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Frequency and prognostic implications of conduction defects in acute myocardial infarction since the introduction of thrombolytic therapy.

OBJECTIVE: To document the frequency of conduction defects and their influence on prognosis in a large series of patients with acute myocardial infarction who underwent coronary care during a period when thrombolytic therapy was in common usage. BACKGROUND: Conduction defects have been associated with an adverse prognosis following acute myocardial infarction, but there are few data on the incidence and outcome of conduction defects since the introduction of thrombolytic therapy. PATIENTS AND METHODS: The study group comprised 1225 consecutive patients with acute myocardial infarction treated in the coronary care unit from 1 January 1988 to 31 December 1994. Conduction defects were recorded prospectively and were classified as follows: complete atrioventricular node block associated with narrow complex escape rhythms; left or right bundle branch block; bifascicular block; complete heart block involving both bundle branches. RESULTS: Electrocardiographic data were available in 1220 patients. Complete atrioventricular node block occurred in 65 (5.3%), left and right bundle branch block in 29 (2.4%) and 44 (3.6%) bifascicular block in 36 (2.9%) and complete heart block involving both bundle branches in 20 (1.6%). The more advanced degrees of block in the bundle branches occurred more commonly in patients with diabetes, previous infarction. Q-wave infarction, anterior infarction and left ventricular failure. Survival analysis showed an increased short- and long-term cardiac mortality in patients with conduction defects, prognosis worsening as the severity of the conduction defect increased. CONCLUSION: Conduction defects complicated acute myocardial infarction in 16% of cases and had a graded impact on the short- and long-term prognosis, patients with advanced bundle branch involvement faring worst. The data showed a small decline in the rate of severe conduction defects compared with previous studies, possibly reflecting the beneficial effects of thrombolytic therapy on infarct size.

Adult↗

Marrow stromal cells embedded in alginate for repair of osteochondral defects.

Articular cartilage defects of sufficient size ultimately degenerate with time, leading to arthritic changes. Numerous strategies have been used to address full-thickness cartilage defects, yet none thus far has been successful in restoring the articular surface to its preinjury state. We compared the effects of agarose, alginate, and type I collagen gels on the expression of cartilage-specific markers from rabbit marrow stromal cells and then assessed the in vivo effects of cells seeded in alginate beads on the repair of full-thickness osteochondral defects in the rabbit model. Marrow aspirates from rabbits were cultured and the stromal population selected. Marrow stromal cells were then placed in either 1.2% w/v alginate, type I collagen gels (3 mg/mL), or 0.5% agarose suspension culture. After 2, 5, 10, and 20 days in culture, the RNA was extracted and analyzed by reverse transcription polymerase chain reaction for the cartilage-specific markers aggrecan and type II collagen. The strongest increase in aggrecan and type II collagen gene expression was found in the agarose suspension followed by alginate; type I collagen gels induced the lowest levels. Alginate beads were chondrogenic and maintained their size and consistency over time in culture, whereas the cell-seeded collagen gels invariably contracted. Full-thickness defects measuring 3 x 6 mm x 3 mm deep were then created in the medial femoral condyles of rabbit knees and filled with alginate beads, alginate beads seeded with stromal cells, or left empty. Alginate beads containing stromal cells remained within the defects and progressively filled the defects with regenerate tissue. Histologic analysis showed viable, phenotypically chondrogenic cells in the defects. The matrix stained positive with safranin O, indicating proteoglycan synthesis, and bonding between the regenerate and host tissue was excellent. We have shown quantitative differences in the chondrogenic effects of the biomaterials tested. Alginate induces the chondrogenic phenotype in marrow stromal cells in vitro, and possesses the necessary physical characteristics and handling properties to support cells and serve as a carrier to fill full-thickness osteochondral defects in vivo.

Alginates↗

Reconstruction of superficial skin cancer defects of the nose.

PURPOSE: This article reviewed the results of reconstruction of surface nasal defects after removal of skin cancer. PATIENTS AND METHODS: One hundred patients with 103 surface defects involving various locations on the nose were treated. Management included direct closure, secondary epithelization, full-thickness skin grafts, and local flaps using 1 or 2 stages. RESULTS: Ten nasal defects were treated by direct closure, 8 defects healed by secondary epithelization, and 30 patients were treated with a full-thickness skin graft. Fifty-five defects were reconstructed with local flaps including 30 one-stage and 25 two-stage flaps. CONCLUSION: Many options are available for reconstructing nasal defects that can lead to acceptable aesthetic results. Among the factors that need to be addressed before choosing a procedure for reconstruction of surface nasal defects resulting from skin cancer are size and location of the defect, aesthetic concerns, and the medical status of the patient.

