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Biomedical subjects

H M Clarke

Publications and source records attributed to H M Clarke.

At least 37 records · Page 2Linked to original sources
PubMed1995

Klumpke's birth palsy. Does it really exist?

Erb's palsy is the most common obstetric brachial plexus injury followed by total plexus palsy. The distribution of Klumpke's birth palsy with modern obstetric practice is unknown. In this paper, we studied the distribution of Klumpke's birth palsy in our series of 235 consecutive cases of obstetrical brachial plexus injury and determined the incidence of this type of palsy to be 0.6% as cited in the English literature over the last decade.

Brachial Plexus↗
PubMed1995

Normal arborization of the deep branch of the ulnar nerve into the interossei and lumbricals.

Ten adult hands were dissected to reexamine in new detail the distribution of the deep branch of the ulnar nerve from its origin in the ulnar tunnel to its termination in the first dorsal interosseous muscle. The relationships of the subdividing branches to each other and to the muscle bellies were clarified. The palmar interossei along with the first and second dorsal interossei were all innervated within the middle third of their corresponding metacarpal. The third and fourth dorsal interossei were innervated within the proximal third of their corresponding metacarpals, and the third lumbrical was innervated within the middle third whereas the fourth lumbrical was innervated along its distal third.

Anthropometry↗
PubMed1995

Two rapidly growing fatty tumors of the upper limb in children: lipoblastoma and infiltrating lipoma.

One case of lipoblastoma and another case of infiltrating lipoma of the upper limb in infancy are reported. These rare benign fatty tumors may be congenital and may grow rapidly soon after birth. The classification of these fatty tumors and their management are presented to increase awareness of the benign nature of these tumors despite their rapid growth and to demonstrate that complete surgical excision should be done to prevent local recurrence.

Arm↗
PubMed1995

An approach to obstetrical brachial plexus injuries.

The approach of one clinic to the early evaluation of the infant with an obstetrical brachial plexus palsy has been presented. The need for a reproducible and standardized grading system has been identified. The natural history of these lesions will be better understood as further studies elucidate key principles. The final goals are the precise prognostication of natural outcome and the early prediction of the need for surgical intervention.

Brachial Plexus↗
PubMed1994

The prognostic value of concurrent clavicular fractures in newborns with obstetric brachial plexus palsy.

This study investigates the prognostic value of concurrent clavicular fractures in newborn babies with obstetric brachial plexus palsy. The records of 183 consecutive newborn babies with brachial plexus birth injury from 1988 to 1993 were reviewed retrospectively. Poor outcome, specifically insufficient spontaneous return of motor function of the limb necessitating primary brachial plexus surgery, was assessed for infants both with and without concurrent clavicular fractures. 13 newborn babies had concurrent clavicular fractures, and of these two required primary brachial plexus surgery. On the other hand, surgery was required for 43 of the remaining 170 infants with intact clavicles. Using Fisher's exact test, P = 0.2. Concurrent clavicular fractures in newborns with obstetrical brachial plexus palsy have no prognostic value in predicting spontaneous recovery.

Birth Injuries↗
PubMed1994

The natural history of obstetrical brachial plexus palsy.

Obstetrical brachial plexus palsy remains an unfortunate consequence of difficult childbirth. Sixty-six such patients were reviewed. Included were 28 patients (42 percent) with upper plexus involvement and 38 (58 percent) with total plexopathy. The natural history of spontaneous recovery in all of these patients has been determined using an appropriate grading mechanism. Sixty-one patients (92 percent) recovered spontaneously and five patients (8 percent) required primary brachial plexus exploration and reconstruction (median age 12 months), demonstrating that most patients do well. Additional analysis was undertaken to examine ways in which outcome might be predicted. The analysis does not consider whether or not the patient was operated upon. Good or poor recovery was determined by the spontaneous recovery observed. Discriminant analysis revealed that whereas elbow flexion at 3 months correlated well with spontaneous recovery at 12 months, when used as a single parameter it incorrectly predicted recovery in 12.8 percent of cases. Shoulder abduction was not a significant predictor of recovery. Numerous other early parameters correlated well with spontaneous recovery. When elbow flexion and elbow, wrist, thumb, and finger extension at 3 months were combined into a test score, the proportion of patients whose recovery was incorrectly predicted was reduced to 5.2 percent.

Brachial Plexus↗
PubMed1993

Syngnathia: a report of two cases.

Syngnathia is a rare anomaly involving soft tissue or bony adhesions between the maxilla and mandible. Two cases of congenital syngnathia secondary to interalveolar soft tissue synechia are presented. These children present problems with airway protection and feeding in the immediate neonatal period. Most have multiple associated anomalies requiring concurrent management. Less than 50 cases have been described, most commonly in association with popliteal pterygium syndrome. Surgical management involves division of the adhesions in the first few days of life. Depending on the severity, these patients may present formidable anesthetic challenges. The prognosis is generally favorable in cases of soft tissue adhesions with eventual restoration of normal mandibular motion and function.

