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PubMed1999

Porous bioactive glass matrix in reconstruction of articular osteochondral defects.

BACKGROUND AND AIMS: This study was carried out to investigate the use of porous bioactive glass implants in promotion of articular cartilage and subchondral bone repair in large osteochondral joint defects. MATERIAL AND METHODS: Two conical osteochondral defects (top diameter 3.0-3.2 mm) were drilled into the patellar grooves of the distal femurs in the rabbit. The defects, extending (approximately 6-7 mm) from the surface of the articular cartilage to the subchondral marrow space, were reconstructed with size-matched porous conical implants made of sintered bioactive glass microspheres (microsphere diameter 250-300 microm, structural implant compression strength 20-25 MPa) using press-fit technique. The implant surface was smoothened to the level of the surrounding articular cartilage. One of the two defects in each femur was left empty to heal naturally and to serve as the control. At 8 weeks, the defect healing was analyzed with use of a semiquantitative histological grading system, histomorphometry of subchondral bone repair, back-scattered electron imaging of scanning electron microscopy (BEI-SEM), and a microindentation test for characterization for the stiffness properties of the cartilage repair tissue. RESULTS: The porous structure of the bioactive glass implants, extending from the articular defect of the patellar groove into the posterior cortex of the femur, was extensively filled by new bone. Cartilage repair varied from near-complete healing by hyaline cartilage to incomplete healing predominantly by fibrocartilage or fibrous tissue. There were, however, no statistical differences in the histological scores of repair between the glass-filled and control defects, although the sum of the averages of each category was lowest for the bioactive glass filled defects. The indentation stiffness values of all the defects were also significantly lower than that of normal cartilage on the patellar groove. CONCLUSIONS: Porous textures made by sintering bioactive glass microspheres may expand the opportunities in reconstruction of deep osteochondral defects of weight-bearing joints. The implants act mechanically as a supporting scaffold and facilitate the penetration of stromal bone marrow cells and their chondrogenic and osteogenic differentiation. Ionic properties of the bioactive glasses make the substances highly potential even as delivery systems for adjunct growth factor therapy.

Animals↗
PubMed2001

Phantom studies for estimation of defect size on cardiac (18)F SPECT and PET: implications for myocardial viability assessment.

UNLABELLED: SPECT with (18)F-FDG has emerged as an alternative to dedicated PET for the assessment of myocardial viability. However, whether FDG SPECT can reliably quantify the extent of viable and scarred myocardium is uncertain. The aim of this study was to investigate whether SPECT with an (18)F-labeled agent would provide information on defect size similar to that provided by dedicated PET. METHODS: Imaging was performed using an elliptic cylinder chest phantom with simulated bone, lung, mediastinum, liver, and heart. (18)F was administered into the myocardium, mediastinum, right and left ventricular cavities, and liver. Plastic inserts (n = 11) ranging in size from 2% to 60% of the myocardium were used to simulate transmural myocardial infarctions. The chest phantom was imaged with a dedicated PET camera and with a double-head SPECT camera equipped with ultra-high-energy collimators. Both SPECT and PET data were analyzed using a semiquantitative polar map approach. Defects were quantified using various cutoff thresholds ranging from 30% to 80% of peak activity and were expressed as a percentage of the left ventricular myocardium. Defect size as measured by SPECT or PET was compared with true defect size. RESULTS: The measured SPECT defect size was highly variable depending on the cutoff used, whereas PET defect size was relatively constant over the range of cutoffs tested. The mean absolute difference between measured and true defect sizes was minimal at a cutoff of 50% of peak activity for both SPECT (3.3% +/- 3.3%) and PET (2.7% +/- 2.5%). For this threshold, both SPECT and PET measurements showed an excellent correlation with true defect size (r = 0.98 for SPECT and 0.99 for PET). The correlation between SPECT and PET measurements was also excellent (r = 0.99; P < 0.01). CONCLUSION: If an appropriate threshold is used to define a defect, SPECT with an (18)F-labeled agent can accurately measure defect size similarly to the manner of PET.

Fluorodeoxyglucose F18↗
PubMed2002

[Long-term effect of nitric oxide synthase inhibitor on repair of articular cartilage defects repairing].

