Acute cholecystitis is a serious condition in transplant patients and elective cholecystectomy is generally recommended when gallstones are found. We reviewed the results of laparoscopic cholecystectomy (LC) in 10 immunosuppressed transplant patients (6 heart, 4 kidney) and compared them to the results of open cholecystectomy performed in 26 transplant patients (14 heart, 11 kidney, 1 kidney/pancreas). The LC group had a 20% incidence of minor complication with no major complications and no deaths. The open-cholecystectomy group experienced 19% minor complications, 23% major complications, and 15% deaths. The average postoperative length of stay for the LC patients was 4.6 days (2 days for the 5 straightforward cases) as compared to 9.1 days after open cholecystectomy (4 days for the 13 straightforward open cases). Oral immunosuppression was stopped prior to operation but could be restarted within 29 hours after operation in the LC patients and 68 h in the open cases. The findings at LC were helpful in assessing whether acute cholecystitis and/or choledocholithiasis was the source of fever, liver-function abnormalities, or pancreatitis in these immunosuppressed transplant patients. We conclude that LC can be performed safely in transplant patients, but that in 10-20% of patients, the operation will be converted to an open procedure. The advantages of LC in these patients are a shorter hospitalization and less delay to resumption of preoperative oral immunotherapy than after open cholecystectomy.

Adult↗

PubMedDate not supplied

The inhibitory effect of proflavine and ethidiumbromide on the cell-free transmission and the growth of the hamster melanoma A Mel 3.

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Acridines↗

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Unusual chromosomal findings in a case of myelofibrosis.

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Aged↗

PubMedDate not supplied

Gait analysis in rehabilitation medicine: a brief report.

Gait analysis can be a powerful tool for rehabilitation research and clinical practice. However, there has been little coordinated effort to set goals for the application of gait analysis in rehabilitation. Therefore, a priority setting process was engaged to obtain the opinions of a diverse pool of experts related to human motion analysis. The primary goal of this process was to develop priorities for future research, development, and standardization in gait analysis. A multistep approach was used that included expert testimony, group discussions, individually developed priorities, and a ranking process. Several important priorities emerged from this activity. The highest priority was assigned to research on the efficacy, outcomes, and cost-effectiveness of gait analysis.

Cost-Benefit Analysis↗

PubMedDate not supplied

Impact of orthoses on the rate of scoliosis progression in children with cerebral palsy.

This study was undertaken to determine the impact of spinal bracing on curve pattern and the rate of progression of neuromuscular scoliosis in children with cerebral palsy. Twenty-one patients were treated with a Wilmington custom-molded orthosis with 23 h a day brace wear for a mean bracing period of 67 months (range, 22-173). Twenty-two patients had a similar follow-up to spinal fusion but had no bracewear. Patients who were braced had a scoliosis that reached a magnitude of 50 degrees at a mean 12.5 years, compared with a mean age of 14 years for those who were not braced (p > 0.05). Spinal orthotics had no impact on scoliosis curve, shape, or rate of progression in spastic quadriplegic patients who were followed-up on fusion. Apical vertebral rotation > 2 (Nash and Moe criteria) is an indicator of impending rapid progression of the scoliosis curve.

Adolescent↗

PubMedDate not supplied

Surgical correction of spinal deformity using a unit rod in children with cerebral palsy.

Thirty-one patients with cerebral palsy and neuromuscular scoliosis underwent instrumentation with a unit rod fixed with sublaminar wires and posterior spine fusion. The mean curve measured 79 degrees preoperatively, 19 degrees immediately postoperatively, and 18 degrees at final follow-up of 2.8 years, excluding two patients who died and four who were lost to follow-up after < 12 months. The preoperative pelvic obliquity was 25 degrees, which was initially corrected to 3 degrees and remained unchanged at 4 degrees at final follow-up. Twenty-four patients underwent a one-stage posterior fusion, and seven patients underwent both anterior and posterior fusions. Complications included one acute deep-wound infection and one late deep-wound infection seeded from the urinary tract. No pseud-arthroses or hardware failures have occurred to date. Seven children with open triadiate cartilages had a posterior spinal fusion only and were followed up to skeletal maturity with a 3 degrees loss of correction of the scoliosis and a 0 degree loss of correction of pelvic obliquity. Questionnaires filled out by primary caretakers demonstrated that the objective of improving the child's ability to sit more comfortably was accomplished for the majority (65%) of patients. Spinal fusion was recommended for other children by 86% of interviewed caretakers.

