Eleven children with Pseudomonas aeruginosa infection complicating foot puncture wounds were reviewed. Delay in presentation (mean 2 days) and diagnosis (mean 9 days) due to a paucity of clinical signs of deep infection was characteristic of this condition. Septic arthritis (5 patients) and osteomyelitis (3 patients) were frequent complications. Treatment involved multiple surgical debridements and prolonged intravenous antibiotic therapy. The clinical outcome was good although long-term radiographic changes were common.

Adolescent↗

PubMedDate not supplied

Hip dysplasia in Hurler's syndrome: orthopaedic management after bone marrow transplantation.

Hurler's syndrome is an autosomal recessive metabolic storage disease with distinct skeletal manifestations, which include progressive hip dislocation. Enzyme-replacement therapy by bone marrow transplantation improves life expectancy but does not prevent hip dislocation. We describe the features of hip dysplasia in a series of eight successfully engrafted patients with Hurler's syndrome. The primary pathologic condition appears to be a failure of ossification of the cartilaginous acetabulum. Five patients underwent bilateral hip-containment surgery, and all operated-on hips were reduced at a mean follow-up of 17 months. Innominate osteotomy would appear to be an essential part of the surgical procedure.

Arthrography↗

PubMedDate not supplied

Tibial hemimelia of a different class.

A variant of tibial hemimelia, previously undescribed in the literature and not classifiable by either of the established classification systems, is described. The features of this condition include a short, deformed tibia; proximal subluxation of the fibula at the knee; a normal knee joint and an ankle joint that may look abnormal but falls short of true diastasis of the joint. Treatment of two cases by differential lengthening of the tibia and fibula using the Ilizarov device is described. This form of tibial hemimelia should be recognised as a separate variant as preservation of the foot and ankle with expected excellent function should be possible, unlike the more severe forms of this condition.

Age Factors↗

PubMedDate not supplied

Kyphectomy in children with myelomeningocele: a long-term outcome study.

Twenty-four children with myelomeningocele and a kyphotic deformity treated by surgical correction between 1980 and 1994 were reviewed. Different techniques of instrumentation and spinal fusion were used. The mean age at surgery was 9.5 years. The mean kyphotic angle was 121 degrees preoperatively, 50 degrees postoperatively, and 57 degrees at final follow-up. The postoperative complication rate was high. Delayed wound healing and late skin breakdown with exposure of instrumentation were common problems. Further surgery to remove protruding hardware was necessary in 18 patients. Long posterior instrumentation with fixation to the pelvis had significantly better stability on follow-up than other methods. Despite the prolonged postoperative morbidity in the majority of the study group, the long-term clinical and radiologic outcome at a mean follow-up of 10 years was excellent.

Adolescent↗

PubMedDate not supplied

Effect of heel height on forefoot loading.

Sixty feet of 30 normal subjects were investigated to determine the effect of changing the heel height on forefoot loading. Subjects walked across footplates barefoot and with rigid polyurethane heels attached to the foot with a tubular bandage. The total load on the forefoot remained unchanged at all of the heel heights, but the distribution of the load changed as the heel was raised. The area of forefoot contact with the footplates decreased and there was a deviation of load toward the medial side of the forefoot with a resultant increase in pressure. These effects could contribute to overload of the distal forefoot and especially of the first ray.

Adolescent↗

PubMedDate not supplied

Urinoma: an unusual case of emesis in a brain-injured child.

The evaluation of acute emesis in a multiple-trauma paediatric patient with severe traumatic brain injury can present a difficult but not unusual problem in the rehabilitation unit. The differential diagnosis will be discussed in a paediatric case in which emesis was related to a urinoma, secondary to ureteropelvic disruption, compressing the duodenum. We present a case of a 6-year-old Caucasian girl with severe brain injury who developed emesis while in rehabilitation. An X-ray of the abdomen revealed a shadow over the right psoas. Subsequently mild compression of the duodenum was diagnosed by computerized tomography, and ultrasound demonstrated a large fluid collection inferior to the right kidney. A large volume of urine was drained and a catheter placed. Pyelogram revealed apparent disruption of the right ureteropelvic junction, which was confirmed intraoperatively. The kidney was removed secondary to severe parenchymal abnormalities. The emesis subsequently resolved. Differential diagnosis of acute onset of emesis in the paediatric brain-injured patient should include a careful search for underlying previously unrecognized problems.

Brain Injuries↗

PubMedDate not supplied

Humoral immune response to infectious agents in aborted bovine fetuses in Argentina.

The purpose of this study was to characterize the exposure of bovine aborted fetuses from beef and dairy herds of the humid pampas of Argentina to different infectious agents by the evaluation of fetal fluid antibodies. Presence of fetal antibodies to bovine viral diarrhea virus genotype 1 (BVDV-1), bovine herpes virus type 1 (BHV-1), Leptospira interrogans, Brucella abortus, and Neospora caninum was determined. Of the 95 fetuses processed, 66 came from 49 beef herds and 29 from 12 dairy herds. The average gestational age of the aborted fetuses was 7.1 months. Antibodies to the mentioned agents were detected in 65 of the 95 fetal fluids (68.4%). In addition, antibodies to more than one infectious agent were detected in 32 fetuses (33.7%), suggesting fetal exposure to multiple antigens during gestation. There were antibodies to BVDV-1, BHV-1, N. caninum and Leptospira interrogans in 43 (45.2%), 29 (30.5%), 26 (27.4%) and 5 (5.2%) specimens, respectively. Antibodies to B. abortus were not detected in any of the fetal fluids. The results of this study provide information on the determination of antibodies in fluids from bovine aborted fetuses exposed to different infectious agents in the region.

Abortion, Veterinary↗

PubMedDate not supplied

[Bovine neosporosis: general concepts, immunity and perspectives for vaccination].

Neospora caninum causes abortions in cattle worldwide. The Neospora-cycle of life is heteroxenous. Dogs (Canis familiaris) and coyotes (Canis latrans) are the definitive hosts known at present. Although, transplacental infection is an efficiently mode of transmission in cattle; there are also experimental and field data that prove horizontal transmission. Several techniques are available for diagnosis since neosporosis is recognized as a disease that causes economic losses in cattle. The mechanisms that produce the abortion are not completely understood. The immunomodulation observed during the pregnancy, is associated with a susceptible period where Neospora-abortion can occur. Resistance to the parasite is dependent on T helper cell 1 cytokine responses. This has important repercussions for pregnant female bovine because strong T helper cell 1 cytokine responses are incompatible with successful pregnancy. However, it was demonstrated that chronically infected cows develop immune mechanisms against the abortion caused by a second Neospora-exposure. The comprehension of those mechanisms is needed for the formulation of Neospora-vaccines that prevent bovine neosporosis. General concepts about neosporosis with emphasis in the immune response and perspectives for vaccination are mentioned in the present review.

Abortion, Veterinary↗