No abstract

Early unilateral brain damage has different implications for language development than does similar damage in adults, given the plasticity of the developing brain. The goal of this study was to examine early markers of language and gesture at 12 and 24 months in children who had peri-natal right hemisphere (RH) or left hemisphere (LH) stroke (n = 71), compared with typically developing controls (n = 126). Parents completed the MacArthur-Bates Communicative Development Inventory (CDI): Words & Gestures (12 month data point), or the CDI: Words & Sentences (24 month data point). Statistical analyses were performed on percentile scores using analysis of variance techniques. At 12 months, there were no differences among groups for Words Understood, Phrases Understood or Words Produced. At 24 months, both lesion groups scored significantly lower than controls on Word Production, Irregular Words, and Mean Length of Sentences, but lesion groups did not differ from each other. In longitudinal subset of participants, expressive vocabulary failed to progress as expected from 12 to 24 months in the stroke group, with no differences based on lesion side. Gesture and word production were dissociated in the left hemisphere subjects. Findings suggest that early language development after peri-natal stroke takes a different course from that of typical language development, perhaps reflecting brain reorganization secondary to plasticity in the developing brain.

A 9-week-old girl had a rash on her back that had been present for 7 weeks. The rash was asymptomatic and started as red bumps that then evolved into pustules and blisters. On further questioning, it was discovered that the patient's father worked in a nursing home that had experienced a recent outbreak of scabies. Shortly after the onset of the outbreak, the patient and all family members were treated with 2 once-weekly doses of permethrin, 5%, cream. All other family members had significant improvement with the treatment; however, our patient's lesions continued to worsen during the subsequent 2 weeks. On physical examination, the patient had numerous erythematous macules, papules, and pustules on her back. Many of the lesions had superimposed hemorrhagic crust and surrounding scale. In addition, several grouped papules were noted, including some in a linear array ( Figure 1A and B). The rest of her cutaneous examination results were unremarkable except for a few fading pink papules noted on her left abdomen ( Figure 1C).

Background Surgical reconstructions following Mohs micrographic surgery and standard surgical excisions are often closed with two layers of sutures: a deep subcuticular layer and a superficial cuticular layer. Some surgeons feel the need to place many deep sutures in order to reduce tension on cuticular sutures, as they believe this may decrease incidence of track marks and dehiscence, and lead to better cosmetic outcomes. However, others feel that a higher number of subcuticular sutures increases the risk of a suture reaction, which leads to patient anxiety and poorer wound cosmesis. To our knowledge, there are no studies published on the effect of subcuticular suture spacing on wound cosmesis. Objectives To determine whether suturing with 1-cm interval subcuticular sutures results in better cosmetic outcomes than suturing with 2-cm interval subcuticular sutures. Methods Fifty patients were enrolled in a randomized clinical trial using a splitwound model, where half of the wound was repaired with sutures spaced 2 cm apart and the other half was repaired with sutures spaced 1 cm apart (ClinicalTrials. gov identifier NCT03327922). Both the evaluators and patients were blinded as to which side received which treatment. The scar was evaluated 3 months postsurgery by two blinded observers and the patients themselves using the Patient and Observer Scar Assessment Scale (POSAS), a validated scar assessment instrument. Results The total mean POSAS score for observers for the sides that received 1-cm interval subcuticular sutures and the sides that received 2-cm interval subcuticular sutures did not differ significantly at 3 months (P = 0Á34). There was also no significant difference in the patient assessment scale score between the two sides at 3 months (P = 0Á084). Conclusions We found that 1-cm suture spacing was not significantly associated with improved overall cosmetic outcome compared with 2-cm suture spacing when evaluated by blinded observers or the patients themselves. Our results support the use of either interval.What is already known about this topic?• Surgeons have differing opinions on the ideal frequency of subcuticular sutures for optimizing cosmetic outcomes and minimizing suture reactions. • The effect of subcuticular suture spacing on wound cosmesis has not been previously explored in the literature.