Midfacial fractures in children.

The purpose of the study was to present a modern classification and discuss the treatment of midfacial fractures in children. From the beginning of 1 January 1998 to 31 October 2000, 147 children were treated for different craniofacial fractures. Among them 28 patients (19 %) had extensive midfacial fractures complicated by impaired vision and/or CNS dysfunction and were treated surgically. The fractures were divided into: zygomatico-orbital (1 pt) and zygomatico-orbito-maxillary (5 pts), isolated orbital wall fractures (14 pts) and naso-orbital dislocations (2 pts), upper facial portion dislocations (2 pts) and fronto-naso-orbital (2 pts) or cranio-orbital fractures (2 pts). Clinical examination revealed mainly dysfunction of facial morphology and aesthetics (enophthalmos, telecanthus), CSF leakage, impairment of vision and restricted eyeball movements. Ophthalmological, neurological and radiological (Waters view, CT, NMR) examinations were performed in all cases. The treatment consisted of bone repositioning, reconstruction with autologous bone grafts and three-dimensional stabilisation using titanium plates. Twenty-three pts were operated on before and 5 pts after 7th day after trauma. The restoration of normal facial morphology was achieved in 26 patients. In 2 cases it was impossible because of the destruction of soft tissue and an extremely extensive bony trauma. Better reposition of bony fragments, prompt healing and better final results were achieved in patients operated before day 7 after trauma. Achieving good results in midfacial fractures requires prompt and adequate treatment and a multidisciplinary (paediatric, maxillofacial, plastic surgeons, neurosurgeon, ophthalmologist) team.

Perspectives of clinical application of bone morphogenetic proteins in children.

UNLABELLED: The purpose of the study was to modify the method of Bone Morphogenetic Protein (BMP) extraction from bovine bones, estimate the osteoinductive potential of the extracted protein fractions in relation to the degree of protein purity and to test collagen formed in porous discs as a carrier. It was required before BMP application in reconstructive surgery in children. MATERIAL AND METHOD: BMP preparation from bovine bones was conducted according to a modification of Luyten's method. Three fractions of different degree of purity - demineralised bone matrix "M", extract "E", and fraction after hydroxyapatite column "HP" - were tested for their osteoinductive potential. They were implanted on a collagen carrier into the right rat femoral muscle pouch. Controls were implanted in the same way in the left muscle pouch. The discs were removed after 3 and 6 weeks and tested for alkaline phosphatase activity, a marker of new bone formation. RESULTS: Out of the 10 animals used for testing the osteoinductive potential of matrix fraction, 7 results were positive and 3 negative. In the case of the extract fraction, the analysis was conducted for 3 weeks on 9 rats and 6 weeks on 13 rats. Six and 11 positive results were obtained, respectively. In the HP group 5 animals were observed for 3 weeks (3 positive, 2 negative) and 10 animals for 6 weeks (7 positive, 3 negative). In the case of the extract, the differences in alkaline phosphatase activity after 6 weeks were statistically significant (p

Rarity of surgical complications after postchemotherapy nephrectomy for nephroblastoma. Experience of the International Society of Paediatric Oncology-Trial and Study "SIOP-9". International Society of Paediatric Oncology Nephroblastoma Trial and Study Committee.

The aim of the study was to assess rates and types of nephrectomy-related complications in children nephrectomized for nephroblastoma after preoperative chemotherapy. Records of 598 Wilms' tumour patients registered in the International Society of Paediatric Oncology Trial & Study No. 9 (SIOP-9), and pretreated correctly according to the protocol with vincristine + actinomycin D +/- epirubicine or adriamycin prior to nephrectomy, were retrospectively reviewed. Forty-nine patients (8%), who suffered from 54 complications, were identified. Most frequent events were small-bowel occlusions (3.7%) and tumour ruptures (2.8%). Other complications were registered in 2.0% of cases. The low rate of nephrectomy complications and no deaths related to registered ones, are another argument for preoperative chemotherapy in Wilms' tumour patients.

[The surgical treatment of advanced stages of solid tumors in children]. / Leczenie chirurgiczne w zaawansowanych stadiach guzów litych u dzieci.

Hope for cure in children with advanced cancer came with introduction of chemo- and radiotherapy, however surgery is still important as a part of the multidirectional treatment. The aim of the review was to assess the impact of surgical treatment in children with advanced cancer. From 1991 to 1997, 30 patients aged from 6 months to 17 years were treated for soft tissue sarcomas (STS: stage III/8 pts, stage IV/2 pts), nephroblastoma (WT: stage IV/5 pts, stage V/3 pts), PNET/Ewing sarcoma (locally advanced/4 pts, metastatic/2 pts) and others (stage III/4 pts, stage IV/2 pts). All patients received pre- and postoperative chemotherapy, all but 6 were irradiated. Twenty one of 30 patients entered remission (CR) after radical surgery for local control: 12 relapsed locally, of whom 7 entered IICR after re-treatment and next surgery and 5 died. 3 of 9 patients who never had any local relapse, died of metastases. Nine of 30 patients never had any radical surgery, 8 died (including 2 toxic deaths) and 1 (stage V Wilms tumour) is in CR after chemotherapy and radiotherapy (12 Gy including both kidney with unresectable tumours). Advanced cancer does not imply the fatal outcome: 14/30 patients are in CR. Possibility of surgical resection of the disease focuses brings some hope for final cure even in initially disseminated disease: 13 such cases of 21 are in ICR or IICR (follow-up: 6 months-7 years) whereas only 1 of 9 those who have never had any radical surgery.

[Alternative methods of central venous access insertion in pediatric oncology]. / Alternatywne sposoby wprowadzania centralnego dostepu zylnego w onkologii dzieciecej.

UNLABELLED: Introduction of the central venous access (CVA) in children treated for malignancies is usually planned procedure. Some patients however require the CVA in emergency. Also in emergency, insertion of CVA should be feasible and safe. The standard technique of CVA insertion is through surgically approached internal jugular vein. This technique requires correct blood coagulation and general anaesthesia in younger patients. Alternative ways of the CVA insertion (via cephalic vein, cubital vein or external jugular vein) seem safe also in case of thrombocytopenia (< 40,000/mm3) and coagulopathy. Aim of the report is to compare efficacy (central tip of the catheter in the superior vena cava on X-ray) and safety (complication rate) of both techniques. PATIENTS: 166 children treated for malignancies aged from 0 to 16 years. The standard technique was used in 109 and in 107 was successful. The alternative technique was used in 57 and in 50 was successful. There were no acute complications, the late ones were observed in 7 of 107 in the standard technique group and in 9 of 50 in the alternative technique group. The alternative ways of the CVA introduction are effective and safe, however the longer X-ray monitoring is necessary.

Speech repetition abilities in children who differ in reading skill.

A previous study (Brady, Shankweiler, and Mann, 1983) demonstrated inferior speech repetition abilities for poor readers with degraded stimuli. The present study, in contrast, used clear listening conditions. Third-grade average and below-average readers were tested on a word repetition task with monosyllabic, multisyllabic, and pseudoword stimuli. No group differences were obtained on speed of responding, and the lack of reaction time differences between reading groups was corroborated on a control task which measured verbal response time to nonspeech stimuli. However, below average readers were significantly less accurate at repeating the multisyllabic and pseudoword stimuli. This evidence is compatible with the hypothesis that encoding difficulties contribute to the memory deficits characteristic of poor readers.