In this expanded case series with increased longevity of follow-up, the keystone design perforator island flap remains a robust alternative for closure of large myelomeningocele defects.

Objectives: To compare two methods of measuring fetal biparietal diameter (BPD)outer-to-inner (BPDoi) vs. outer-to-outer (BPDoo) calliper placementand to compare the differences in EFW calculated using the Hadlock 4 formula and other common EFW formulae. Methods: A total of 543 fetuses underwent a single ultrasound prospectively performed by 40 sonographers between 14 and 40 weeks of gestation, taking into account the intra-and inter-observer variability. The measurements for each fetus consisted of BPDoi and BPDoo, and EFW is calculated from HC, AC and FL measurements. The difference between BPDoo and BPDoi was estimated, and this difference was compared with gestational age using linear regression. Translational equations that allow interconversion of the two parameters were derived. EFW calculated from four different formulae using various combinations of biometric measurements was compared. Results: The difference between BPDoi and BPDoo increases with gestational age, although this difference was small. For BPDoo, the regression equation is BPDoo = 0.555934 + 1.027318 9 BPDoi. Similarly, for BPDoi, the regression equation is BPDoi = À0.403458 + 0.9714153 9 BPDoo. There is a minimal difference in the EFW calculated from the four formulae, except for gestations prior to 27-28 weeks. EFW derived from INTERGROWTH-21st formulae plot is higher than that from Hadlock 3 or Hadlock 4 before 27-28 weeks. Conclusions: Although the absolute difference between BPDoo and BPDoi increased across gestational age, this difference was small. The method of BPD measurement should follow that as prescribed in the EFW equation used in the local context. Estimation of fetal weight using Hadlock 3, Hadlock 4 and INTERGROWTH-21st is similar, with slight differences at gestations less than 27-28 weeks.

We studied the effect of coronary-artery bypass surgery on blood cells and platelets. Hematological parameters of eighty-three patients were measured by an automated cell counting and sizing analyzer. Sampling time was from 24 h prior to 10 days after surgery. During this time leukocytes and platelets showed characteristic changes in numbers and size, whereas red blood cells revealed no typical modifications. Even though it seems clear that changes of hematological parameters occur after bypass surgery, it is important to be aware of the actual extent of such changes. Therefore the data of 50 patients who had had no post-operative clinical complications were combined to generate diagrams of those parameters that had changed in a characteristic fashion. The diagrams showing average changes, and 99% confidence intervals in mean platelet volume and platelet count were able to identify seven (out of 7) cases with complications up to 48 h before clinical signs were apparent. Complications ranged from mild (3 cases with infections) to severe (4 cases with thrombosis, embolic thrombosis and/or reinfarction). Diagrams showing changes in leukocyte parameters were able to identify only two cases with infections. Even though the number of cases is yet small, the results suggest that surveillance of platelet parameters may be useful in postoperative care. Furthermore, this study was able to confirm the recent findings of Trowbridge and Martin that an abnormal increase in platelet volume distribution width and low platelet counts found in patients with coronary heart disease may serve as good indicators for the prethrombotic state and the risk of myocardial infarction.

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