Sporting activity after craniosynostosis surgery in children: a source of parental anxiety

Purpose: Craniosynostosis correction involves major skull surgery in infancy—a potential source of worry for parents when their treated children begin involvement in sports. Methods: Electronic multiple choice survey of parents of children who had undergone craniosynostosis surgery in infancy using 5-point Likert scales. Results: Fifty-nine completed surveys were obtained from parents of children who had undergone previous craniosynostosis surgery. Mean age of children was 7.8 years (range 3 months to 22 years), with 36 non-syndromic and 23 syndromic cases. The most common surgery was fronto-orbital remodelling (18). Fifty-two of 59 were involved in athletic activity. The most intense sport type was non-contact in 23, light contact in 20, heavy contact in 4 and combat in 5. Participation level was school mandatory in 12, school club in 17, non-school sport club in 21 and regional representative in 2. One child had been advised to avoid sport by an external physician. Mean anxiety (1–5 Likert) increased with sport intensity: non-contact 1.7, light contact 2.2, heavy contact 3.5 and combat 3.6. Twenty-nine of 59 parents had been given specific advice by the Craniofacial Team regarding athletic activity, 28 of which found useful. Three sport-related head injuries were reported, none of which required hospitalisation. Conclusion: Little information exists regarding sports for children after craniosynostosis surgery. This study suggests that parental anxiety remains high, particularly for high impact/combat sports, and that parents would like more information from clinicians about the safety of post-operative sporting activities

Role of snow and glacier melt in controlling river hydrology in Liddar watershed (western Himalaya) under current and future climate

This is the publisher's version, also available electronically from http://onlinelibrary.wiley.com/doi/10.1029/2011WR011590/abstract.[1] Snowmelt and icemelt are believed to be important regulators of seasonal discharge of Himalayan rivers. To analyze the long term contribution of snowmelt and glacier/icemelt to river hydrology we apply a water budget model to simulate hydrology of the Liddar watershed in the western Himalaya, India for the 20th century (1901–2010) and future IPCC A1B climate change scenario. Long term (1901–2010) temperature and precipitation data in this region show a warming trend (0.08°C yr−1) and an increase in precipitation (0.28 mm yr−1), with a significant variability in seasonal trends. In particular, winter months have undergone the most warming, along with a decrease in precipitation rates; precipitation has increased throughout the spring. These trends have accelerated the melting and rapid disappearance of snow, causing a seasonal redistribution in the availability of water. Our model results show that about 60% of the annual runoff of the Liddar watershed is contributed from the snowmelt, while only 2% is contributed from glacier ice. The climate trend observed from the 1901 to 2010 time period and its impact on the availability of water will become significantly worse under the IPCC climate change scenarios. Our results suggest that there is a significant shift in the timing and quantity of water runoff in this region of the Himalayas due to snow distribution and melt. With greatly increased spring runoff and its reductions in summer potentially leading to reduced water availability for irrigation agriculture in summer

Prevalence of Helicobacter pylori Infection in Peptic Ulcer Patients of Highly Endemic Kashmir Valley

Objective This study aimed to find out prevalence of Helicobacter pylori (H. pylori) in peptic ulcer disease (PUD) which is highly endemic disease in Kashmir

Endoscopic Evaluation of Peptic Ulcer Disease During Ramadan Fasting

The effects of fasting on peptic ulcer disease were evaluated in a prospective study, involving 23 fasting patients who underwent endoscopy before and after Ramadan. Eighteen patients took an H2-blocker (ranitidine, 150 mg twice daily) regularly at “Suhur” and “Iftar” as prescribed, while 5 were drug defaulters. On the first endoscopy the diagnosis in 4 patients was active acute duodenal ulcer (AADU), in 8 patients was active chronic duodenal ulcer (ACDU) in 8 patients was healed duodenal ulcer (HDU), in 2 patients was erosive duodenitis (ED), and in 1 patient was chronic gastric ulcer (CGU). All of the patients with AADU showed signs of healing on repeat endoscopy. None of the ACDU patients showed signs of healing on repeat endoscopy. Instead, 7 patients in this group bled during fasting. All of the 5 drug defaulters belonged to the ACDU group. One patient in the HDU group had developed an active ulcer near the previous scar, as which was seen on repeat endoscopy. The 2 patients with ED showed signs of healing, while the only patient with CGU had bled from the same ulcer as seen on repeat endoscopy. The results were compared with those of 15 nonfasting control subjects (6 patients with ACDU, 3 with HDU, and 6 with ED as diagnosed on the first endoscopy), who took an H2-blocker regularly. The repeat endoscopy did not show any change in these patients. In conclusion, we inferred that Ramadan fasting may prove hazardous in patients with peptic ulcer disease in general and with active chronic ulcers in particular, although the fact that only 23 patients volunteered for this study, of whom 5 were drug defaulters, is a limitation

