Biomedical subjects
Publications and source records attributed to J Mayr.
Foreign-body (FB) aspirations account for a reasonable percentage of respiratory emergencies in young children. Whereas 67% of aspirated FBs are of organic origin, metallic-ferromagnetic FBs are observed less frequently. We report the use of a wire with a magnetic tip fitting into the working channel of a rigid bronchoscope for removal of ferromagnetic FBs from the tracheobronchial tree.
Twelve infants operated upon for choledochal cyst (CC) are reviewed with emphasis on the operative technique of biliary tract reconstruction, incidence of cholangitis, postoperative hypergastrinemia, biliary excretion, and upper gastrointestinal (GI) motility in a follow-up of 24 to 35 months. In 7 patients biliary reconstruction was performed with a Roux-en-Y hepaticojejunostomy (HJ), and in 5 with a hepaticoantrostomy (HAST). In the HJ group 4 patients had recurrent episodes of cholangitis and intermittent diarrhea and serum gastrin levels were significantly elevated in 5. Hepatobiliary scintigraphy showed unobstructed excretion of labelled bile through bile ducts into the Roux-en-Y loop, but with significantly delayed emptying of bile into the distal jejunum in all patients. Gastric emptying and upper intestinal passage were normal. In the HAST group no episode of cholangitis occurred and serum gastrin levels were within the normal range. Scintigraphically, hepatobiliary excretion, and duodenojejunal passage of labelled bile was normal, except in 1 patient who developed a postoperative stenosis of the left hepatic duct. Upper GI contrast studies demonstrated normal gastric emptying without reflux into the biliary system. These results suggest that biliary reconstruction with HAST can be performed safely with a low incidence of complications HAST offers a more physiologic method of biliary reconstruction after resection of a CC that allows bile to drain directly into the duodenum.
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OBJECTIVE: Our purpose was to investigate the influence of the mode of delivery on the outcome of children with gastroschisis. METHODS: 38 children were born and treated at the University Hospital of Graz between 1977 and 1995. The perinatal and surgical data were analyzed retrospectively. Furthermore, we compared the prevalence of gastroschisis in Styria to international data. RESULTS: The mode of delivery did not influence the fetal outcome. The higher rate of acidosis and shorter interval from rupture of the membranes to delivery in cases of cesarean section may be attributable to the obstetric decision for an operative delivery. The prevalence of gastroschisis is high as compared to European data. CONCLUSIONS: Our data and the majority of publications do not show a benefit of cesarean section for children with gastroschisis. A randomized prospective trial is still lacking to end controversies.
PURPOSE: We reviewed the results of 64 cases of hypospadias repair using a modified Beck's operation with mobilization of the anterior urethra. MATERIALS AND METHODS: Patient age at correction ranged from 10 months to 12 years (mean 3.83 years). Six patients had undergone previous surgical treatments. Uroflowmetry and evaluation of the urinary stream, meatus, glans, shaft and scar formations were used as objective criteria, and grading of management and results by parents was considered subjective criteria. RESULTS: An average of 2.1 years postoperatively 59 patients were available for this followup study. The urethral meatus was positioned satisfactorily onto the distal glans in all cases and no urethrocutaneous fistulas developed. Meatal stenosis requiring meatal dilation occurred in 2 boys. In 2 cases a curved glans, and curved penis and glans, respectively, were caused by cicatricial tissue, necessitating surgical correction. Uroflowmetry was possible in 46 cases (78%). One patient with meatal stenosis had pathological flow values. All other flow rates were within the normal range. In the second case of meatal stenosis objective evaluation was impossible. In 55 cases (93%) parents judged management and results as optimal. CONCLUSIONS: Mobilization of the anterior urethra for correction of distal hypospadias with or without chordee is highly successful, less extensive, and provides an excellent cosmetic and functional result with a minimal risk of complication. Uroflowmetry is a noninvasive, objective diagnostic tool for evaluating the functional results of hypospadias repair.