OBJECTIVE: To discuss the long-term effect of inducible nitric oxide synthase inhibitor S-methylisothiourea (SMT) on repair of articular cartilage defects. METHODS: Twenty-four adult New Zealand White rabbits with full-thickness defects of cartilage created in the trochlear groove of their bilateral femurs were divided into three groups randomly, 8 in each group: (1) control group in which nothing was filled into the defects; (2) BMP group in which the defects were filled with collagen fibrin gel impregnated with recombinant human bone morphogenic protein (rhBMP); and (3) SMT group in which the defects were filled with collagen fibrin gel impregnated with rhBMP and hypodermic injection of SMT (5 mg .(-1) 12 h(-1)) was given. The animals were killed one year later. The gross appearance of the defects was assessed. The amount of released NO and the activity of NOS were examined by chemical colorimetry. The distribution of collagen was examined by immunohistochemistry. The proteoglycan synthesis and cell activity was assessed by incorporation of radiolabelled sodium sulphate Na(2)(35)SO(4) and bromodeoxyuridine. RESULTS: One year after the defects in SMT group showed greater improvement in margin integration, cellular morphology, and architecture within defect than those in BMP group and control group (P < 0.01). Immunohistochemistry showed that there was less type-I collagen and more type-II collagen in SMT group than in the other two groups. Radiolabelled sodium sulphate (Na(2)(35)SO(4)) incorporation test showed that the proteoglycan synthesis in defects was higher in SMT group than in the other two groups (P < 0.01). BrdU incorporation test showed cells in repaired tissue with remarkable proliferous activity. CONCLUSION: iNOS inhibitor SMT significantly improves the quality of repair of defected cartilage and delays its degradation.

Animals↗
PubMed2002

The effect of the small and unstable autologous osteochondral graft on repairing the full-thickness large articular cartilage defect in a rabbit model.

We have investigated the effect of the insufficient autologous osteochondral graft on healing of the large articular cartilage defect using a rabbit model. An osteochondral defect, 7 mm in diameter, was made on the patellar groove of the femoral condyle and repaired with two surgical procedures: Group I, the osteochondral fragment as half as the defect was grafted. The graft was unstable and the size of the graft was smaller than the defect. This is a model of the insufficient autologous osteochondral graft to the large articular cartilage defect; Group II, the defect was left empty. At 2, 4, 12, and 24 weeks after the surgery, the specimens were analyzed macroscopically and histologically. To evaluate the microscopic morphology, a histologic grading scale composed of 5 categories was used. In Group I, although the graft sank a little, a grafted cartilage survived and the reparative fibrous tissue filled the defect covering implanted cartilage. In contrast, in Group II, the defect was only partially covered by fibrocartilaginous tissue with a faintly staining matrix. Throughout the entire observed periods, the scores of the repaired cartilage in Group I are significantly higher than those in Group II. Even the half size of osteochondral graft has an effect to reduce the size of the cartilage defect such as the spacer and leads to better healing compared to the cartilage defect untreated. In case that it is hard to transplant an optimal osteochondral graft because of large cartilage lesion, even the small and unstable osteochondral plug should be transplanted.

Animals↗
PubMed2005

[Morphological and biomechanical study on in vivo osteogenesis after repair of cranial defects with plastic engineered bone in rabbits].