Isotopic composition of daily precipitation along the southern foothills of the Himalayas: impact of marine and continental sources of atmospheric moisture

The flow of the Himalayan rivers, a key source of fresh water for more than a billion people primarily depends upon the strength, behaviour and duration of the Indian summer monsoon (ISM) and the western disturbances (WD), two contrasting circulation regimes of the regional atmosphere. An analysis of the 2H and 18O isotope composition of daily precipitation collected along the southern foothills of the Himalayas, combined with extensive backward trajectory modelling, was used to gain deeper insight into the mechanisms controlling the isotopic composition of precipitation and the origin of atmospheric moisture and precipitation during ISM and WD periods. Daily precipitation samples were collected during the period from September 2008 to December 2011 at six stations, extending from Srinagar in the west (Kashmir state) to Dibrugarh in the east (Assam state). In total, 548 daily precipitation samples were collected and analysed for their stable isotope composition. It is suggested that the gradual reduction in the 2H and 18O content of precipitation in the study region, progressing from δ18O values close to zero down to ca. −10 ‰ in the course of ISM evolution, stems from regional, large-scale recycling of moisture-driven monsoonal circulation. Superimposed on this general trend are short-term fluctuations of the isotopic composition of rainfall, which might have stem from local effects such as enhanced convective activity and the associated higher degree of rainout of moist air masses (local amount effect), the partial evaporation of raindrops, or the impact of isotopically heavy moisture generated in evapotranspiration processes taking place in the vicinity of rainfall sampling sites. Seasonal footprint maps constructed for three stations representing the western, central and eastern portions of the Himalayan region indicate that the influence of monsoonal circulation reaches the western edges of the Himalayan region. While the characteristic imprint of monsoonal air masses (increase of monthly rainfall amount) can be completely absent in the western Himalayas, the onset of the ISM period in this region is still clearly visible in the isotopic composition of daily precipitation. A characteristic feature of daily precipitation collected during the WD period is the gradual increase of 2H and 18O content, reaching positive δ2H and δ18O values towards the end of the period. This trend can be explained by the growing importance of moisture of continental origin as a source of daily precipitation. High deuterium-excess (d-excess) values of daily rainfall recorded at the monitoring stations (38 cases in total, range from 20.6 to 44.0 ‰) are attributed to moisture of continental origin released into the atmosphere during the evaporation of surface water bodies and/or soil water evaporation

Helicobacter Pylori Infection in Endoscopic Biopsy Specimens of Gastric Cancer: A Preliminary Evaluation in a High Risk Population of Kashmir Valley

Objective: The aim of the present study was to assess the prevalence of Helicobacter pylori (H. pylori) infection in Kashmiri patients with gastric cancer and to compare this with a matched control population

Spring-assisted posterior vault expansion: a parametric study to improve the intracranial volume increase prediction

Spring-assisted posterior vault expansion has been adopted at the London Great Ormond Street Hospital for Children to treat raised intracranial pressure in patients affected by syndromic craniosynostosis, a congenital calvarial anomaly causing the premature fusion of skull sutures. This procedure involves elastic distractors used to dynamically reshape the skull and increase the intracranial volume (ICV). In this study, we developed and validated a patient-specific model able to predict the ICV increase and carried out a parametric study to investigate the effect of surgical parameters on that final volume. Pre- and post-operative computed tomography data relative to 18 patients were processed to extract simplified patient-specific skull shape, replicate surgical cuts, and simulate spring expansion. A parametric study was performed to quantify each parameter’s impact on the surgical outcome: for each patient, the osteotomy location was varied in a pre-defined range; local sensitivity of the predicted ICV to each parameter was analysed and compared. Results showed that the finite element model performed well in terms of post-operative ICV prediction and allowed for parametric optimization of surgical cuts. The study indicates how to optimize the ICV increase according to the type of procedure and provides indication on the most robust surgical strategy

