Age as a critical factor in the success of surgical correction of craniosynostosis

1981 ◽  
Vol 54 (5) ◽  
pp. 601-606 ◽  
Author(s):  
John Persing ◽  
William Babler ◽  
H. Richard Winn ◽  
John Jane ◽  
George Rodeheaver

✓ The effect of timing of the surgical release of prematurely immobilized coronal sutures was studied in rabbits. At 9 days of age, the coronal suture was mechanically immobilized by the application of methyl cyanoacrylate adhesive. These animals and a control group then received metallic implants on each side of the suture to monitor growth. At 30, 60, or 90 days after suture immobilization, separate groups of animals underwent a linear suturectomy to release the restriction. In animals in which the suture was not released, growth at the coronal suture was significantly restricted and resulted in severe deformities in the neurocranium. The benefits derived from surgical release were time-dependent. Suturectomy at 30 days of age resulted within 60 days in achievement of 100% of the growth in sham-treated controls. In contrast, delayed surgery at 60 or 90 days of age resulted in achievement of only 38% and 17% of normal growth, respectively. Angular measurements of the vault and base of the cranium showed a similar graded response toward normality, with the greatest correction occurring with the earliest operation. These results support the clinical impression that early surgical correction of craniosynostosis results in superior cosmetic appearance. A further implication of this work is that abnormality at a single suture strongly influences the development of other areas in the craniofacial complex.

1982 ◽  
Vol 57 (4) ◽  
pp. 535-542 ◽  
Author(s):  
William J. Babler ◽  
John A. Persing ◽  
H. Richard Winn ◽  
John A. Jane ◽  
George T. Rodeheaver

✓ Premature closure of a cranial suture results in skull deformation characterized by inhibited skull growth in a direction perpendicular to the course of the affected suture. Early surgical release of the closed suture results in a “normal” skull morphology. The present experimental study measured alterations in growth at the transverse cranial sutures that occurred following induced premature closure of the coronal suture and its subsequent release in New Zealand White rabbits. Using roentgenocephalometric methods, growth and morphometric changes were monitored at the frontonasal, coronal, and anterior lambdoid sutures following premature closure of the coronal suture at 9 days of age. The results indicated that premature closure of the coronal suture did not result in compensatory (increased) growth at the other transverse sutures of the vault. In fact, growth at these sutures was significantly reduced. This reduced growth at adjacent transverse sutures was not ameliorated by early surgical release of the fused suture.


1984 ◽  
Vol 60 (1) ◽  
pp. 166-173 ◽  
Author(s):  
Per Alberius ◽  
Göran Selvik

✓ The effect of temporary fusion of sutures on craniofacial growth was studied biometrically in 4-week-old male New Zealand White rabbits. Tantalum bone markers were implanted in the cranial vault, and the coronal suture immobilized with isobutyl-2-cyanoacrylate adhesive. Linear craniectomy was performed after 2 or 6 weeks of sutural growth restriction (four animals in each group). The animals were followed for approximately 17 weeks. Early craniectomy resulted in greatly increased coronal suture bone separation (175% of control growth rates in peers and 125% of maximal control rates). Growth after late craniectomy showed an age-dependent lower rate, but still the overshoot markedly surpassed controls (210% of control rates in peers and 65% of maximal control growth rates). Overall, both exhibited overcompensation in coronal suture growth. A rapid compensation of adjacent sutures to temporary growth restriction and a tendency toward spontaneous correction following release of growth inhibition were demonstrated. Thus, the total anteroposterior growth of the combined frontonasal and coronal sutures nearly equaled that of control animals. Following linear craniectomy, volumetric calvarial expansion increased considerably in both early and late groups, due to compensatory coronal suture growth, but probably due also to spatial bone rearrangements. Based upon the findings, the length of the suture immobilization period seems critical to longitudinal and volumetric growth as well as to subsequent compensatory activity after surgical correction.