Abnormalities, Multiple↗
PubMed1993

Pediatric free tissue transfer: an evaluation of 99 cases.

OBJECTIVE: To evaluate the results of free tissue transfers in children who undergo reconstructive surgery. DESIGN: Case series chart review. Mean follow-up longer than 2 years. SETTING: Two tertiary care pediatric hospitals. PATIENTS: Consecutive sample of 99 children. INTERVENTIONS: Free tissue transfers for reconstruction of a variety of defects. MAIN OUTCOME MEASURES: Indications, operations, complications, survival. RESULTS: The most common indications were for restoration of muscle function and for difficulties with soft-tissue coverage. Multiple donor sites were used, with the gracilis muscle, fibula, latissimus dorsi and groin flaps predominating. The overall survival rate was 99.0%. Complications were common, with an overall rate of 59.6%; most were graded as minor or moderate. CONCLUSIONS: Meticulous planning is paramount in achieving a successful outcome. Complications are common but do not include vascular spasm. Free tissue transfers can be successfully completed in small children despite the dimensions of the tissues.

Adolescent↗
PubMed1992

Constriction bands and limb reduction defects in two newborns with fetal ultrasound evidence for vascular disruption.

Most structural anomalies attributed to vascular disruption have been inferred, though not proven, to be the result of disruptive events in utero. We report on 2 pregnancies with ultrasound evidence of disruptive events resulting in terminal limb "reduction" defects with constriction bands and other anomalies. In the first patient a fetal ultrasound study at 12 weeks post-LMP demonstrated a monochorionic (MC) twin pregnancy with a nonviable co-twin and no evidence of amniotic bands. At birth, there was a left cleft lip and palate, and terminal limb "reduction" defects with ring constrictions of the left hand and both feet. In the second patient, a routine fetal ultrasound study at 18 weeks post-LMP identified a subhepatic cyst which subsequently resolved. Fetal ultrasound examination and neonatal computed tomography (CT) scan of the liver were consistent with a hepatic infarct due to emboli from the umbilical vein. At birth, patient 2 had acrosyndactyly of the left hand with ring constrictions of the digits and reduction of the left big toe. There was no evidence of abnormal amnion. Postnatal development has been normal in both cases. We present ultrasound evidence supporting the hypothesis that vascular disruption from death of a co-twin or from in utero embolic infarcts can cause: 1) terminal limb "reduction" defects and possibly cleft lip and palate; and 2) ring constrictions similar to those of "amniotic band disruption sequence" in the absence of an abnormal amnion. Serial pregnancy ultrasound studies are recommended for evaluation of the development of fetal structural anomalies following ultrasound evidence of a disruptive event in utero.

Abnormalities, Multiple↗
PubMed1992

Case report: hepatic ultrasound findings in a case of toxocariasis.

Multiple hypoechoic areas within the liver may be caused by a large variety of disorders. We report a case of Toxocara infestation which produced such an appearance within the liver of an 18-month-old child. We believe that this is the first report of Toxocara granulomata detected by ultrasound, and suggest that ultrasound examination may provide a useful diagnostic clue to this disease.

Female↗
PubMed1992

Parasymphyseal fracture with an associated temporomandibular joint dislocation: case report.

A case of traumatic mandibular fracture with associated unilateral anterior dislocation of the temporomandibular joint in a child is described. Although anterior dislocation is common, this combination of fracture and separate dislocation to our knowledge has not been reported in a young child. The unusual management required in this case is discussed.

Accidents, Traffic↗
PubMed1992

Peripheral neovascularization of muscle and musculocutaneous flaps in the pig.

Late loss of free muscle flaps following surgical or accidental trauma to the dominant vascular pedicle has been reported. In this study, time-dependent ligation of the dominant vascular pedicle was undertaken in denervated latissimus dorsi musculocutaneous or muscle-only island flaps in the pig. Muscle flaps were covered with a skin graft, and silicon rubber sheets were inserted between the flaps and their bases to simulate a poorly vascularized bed. Hemodynamic and viability studies were then performed using intravenous fluorescein (skin viability), tetrazolium blue (muscle viability), and radiolabeled 15-micron microspheres (capillary blood flow). Blood flow did not change in acutely raised musculocutaneous flaps (n = 10) but was significantly elevated in acutely raised muscle-only flaps (n = 10), suggesting that the skin paddle may steal blood flow from the underlying muscle in musculocutaneous flaps. Peripheral neovascularization at 1 day to 8 weeks was assessed (n = 30). Viability increased during the first week of revascularization and was not different in musculocutaneous and muscle-only flaps. Revascularization of muscle-only flaps was enhanced compared with musculocutaneous flaps in the 2- to 8-week period.

Analysis of Variance↗