OBJECTIVE: To investigate the morphology and biomechanics of in vivo osteogenesis after repairing rabbit skull defects with plastic engineered bone which was prefabricated with alginate gel, osteoblasts and bone granules. METHODS: Twenty-eight rabbits were divided into group A (n=16), group B (n=8) and group C (n=4). The bilateral skull defects of 1 cm in diameter were made. Left skull defects filled with alginate gel-osteoblasts-bone granules (group A1) and right skull defects filled with alginate gel-bone granules (group A2). The defects of group B was left, as blank control and group C had no defect as normal control. The morphological change and bone formation were observed by methods of gross, histology and biomechanics. RESULTS: In group A1, the skull defects were almost entirely repaired by hard tissue 12 weeks after operation. The alginate gel-osteoblasts-bone granule material had changed into bone tissue with few bone granules and some residuary alginate gel. The percentage of bone formation area was 40.92% +/- 19.36%. The maximum compression loading on repairing tissue of defects was 37.33 +/- 2.95 N/mm; the maximum strain was 1.05 +/- 0.20 mm; and loading/strain ratio was 35.82 +/- 6.48 N/mm. In group A2, the alginate and bone granules material partially changed into bone tissue 12 weeks after operation. The percentage of bone formation area was 18.51% +/- 6.01%. The maximum compression loading was 30.59 +/- 4.65 N; the maximum strain was 1.35 +/- 0.44 mm; and the loading/strain ratio was 24.95 +/- 12.40 N/mm. In group B, the skull defects were mainly repaired by membrane-like soft tissue with only few bone in marginal area; the percentage of bone formation area was 12.72% +/- 9.46%. The maximum compression loading was 29.5 +/- 2.05 N; the maximum strain was 1.57 +/- 0.31 mm; and the loading/strain ratio was 19.90 +/- 5.47 N/mm. In group C, the maximum compression loading was 41.55 +/- 2.52 N; the maximum strain was 0.95 +/- 0.17 mm; and the loading/strain ratio was 47.57 +/- 11.22 N/mm. CONCLUSION: The plastic engineered bone prefabricated with alginate gel-osteoblasts-bone granule may shape according to the bone defects and has good ability to form bone tissue, whose maximum compression loading can reach 89% of normal skull and the hardness at 12 weeks after operation is similar to that of normal skull.

Alginates↗
PubMed2005

Birth defects in Singapore: 1994-2000.

INTRODUCTION: To study characteristics of birth defect cases among live births, stillbirths and abortions in Singapore between 1994 and 2000. METHODS: Index cases for the National Birth Defects Registry (NBDR) were obtained from all neonatal nurseries in Singapore, all hospital discharge summaries, cytogenetic and pathology reports from all pathology laboratories in Singapore, and from the compulsory reporting of all termination of pregnancy cases and stillbirths delivered. Further information was obtained from case notes retrieved from the medical record offices, antenatal clinics, cytogenetic laboratories, pathology departments and the Registry of Births and Deaths. The notified cases (live births, stillbirths and abortions) between 1994 and 2000 were extracted from the NBDR and analysed with regard to ethnicity, maternal age, trend over the seven years and types of birth defects using the British Paediatric Association Classification. RESULTS: Between 1994 and 2000, a total of 7,870 cases (6,278 births and 1,592 abortuses) were notified, giving a rate of 23.99 birth defect cases per 1000 live births. There was a decreasing trend in birth defect incidence (19.76 to 16.85 per 1,000 live births) among live births and stillbirths and an increasing trend of abortion (3.25 to 7.57 per 1,000 live births) for birth defects. Malays had a higher rate of congenital defects at birth (24.4/1,000 live births) compared to Chinese (18.4/1,000 births). The 25-29 years age group had the lowest overall rate (22.6/1,000 live births) compared to the 19 years and below group at 31.6/1,000 live births and the 45-49 years group at 126.6/1,000 live births. The five most common groups of anomalies (per 1,000 live births) were those of heart (9.07), musculoskeletal (4.98), chromosomal (4.35), urinary (3.12) and nervous systems (2.90). The five most common aborted anomalies (per 1,000 live births) were those of chromosomal (2.40), nervous (1.23), heart (0.95), musculoskeletal (0.85) and urinary systems (0.36). CONCLUSION: There was an increasing trend of abortion for birth defects, accompanied by a falling trend in the congenital anomalies of live births. Both extremes of maternal age were at higher risk of non-chromosomal birth defects while advanced maternal age was at higher risk of chromosomal defects.

Adolescent↗
PubMed2006

[Core-binding factor alpha1 gene modified marrow mesenchymal stem cells for repairing radial defects].