Cicatrix↗

Closure of palatal defects without a surgical flap: an experimental study in rabbits.

PURPOSE: This study evaluated the use of resorbable calcium sulfate with and without bone grafting in palatal defects in rabbits as a guide to regeneration of the mucoperiosteal tissue and bone. METHODS AND MATERIALS: Eighteen New Zealand rabbits were used in the experiment. A 1-cm wide region of mucoperiosteum, nasal mucosa, and bone between the incisor and premolar teeth was excised from the left side of the palate to create a defect. These gaps were left open and unfilled in 6 animals as a control (group 1). Defects in a second group of 6 animals were packed with calcium sulfate (group 2). The osseous defects in a third group of 6 animals were filled with bovine demineralized xenographic bone particles, and the soft tissue gaps were covered with calcium sulfate (group 3). The various sites were evaluated clinically at 1, 3, and 4 weeks, and then at 3 months after surgery. All animals were killed at the 3 months period, and the sites were evaluated histologically. RESULTS: The calcium sulfate had resorbed and the mucoperiosteal margins of the defects in both experimental groups had regenerated and the soft tissue gaps were closed at 4 weeks. Osseous defects in group 3 showed complete bone regeneration compared with osseous defects in group 2. Defects in the control group showed persistent oronasal fistulae and fibrous healing. CONCLUSION: Open mucoperiosteal wounds in rabbits packed with calcium sulfate can heal uneventfully, and the gaps can be closed successfully.

Absorbable Implants↗

Acylcarnitine profiles in fibroblasts from patients with respiratory chain defects can resemble those from patients with mitochondrial fatty acid beta-oxidation disorders.

Mitochondrial fatty acid beta-oxidation (FAO) is coupled to the respiratory chain (RC). Functional defects of one pathway may lead to secondary alteration in flux through the other. We investigated the acylcarnitine profiles in cultured fibroblasts obtained from 14 healthy subjects, 31 patients with 8 different primary enzyme deficiencies of FAO, and 16 patients with primary RC defects including both isolated and multiple enzyme complex defects. Intact cells were incubated in media containing deuterium-labeled hexadecanoic acid and L-carnitine, and the acylcarnitines analysed using an electrospray tandem mass spectrometer. All FAO-deficient cell lines revealed disease-specific acylcarnitine profiles related to the sites of defects. Some cell lines from patients with RC defects showed profiles similar to those of controls, whereas others had abnormal profiles mimicking those found in FAO disorders. The acylcarnitine profiles of patients with RC enzyme defects were not predictable, and in some patients defects caused by mutations in either nuclear-encoded or mitochondrial DNA were associated with acylcarnitine abnormalities. While in vitro acylcarnitine profiling is useful for the diagnosis of FAO deficiencies, abnormal profiles do not exclusively indicate these disorders, and primary defects of the RC remain a possibility. Awareness of this diagnostic pitfall will aid in the selection of subsequent confirmatory tests and therapeutic options.

Carnitine↗

Regeneration of defects in the articular cartilage in rabbit temporomandibular joints by bone morphogenetic protein-2.

The purpose of this study was to investigate the therapeutic use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in internally deranged temporomandibular joints (TMJ). Defects (2 mm in diameter) were created in the surface of the condylar head. Lyophilized rhBMP-2 with collagen as the carrier was implanted in the defects in different doses: rhBMP-2 15 microg (n = 5); rhBMP-2 3 microg (n = 5); rhBMP-2 0.6 microg (n = 5). In the two control groups, the defects were either filled with collagen alone (n = 5) or left untreated (n = 5). Three weeks postoperatively the sites of defects were examined under light microscopy. In the 15 micromg and the 3 microg groups, new cartilage had filled the defects; endochondral ossification was also found deep within the defect. In the 0.6 microg group, fibrous tissue was proliferating in most areas of the defect, although cartilage was also found in some parts. In the two control groups, there was either soft tissue repair only or no evidence of tissue repair. These findings suggest that BMP-2 could stimulate the repair of defects in the articular cartilage of the mandibular condyle head during the 3 weeks postoperatively. To observe the progress of endochondral ossification in more detail, it may be necessary to extend the experiment for a longer period of time. However, this study supports the contention that BMP-2 may be useful in the regeneration of cartilage in TMJ disease.