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BACKGROUND: Staphylothermus marinus, an archaeon isolated from a geothermally heated marine environment, is a peptide-fermenting, sulphur-dependent organism with an optimum growth temperature of 92 degrees C. It forms grapes of cells, which adhere to each other and to sulphur granules via their surface layer. This glycoprotein layer forms a canopy which is held at a distance of about 70 nm from the cell membrane by membrane-anchored stalks, thereby enclosing a 'quasi-periplasmic space'. Two copies of a globular protease, which probably serves an exodigestive function related to the organism's energy metabolism, are attached near the middle of each stalk. RESULTS: We have purified and characterized this protease with regard to its enzymatic properties and thermostability, and have sequenced its gene using an approach based entirely on the polymerase chain reaction. The precursor form is 1345 amino acids long; between residues 64-741, it contains a domain with clear homology to subtilisins, which is interrupted by two large insertions. The enzyme has a broad substrate specificity and a pH optimum of 9.0. It is fully stable from pH 3.2 to 12.7 and is resistant to heat-inactivation to 95 degrees C in the free form and to 125 degrees C in the stalk-bound form. CONCLUSIONS: This protease is one of the most stable proteases known. Its high resistance towards denaturing agents makes it an interesting target for practical applications. Despite its large size, it is clearly a member of the subtilisin family and represents the only known enzyme that is a stoichiometric S-layer component.
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Paid work, unpaid work in the home and social support are important elements of the social production of health and illness, though their combined effects on both women and men have only recently become a focus of research. This paper examines their association with the health problems of nurses, presenting data from a survey of a proportional random sample of 2285 male and female nurses registered in the Province of Ontario. The data are first analysed for the full sample and then multiple regression analyses are run separately for male and female Registered Nurses. The demands of paid work (overload, exposure to hazards), unpaid work (time pressures, caring for a dependent adult) and overall stress in life are associated with greater health problems. There is also evidence of significant links between social support and health. A poor relationship with a supervisor is associated with health problems. On the other hand, enjoying a confiding relationship with a friend and having up to 4 children reduces the likelihood of experiencing health problems. The features of nursing associated with fewer health problems are challenge, statisfaction with work and working under 20 hours a week. Several common themes emerge in the analyses of women and men: overload, hazard exposure, satisfaction with work, having 3-4 children and level of overall stress in life. Yet the models are also very different and point to the need for further analyses of the social production of health problems in relation to gender. They also suggest that female nurses, in particular, may suffer the effects of restructuring in the health care sector. Workload issues are especially important for women. Younger women, those reporting time pressures and caring for a dependent adult are more likely to report health problems. Having a confiding relationship with a friend is associated with fewer health problems for women. Among men, those who dislike housework are more likely to experience health problems. Satisfaction with work and overall stress in life were associated with health problems for both men and women, though there may be gender differences in what generates satisfaction and stress.
We report the case of a 4-year-old boy who sustained an oesophageal burn grade II-III due to ingestion of an alkaline substance from a leaking cylindric 3.3 cm diameter battery, by putting the battery to his mouth and sucking the caustic solution. Lye ingestion by sucking a big cylindrical alkaline battery has not yet been reported in the medical literature. We recommend the production of safer alkaline battery cover tubes in order to eliminate any possibility of leakage. Accidents like this might occur more often, since battery collecting and recycling is becoming more common.
In a retrospective multicenter study 28 relapse fractures of the forearm in children were reviewed. The male to female ratio was 23:5. Six children were younger than 6 years, 12 were between 6 and 10 years, and 10 were between 10 and 14 years old. The primary fracture was treated by cast fixation of 3-7 weeks duration. The refracture occurred on a average 14 weeks (4-32 weeks) after the primary fracture by a simple fall (n = 14) or a fall from height (n = 4), or during school (n = 6) or leisure-time (n = 3) sporting activities. In 84% of the patients partial consolidation, i.e. incomplete healing of one cortex of one or both forearm bones, preceded the refracture. In the majority of patients this was observed after a green stick fracture due to permanent angulation. Six patients were operated upon for irreducibility of the relapse fracture; the others were treated by conservative means. In two patients a second refracture occurred. Fifteen patients were available for a 2 year result. Definitive angulation of more than 10 degrees caused a clinically relevant limitation of pro-supination in five of six patients. To prevent relapse fractures of the forearm in children, complete circular consolidation of the original fracture has to be guaranteed. It remains unclear whether this is best achieved by special plaster techniques or by converting a greenstick fracture into a complete, unstable fracture.