OBJECTIVE: To study the feasibility of core-binding factor alpha1 (Cbfal) gene modified marrow mesenchymal stem cells (MSCs) composed with porcine acellular bone extracellular matrix in repairing the radial defects. METHODS: Radial defects of 1.2 cm in length were created in 40 Japanese white rabbits and they were divided into four groups. In group A, MSCs isolated from homogeneous rabbits were infected with Cbfal recombinant adenovirus and implanted into acellular bone extracellular matrix, and then the complexes were implanted into defects. In group B, the complexes including the MSCs without Cbfal gene-modified and scaffold material were implanted into defects. In group C, only the scaffold material was implanted. In group D, defects were not treated as the control. The macroscopic, X-ray and histologic analysis were performed to evaluate the repair effect at 4, 8 and 12 weeks postoperatively. The repaired radius were examined by biomechanical test at 12 weeks postoperatively. RESULTS: By gross examination,mature hard new bone formed at grafted areas at 12 weeks postoperatively in group A, osteotomized ends connected by much callus in group B and less callus in group C at grafted areas. In contrast, bone nonunion formed in group D. X-ray and histological examination showed that the repaired results of defects in the group A were better than those in others groups evidently in extracellular matrix degradation, new bone remodeling and marrow cavity rebuilding at 4 and 8 weeks postoperatively. At 12 weeks postoperatively, the cortical bone became mature lamellar bone, new bone remodeling was complete and marrow cavity was smooth in group A. Only proximal end of defects showed that marrow cavity was refolded partially in group B. The continuous callus could be observed in bone defect, and no obvious marrow cavity remodeling was observed in group C. Lots of fibrous connective tissue filled in defect and bone nonunion was shown in group D. There was no significant difference in the damage compress loading of repaired radius between groups A, B and D (P>0.05), but there was significant difference between groups C and D (P<0.01). CONCLUSION: These results demonstrate that Cbfal gene modified MSCs combined with acellular bone extracellular matrix can be used to repair rabbit radial defects.

Animals↗
PubMed2006

[Birth defects' occurrence in offspring of mothers taking 1st trimester medication in the Czech Republic in 1996-2004].

OBJECTIVE: An analysis of birth defects incidence in offspring of mothers taking 1st trimester medication in the Czech Republic in 1996-2004. TYPE OF STUDY: A retrospective demographical-epidemiological analysis of data from a National Register of Congenital Anomalies of the Czech Republic. METHODOLOGY: Data on birth defects in the Czech Republic from the Institute of Health Information and Statistics--National Register of Congenital Anomalies from the 1996-2004 period and a control group data on healthy children born to mothers taking medications from the same time period. Data on medication were analyzed in relation to particular defects and were also used in international databases. RESULTS: There were 1,125 children born with a birth defect to mothers taking 1st trimester medication making a total of 1,456 particular birth defects. A control group covered 1,321 exposed women giving birth to a child without any birth defect. Some types of congenital heart defects, cleft lip with cleft palate and limb reduction defects. A significantly higher risk was found also in following 5 types of drugs: anticoagulants, antihypertensives, peripheral vasodilatants, urologics and antiepileptics. CONCLUSIONS: A significantly higher risk was found for the following defects: anencephaly, spina bifida, congenital hydrocephalus, anophthalmia/microphthalmia and auricular and limb reduction defects. Although the results are not always unambiguous and are probably influenced by both information and recall bias, they complement data on adverse effects of drugs in pregnancy in the Czech Republic. They also stress the need for a high preliminary caution in drug prescription and for a complex and individual risk assessement by a clinical geneticist.

Abnormalities, Drug-Induced↗
PubMed2006

[Birth defects occurrence and their role in perinatal mortality in the Czech Republic in 2004].

OBJECTIVE: An analysis of birth defects occurrence in the Czech Republic in 2004 and a comparison to data from 1996-2003. TYPE OF STUDY: A retrospective analysis of data from a National Register of Congenital Anomalies of the Czech Republic. METHODOLOGY: Data on birth defects in the Czech Republic from the Institute of Health Information and Statistics--National Register of Congenital Anomalies from the 1996-2004 period were used. An analysis of incidence of selected type of birth defects was performed along with their contribution to perinatal mortality according to particular types of defects. RESULTS: There were 29 186 children born with a birth defect, out of it were 17,063 boys and 12,116 girls, an undetermined sex was reported in 7 cases. A mean incidence of birth defects 2004 in was 367.9/10,000 live births. Corresponding data from years 2003, 2002 and 2001 were 405.2, 4043 and 407.9/10,000 live births. CONCLUSIONS: Current data on birth defects in 2004 in the Czech Republic are presented with a comparison to a 8-year period. An analysis of temporal and demographic changes in birth defects incidence is given along with data on birth defects contribution to perinatal mortality in selected types of defects.

Congenital Abnormalities↗
PubMed1991

[Prognostic significance of perfusion defect and its extension in dilated cardiomyopathy: assessment with thallium-201 myocardial scintigraphy].