Animals↗

Effects of liquid nitrogen cryotherapy and bone grafting on artificial bone defects in minipigs: a preliminary study.

Liquid nitrogen cryotherapy has been advocated as an adjunct in the enucleation and curettage of locally aggressive lesions of the jaws. Simultaneous autogenous bone grafting has also been advocated to accelerate bone formation and reduce morbidity. There is, however, relatively little scientific basis for either of these hypotheses. In this study, nine Yucatan minipigs had artificial defects created in the mandible, which were treated with liquid nitrogen spray. Half of the defects were grafted with autogenous bone from the chin and half were closed primarily. Two animals were sacrificed 3 days postoperatively to measure the width of necrosis and the rest were sacrificed at 3 months to assess healing and new bone formation. It was found that drilling the artificial defects alone caused bone necrosis for a mean depth of 0.09 mm. Liquid nitrogen cryospray caused a mean depth of bone necrosis of 0.82 mm (range 0.51-1.52 mm). The defects that were bone grafted healed well clinically. Defects not bone grafted showed a 50% rate of wound breakdown and sequestrum formation with delayed healing. Vital staining showed a non-significantly greater rate of bone formation in the grafted defects. Digitally superimposed radiography showed a non-significantly greater bone density in the non-grafted defects at 3 months postoperatively. It appears that liquid nitrogen cryospray does devitalize an area of bone around defects in the mandible. The width of necrosis is usually less than 1 mm and subsequent healing is enhanced by autogenous bone grafting. This has clinical implications.

Animals↗

[Value of various MR sequences using 1.5 and 3.0 Tesla in analyzing cartilaginous defects of the patella in an animal model].

PURPOSE: Comparison of MRI and macropathologic evaluation using various sequences and field strengths in the detection, localization and measurement of cartilage defects in an animal model. MATERIALS AND METHODS: After open creation of retropatellar cartilage defects of various widths, depths and locations in 8 cadaveric sheep knee joints, the knees were examined using a fat-suppressed (FS), proton density-weighted (PD) fast spin echo (FSE), and 2D and 3D gradient echo (GE) sequences on 1.5 T and 3.0 T MR scanners. The images were analyzed by two independent radiologists in a blinded manner, by dividing the patella into 15 virtual segments. The results were correlated with the macropathologic findings with regards to location, width, and depth of the defects. RESULTS: The highest sensitivity (67.1 %), diagnostic accuracy (85.4 %), positive (87.3 %), and negative (84.7 %) predictive values in detecting defects were obtained using the 3.0 T FS-3D-GE sequence. The highest specificity (95.6 %) yielded the 3.0 T FS-2D-GE sequence, with the other sequences inferior by no more than 2.6 %. In general, FS-3D-GE sequences were superior to FS-2D-GE (3.0 T: p < 0.05; 1.5 T: p < 0.05) and especially to FS-PD-FSE sequences (3.0 T: p < 0.01; 1.5 T: p < 0.05). In determining the defects' widths, the 3.0 T FS-3D-GE sequence was superior to all other sequences (correct measurements: 50.0 %), with only slight superiority to the 1.5 T FS-3D-GE sequence (46.9 %, p > 0.05) but clear superiority to the other sequences (28.1 - 40.6 %, vs. 1.5 T FS-PD-FSE: p < 0.05, vs. other sequences: p > 0.05). To determine the defects' depths, the 1.5 T FS-3D-GE sequence was most reliable (correct measurements: 53.1 %), followed by the 3.0 T FS-3D-GE sequence (50.0 %, significance of difference: p > 0.05). CONCLUSION: In detecting cartilage defects, the field strength of 3.0 Tesla was only superior to 1.5 T MRI using fat-saturated 3D- or 2D-GE-sequences but not in fat-saturated proton density-weighted SE-sequences. In determination of depth and length of the defects, the higher field strength was not advantageous.

