[Elbow Luxation at Birth? - Differential Diagnosis of Elbow Disorders presenting at Birth]. / Ellbogenluxation bei Geburt? ­ Differenzialdiagnose von Ellbogenpathologien bei Geburt.

This is a case report of an isolated congenital radial head dislocation (CRHD) presenting after a breech delivery. The implications of this delivery mode led to the misdiagnosis of an elbow luxation. We found that elbow luxation is a common misdiagnosis of CRHD, although it has not been reported in children younger than one year. For the experienced clinician, repeated examinations and appropriate imaging usually lead to the exclusion of such misdiagnoses. CRHD itself usually remains asymptomatic until adolescence. Without pain or functional impairment of the joint, no specific therapy is needed. This case prompted us to provide an overview of elbow pathologies presenting at birth.

Combined epicardial and transvenous placement of an implantable cardioverter defibrillator (ICD) lead without a median sternotomy in an 8-year-old child.

An alternative to median sternotomy for epicardial placement of an implantable cardioverter defibrillator (ICD) lead in a child with hypertrophic cardiomyopathy is described. Implantation of an ICD lead via the tricuspid valve was avoided by the use of an epicardial pacing lead and a transvenous defibrillator lead placed in the vena brachiocephalica. The abdominal, subcostal pocket incision was used for an anterolateral minithoracotomy to implant the epicardial pacing lead.

Compensatory lung growth in NOS3 knockout mice suggests synthase isoform redundancy.

Nitric oxide synthase 3 (NOS3) produces nitric oxide (NO) in endothelial cells, which stimulates cyclic guanosine monophosphate (cGMP) production and thereby mediates pulmonary vasodilation. Inhibition of cGMP enzymatic cleavage by sildenafil might be involved in lung growth stimulating processes in pulmonary hypoplasia. The aim of this study was to discover insights into the transcriptional regulation of NOS3 in a mouse model of compensatory lung growth (CLG). CLG was studied in wild type animals (WT) and NOS3 knockout mice (NOS3-/-) by dry weight, DNA, and protein quantification as well as relative quantification of NOS mRNA. All assessments were done on adult female mice, 10 days after left pneumonectomy (PNX) or sham thoracotomy. Weight ratios of right NOS3-/- lungs were no different than controls. There was a compensatory increase in DNA and a noncompensating increase in protein ratios in NOS3-/- mice compared with controls. Pharmacological knockdown with the pan-NOS inhibitor l-NAME (nitro-arginine methyl ester) reduced CLG by only 8% compared with the d-NAME treated control mice. Relative quantification of lung mRNA revealed no up-regulation of NOS3 expression in WT lungs after PNX, but NOS3-/- lungs showed a 2.6-fold higher inducible NOS2 expression compared with shams. These data suggest that NOS3 loss of function alone does not impair CLG in mice, possibly because of redundancy mechanisms involving NOS2.

Characterization of endothelial progenitor cells mobilization following cutaneous wounding.

Bone marrow (BM)-derived endothelial progenitor cells (EPCs) are known to play an important role in neovascularization and wound healing. We investigated the temporal effects of cutaneous wounding on EPC surface markers within the peripheral blood and BM, and to better understand the role of the stromal cell-derived factor-1 alpha (SDF-1alpha/CXCR4) axis on EPC mobilization after wounding. FVB/NJ mice were administered bilateral 8 mm circular full-thickness skin wounds. Peripheral blood and BM were isolated at daily intervals postwounding through day 7 and analyzed for EPC mobilization characteristics and levels of SDF-1alpha. Cutaneous wounding was found to cause a transient increase in EPC mobilization that peaked on day 3. In contrast, SDF-1alpha protein within blood plasma was observed to significantly decrease on days 3, 4, and 7 following cutaneous wounding. BM levels of SDF-1alpha protein decreased to a nadir on day 3, the same day as peak mobilization was observed to occur. The decrease in BM SDF-1alpha protein levels was also associated with a decrease in SDF-1alpha mRNA suggesting transcriptional down-regulation as a contributing factor. This study for the first time characterizes EPC mobilization following cutaneous wounding in mice and supports a major role for the SDF-1alpha/CXCR4 axis in regulating mobilization within the BM, without evidence for systemic increases in SDF-1alpha.

Minimally invasive correction of pectus excavatum in adult patients.

OBJECTIVE: The repair of pectus excavatum by minimally invasive surgery (Nuss procedure) is well established among pediatric surgeons. Studies on adult patients are rare. We analyzed the efficacy of minimally invasive pectus repair in a series of adult patients. METHODS: We prospectively included all adult patients with minimally invasive repair of funnel chest treated from 2000 to 2005. The pectus bar was inserted under thoracoscopic control. On the right side a stabilizer was used to prevent bar displacement. Postoperative pain control was provided by epidural catheters. Clinical checks were performed 2 weeks, 3 months, and then annually after discharge. RESULTS: Forty-three adult patients (39 men, 4 women) with a mean age of 22 years (range 18-39 years) were included. Mean duration of the operative procedures was 70 minutes (range 29-125 minutes); mean length of hospital stay was 9.3 days. Bars were removed from 15 patients 3 years after implantation. Minor complications occurred in 8 patients (19%), with intrapleural effusions being most frequent (n = 5). Three patients (7%) had major complications: drainage of a pneumothorax (n = 2) and bar displacement (n = 1). The cosmetic results were excellent and patient satisfaction was high. CONCLUSIONS: We conclude that the Nuss procedure was beneficial in adult patients. Dislocation of the pectus bar can be prevented by submuscular placement. The use of corticosteroids may be helpful in case of repeated, uncontaminated pleural effusions. Patient satisfaction and the acceptable number and kind of complications are encouraging.