Local Soft Tissue and Bone Displacements Following Midfacial Bipartition Distraction in Apert Syndrome – Quantification Using a Semi-Automated Method

ABSTRACT: Patients with Apert syndrome experience midfacial hypoplasia, hypertelorism, and downslanting palpebral fissures which can be corrected by midfacial bipartition distraction with rigid external distraction device. Quantitative studies typically focus on quantifying rigid advancement and rotation postdistraction, but intrinsic shape changes of bone and soft tissue remain unknown. This study presents a method to quantify these changes. Pre- and post-operative computed tomography scans from patients with Apert syndrome undergoing midfacial bipartition distraction with rigid external distraction device were collected. Digital Imaging and Communications in Medicine files were converted to three-dimensional bone and soft tissue reconstructions. Postoperative reconstructions were aligned on the preoperative maxilla, followed by nonrigid iterative closest point transformation to determine local shape changes. Anatomical point-to-point displacements were calculated and visualized using a heatmap and arrow map. Nine patients were included.Zygomatic arches and frontal bone demonstrated the largest changes. Mid-lateral to supra-orbital rim showed an upward, inward motion. Mean bone displacements ranged from 3.3 to 12.8 mm. Soft tissue displacements were relatively smaller, with greatest changes at the lateral canthi. Midfacial bipartition distraction with rigid external distraction device results in upward, inward rotation of the orbits, upward rotation of the zygomatic arch, and relative posterior motion of the frontal bone. Local movements were successfully quantified using a novel method, which can be applied to other surgical techniques/syndromes

Fourth ventricle tumors in children: complications and influence of surgical approach

OBJECTIVES: The goal of this study was to characterize the complications and morbidity related to the surgical management of pediatric fourth ventricle tumors. / METHODS: All patients referred to the authors’ institution with posterior fossa tumors from 2002 to 2018 inclusive were screened to include only true fourth ventricle tumors. Preoperative imaging and clinical notes were reviewed to extract data on presenting symptoms; surgical episodes, techniques, and adjuncts; tumor histology; and postoperative complications. / RESULTS: Three hundred fifty-four children with posterior fossa tumors were treated during the study period; of these, 185 tumors were in the fourth ventricle, and 167 fourth ventricle tumors with full data sets were included in this analysis. One hundred patients were male (mean age ± SD, 5.98 ± 4.12 years). The most common presenting symptom was vomiting (63.5%). The most common tumor types, in order, were medulloblastoma (94 cases) > pilocytic astrocytoma (30 cases) > ependymoma (30 cases) > choroid plexus neoplasms (5 cases) > atypical teratoid/rhabdoid tumor (4 cases), with 4 miscellaneous lesions. Of the 67.1% of patients who presented with hydrocephalus, 45.5% had an external ventricular drain inserted (66.7% of these prior to tumor surgery, 56.9% frontal); these patients were more likely to undergo ventriculoperitoneal shunt (VPS) placement at a later date (p = 0.00673). Twenty-two had an endoscopic third ventriculostomy, of whom 8 later underwent VPS placement. Overall, 19.7% of patients had a VPS sited during treatment. Across the whole series, the transvermian approach was more frequent than the telovelar approach (64.1% vs 33.0%); however, the telovelar approach was significantly more common in the latter half of the series (p < 0.001). Gross-total resection was achieved in 70.7%. The most common postoperative deficit was cerebellar mutism syndrome (CMS; 28.7%), followed by new weakness (24.0%), cranial neuropathy (18.0%), and new gait abnormality/ataxia (12.6%). Use of intraoperative ultrasonography significantly reduced the incidence of CMS (p = 0.0365). There was no significant difference in the rate of CMS between telovelar or transvermian approaches (p = 0.745), and multivariate logistic regression modeling did not reveal any statistically significant relationships between CMS and surgical approach. / CONCLUSIONS: Surgical management of pediatric fourth ventricle tumors continues to evolve, and resection is increasingly performed through the telovelar route. CMS is enduringly the major postoperative complication in this patient population