Adult↗

[New-bone formation by osteogenic protein-1 and autogenic bone marrow in a critical tibial defect model in sheep].

AIM: Osteogenic Protein-1 (OP-1) is known to be a very potent osteoinductive growth factor. However, experimental studies using critical-size defect models in the weight-bearing lower extremity show non-uniform results. Therefore, we studied the osteoinductivity of OP-1 in a tibial worst-case defect model in sheep. Potential improvement of OP-1 induced new bone formation using a composite graft with autogenous bone marrow was to be investigated. METHOD: In 19 sheep a 5 cm segmental defect of the tibial diaphysis was treated by intramedullary nailing and filled with the following implants: 5 mg OP-1 + inactivated demineralized bone matrix (group 1; n = 6); 5 mg OP-1 + inactivated demineralized bone matrix + 5 ml autogenous bone marrow (group 2; n = 5); autogenous cancellous bone (group 3; n = 4), or inactivated demineralized bone matrix + 5 ml autogenous bone marrow (group 4; n = 4). RESULTS: In total, 3 out of 10 defect sites treated with OP-1 were completely bridged radiographically by 12 weeks. Initially, x-rays showed accelerated new bone formation by use of the composite grafts containing OP-1 and autogenous bone marrow. However, 12 weeks post surgery 3D-CT-volumetry could not detect significant differences of new bone formation within the defect sites treated by OP-1 with or without bone marrow, while new bone formation by autogenous cancellous bone was better than by OP-1. CONCLUSION: In our worst case defect model, the osteoinductive potential of OP-1 is initially accelerated but 12 weeks post surgery not increased when combined with autogenous bone marrow transplantation. So far, critical segmental bone defects of the weight-bearing lower extremity can not be bridged regularly in our model by use of OP-1. Therefore, for the treatment of such critical defects with rotational instability the examined application device of OP-1 can not yet be recommended.

Animals↗

[Vacuum assisted closure (V.A.C.) therapy is an essential tool for treatment of complex defect injuries of the upper extremity].

INTRODUCTION: Complex injuries of the upper extremity remain a therapeutic challenge. The prognosis of the damaged extremity is often limited by soft tissue defects. Vacuum Assisted Closure (V.A.C.) therapy facilitates temporary coverage of soft tissue defects prior to surgical reconstruction. METHODS: In a retrospective study all patients with complex defect injuries of the upper extremity that were treated by V.A.C. prior to reconstruction between August 2003 and September 2005 were analyzed. RESULTS: 7 patients (6 male, 1 female, 14-70 years) were included in the study. The patients suffered from subtotal upper arm (n = 1) and forearm (n = 1) amputation, complex multilevel amputation injury of the forearm (n = 1), slash wound of the forearm with skin defect and discontinuity of all volar structures (n = 1), complex open forearm fractures with skin and soft tissue defects (n = 2), and almost complete necrosis of the flexor compartment following distal radius and proximal ulnar fracture and compartment syndrome (n = 1). Stabile defect coverage was achieved in all patients following V.A.C. therapy by myocutaneous free flaps (n = 2), split thickness skin grafts (STSG) (n = 2), sequential secondary suture (n = 1), and STSG + secondary suture (n = 2). Wound conditions improved significantly under V.A.C. therapy. 5 patients reported pain relief following induction of V.A.C. therapy. Due to reduction of tissue oedema secondary suture was facilitated in 3 patients. DISCUSSION: V.A.C. therapy represents an essential tool for treatment of complex injuries of the upper extremity with extended soft tissue defects. Decreased frequency of dressing changes as well as reduced tissue oedema considerably improved patient's comfort. Posttraumatic compartment syndrome or skin necrosis, which are often associated with macro amputations of the upper extremity, are efficiently treated with V.A.C., and secondary sutures may be performed despite initial skin defects.

Adolescent↗

[Disorders of the membrane skeleton of erythrocytes in hereditary spherocytosis and elliptocytosis: significance of the molecular defect for pathogenesis and clinical severity].

