2-point discrimination tests. There were no confirmed recurrences of GCTTS and no skin cancers. Conclusions: Patients who received radiation therapy to the hand report high levels of satisfaction with the therapy. Radiation therapy is tolerated well by these patients and has a low level of morbidity in our population.

Three-Dimensional Imaging and Breast Measurements: How Predictable Are We?

BACKGROUND: Outcomes in aesthetic breast surgery are dependent on preoperative breast measurements. The accuracy of 3-dimensional (3D) imaging in measuring critical landmarks in augmentation mammaplasty surgery has not been described. OBJECTIVES: We aimed to determine the predictability of 3D imaging compared to direct measurements. METHODS: Two raters measured the breasts of 28 women using four anthropometric (direct) measurements: sternal notch to nipple distance (Sn-N), nipple to midline (N-M), nipple to inframammary-fold distance under maximal stretch (N-IMF), and base width (BW). Measurements (indirect) were also obtained using 3D imaging. Statistical analysis was completed with Bland-Altman plots. RESULTS: Each rater collected 56 data points for each of the four measurements. This resulted in 224 data points per rater. The Sn-N measurement had a 0.05 cm (SD, 0.65) difference in the mean values obtained between direct and indirect measurements. N-M had a mean difference of 0.20 cm (SD, 0.62). The mean difference for BW was 1.26 cm (SD, 0.69 cm), and N-IMF showed a mean difference of 1.22 cm (SD, 0.74 cm). Three-dimensional imaging overestimated Sn-N, N-M, and BW, while it underestimated N-IMF. CONCLUSIONS: Three-dimensional imaging has good utility and is most accurate for Sn-N and N-M measurements, which require frontal imaging of a standing patient. BW and N-IMF are less accurate due to obscured landmarks on frontal imaging. The medial and lateral aspects of the breast may be obscured when measuring BW on 3D imaging, which may explain this difference. N-IMF is a dynamic measurement, and as a result, 3D imaging has limited ability to measure this distance accurately.