Lung function in school-aged congenital diaphragmatic hernia patients; a longitudinal evaluation

Objective: Children with congenital diaphragmatic hernia (CDH) are at risk for pulmonary morbidity. Data on longitudinal evaluation of lung function in CDH are scarce. We hypothesized that CDH patients would have impaired lung function that worsens over time. We evaluated lung function and its determinants at ages 8 and 12 years. Methods: Dynamic and static lung volumes, and diffusion capacity were measured. Extracorporeal membrane oxygenation (ECMO) treatment, the standardized European neonatal treatment protocol, patch repair, duration of ventilation, type of initial mechanical ventilation, and nitric oxide treatment were entered as covariates in linear mixed models with standard deviation score (SDS) lung function parameters (FEV1, FEF 25-75, and K CO) as dependent variables. Results: Seventy-six children (27 ECMO-treated) born between 1999 and 2009 performed 113 reliable lung function tests. Severity of airflow obstruction deteriorated significantly from age 8 to 12 years: estimated mean difference (95% confidence interval [CI]) SDS FEV1 was −0.57 (−0.79 to −0.36) and SDS FEF25-75 was −0.63 (−0.89 to −0.37), both P <.001. Static lung volumes were within normal range and unchanged over time: estimated mean difference (95% CI) SDS TLC −0.27 (−0.58 to 0.04); P =.085. SDS KCO was below normal at 8 and 12 years and remained stable: −0.06 (−0.22 to 0.35); P =.648. These observations were irrespective of ECMO treatment. FEV1 and FEF25-75 were negatively associated with duration of ventilation (P <.001). Baseline data were not related with TLC or KCO. Conclusions: CDH patients should be followed into adulthood as they are at risk for worsening airflow obstruction and decreased diffusion capacity at school age, irrespective of ECMO treatment

Clinical outcome of fractures of the talar body

Fractures of the talar body present a great challenge to surgeons due to their rarity and high incidence of sequelae. This study reports the medium-term results of displaced fractures of the talar body treated by internal fixation. Nineteen patients (13 M, 6 F, mean age 31) with talar body fractures were studied retrospectively to assess outcome after operative treatment. The fractures were classified as coronal (11), sagittal (6) and crush fractures (2). Six patients sustained open fractures and two had associated talar neck fractures. Average follow-up was 26 months (range: 18–43). Clinical outcome based on American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scoring was excellent function in four patients, good in six, fair in four and poor in five. Early complications included two superficial wound infections, one partial wound dehiscence, one instance of skin necrosis and one deep infection. Other complications included delayed union in one, avascular necrosis in seven and malunion in one patient. Talar injuries are serious because they can compromise motion of the foot and ankle and result in severe disability. Crush fractures of the talar body and those associated with open injuries and talar neck fractures are associated with a less favourable outcome

Testing single-sample estimators of effective population size in genetically structured populations

This research was supported by Australian Research Council Grant DP0559363 to WBS and RAN