1979 ◽  
Vol 50 (2) ◽  
pp. 187-197 ◽  
Author(s):  
K. Maurits Persson ◽  
William A. Roy ◽  
John A. Persing ◽  
George T. Rodeheaver ◽  
H. Richard Winn

✓ Premature fusion of the coronal suture was produced in 9-day-old rabbits by immobilization of the suture area bilaterally with methyl-cyanoacrylate adhesive. The effects of suture fusion and its surgical release on suture growth and on skull morphology were evaluated by radiographic cephalometry. Immobilization resulted in significant changes in the angular dimensions in the vault toward an anteroposterior shortening. No permanent deformity was observed in the angular relationship between the cranial base and the facial skeleton. Craniectomy at 30 days, when a skull deformity had been established, resulted in rapid separation of the bones at the suture site which returned the deformed skull to a normal configuration by 90 days of age. Surgical removal of a normal suture in a control group also resulted in accelerated separation of the bones at the excised suture site, but it was less than after removal of an immobilized suture. The experimental data indicate that premature fusion of rapidly growing sutures results in consistent skull deformity. Early release of the fusion, when this is the primary abnormality, will result in spontaneous correction of the deformity.


1982 ◽  
Vol 56 (4) ◽  
pp. 529-535 ◽  
Author(s):  
William J. Babler ◽  
John A. Persing ◽  
K. Maurits Persson ◽  
H. Richard Winn ◽  
John A. Jane ◽  
...  

✓ Using radiocephalometric procedures, the authors examined the separate effects of suturectomy, periostectomy, and dural transection on the growing skull in young rabbits. When the coronal suture was surgically removed during normal growth, the freed frontal and parietal bones separated at a significantly accelerated rate. No accelerated separation was found when only the overlying periosteum and aponeurosis were transected. Furthermore, no additional separation was observed when the dura mater and falx cerebri were transected following suturectomy. Analysis of growth at the adjacent frontonasal and anterior lambdoid sutures suggested that the accelerated separation of bones after suturectomy was compensated for by reduced growth at these adjacent sutures. The result of these compensatory actions was that the total length of the skull remained unchanged. This study not only supports earlier observations that sutures grow in response to extrinsic separative forces but, significantly, that the suture tissue itself, rather than the dura or pericranium, acts as a restraint during normal translatory growth.


1996 ◽  
Vol 84 (5) ◽  
pp. 831-838 ◽  
Author(s):  
Xiao-Nan Li ◽  
Zi-Wei Du ◽  
Qiang Huang

✓ The modulation effects of hexamethylene bisacetamide (HMBA), a differentiation-inducing agent, on growth and differentiation of cells from human malignant glioma cell line SHG-44 were studied. At cytostatic doses (2.5 mM, 5 mM, 7.5 mM, and 10 mM for 15 days), HMBA exerted a marked inhibitory effect on cell proliferation. Exposure to HMBA (5 mM and 10 mM for 12 days) also resulted in an accumulation of cells in G0/G1 phase and a decrease of cells in S phase as analyzed by flow cytometry. The reversible effects of 7.5 mM HMBA and 10 mM HMBA on cell proliferation and 10 mM HMBA on disruption of cell cycle distribution were observed when HMBA was removed from culture media on Day 6 and replaced with HMBA-free media. Colony-forming efficiency (CFE) in soft agar was remarkably decreased by HMBA (2.5 mM, 5 mM, 7.5 mM, and 10 mM for 14 days), and in 7.5 mM HMBA— and 10 mM HMBA—treated cells, the CFEs were reduced to 25% and 12.5%, respectively, of that in untreated cells. Cells treated with HMBA (5 mM and 10 mM for 15 days) remained tumorigenic in athymic nude mice, but the growth rates of the xenografts were much slower than those in the control group. The effects of HMBA on cell proliferation, cell cycle distribution, CFE, and growth of xenografts were dose dependent. A more mature phenotype was confirmed by the morphological changes from spindle shape to large polygonal stellate shape and remarkably elevated expression of glial fibrillary acidic protein in cells exposed to HMBA (5 mM, 10 mM for 15 days). Our results showed that a more differentiated phenotype with marked growth arrest was induced in SHG-44 cells by HMBA.


2021 ◽  
pp. 1-4
Author(s):  
Xian-Rong Yu ◽  
Yu-Qing Lei ◽  
Jian-Feng Liu ◽  
Zeng-Chun Wang ◽  
Hua Cao ◽  
...  