During recent years an increasing number of inherited variants of erythrocyte membrane proteins and defects of the membrane skeleton could be described. Mostly these defects explain the pathogenesis of hemolytic anemias due to erythrocyte membrane defects. For hereditary spherocytosis and elliptocytosis a close correlation between the clinical severity and the biochemical defect was found; thus biochemical characterization can give valuable information about the expected course of the disease and the need for splenectomy. The erythrocyte membrane skeleton stretches along the inner surface of the membrane; it provides the stability of the erythrocyte under circulatory shear stress. The membrane skeleton consists of spectrin, actin, band 4.1 and band 4.9. Spectrin is the major component. In the membrane mostly all spectrin self-associates to the tetrameric form: one tetramer is formed by two alpha and two beta-chains. By denaturing SDS polyacrylamide gelelectrophoresis the composition of the membrane proteins can be analysed. The portion of tetrameric and dimeric spectrin is determined on native agarose gel electrophoresis. The concentration of spectrin in the membrane can be measured by an enzyme linked immunosorbent assay using monoclonal antibodies against human spectrin. By polymerase chain reaction and DNA sequencing the moleculargenetic cause of singular membrane defects was clarified. Hereditary spherocytosis was mostly due to a more or less diminished concentration of spectrin. Based on hematological, clinical' and biochemical observations, a new classification of spherocytosis (mild, moderate and severe form) is proposed. In addition to routine hematologic determinations and osmotic fragility, erythrocyte spectrin content is taken into account. The disease severity correlates with the diminution of spectrin. In hereditary elliptocytosis the concentration of tetrameric spectrin is reduced in about 30% of the patients. Defects of the N-terminal alpha I 80,000 dalton peptide are predominantly found. The defective alpha chain can be further studied by analysis of "tryptic" peptides after limited tryptic digestion of the spectrin. According to the reduced molecular weight of the anomalous tryptic alpha I peptide the variant spectrin alpha chains are designed as Spectrin alpha I/46, Sp alpha I/50, Sp alpha I/65, Sp alpha I/74 and Sp alpha I/78. In most cases a single amino acid substitution of the alpha chain could be proven. Until now only singular patients with hereditary elliptocytosis due to a shortened spectrin beta chain have been described. The shortening of the beta chain is due to a loss of the C-terminal phosphorylated peptide. The molecular cause is a defect at the 3' end of the beta spectrin gen, resulting in a premature termination of the peptide chain-synthesis.(ABSTRACT TRUNCATED AT 400 WORDS)

Actins↗

[Ventral abdominal wall defects--antenatal diagnosis, course of pregnancy and post partum therapy].

The article reports on antepartal sonographic diagnosis and the course and completion of 27 cases with ventral abdominal wall defects. There were 17 cases of omphalocele, 4 cases of gastroschisis and 6 cases of complex ventral abdominal wall defects with associated malformations. In 23 of the 26 women examined prenatally via sonography (89%), the diagnosis was ventral abdominal wall defect. In the 3 cases not diagnosed via sonography, there was one case of intrauterine foetal death. In another case, Potter's syndrome with anhydramnion was found besides a foetal abdominal wall defect, whereas the last unrecognised case had been subjected to sonographic examination outside the hospital only. In 13 out of 17 cases (77%) with omphalocele there were additional malformations. On the other hand, no further associated malformations were seen in the 4 patients with gastroschisis. Complex abdominal wall defects (in the sense of total abdominal wall aplasias or thoracoabdominal gastroschisis, etc.) with multiple associated malformations occurred in the remaining 6 cases. The most frequently seen associated malformations in children with omphalocele were neural tube defects and skeletal malformations (35% each), followed by cardiac and vascular malformations and malformations of the digestive tract. In those women examined in our clinic via sonography who had foetal abdominal wall defects, amniotic anomalies were seen (hydramnion 44%, oligohydramnion 13%). Chromosomal anomalies occurred in omphalocele with 35% incidence. The results obtained point to the necessity of conducting detailed and accurate sonographic examination if a foetal abdominal wall defect is discovered, in order to exclude or confirm further associated malformations.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗

[Experimental studies of mechanically-induced articular cartilage defects following implantation of allogeneic embryonal chondrocytes in a collagen-fibrin gel in chickens].

