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Biomedical subjects

F Miller

Publications and source records attributed to F Miller.

At least 307 records · Page 17Linked to original sources
PubMedDate not supplied

Crankshaft effect after posterior spinal fusion and unit rod instrumentation in children with cerebral palsy.

Radiographs and charts were reviewed for all children with cerebral palsy who underwent posterior-only spinal fusion with the unit rod for neuromuscular scoliosis by the senior author from 1989 through 1996. Fifty patients were found to have an open triradiate cartilage at the time of fusion. A single observer obtained measurements of the preoperative, postoperative, and most recent spine films using the standard Cobb angle. Amount of change was calculated over the respective periods. Forty-three patients had at least 2 years of clinical follow-up. Twenty-nine patients had more than 2 years of both radiographic (mean, 4.6 years) and clinical follow-up (mean, 4.8 years) with a closed triradiate cartilage on their most recent films. In this group, the mean absolute curve change over the length of radiographic follow-up was 0.6 degrees (range, -9-14). None of the 43 patients with at least 2 years of clinical follow-up (mean, 4.5 years) had any radiographic change that was clinically significant on chart review. Therefore posterior spinal fusion alone with unit rod instrumentation is adequate treatment to control crankshaft deformity in skeletally immature children with neuromuscular scoliosis due to cerebral palsy.

Adolescent↗
PubMedDate not supplied

Hip instability in spinal cord injury patients.

Seventeen children with spinal cord injuries that occurred before the age of 9 years were followed at the Alfred I. duPont Institute for a mean of 13.2 years (range 3-32 years). Fourteen of these patients (82%) developed subluxation or dislocation in one or both hips. Patients with spastic spinal cord injury (SCI) developed hip flexion and adduction contractures and had symptoms that tended to mimic those of cerebral palsy. Patients with flaccid SCI mirrored the "flail" hips of myelomeningocele. Pelvic obliquity occurred in spastic and flaccid children. Only one patient developed pain, and three had deformities suggesting avascular necrosis of the femoral head. At final follow-up, no patient had physical problems relating to the hip dysplasia.

Child↗
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Rapid progression of hip subluxation in cerebral palsy after selective posterior rhizotomy.

Rapid progression of hip subluxation was noted in the year after selective dorsal rhizotomy in seven hips (six patients). The hips that subluxed progressed from a lateral extrusion index averaging 25% preoperatively as compared with 50% after rhizotomy. Although preexistent hip dysplasia was a predisposing factor, hips with an intermediate degree of preoperative lateral extrusion (12-25%) had variable results. Ongoing and more frequent evaluation of hip stability is necessary after dorsal rhizotomy.

Adolescent↗
PubMedDate not supplied

Long-term follow-up of hip subluxation in cerebral palsy patients.

Spastic subluxation of 64 hips in 45 patients with cerebral palsy (CP) was reviewed in a 19-year follow-up. Varus osteotomy prevented dislocation in all patients. All nine hips that later dislocated were in quadriplegic patients who had not received treatment or who had had muscle releases. Dislocated hips had the most degenerative arthritis, pain, and the least movement. Subluxated hips also had more degenerative arthritis but approximately the same level of pain as reduced hips.

Adolescent↗
PubMedDate not supplied

Femoral version and neck shaft angle.

We measured femoral anteversion by the Kingsley-Olmsted method in 24 unpaired, dry femurs. When the head and neck of the same femurs were measured by computed tomography (CT) scan, measurement was 5 degrees less than the Kingsley-Olmsted method, whereas ultrasound of the head and neck was 5 degrees higher. An anterior flat plane was also defined to help measure anteversion in patients with a high neck shaft angle. Physical and ultrasound measurement correlated well with the previous measurement by the Kingsley-Olmsted method and CT scan of anteversion. Although measurement by CT scan and ultrasound are different their results are both reproducible and measure the same parameters; however, ultrasound measurement yields a number approximately 10 degrees higher.

Anthropometry↗
PubMedDate not supplied

Long-term follow-up of triple arthrodesis in patients with cerebral palsy.

This study was a long-term retrospective review of patients with cerebral palsy (CP) who had triple arthrodeses as children before 1981. The medical records were reviewed, and the patients were requested to return for reevaluation, during which a radiograph, physical examination, and patient questionnaire were obtained. Twenty-four patients who had triple arthrodesis on 35 feet returned for evaluation. Twenty-three feet had planovalgus deformities and 12 equinovarus deformities. Mean age at operation was 14.2 years, with a mean follow-up of 17.8 years (range 11-45 years). Of the 24 patients questioned, 19 were satisfied and five were dissatisfied with their result. Nine patients had occasional pain; one patient reported frequent pain in one foot. Six patients had limited distance ambulation owing to their feet. Radiographic evaluation demonstrated that 43% of the feet had degenerative changes at the ankle joint. Four of six patients reported ambulatory limitation due to pain. Ankle joint range of motion (ROM) and degenerative arthritis were not correlated with pain, distance limitations, residual deformity, or patient satisfaction. Patient satisfaction was predominantly related to persistent pain, especially pain causing distance limitations in ambulation. Patient satisfaction was also strongly correlated with residual deformity. Persistent pain and distance limitation were also strongly correlated with residual planovalgus deformity.

Adolescent↗
PubMedDate not supplied

Heterotopic ossification after hip and spine surgery in children with cerebral palsy.