To determine whether a change in the size of a scintigraphic perfusion defect is of prognostic significance in dilated cardiomyopathy (DCM), we performed thallium-201 myocardial scintigraphy twice for each of 13 patients with mean intervals of 45 +/- 18 months. Seven patients showed clinical deterioration (Group D) during the follow-up period of 58 +/- 22 months; whereas, 6 patients improved clinically as well as echocardiographically (LVDd < or = 5.5 cm and %FS > or = 20%) (Group I). 1. The initial scintigraphy showed that 3 patients had large defects (LD), 2 had multiple small defects (MSD) and 2 had no defects (NL) in Group D. Among 6 patients in Group I, one had LD, 3 had MSD and 2 had NL. 2. The second scintigraphy showed that in 5 patients in Group D, the defects were progressively enlarged and in the remaining 2 who had no defects at the initial scintigraphy, new defects developed (MSD). Among 6 patients in Group I, no patient had enlargement of defects. In 4 patients with defects (1LD, 3MSD), the sizes in their defects reduced. 3. At the initial study, all 7 patients in Group D fitted NYHA functional class III-IV; while, in Group I, 4 of the 6 patients fitted class III-IV and 2 patients class II. In the second study, all 7 patients in Group D remained in class III-IV; whereas, all 6 patients in Group I fitted class I-II. Five of the 7 patients in Group D died of heart failure after the second study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Contribution of birth defects to infant mortality among racial/ethnic minority groups, United States, 1983.

Linked birth/infant death data from the National Center for Health Statistics (NCHS) for the 1983 U.S. birth cohort, the latest year for which linked data were available, were evaluated in order to assess the contribution of birth defects to infant mortality among racial/ethnic groups. Of the 34,566 singleton infant deaths with specified birth weight born to U.S. residents, birth defects were listed as an underlying cause of death for 7,678 (22.2%) infants and as a contributing cause of death for an additional 1,006 (2.9%) infants. Infant mortality rates due to birth defects were highest among American Indians (2.9 deaths/1,000 live births), followed by Asians and Hispanics (2.6), and blacks (2.5). Proportional mortality due to birth defects varied among racial/ethnic groups; it was greatest among Asians (27%), followed by whites (25%), Hispanics (24%), American Indians (18%), and blacks (13%). Also, infant mortality rates due to birth defects were high among minority infants of low birth weight, particularly among those born weighing between 1,500 and 2,499 g. Within this group of infants, proportional mortality due to birth defects ranged from 52% among Asians to 29% among blacks. These data indicated that birth defects were an important contributor to infant mortality among all racial/ethnic groups. Birth-defects surveillance systems should be used to evaluate whether racial/ethnic differences in infant mortality from birth defects are due to differences in incidence and/or survival among minority infants with birth defects.

Black People↗
PubMed1987

Effects of bone graft and electrical stimulation on the strength of healing bony defects in dogs.

Autogenous cancellous bone graft alone or in combination with electrical stimulation is commonly employed yet there exists no conclusive data that the strength of the healing defect is actually modified. The authors examined three groups of paired canine femurs that were torsion tested to failure. Group I (in vitro): an intact femur was compared to a standard defect; Group II (in vivo): a defect alone was compared to a defect plus graft killed at eight weeks; Group III (in vivo): a defect plus graft was compared to a defect graft plus Osteostim (BGS Medical Corp., Milwaukee, Wisconsin) implantable stimulator killed at eight weeks. In Group I the defect decreased the average strength 45% (p = 0.005); in Group II the grafted defect decreased the strength 20% (p = 0.121); in Group III the defect graft plus electrical stimulation increased strength 4% (p = 0.669). At eight weeks, bone grafting, alone or with electrical stimulation did not statistically increase the torsional strength of the healing bony defect.

Animals↗
PubMed1986

Paternal age and the occurrence of birth defects.

The association between paternal age and the occurrence of birth defects was studied using data collected in Metropolitan Atlanta. Paternal-age information for babies born with defects was obtained from birth certificates, hospital records, and interviews with mothers; for babies born without defects, the information was obtained from birth certificates. Several statistical techniques were used to evaluate the paternal-age-birth-defects associations for 86 groups of defects. Logistic regression analysis that controlled for maternal age and race indicated that older fathers had a somewhat higher risk for having babies with defects, when all types of defects were combined; an equivalent association for older mothers was not found. Logistic regression analyses also indicated modestly higher risks for older fathers for having babies with ventricular septal defects and atrial septal defects and substantially higher risks for having babies with defects classified in the category chondrodystrophy (largely sporadic achondroplasia) and babies with situs inversus. An association between elevated paternal age and situs inversus has not been reported before; the magnitude of the estimated increased risk for situs inversus was about the same as that found in this study for chondrodystrophy.

