Possible secular trend in the incidence of an anatomical variant: Median artery of the forearm

Occurrence of a secular trend in the presence of a common anatomical variant—median artery of the forearm is studied. Data from the literature indicated the incidence of the median artery to be between 4.4 and 8.3% in adult cadavers studied before 1960 while our recent study found a frequency of 27.2%. In 224 adult and 60 infant cadavers of people born between 1900 and 1991 studied using a uniform method the incidence of the median artery in the birth cohort 1900–1910 was 15.0% of individuals, it rose to 29.7% in 1921–1930 and further to 38.1% in 1951–1960 to become 52.8% in 1980–1991. This trend is statistically significant. Since the median artery is deemed to dwindle away in most individuals around the 7th week of the intrauterine life, the increasing proportion of individuals who retain it into postnatal life may indicate a recent trend in human intrauterine development. © 1995 Wiley-Liss, Inc.     

Mesadenitis in children with acute abdominal pain syndrome: clinical and echographic parallels

The paper pools the experience of ultrasound assessment of acute mesadenitis in children with acute abdominal pain syndrome. It reviews the literature on its etiology, pathology, and diagnosis and treatment principles. B-mode and Doppler echograms made by general practice ultrasound diagnosticians are shown. The technique is demonstrated to be effective and of informative value in the early stages of diagnosis in the patient contingent in question.     

A recurrent pattern syndrome of craniosynostosis associated with arachnodactyly and abdominal hernias

A new syndrome of craniosynostosis is described in two unrelated male children. Associated anomalies include severe exophthalmus; maxillary and mandibular hypoplasia; soft tissue hypertrophy of the palatal shelves; low-set ears with soft, pliable auricles; thoracic anomalies; multiple abdominal hernias; arachnodactyly; and camptodactyly. Functional disorders include infantile hypotonia, developmental delay, mental retardation, and obstructive apnea. Karyotypes were normal. An etiology for this recurrent pattern syndrome has not yet been established in the absence of a family history of similar anomalies in both cases.     

Erythermalgia: molecular basis for an inherited pain syndrome

Inherited erythermalgia (also termed erythromelalgia) is characterized by severe pain in the limbs in response to mild thermal stimuli or exercise. Its molecular basis has, until recently, been enigmatic. Studies of families with autosomal dominant erythermalgia have now demonstrated mutations in sodium channel Na(v)1.7, which is selectively expressed within nociceptive dorsal root ganglion and sympathetic ganglion neurons. Shifts in activation and deactivation, and enhanced responses to small stimuli in mutant channels, decrease the threshold for single impulses and high-frequency trains of impulses in pain-sensing neurons. Erythermalgia, the first inherited painful neuropathy to be understood at a molecular level, is a model disease that could hold lessons for other painful conditions and for the development of rational, mechanism-based treatments for pain.     

Use of the rectus abdominis muscle for abdominal stoma sphincter construction: an anatomical feasibility study

Permanent fecal abdominal stomas significantly decrease quality of life. Previous attempts to create continent stomas by using dynamic myoplasty procedures have resulted in disappointing outcomes, primarily owing to denervation atrophy of the muscle flap that was used in the creation of the sphincter and because of muscle fatigue resulting from continuous electrical stimulation that is received by the flap to force contraction. On the basis of these problems, we designed two separate studies: an anatomical study addressing flap denervation and a functional study addressing muscle fatigue. The present study addresses the first topic and was designed to develop a rectus abdominis muscle flap into a sphincter that was anatomically situated to create a stoma while preserving as much innervation as possible. In 24 rectus abdominis muscles of human cadavers, the neurovascular anatomy was defined, then the anatomical feasibility of two different muscle flap configurations was considered. The flaps investigated were the peninsula flap and island flap designs, with both using the most caudal segment of the rectus abdominis muscle in construction of the sphincter. Neither flap design required the killing of a nerve for stoma sphincter creation, resulting in minimal muscle denervation. The conclusion of our comparison was that the above, in conjunction with other features of the island flap design, such as muscle overlap after sphincter formation and abdominal wall positioning of the sphincter, made the island flap design better suited to stoma sphincter construction.     