Full thickness defects (diameter 1,7 mm; depth 2,5 mm) were created mechanically in articular cartilage and subchondral bone of the condyles of tibiotarsal joints of 9-month old chickens. This full-thickness defects were repaired with cultured allogenic embryonic chick epiphyseal chondrocytes from the tibiae and femura of 10-days-old chicken embryos. The cells were embedded in a collagen-fibrinogen-matrix. Controls were similarly operated, but received either no treatment or implants the delivery substance only. Healing of the defects was observed macroscopically, histologically, histochemically and histomorphometrically after 3, 12 and 24 weeks. This graft was successfully transplanted in mechanically induced defects in 80%. The resulting hyaline cartilage was structurally reorganized according to the host pattern and under the influence of environmental conditions. The articular zone preserved it's cartilaginous phenotype, whereas the subchondral regions were transformed into bone. 12 weeks after the operation the defects in the experimental group were completely filled. In all instances in this group, there was an initial extreme increase of mitotic rate and cell number. After 24 weeks normal and subnormal values were founded. The defects in the control groups healed with fibrocartilage. Our results showed, that only the defects in the experimental group were completely filled with reparative hyaline cartilage tissue. In the present study the mixture of cultured allogenic embryonic chondrocytes and a collagen-fibrinogen-matrix was used successfully as a transplant for repairing defects in articular cartilage of chickens. Thus allogenic transplantation of cultured embryonal chondrocytes appears to be one of the most promising methods for the restoration of articular cartilage.

Animals↗

[Quantification and progression of the visual field defect in glaucoma without hypertension, glaucoma simplex and pigmentary glaucoma. A clinical study with the Delta Program of the 201 Octopus perimeter].

Visual field defects of stages I-IV, in 451 eyes of 451 glaucoma patients, were examined with the Octopus 201 perimeter: 83 patients with low-tension glaucoma (LTG), 316 patients with primary open-angle glaucoma (POAG), and 52 patients with pigmentary glaucoma (PG). Program 31 or 33 was used, with an eccentricity range of up to 30 degrees, 73 test points, and a 6 degrees grid. The mean total field loss (TL) as well as the mean loss per test point (TL/TP) in the 30 degrees field, in the field quadrants, and in the eccentricity ranges from 0-10 degrees, 10-20 degrees, and 20-30 degrees were calculated for each patient with Program Delta. In addition, for each visual field the quotient of total loss and of the number of disturbed test points was calculated, providing a measurement of the mean depth of the field defects. For definition and comparison of visual fields in the different glaucomas at identical stages of the disease according to the amount of TL, the 3 patient groups were subdivided into 4 stages of sensitivity loss: Stage 1: TL less than or equal to 100 dB; Stage 2: TL 101-400 dB; Stage 3: TL 401-800 dB; Stage 4: 801-1600 dB. The results of a comparison of eyes with LTG, POAG, and PG at the same stage of disease were as follows: I. Location of scotomas: 1. Defects more frequent in the lower field in LTG as compared to POAG in stage 2. 2. Defects more frequent in the upper than in the lower field in POAG. 3. Almost equal number of defects in the upper and lower halves in PG. 4. In all 3 glaucoma types the defects are more frequently found in the nasal than in the temporal half of the visual field. 5. In LTG and POAG of all stages the defects are most frequently found in the upper nasal and most seldom in the lower temporal quadrant. 6. In all glaucoma types the defects occur on average most frequently between 10 degrees and 20 degrees of eccentricity. 7. With increasing IOP in POAG the scotomas tend to be equally distributed in the upper and lower quadrants. II. Depth of scotomas: 1. Scotomas are deepest in LTG; they are less deep in POAG, and least deep in PG. 2. In PG the mean scotoma depth depends significantly on maximum IOP.(ABSTRACT TRUNCATED AT 400 WORDS)

Computers↗

The risk of birth defects among children of Persian Gulf War veterans.

BACKGROUND: There has been suspicion that service in the Persian Gulf War affected the health of veterans adversely, and there have been claims of an increased rate of birth defects among the children of those veterans. METHODS: We evaluated the routinely collected data on all live births at 135 military hospitals in 1991, 1992, and 1993. The data base included up to eight diagnoses from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) for each birth hospitalization, plus information on the demographic characteristics and service history of the parents. The records of over 75,000 newborns were evaluated for any birth defect (ICD-9-CM codes 740 to 759, plus neoplasms and hereditary diseases) and for birth defects defined as severe on the basis of the specific diagnoses and the criteria of the Centers for Disease Control and Prevention. RESULTS: During the study period, 33,998 infants were born to Gulf War veterans and 41,463 to non-deployed veterans at military hospitals. The overall risk of any birth defect was 7.45 percent, and the risk of severe birth defects was 1.85 percent. These rates are similar to those reported in civilian populations. In the multivariate analysis, there was no significant association for either men or women between service in the Gulf War and the risk of any birth defect or of severe birth defects in their children. CONCLUSIONS: This analysis finds no evidence of an increase in the risk of birth defects among the children of Gulf War veterans.