Congenital Abnormalities↗
PubMed1983

[Allograft of cultured chondrocytes into articular cartilage defects in rabbits--experimental study of the repair of articular cartilage injuries].

Articular cartilage defects were created by dill holes, 2 mm wide and 3 mm deep, through the articular cartilage into the subchondral bone in the patellar groove of the femur in mature rabbits. The defects received graft of cultured chondrocytes and the matrix obtained from the primary culture of chondrocytes isolated from the articular cartilage or auricular cartilage in immature rabbits. The isolated cells were cultured for 10 to 14 days. For graft, the cultured chondrocytes together with the matrix were detached from the culture chamber using rubber policemen and centrifuged. The repair of the grafted defects or defects without graft (control) was histologically studied 2 to 12 weeks after operation. The defects without the graft were progressively filled with fibrous tissue containing spindle shaped cells, fibers perpendicular to the surface, and matrix showing weak metachromasia with toluidin blue at 8 weeks. The defects received articular cartilage cell graft were occupied by new cartilage tissue consisting colonylike crumps of chondrocytes 2 weeks after operation. The crumps showed strong metachromasia with toluidin blue and strong stainability for safranin-O. By 4-8 weeks, the defects were filled with homogeneous cartilage. At 12 weeks, arrangement of the chondrocytes of the superficial layer of the new cartilage became columnar as seen in the normal articular cartilage. The defects received elastic cartilage cell graft were filled by reformed cartilage with chondrocytes surrounded by elastic fibers 2-12 weeks after operation. The results indicate that allograft of cultured chondrocytes with matrix into the articular cartilage defects accerated the repair process of the defects by formation of the new cartilage derived from the grafted chondrocytes.

Animals↗
PubMed1995

[Comparison of inferior myocardial defect between planar and SPECT image of 123I-metaiodobenzylguanidine cardiac scintigraphy].

Discordant findings of inferior MIBG defect between SPECT and planar images were sometimes observed in the clinical studies. In this study, we compared inferior myocardial findings between planar and SPECT image of 123I-metaiodobenzyl-guanidine (MIBG) cardiac scintigraphy in 29 patients. All patients were estimated as normal in anterior accumulation of MIBG. The patients were divided into 3 groups according to the visual finding of inferior defect in the planar and SPECT image; normal group (normal inferior accumulation of MIBG both in the planar and SPECT image, N = 10), discordance group (inferior MIBG defect was only observed in the SPECT image, but was not observed in the planar image, N = 7), inferior defect group (inferior MIBG defect was observed both in the planar and SPECT image, N = 12). Inferior/anterior count ratio of SPECT and planar image were 0.96 +/- 0.11 vs. 0.97 +/- 0.05 in normal group, 0.59 +/- 0.21 vs. 0.99 +/- 0.13 in discordance group, 0.46 +/- 0.13 vs. 0.82 +/- 0.04 in inferior defect group. Liver/heart count ratio was significantly higher in the discordance group (2.07 +/- 0.49) than that in the normal (1.14 +/- 0.15) and inferior defect group (1.45 +/- 0.39). In phantom study, it has been reported that increased liver accumulation of MIBG causes artifactual inferior defect adjacent to the liver. These data indicate that increased liver/heart count ratio may cause artifactual inferior defect on MIBG SPECT image in the clinical studies. Planar image evaluation may be helpful to distinct the artifactual inferior defect on SPECT image.

3-Iodobenzylguanidine↗
PubMed1995

Early childhood surveillance of developmental disorders by a birth defects surveillance system: methods, prevalence comparisons, and mortality patterns.