Abstract Objective: This study explored the clinical effect of employing breast milk oral care for infants who underwent surgical correction of ventricular septal defect. Methods: A prospective randomised controlled study was conducted in a provincial hospital between January, 2020 and July, 2020 in China. Patients were randomly divided into an intervention group (breast milk oral care, n = 28) and a control group (physiological saline oral care, n = 28). The intervention group was given oral nursing using breast milk for infants in the early post-operative period, and the control group was given oral nursing using physiological saline. Related clinical data were recorded and analysed. Results: There were no significant differences in age, gender, weight, operation time, cardiopulmonary bypass time, or aortic cross-clamping time between the two groups. Compared with the physiological saline oral care group, the mechanical ventilation duration, the length of ICU stay in the breast milk oral care group were significantly shorter. The time of start feeding and total enteral nutrition were significantly earlier in the intervention group than those in the control group. The incidence of post-operative pneumonia in the breast milk oral care group was 3.6%, which was significantly lower than that of the physiological saline oral care group. Conclusion: The use of breast milk for oral care in infants who underwent surgical correction of VSD can reduce the incidence of post-operative pneumonia and promote the recovery of gastrointestinal function.


2015 ◽  
Vol 12 (3) ◽  
pp. 169-182 ◽  
Author(s):  
Zülfü Genç ◽  
Emrah Aydemir

Purpose – The purpose of this study is to determine whether the use of online puzzles in the instructional process has an effect on student achievement and learning retention. This study examined students ' perception and experiences on use of puzzle as an alternative evaluation tool. To achieve this aim, the following hypotheses were tested: using puzzle activities in lessons increases student achievement, using puzzle activities in lessons increases retention of information learned by the students and students have positive attitudes toward using puzzle activities in lessons. This study uses an online puzzle system (OPS) by which instructors can prepare puzzle activities for students to solve online. The technical and functional properties of the OPS developed and used are beyond the scope of this study. Design/methodology/approach – A pre- and post-test with control group experimental research design was implemented. Study participants were tenth-grade students in the Information Technologies Department of Gazi Anatolia Technical and Industrial Vocational School in Elazig during the 2011-2012 year. Thirty students each were chosen for the experimental and control groups, totaling 60 students. During the study, a traditional instruction method was used for the control group, while the experimental group received both traditional instruction and performed activities using the OPS. The subject Fundamentals of Networking was chosen, and the implementation period lasted six weeks. Four weeks after completion of the study, the achievement level of students was calculated again to test learning retention. Findings – The first hypothesis of the study is, “Using puzzle activities in the lessons increases the achievement of the students”. In the teaching of the Networking Fundamentals Module of Information Technologies Course for tenth graders, a significant difference in favor of the experimental group was seen, where online puzzle activities were used in terms of student achievement. The second hypothesis of the study is, “Using puzzle activities in the lessons increase the retention of the information learned by the students”. Four weeks after completion of the study, the achievement levels of the students were calculated again to test learning retention. The learning retention of the students in the experimental group is higher than that of the students in the control group. In addition, students in the experimental group had positive attitudes toward online puzzle activities. Doing online puzzle activities accelerates learning for students and helps them learn networking terms by creating an enjoyable environment. Research limitations/implications – The current study was limited to six weeks of implementation during the 2011-2012 school year at Gazi Anatolia Technical and Industrial Vocational High School in Elazig. Similar studies could be conducted in other schools for longer periods and at different levels, so the findings can be compared with those of the current study. This study is further limited to an Information Technologies Course. Studies can be conducted with various courses using appropriate online puzzle activities. Puzzle types other than the crossword used in the OPS of the current study should be developed and added. The system should also be developed by visual multimedia objects, allowing it to be more interactive. Moreover, in the development process of such an OPS, educators, software designers, psychologists and scholars from other fields should work together. Usability tests should be conducted to improve user-friendliness of the system by adding various features related to functionality and visuality. Practical implications – From the findings of the study, it can be concluded that online puzzle activities help students understand subjects better and aid in exam preparation. Moreover, these activities are effective for students in terms of increasing understanding and retention of learned terms in and outside class, forming valuable learning experiences. Doing online puzzle activities in class as a course-end activity can be said to be more effective in students’ learning than doing them outside of class. Crossword puzzles offer opportunities for students to accelerate learning by quickly mastering new words and phrases and by directing students to more actively interact with computer-related vocabulary and terminology as compared with the rote learning method. Originality/value – Paper-based puzzles are frequently used, and there are few Web-based puzzles. Despite their frequent use, preparing and evaluating paper-based puzzles can require a significant time investment; another disadvantage is the lack of immediate feedback. Based on the literature review, there is no dynamic OPS used for educational purposes. This study uses an OPS by which instructors can prepare puzzle activities for students to solve online. The originality of this study is OPS features and puzzle generation mechanism. The system presents a user-friendly interface with Turkish character (or any language) support and number-writing properties.


