A new technique for the repair and reconstruction of frontoethmoidal encephalomeningoceles by medial orbital composite-unit translocation.

A frontoethmoidal encephalomeningocele is a herniation of brain and meninges through a congenital bone defect in the skull at the junction of the frontal and ethmoidal bones. Between 1992 and 1999, we treated 145 cases of frontoethmoidal encephalomeningocele. Before 1993, the operation was performed in two stages. An intracranial repair by neurosurgeons preceded the external extirpation of the mass. In 70 cases that were operated on after 1993, a one-stage closure of the skull defect with a medial orbital composite-unit translocation technique was used. The medial orbital rim on each side, with intact periosteum, medial canthal ligament and lacrimal apparatus, was translocated as a unit to the midline. The advantages of this technique are that it allows convenient access to resect the herniation mass and close the defect, it restores normal interorbital and intercanthal distances and it eliminates the need for a transnasal medial canthopexy. Augmentation rhinoplasty can be avoided in most cases by tilting the composite unit with its preserved blood supply.

Morphologic study of 120 skull base defects in frontoethmoidal encephalomeningoceles.

Frontoethmoidal encephalomeningocele is a herniation of brain and meninges through a congenital bone defect in the skull at the junction of the frontal and ethmoidal bones. From 1992 to 1996, 120 cases of frontoethmoidal encephalomeningocele were seen in our institutes, and the morphology of the skull defects was studied. The patients underwent thorough physical examinations and radiographic investigations including spiral three-dimensional computed tomography scan. Together with intraoperative findings, we found more types of the defects than previously reported. Our findings were categorized into the following types: type I, a single external opening between frontal, nasal, ethmoidal, and orbital bones; type IA, opening is limited between two bones of the area; type IB, opening is extended transversely or cephalad to involve adjacent structures; type II, multiple external openings in the region; type IIA, all of the openings are limited types; type IIB, one or more of the openings is/are extended type(s) that involve adjacent structures. There are 14 subtypes in these two types: 3 in type IA, 6 in type IB, 3 in type IIA, and 2 in type IIB. This classification is helpful in understanding the herniation pathway and in keeping informative records.

Deconvolution analysis of renal blood flow: evaluation of postrenal transplant complications.

UNLABELLED: Medical complications after renal transplantation cause problems in treatment decision making. To differentiate acute tubular necrosis from acute rejection when it occurs in the early posttransplant period is difficult. Renal scintigraphy offers a noninvasive means for renal blood flow (RBF) and renal function assessment. METHODS: This retrospective study of RBF and renal function evaluation after kidney transplantation is an attempt to calculate the "renal vascular transit time" from the 99mTc-diethylenetriaminepentaaacetic acid renal vascular flow with a deconvolution technique. The results of 102 studies on 38 graft recipients were evaluated. Of these, 19 were diagnosed as acute rejection, 12 as acute tubular necrosis, 4 as chronic rejection, 1 as vesicoureteric reflux, 1 as recurrent immunoglobulin A nephropathy, 1 as iliac vein thrombosis, 1 as cyclosporine nephrotoxicity and 63 as normal. All diagnoses were established by clinical and/or pathologic criteria. RESULTS: With renal vascular transit times more than 12.8 secm the sensitivity and specificity for the detection of acute rejection was 95% and 94%, respectively. The sensitivity and specificity for the differential diagnosis of acute rejection against acute tubular necrosis was 95% and 92%, respectively. CONCLUSION: The use of renal vascular transit time in addition to 131I-labeled hippuran renogram provides a promising diagnostic parameter to differentiate between acute rejection and acute tubular necrosis.

Elemental analysis of hair among children living in Bangkok, Negros Island and Takarazuka. A comparative study in three countries.

Twelve elements in the hair of children living in Bangkok (Thailand) were compared with those of children living in Negros Island (Philippines) and Takarazuka (Japan). With the exception of lower Se and F values, the contents of Ca, Mg, Na, K, Fe and Al in the hair of children in Bangkok were higher than those in Japanese children. A high coefficient of correlation was obtained between Cu and Fe, Cu and Mn, Se and Fe, Se and Cu, Se and Mn in the children of Bangkok. These findings were not found in other groups.

Monoclonal antibody (OKT3) rescue in refractory acute renal allograft rejection: report of 3 cases.

We report the first experience in Thailand with the use of OKT3 (monoclonal anti T lymphocyte antibody) in rescuing an acute rejection unresponsive to methylprednisolone pulses in 3 cadaveric renal transplant patients. The treatment regimen was 10 daily 5 mg intravenous injections of OKT3. In the first and second patients OKT3 was started on days 26 and 18 of the rejection episode. In the third one OKT3 was given when he became anuric secondary to severe acute rejection. Within 24 hours of the therapy, urine flow increased. A brisk diuresis and a decline in serum creatinine started within 4 days. The kidney function returned to normal within the 10-day course of therapy. Side effects were fever, conjunctivitis, stuffiness of nose and herpes infection.

