ISSN:1049-2275    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

To determine the future needs in manpower for pediatric care as it relates to pediatric specialists, a study was conducted by the American Academy of Pediatrics to see the needs of manpower that will provide access of pediatric care to all. A pediatric plastic surgery survey was set in the form of a list of questions that was mailed to the respective societies with pediatric plastic surgeons as members. The survey was reviewed, and the results were studied. The outcome is presented in the form of findings related to the overall practice of plastic surgery. Based on the percentage of pediatric care that is provided, there were two types of pediatric plastic surgeons. Those with the high percentage of pediatric care tend to stay near health science centers; however, both groups tend to spend time (each to a different extent) tending to other plastic surgery problems. Today we have adequate access to care in the health system for pediatric plastic surgery problems despite the shift in the health care environment. Managed care continues to use the pediatrician as a “gatekeeper” in determining the overall access for patients with problems related to pediatric plastic surgery.

ISSN:1049-2275    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1049-2275    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The authors corrected a contracted eye socket and orbitozygomatic hypoplasia simultaneously, secondary to previous surgery and radiotherapy. A one-stage surgical reconstruction was undertaken using both a postauricular skin flap and a temporal fascial flap, which were rotated for eye socket reconstruction and bone graft coverage. Hydroxyapatite was inserted as an onlay bone graft substitute to enlarge the orbitozygomatic region. The authors' experience with 12 patients resulted in contours that were satisfying and encouraging.

ISSN:1049-2275    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

To tabulate and assess quantitative differences between anthropometric and corresponding radiographic cephalometric measurements obtained from the same persons, 19 projective linear measurements were taken from the surface of the heads and faces of 41 patients with cleft lip, cleft palate, or both, all of whom were white North Americans aged 14 to 29 years. They underwent radiographic examination shortly afterward, and corresponding cephalometric measurements were obtained. Differences between the methods were assessed by the numeric differences between the mean values of concurrent measurements. Statistical difference was assessed by paired f test, Pearson productmoment correlations, and intraclass index for degree of agreement between findings. By numeric difference, 6 of 19 anthropometric measurements were similar to (within 2% of) those taken from radiographs. Paired t tests disclosed significant differences between 16 of 19 measurements. Half of the six surface measurements similar to their skeletal counterparts showed no statistical difference; the other half showed only moderately significant differences. Differences between the 13 “dissimilar” measurement pairs (differences >2%) were highly significant. Good correlations were found in five of the six similar measurements, which may have an important prognostic value in understanding changes in the craniofacial measurements of the face. Knowledge of the correlations between all major measurements of the head and face on the surface and skeleton is essential for anticipating changes in the morphologic characteristics of the growing face.

ISSN:1049-2275    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1049-2275    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Recent studies have identified a subpopulation of persons with craniosynostosis who exhibit progressive or delayed-onset synostosis and mild cranial vault deformities. These persons may be good candidates for nonextirpation distraction osteogenesis. The present studies were designed to determine force-displacement parameters and assess the effects of distraction osteogenesis on coronal suture growth and morphologic characteristics in a rabbit model with congenital, delayed-onset craniosynostosis. Data were collected from a total of 178 rabbits: 71 normal controls; 16 normal controls with distraction; 72 with delayed-onset coronal suture synostosis; and 19 with delayed-onset coronal suture synostosis and distraction. At 10 days of age, all rabbits had amalgam markers placed on both sides of the coronal suture. In the force-displacement study, force-displacement distractors were placed across the coronal suture and distracted acutely for 1.0 mm at 42 days of age. Force-displacement curves for the coronal suture were best described by a third-order polynomial regression equation for both normal and synostosed groups. Significant differences (P <0.05) were found in the

ISSN:1049-2275    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Craniosynostosis, the premature fusion of one or more cranial sutures, may occur in isolation or in association with a syndromic constellation. Multiple-suture synostosis has consistently been associated with brain compression and increased intracranial pressure, and frequently decreased cognitive development. Single-suture craniosynostosis, however, has been thought by some to be an aesthetic problem with infrequent consequences on brain function and development. Some studies have disputed this concept and have argued a correlation between single-suture craniosynostosis and abnormalities in development. The purpose of this study was to determine, using an objective radiographic tool, positron emission tomography scans, if patients with single-suture craniosynostosis had any abnormalities in cerebral glucose metabolism that would indicate changes in local brain function. A total of 10 children with single-suture craniosynostosis, eight males and two females, ranging in age from 0.1 to 3.2 years, were enrolled in this prospective study approved by the Internal Review Board. Six of the children had sagittal synostosis, three had metopic synostosis, and one had coronal craniosynostosis. Each of the patients had preoperative positron emission tomography scans performed 1 to 5 weeks before cranial reconstructive surgery and postoperative scans at 6 to 12 weeks after surgery. Surgical treatment consisted of cranial vault remodeling in eight of the children and strip craniectomy with cranial expansion in two of the children. After surgery, the two scans were compared qualitatively and quantitatively by a single radiologist. The results demonstrated variable regional increases and decreases in local postoperative cerebral glucose metabolism. However, in the posterior occipital region, the area of visual development and visual spatial coordination, there was a consistent postoperative increase in all 10 patients. Maximum glucose metabolic rate was increased up to 30.2% with a mean of 9.9%, and average glucose metabolic rates demonstrated a maximum increase of up to 18.8%. The results of this study indicate cerebral glucose metabolism consistently increases in the posterior occipital cortex after surgical release of single-suture craniosynostosis. Future developmental studies are being performed to examine the functional consequences of these metabolic changes.

ISSN:1049-2275    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1049-2275    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Children who undergo craniofacial operations are especially at risk of postoperative nausea and vomiting. These operations are more complex than the craniotomies for resective procedures. Postoperative vomiting is a common occurrence that can delay recovery and result in cerebrospinal fluid leak and fistula formation in these patients. Ondansetron, a selective serotonergic antagonist, is effective in reducing postoperative nausea and vomiting in several high-risk populations. In a randomized, double-blind, placebo-controlled study, the authors compared the prophylactic use of intravenous ondansetron 0.15 mg/kg with induction of anesthesia versus a placebo of normal saline 0.3 ml/kg with induction. A second dose was given 8 hours after the first dose. After surgery, episodes of vomiting were recorded separately in 0 to 2 hours, 2 to 6 hours, 6 to 12 hours, 12 to 24 hours, and 24 to 48 hours. Postoperative vomiting is significantly reduced in the ondansetron group compared with the placebo group (P= 0.000258). Ondansetron is effective in the prevention of postoperative vomiting in the pediatric population undergoing craniofacial operations.

ISSN:1049-2275    

出版商:OVID    

年代:1999

数据来源: OVID