1981 ◽  
Vol 55 (6) ◽  
pp. 935-937 ◽  
Author(s):  
Giuseppe Salar ◽  
Salvatore Mingrino ◽  
Marco Trabucchi ◽  
Angelo Bosio ◽  
Carlo Semenza

✓ The β-endorphin content in cerebrospinal fluid (CSF) was evaluated in 10 patients with idiopathic trigeminal neuralgia during medical treatment (with or without carbamazepine) and after selective thermocoagulation of the Gasserian ganglion. These values were compared with those obtained in a control group of seven patients without pain problems. No statistically significant difference was found between patients suffering from trigeminal neuralgia and those without pain. Furthermore, neither pharmacological treatment nor surgery changed CSF endorphin values. It is concluded that there is no pathogenetic relationship between trigeminal neuralgia and endorphins.


1979 ◽  
Vol 51 (5) ◽  
pp. 587-596 ◽  
Author(s):  
Albert N. Martins ◽  
Ralph E. Severance ◽  
James M. Henry ◽  
Thomas F. Doyle

✓ The authors have designed an experiment to detect a hitherto unrecognized interaction between high doses of the glucocorticoid, dexamethasone, and brain irradiation. Eighteen juvenile male rhesus monkeys received 1800 rads to the whole brain in 8.5 minutes. For 1½ days before and 10½ days after the irradiation, nine animals received approximately 2.9 mg/kg/day of dexamethasone intramuscularly in addition to irradiation, while the remaining nine animals served as the control group and received saline. All animals eventually developed a progressive neurological syndrome, and died of delayed radiation necrosis of the brain. The two groups were compared with regard to latency to onset of clinical signs, survival time, and number, distribution, and location of lesions of radionecrosis. Large doses of dexamethasone did not alter the susceptibility of the primate brain to delayed radiation necrosis. Detailed morphological study of the radionecrotic lesions supports the hypothesis that most, if not all, of the lesions develop as the consequence of injury to blood vessels.


2015 ◽  
Vol 83 (9) ◽  
pp. 3445-3457 ◽  
Author(s):  
Kate M. O'Keeffe ◽  
Mieszko M. Wilk ◽  
John M. Leech ◽  
Alison G. Murphy ◽  
Maisem Laabei ◽  
...  

The capacity for intracellular survival within phagocytes is likely a critical factor facilitating the dissemination ofStaphylococcus aureusin the host. To date, the majority of work onS. aureus-phagocyte interactions has focused on neutrophils and, to a lesser extent, macrophages, yet we understand little about the role played by dendritic cells (DCs) in the direct killing of this bacterium. Using bone marrow-derived DCs (BMDCs), we demonstrate for the first time that DCs can effectively killS. aureusbut that certain strains ofS. aureushave the capacity to evade DC (and macrophage) killing by manipulation of autophagic pathways. Strains with high levels of Agr activity were capable of causing autophagosome accumulation, were not killed by BMDCs, and subsequently escaped from the phagocyte, exerting significant cytotoxic effects. Conversely, strains that exhibited low levels of Agr activity failed to accumulate autophagosomes and were killed by BMDCs. Inhibition of the autophagic pathway by treatment with 3-methyladenine restored the bactericidal effects of BMDCs. Using anin vivomodel of systemic infection, we demonstrated that the ability ofS. aureusstrains to evade phagocytic cell killing and to survive temporarily within phagocytes correlated with persistence in the periphery and that this effect is critically Agr dependent. Taken together, our data suggest that strains ofS. aureusexhibiting high levels of Agr activity are capable of blocking autophagic flux, leading to the accumulation of autophagosomes. Within these autophagosomes, the bacteria are protected from phagocytic killing, thus providing an intracellular survival niche within professional phagocytes, which ultimately facilitates dissemination.


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