The prevalence of developmental disabilities in early childhood is not well documented. An established birth defects registry extended surveillance to identify cases of developmental disorders in early childhood by adding all known sources of diagnosis and service to case-finding methods. Residents of a northwest Arkansas region born during 1985 to 1987 and diagnosed with either a birth defect or a developmental disorder by the 4th birthday comprised the studied cohort. Case records were linked with death certificates to examine the influence of mortality on prevalence ratios. Prevalence ratios estimated were 64.5/1000 resident live births (60.9/1000 among survivors to age 4 years) for either birth defect or developmental disorder, 33.4/1000 for developmental disorder, 37.0/1000 for birth defect, and 9.5/1000 for both developmental disorder and birth defect. Prevalence ratios of specific developmental disorders and the role of mortality in decreasing population prevalence are reported. The most common diagnostic categories in this age group were developmental delay, seizures, and failure to thrive. Overlap of birth defect categories with a diagnosed developmental disability was examined; 68.8% of children diagnosed with neural tube defects and 45.5% of those with chromosomal abnormalities who survived to age 4 years had clinically diagnosed developmental disorders. An anticipated high degree of overlap (77%) for other central nervous system defects was found. For other birth defect categories, developmental disorder diagnosis was present in 20 to 30% of the study group. Death before age 4 years occurred most often when the diagnosis was newborn seizures (17.1%) or "conditions of the brain" (13.6%); the mortality rate was 6 to 8% for epilepsy or seizure disorders, mental retardation, and vision loss. The large number of developmental diagnoses among this cohort indicates that surveillance of these disorders in early childhood, even with tentative diagnoses, is feasible. Data obtained indicate that many birth defects are associated with developmental disorders; potentially, this association can contribute to earlier identification of developmental disorders in childhood.

Arkansas↗
PubMed1995

The retinal nerve fiber layer defects in patients with anterior ischemic optic neuropathy.

PURPOSE: To demonstrate the effects of optic nerve ischemia on retinal nerve fiber layer (RNFL) and the associated visual dysfunction. METHODS: 23 patients (25 eyes) with anterior ischemic optic neuropathy (AION) underwent fundus fluorescein angiography (FFA), and then red-free light pictures were taken via SE-40 exceiter filter. All pictures were printed for RNFL analysis. Humphrey central field analysis was conducted. All data obtained from FFA and visual field defects were analysed statistically. RESULTS: The RNFL defects and the corresponding visual field defects were presented in 23 of 25 eyes (92%). The optic disc filling defects, RNFL defects and visual field defects were found to be highly correspondent to each other. The RNFL defects were mainly the local losses of RNFL which were correspondent to the ischemic regions. CONCLUSION: The poor optic disc filling or ischemia can result in the RNFL defects which cause the associated visual dysfunction. Because RNFL defects are irreversible changes, the potential values in predicting the prognosis of visual field defects caused by RNFL damages were suggested.

Female↗
PubMed1996

Assessment of myocardial viability in persistent defects on thallium-201 SPECT after reinjection using gradient-echo MRI.

This prospective study assessed myocardial viability in 30 patients with coronary heart disease and persistent defects despite reinjection on TI-201 single-photon computed tomography (SPECT). In each patient, three observers graded TI-201 uptake in 7 left ventricular wall segments. Gradient-echo magnetic resonance imaging in the region of the persistent defect generated 12 to 16 short axis views representing a cardiac cycle. A total of 120 segments were analyzed. Mean end-diastolic wall thickness and systolic wall thickening (+/-SD) was 11.5 +/- 2.7 mm and 5.8 +/- 3.9 mm in 48 segments with normal TI-201 uptake, 10.1 +/- 3.4 mm and 3.7 +/- 3.1 mm in 31 with reversible lesions, 11.3 +/- 2.8 mm and 3.3 +/- 1.9 mm in 10 with mild persistent defects, 9.2 +/- 2.9 mm and 3.2 +/- 2.2 mm in 15 with moderate persistent defects, 5.8 +/- 1.7 mm and 1.3 +/- 1.4 mm in 16 with severe persistent defects, respectively. Significant differences in mean end-diastolic wall thickness (p < 0.0005) and systolic wall thickening (p < 0.005) were found only between segments with severe persistent defects and all other groups, but not among the other groups. On follow-up in 11 patients after revascularization, 6 segments with mild-to-moderate persistent defects showed improvement in mean systolic wall thickening that was not seen in 6 other segments with severe persistent defects. These data indicate that most myocardial segments with mild and moderate persistent TI-201 defects after reinjection still contain viable tissue. Segments with severe persistent defects, however, represent predominantly nonviable myocardium without contractile function.

Adult↗