Protein and amino acids of breast milk from Thai mothers.

The protein, amino acids, and nonprotein nitrogen of milk samples obtained from Thai mothers over a period of 0 to more than 270 days postpartum were determined. Protein levels decreased from 1.56% during the 1st wk to a low of about 0.6% from 180 to 270 days and then rose to about 0.7%. The amino acid pattern of the milks suggested a number of differences in their composition and those of samples analyzed in other countries. Nonprotein nitrogen varied from 20 to 40% of the total nitrogen of the milk. It has been concluded that the need for supplementation of breast-fed Thai babies may occur earlier than many nutritionists advocate.

PIP: This study evaluates the effects of prolonged lactation on the quantity of protein and pattern of amino acids in breast milk of 135 Thai women at various times of lactation (from 0 to 270 days postpartum). Breast milk samples were collected approximately 3 hours after nursing at various times during 1978. Total nitrogen, tryptophan and amino acids were respectively analyzed by the methods of Williams, Lorenzo-Andreu and Frandsen and Matheson, and Hitachi Perkin-Elmer Model KLA3B amino acid analyzer. Protein level in breast milk was highest during the 1st week (1.56%) and decreased steadily with time until a level of 0.60% during the period of 180 to 270 days, after which protein content appeared to increase. Ratio of essential to nonessential amino acids was constant throughout the study. Protein or amino acid levels during lactation were not significantly affected by maternal age and parity, although maternal age, parity and socioeconomic factors had been known to affect total milk secretion. Amino acid levels in this study were generally similar to reported values from American and Scottish women, although methionine, valine and tyrosine were lower and tryptophan and lysine were higher. Although breast milk has a nutritional value of the highest quality, it can be argued that the need for supplemental feeding may still occur earlier in life than is often realized. A discussion of the FAO/WHO standards for protein allowances suggests that infants up to 3 months of age require approximately 2 or more g of milk protein per kg daily, while children 60 to 12 months of age require about 1.5 g/kg/daily. Considering that protein content of Thai breast milk is about 0.9% after 3 months of lactation, it is estimated that 1250 ml of milk are needed to supply the protein needs of a 3-month old child, and 950 ml would be insufficient (average daily production of milk varies from 850 ml to 1200 ml). Many Thai and other women who are exclusively breastfeeding may find it difficult to provide the protein needs of their infants, unless supplemental feeding is carried out.

Pulmonary perfusion abnormalities and ventilation-perfusion imbalance in children after total repair of tetralogy of Fallot.

The pulmonary perfusion of 25 children who had total surgical correction of tetralogy of Fallot was evaluated by radionuclide perfusion scans. In addition, 18 had 133Xe ventilation studies. Eighteen of the children previously had palliative systemic-pulmonary shunts; 14 had aortic-pulmonary shunts (Waterston or Potts-Smith) and four had Blalock-Taussig shunts. Seven children had single stage total corrections. An asymmetric perfusion pattern was found in 13 of 18 children who previously had systemic-pulmonary shunts, including 12 of 14 with previous aortic-pulmonary shunts (P less than 0.05). The most common finding was relative hypoperfusion of the lung which had received the palliative shunt (P less than 0.001). The distribution of ventilation remained relatively symmetric, even when perfusion was markedly abnormal, and this resulted in ventilation-perfusion imbalance in several patients. Asymmetric perfusion was significantly less common in patients who had undergone single stage corrections (P less than 0.05). The findings document the frequent occurrence of residual abnormalities of pulmonary perfusion and ventilation-perfusion imbalance in patients who have palliative aortic-pulmonary shunts prior to total repair, and support the position that single stage correction is preferable to aortic-pulmonary shunting in the surgical management of tetralogy of Fallot.

Radionuclide angiocardiography. Improved diagnosis and quantitation of left-to-right shunts using area ratio techniques in children.

A comparison of several reported methods for detection and quantitation of left-to-right shunts by radionuclides was performed in 50 children. Count ratio (C2/C1) techniques were compared with the exponential extrapolation and gamma function area ratio techniques. C2/C1 ratios accurately detected shunts and could reliably separate shunts from normals, but there was a high rate of false positives in children with valvular heart disease. The area ratio methods provided more accurate shunt quantitation and a better separation of patients with valvular heart disease than did the C2/C1 ratio. The gamma function method showed a higher correlation with oximetry than the exponential method, but the difference was not statistically significant. For accurate shunt quantitation and a reliable separation of patients with valvular heart disease from those with shunts, area ratio calculations are preferable to the C2/C1 ratio.