Adolescent↗

PubMedDate not supplied

Measurement of acetabular index intraobserver and interobserver variation.

Pelvic radiographs of 25 children aged 6 months to 2 years had the acetabular index measured 3 times by each of five pediatric orthopaedists. Interobserver measurements were found to vary +/-3.0 degrees, whereas the intraobserver variation was +/-3.6 degrees. This error reflects only measurement error and does not consider error introduced with different positioning of the pelvis.

Acetabulum↗

PubMedDate not supplied

Soft-tissue release for spastic hip subluxation in cerebral palsy.

Children with spastic hip subluxation secondary to cerebral palsy were treated with a standard protocol that focused on early detection of the subluxation using physical examination and anteroposterior pelvis radiographs. Using limited hip abduction of < or =30 degrees and subluxation of > or =25% migration percentage as indications, patients had open adductor and iliopsoas lengthenings with immediate postoperative mobilization and no abduction bracing. The protocol was applied to 74 children with a mean age of 4.5 years and had 147 hips surgically addressed. Of these hips initially, 20% were normal (migration percentage <25%), 52% were mildly subluxated (migration percentage 25-39%), 22% were moderately subluxated (migration percentage 40-59%), and 6% were severely subluxated (migration percentage > or =60%). At a final postoperative follow-up of 39 months, 54% of these hips were classified as good (migration percentage <25%), 34% were fair (migration percentage 25-39%), and 12% were poor (migration percentage > or =40%). Of this patient population, 69% were nonambulators and their outcomes were not statistically different from children who could walk. No child developed an abduction contracture or wide-based gait that required treatment. With early detection and applying this treatment algorithm, 80% of children with spastic hip disease should have good or fair outcomes. Longer follow-up will be required to determine how many children will need bony reconstruction to maintain stable and located hips at the conclusion of growth.

Cerebral Palsy↗

PubMedDate not supplied

Reconstruction of the dysplastic spastic hip with peri-ilial pelvic and femoral osteotomy followed by immediate mobilization.

All children with cerebral palsy who had a pelvic osteotomy performed by the senior author (F.M.) from 1989 through 1991 were reviewed. Indications for operative reconstruction were failed muscle lengthening in a child younger than 8 years or a painful hip. The operative procedure included adductor muscle lengthening, varus shortening femoral osteotomy, and peri-ilial pelvic osteotomy. Patients were immediately mobilized after surgery by physical therapy. Fifty-one children had reconstruction of 49 subluxated and 21 dislocated hips. Femoral and pelvic osteotomies were performed on 59 hips, and 11 hips had only a femoral osteotomy. Forty-nine hips had adductor muscle lengthening, and 27 hips had femoral osteotomy to provide for relief of contractures. At mean follow-up of 34 months, two hips in two patients had redislocated, requiring repeated surgery. Two hips remained subluxated and asymptomatic. Twenty-three hips in 18 patients were painful before surgery. One hip continued with severe pain after surgery, requiring further surgery. Three hips continued with mild pain not requiring surgery, and 14 (82%) hips had complete pain relief. Of 37 caretakers interviewed, 80% felt the procedure was beneficial and would recommend it to others. Eight percent were uncertain, and 6% (two caretakers) thought it was not helpful.

Acetabulum↗

PubMedDate not supplied

The effect of rectus EMG patterns on the outcome of rectus femoris transfers.