Diagnostic value of a peroral sucrose permeability test in children with recurrent upper abdominal pain

The access of ingested sucrose into blood and urine indicates the presence of mucosal lesions in the upper gastrointestinal tract. The study involved 42 children, aged 5-15, having recurrent upper abdominal pain and 43 peers with minor extra-abdominal complaints. Sucrose in urine was determined by thin layer chromatography. The test was positive in 27 out of 42 children having recurrent abdominal pain (64.3%) and in none of the control children (chi2 = 37.6, p < 0.0001). When correlated with endoscopic findings it was falsely negative in 12 out of 38 patients with endoscopically verified lesions of the stomach or duodenum and falsely positive in 1 out of 4 without lesions. Sensitivity of the test was 68.4%, specificity 97.9%, positive predictive value 96.3%. The test cannot be used as an alternative to endoscopy, but may serve for screening of candidates for it.     

A migraine variant with abdominal colic and Alice in wonderland syndrome: a case report and review

Background  

Abdominal migraine is a commonly described migraine variant in children and young adults, but associations with Alice in Wonderland syndrome and lilliputian hallucinations are exceptional.     

儿童再发性腹痛中幽门螺杆菌不同检测方法

目的 评价幽门螺杆菌（H.pylori）的不同检测方法及H.pylori感染在儿童再发性腹痛（RAP）诊断中的应用.方法 对在我院诊治的儿童RAP 72例,分为学龄期组24例,少年组48例,同时进行细菌培养、快速尿素酶试验、病理组织学检查、血清学H.pylori抗体检测和粪便H.pylori抗原（HpSA）检测.将前3项检查中2项阳性或细菌培养一项阳性作为诊断H.pylori感染的金标准.结果 金标准诊断H.pylori感染,阳性占37例,阴性占35例,总阳性率为51.4%;学龄期儿童组H.pylori检出阳性率为37.5%,少年组H.pylori检出阳性率为58.3%,两组比较差异有显著性（P＜0.01）;比较6种不同检测方法的敏感性、特异性、准确性,经x2检验,差异均无显著性（P＞0.10）.结论 H.pylori感染与儿童RAP之间存在一定的联系,少年组H.pylori感染率高于学龄期儿童组,而粪便HpSA检测有较高的敏感性和特异性,是一种简便可靠,非侵入性的诊断H.pylori感染的方法,尤其适合儿童.     

Axillar compression syndrome: anatomical and clinical study

In order to evaluate the possibility of compression of axillar artery by medial and lateral fascicle of brachial plexus, authors performed 26 axillar dissections on cadavers. Second part included analysis of 24 selective angiograms of axillar artery of patients with diagnosis of TOS. Third part included the use of modified hyperabduction test for determination of vascular bruit as safe test for diagnosis of axillar compression. Macroscopic changes of axillar artery by compression of medial and lateral fascicle of brachial plexus were present in 11.5%. Specific angiographic horizontal spike-shaped stop of contrast behind the surgical neck of humerus was present in 12.5%. Use of modified hyperabduction test revealed vascular bruit 29.5%. Specific relation of axillar artery and medial and lateral fascicle of brachial plexus revealed another possible etiologic factor in hyperabduction syndrome as a part of TOS. Use of modified hyperabduction test revealed subclinical phase of possible syndrome.     

Severe hypernatremic dehydration in an infant with Netherton syndrome.

Netherthon syndrome is a rare autosomal recessive disease characterized by ichthyosis, the characteristic hair abnormality trichorrhexis invaginata and atopic manifestations. We report a female child with the severe hypernatremic dehydration form of the Netherton syndrome born as the first child of consanguineous parents. Ichthyosis was present at birth. She was admitted to the intensive care unit at the age of 4 days with important loss of weight and dehydration. Severe hypernatremia and convulsions occurred. Despite intensive care the baby died at the age of 11 days. The diagnosis of Netherton syndrome was confirmed by the finding of the pathognomonic hair shaft anomaly trichorrhexis invaginata (bamboo hair) and premature lamellar body secretion and foci of electron-dense material in the intercellular spaces of stratum corneum as relatively specific markers for Netherton syndrome. Netherton syndrome is characterized by a large variability in phenotypic expression. The major neonatal complication is the hypernatremic dehydration, which can be fatal as in this patient or complicated by neurologic signs (intracranial hemorrhage) and secondary sequellae. Molecular studies revealed a mutation in SPINK 5, encoding a serine protease inhibitor. Prenatal diagnosis was performed in the second pregnancy and showed that the fetus was equally affected.