Adult↗

The risk of major birth defects after intracytoplasmic sperm injection and in vitro fertilization.

BACKGROUND: It is not known whether infants conceived with use of intracytoplasmic sperm injection or in vitro fertilization have a higher risk of birth defects than infants conceived naturally. METHODS: We obtained data from three registries in Western Australia on births, births after assisted conception, and major birth defects in infants born between 1993 and 1997. We assessed the prevalence of major birth defects diagnosed by one year of age in infants conceived naturally or with use of intracytoplasmic sperm injection or in vitro fertilization. RESULTS: Twenty-six of the 301 infants conceived with intracytoplasmic sperm injection (8.6 percent) and 75 of the 837 infants conceived with in vitro fertilization (9.0 percent) had a major birth defect diagnosed by one year of age, as compared with 168 of the 4000 naturally conceived infants (4.2 percent; P<0.001 for the comparison between either type of technology and natural conception). As compared with natural conception, the odds ratio for a major birth defect by one year of age, after adjustment for maternal age and parity, the sex of the infant, and correlation between siblings, was 2.0 (95 percent confidence interval, 1.3 to 3.2) with intracytoplasmic sperm injection, and 2.0 (95 percent confidence interval, 1.5 to 2.9) with in vitro fertilization. Infants conceived with use of assisted reproductive technology were more likely than naturally conceived infants to have multiple major defects and to have chromosomal and musculoskeletal defects. CONCLUSIONS: Infants conceived with use of intracytoplasmic sperm injection or in vitro fertilization have twice as high a risk of a major birth defect as naturally conceived infants.

Abnormalities, Multiple↗

Defect-assisted conductivity in organic ionic plastic crystals.

In order to determine the role of defects (vacancies and extended lattice defects) in the conductivity mechanism of a well studied organic ionic plastic crystal electrolyte, conductivity and mean defect volumes were measured. The ionic conductivity of the salt showed a characteristic phase dependence. Defect volumes, as measured by positron annihilation lifetime spectroscopy, showed increasing rates of expansion with increasing rotational disorder. The dependence of ionic conductivity on defect volume was observed to be phase dependent. Increases in mean defect volume size below approximately 100 cm(3) mol(-1) did not always facilitate ionic conductivity. It was shown that the material undergoes a solid-solid phase transition to the most disordered phase (a plastic crystalline phase with the highest conductivity) when the mean defect volume becomes larger than the molar volume of either the rotating anionic or cationic species. Conductivity in this phase had the strongest dependence on defect volume. Critical volumes calculated from the free volume model of Cohen and Turnbull were unrealistically large.

Journal Article↗

The use of second-intention healing for partial-thickness Mohs defects involving the vermilion and/or mucosal surfaces of the lip.

BACKGROUND: Partial-thickness defects involving the vermilion and mucosa of the lip are difficult to repair surgically. OBJECTIVE: The purpose of this study was to evaluate the cosmetic and functional effectiveness of second-intention healing in the repair of partial-thickness defects confined predominantly to the vermilion and mucosa of the lip. METHODS: Thirteen patients with squamous cell carcinoma of the lip underwent Mohs micrographic surgery, which resulted in partial-thickness defects predominantly confined to the vermilion and/or mucosa of the lip. All defects were allowed to heal by secondary intention. RESULTS: Twelve patients had good to excellent cosmetic results, and functional impairment was not noted in any of the patients. One patient whose defect extended to the cutaneous portion of the lip had deformation of the vermilion border. CONCLUSIONS: Second-intention healing yields good to excellent cosmetic and functional results for the repair of partial-thickness defects involving the vermilion and/or mucosa of the lip. Defects involving more than 2 mm of the cutaneous lip or defects extending deeper than the superficial portion of the orbicularis oris muscle may result in cosmetic or functional deformity or both if allowed to heal secondarily.

Administration, Topical↗