We made a retrospective review of 198 children with cerebral spasticity to determine development of heterotopic ossification. Of 61 children undergoing hip adduction lengthening, 21 had mild to moderate grades of heterotopic ossification. Only two of 132 patients who underwent spine fusions had developed heterotopic ossification, but in both it was severe, resulting in hip fusion. Two of five patients undergoing concomitant hip surgery and spine fusion developed heterotopic ossification of severe degree. The occurrence of heterotopic ossification after hip muscle surgery in children with cerebral spasticity is common but usually minor. Heterotopic ossification developing after spine fusion is rare but severe when it occurs, and concomitant hip and spine surgery causes frequent severe occurrences of heterotopic ossification.

Adolescent↗
PubMedDate not supplied

Receptor depletion in diabetes mellitus: correction with therapy.

This report describes two patients with diabetes mellitus, presenting with insulin resistance and depression of erythrocyte insulin receptor binding to less than one-third of normal. Scatchard analysis of the data was consistent with a depletion in insulin receptors in these poorly controlled diabetic patients. Therapy with tolbutamide and reduced insulin administration resulted in restoration of erythrocyte receptor binding, clinical resolution of the insulin resistance, and amelioration of hyperglycemia. These data suggest a role for transient depletion and/or dysfunction of cellular receptors of insulin activity in the evolution of insulin resistance in diabetes.

Adult↗
PubMedDate not supplied

Prodromal syndromes in delirium tremens.

Three cases of hallucinatory delirium preceded by prodromal symptoms of several months duration are described. The prodromes were reoccurring visual and tactile hallucinations which were misdiagnosed and ascribed to nonalcohol-related illness such as schizophrenia and disorders of mood.

Adult↗
PubMedDate not supplied

Using Roy's model in a special hospital.

Using a nursing model to help systematise the care of a young patient in a special hospital resulted in tangible improvements in his behaviour, yet Francesca Miller found that it raised questions about the function and value of nursing for this client group. Her study reveals how she had to cope with her own negative feelings about the nature of her patient's offences and how the use of basic counselling skills, and encouraging the patient to take responsibility for his own care, achieved notable developments in his social skills. But despite this, she is left to ponder, 'at what cost?'

Adaptation, Psychological↗
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Prosthetic interposition arthroplasty for the palliative treatment of end-stage spastic hip disease in nonambulatory patients with cerebral palsy.

We reviewed our experience in using a prosthetic arthroplasty for the treatment of painful degenerative arthritis in 11 nonambulatory patients (14 hips) with cerebral palsy. Age of the patients ranged from 11 to 20 years. Three patients had previously undergone a salvage procedure. Radiographic follow-up averaged 16 months (range, 4 months to 5 years). Ten of the hips remained located on the latest radiographs, and four of the hips dislocated within 4 months of the procedure. No patient exhibited migration or failure of the implants, although one patient exhibited periprosthetic osteolysis, which remained unchanged over a 4-year period. Clinical follow-up averaged 5 years (range, 2-6 years). Ten patients (13 hips) had complete relief of hip pain. Caretaker satisfaction was high for these patients, with all 10 caretakers stating that they would recommend the procedure. One patient continued to have persistent pain in the hip, and the caretaker stated that she would not recommend the procedure.

Adolescent↗
PubMedDate not supplied

The efficacy of tone-reducing features in orthotics on the gait of children with spastic diplegic cerebral palsy.

This study analyzed the effects of tone-reducing features in ankle-foot orthotics (AFOs) on the gait of eight children (ages 4-11 years) with spastic diplegic cerebral palsy. A standard gait analysis was performed on each subject in each of three trial orthotics and in a baseline shoes-only condition. A 4-week accommodation period was allotted for each of the three devices: a standard hinged AFO, an AFO with tone-reducing features, and a supramalleolar orthotic with tone-reducing features. Most significant differences were at the ankle, between free-ankle and plantar flexion-limiting conditions. No significant functional changes in gait were evident with the addition of tone-reducing properties to a standard articulating AFO.

Analysis of Variance↗
PubMedDate not supplied

Lateral column lengthening as treatment for planovalgus foot deformity in ambulatory children with spastic cerebral palsy.

The purpose of this study was to investigate the effectiveness of lateral column lengthening in the treatment of flexible, planovalgus foot deformity of ambulatory children with spastic cerebral palsy (CP). Fifteen ambulatory children (23 feet) with spastic CP and flexible planovalgus foot deformities received lateral column lengthenings through the calcaneus or calcaneocuboid joint. At an average of 4.1 years of follow-up (minimum, 2.3 years), 17 (74%) feet had good, two (9%) had fair, and four (17%) had poor outcomes. Poor outcomes resulted from recurrence of deformity. Improvements in preoperative, postoperative, and follow-up radiographic measurements were found. However, these improvements are not related to the clinical outcomes. Calcaneal lengthening is a successful treatment for flexible planovalgus foot deformity in ambulatory children with spastic CP. The high failure rate is a significant limitation to the procedure. Further investigation of the objective measurement of planovalgus foot deformity is needed.

Adolescent↗
PubMedDate not supplied

Proximal femoral osteotomy using the AO fixed-angle blade plate.

We describe the technique and results of proximal femoral osteotomy performed with the AO fixed-angle blade plate in 157 hips of 101 pediatric patients. Postoperative immobilization or restriction of activity was not prescribed. Fourteen complications occurred in 11 patients. Use of preoperative antibiotics decreased the rate of infection from 12% to 0%, which was significant. All osteotomies healed by 16 weeks postoperatively with no nonunions, malunions, device failures, or avascular necrosis. Using no postoperative immobilization in these children was successful and resulted in few complications when the appropriate-sized blade plate was used.

Adolescent↗