In a retrospective study we reviewed 28 refractures of the forearm in children, which occurred at a mean of 14 weeks after conservative treatment of the primary fracture. The cause for the refracture was incomplete healing of a primary greenstick fracture in 21 cases (84%). Twenty-two recurrent fractures were treated conservatively, but two had a second refracture. Fifteen patients were followed for over two years. Definitive angulation of more than 10 degrees caused a deficit of forearm rotation. To prevent refracture of the forearm in children, complete and circular consolidation of the primary fracture must be guaranteed.
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Among 460 children who had an orchiopexy (ORP), we identified 72 children who had attended our institution 1-12 years earlier and in whom the testicular position had been specified. Of the 72 boys 19 were had ascended testes (26%). The age at ORP of the children with ascent of the testes was 7.0 years (1.8-14.0 years). Light and electron microscopy of 13 testicular biopsies taken at ORP, showed alterations of germ cells and Sertoli cells, similar but less pronounced than alterations seen in congenital undescended testes. Conclusion. A normally positioned testis may ascend into the inguinal region or upper scrotum and remain there fixed. This secondary cryptorchidism does not usually respond to human chorionic gonadotropin treatment and must be corrected by orchiopexy.
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To study the causes and sequelae of playground accidents we analysed, in a retrospective study, 374 playground accidents. Questionnaires were sent to the parents and 103 parents (28%) provided detailed information on the playground accidents of their children. Thirty-one percent of the children injured in playground accidents sustained fractures of the extremities or concussion of the brain. Swings, slides, climbing frames, metal bars and merry-go-round accidents accounted for 71% of the 338 playground equipment-related accidents, whereas 36 accidents (10%) occurred without the use of playground equipment. The majority of these accidents were caused by children fighting. Rope-plank-type swings were frequently involved in backward falling accidents and 86% of the slide accidents were fall accidents. Climbing frames should not be taller than 1.6 m. Further efforts are mandatory to create and maintain playgrounds which help children develop their skills with a minimal risk to injury.
Baby walkers (BWs) continue to be a frequent cause of head injuries in young children. A random sample survey of 240 families with children aged 2-6 years revealed a use rate of baby walkers of 55%. Of the children using baby walkers 20% were found to have suffered a BW-related accident. In a retrospective study we reviewed 172 case reports of infants who suffered a BW-related injury between January 1990 and June 1993. We observed 19 skull fractures, 23 concussions of the brain and 125 contusions and lacerations of the head including 4 teeth luxations and 3 fractures or distortions of the upper extremity. BW-related injuries represent the third most common mode of injury in children aged 7-14 months. We conclude that despite previous warnings BW still represent a frequent cause of severe head injuries in young children. We recommend a general ban on the sale and manufacture of BWs.
Three hundred nine cases of esophageal atresia were retrospectively investigated. One hundred and sixty-two (52.4%) had associated congenital malformations. The total number of malformations was 357. The eight groups of malformations in decreasing order of frequency were as follows; cardiac, 72 cases (23.3%); musculoskeletal, 55 cases (17.8%); anointestinal, 50 cases (16.2%); genitourinary, 45 cases (14.6%); head and neck, 31 cases (10.0%); mediastinal, 26 cases (8.4%); chromosomal, 17 cases (5.5%); pulmonary, 6 cases (1.9%). Of the 162 cases with associated malformations, 83 (51.2%) had a single group of malformations, 41 (25.3%) had two groups of malformations, and 38 (23.5%) had three or more groups of malformations. More than 50% of pulmonary (83.3%), head and neck (77.4%), chromosomal (58.8%), and mediastinal malformations (53.8%) were found in association with cardiac malformations. The frequency of associated malformations in esophageal atresia cases was found to be increased significantly during the investigated interval. Early gestational age and lower birthweights were significantly correlated with higher rates of malformations. The survival rates of patients with esophageal atresia was also found to be significantly increasing over time. The mean survival rates over 32 years for groups with and without malformations were 38.3% and 70.7%, respectively, and were statistically significant. The mean survival rates of the same groups in the last 5 years were found to have changed dramatically, rising to 62.9 in the group with malformations and to 100% in the group without malformations; again, the difference is significant.