Rectus femoris transfer to the sartorius is performed in children with cerebral palsy to treat stiff-knee gait. To determine whether preoperative electromyographic (EMG) activity of the rectus femoris is predictive of outcome, we studied 25 children with stiff-knee gait who had preoperative EMG gait analysis before rectus femoris transfer. Fifteen patients had bilateral surgery, and 10 patients had unilateral surgery. The mean age at surgery was 9.6 years for the retrospective review. Patients were divided into three groups based on the recorded EMG patterns of the rectus femoris during the gait cycle. Group I patients had predominant swing-phase activity only. Group II patients had constant rectus activity through the entire gait cycle. Group III patients had normal rectus, defined as minimal EMG activity in the last 75% of swing phase. A repeated gait analysis at a mean of 1.5 years after surgery was available for comparison. In group I, mean peak knee flexion increased 26 degrees after surgery from 44 to 70 degrees. In group II, mean peak knee flexion increased 18 degrees after surgery from 51 to 69 degrees. In group III, mean peak knee flexion increased 12 degrees from 54 to 66 degrees. Results of this study show the greatest improvement in outcome, as measured by knee flexion, occurred in group I in which the rectus fired predominantly in swing phase. Preoperative EMG patterns are therefore useful in determining the outcome after rectus femoris transfer to the sartorius.

Cerebral Palsy↗

PubMedDate not supplied

A method for normalization of oxygen cost and consumption in normal children while walking.

Measurement of oxygen use is helpful in determining energy consumption in children with walking abnormalities; however, no statistically valid measurements of nondisabled children have been established using a telemetric system. Data from 94 nondisabled children, ages 5-15 years, were collected using the Cosmed K2 oxygen analysis system. Oxygen cost, measured in milliliters O2/kg/m walked, and oxygen consumption, measured in milliliters O2/kg/min, were correlated to inverse body surface area (IBSA) measured in meters(-2). Linear relationships between oxygen cost and IBSA and between oxygen consumption and IBSA were best described by the following equations: oxygen cost = 0.256 (IBSA) + 0.052 (r = 0.806) and oxygen consumption = 17.635 (IBSA) + 4.956 (r = 0.758). From these data, equations were derived to calculate predicted oxygen cost and predicted oxygen consumption for each child. Indices were developed to express the difference between a measurement and the predicted mean in reference to the normal variation. These equations and indices can help quantify the variation of energy use of children with walking abnormalities when compared with their nondisabled peers. Additionally, the indices enable multiple tests from one subject to be compared, regardless of a change in age, height, and weight between measurements.

Adolescent↗

PubMedDate not supplied

Computer modeling of the pathomechanics of spastic hip dislocation in children.

Spastic muscles about the hip cause subluxation, dislocation, and lead to acetabular dysplasia. Spastic hip disease occurs when the muscles about the hip exert forces that are too high or in the wrong direction or both. To determine the role of the hip forces in the progression of spastic hip disease and the effect of both muscle-lengthening and bony reconstructive surgeries, a computerized mathematical model of a spastic hip joint was created. The magnitude and direction of the forces of spastic hips undergoing surgery were analyzed preoperatively and postoperatively to determine which procedure is best suited for the treatment of spastic hip disease. The muscle-lengthening procedures included (a) the adductor longus, (b) the psoas, iliacus, gracilis, adductor brevis, and adductor longus, and (3) the psoas, iliacus, gracilis, adductor brevis, adductor longus, semimembranosus, and semitendinosus. The bony reconstructive and muscle-lengthening procedures included (a) lengthening the psoas, iliacus, gracilis, adductor brevis, adductor longus, semimembranosus, and semitendinosus combined with changing femoral neck anteversion from 45 to 10 degrees , (b) lengthening of the psoas, iliacus, gracilis, adductor brevis, adductor longus, semimembranosus, and semitendinosus combined with changing neck-shaft angle from 165 to 135 degrees , and (c) lengthening of the psoas, iliacus, gracilis, adductor brevis, adductor longus, semimembranosus, and semitendinosus combined with changing femoral neck anteversion from 45 to 10 degrees and neck-shaft angle from 165 to 135 degrees . Results show that a child with spastic hip disease has a hip-force magnitude 3 times that of the a child with a normal hip in the normal physiologic position. Based on this mathematical model the best to normalize the magnitude of the hip-joint reaction force, the muscles to be lengthened should include the psoas, iliacus, gracilis, adductor brevis, and the adductor longus. To normalize the direction of the hip force, the extremity should be positioned in the normal physiologic position. The impact of decreasing the femoral anteversion or femoral neck-shaft angle or both had little additional effect on the direction or magnitude of hip forces.

Biomechanical Phenomena↗