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Biomedical subjects

H R Cowell

Publications and source records attributed to H R Cowell.

72 records · Page 4Linked to original sources
PubMed1974

Incidence of abnormalities of the kidney and ureter in congenital scoliosis.

The frequent occurrence of urinary tract anomalies which have been observed in patients with congenital scoliosis at the Alfred I. duPont Institute led us to evaluate this group to determine its incidence. We found that 13% of the patients with congenital scoliosis had renal abnormalities of varying types-lesions which may predispose to urinary tract pathology--but only one had any symptoms suggesting urinary tract disease.

Humans↗
PubMedDate not supplied

Congenital diastasis of the inferior tibiofibular joint: a review of the literature and report of two cases.

Congenital inferior tibiofibular diastasis is a rare condition of unknown etiology, possibly a form of tibial hypoplasia, marked by a clinical triad of talipes equinovarus, ankle diastasis, and limb length inequality. An analysis of 10 cases reported previously is given with two additional examples. Ankle mortise reconstitution and clubfoot correction by surgery have been the basis of treatment. We present two cases in which no ankle reconstruction was done with good results. Syme amputation is considered for cases with severe tibial shortening. Prognosis for a plantigrade foot is encouraging if limb length inequality is corrected operatively or non-operatively as indicated.

Ankle Joint↗
PubMedDate not supplied

Congenital deficiency of the femur.

A classification system for congenital deficiency of the femur is introduced, based on initial radiographic appearance of the hip joint in 60 patients (70 affected limbs). Follow-up records ranging from 1 to 30 years demonstrated a relatively constant percentage of shortening in each patient with further growth (2.4% average change). Treatment programs have been established for each of the following groups: I, short femur with good hip joint (19 limbs); II, short femur and coxa vara (17 limbs); III, short femur with proximal deficiency, a well-developed hip joint, and broad angulated and sclerosed diaphysis (15 limbs); IV, dysplastic distal femoral segment with no hip joint (16 limbs); and V, total absence of the femur (3 limbs).

Acetabulum↗
PubMedDate not supplied

Polyurethane foam in postoperative casts.

One-half inch thick polyurethane foam is recommended for use in postoperative casts to avoid complications seen with postoperative swelling. The polyurethane is placed over the operative area, over the dorsum of the foot, and the anterior surface of the leg. The use of polyurethane foam in the postoperative cast not only avoids the necessity of having to split the cast in many instances but the foam also constitutes a compression dressing. If splitting of the postoperative cast should become necessary, the foam protects the skin.

Casts, Surgical↗
PubMedDate not supplied

Rigid painful flatfoot secondary to tarsal coalition.

Rigid flatfoot secondary to tarsal coalition requires proper clinical and roentgenographic evaluation. In patients with limited subtalar motion and pain in the tarsal area, a coalition should be suspected. Proper roentgenographic evaluation with standard anteroposterior, lateral, and oblique views is essential. Calcaneonavicular coalition, as visible on an oblique film, may be a solid bony fusion or, more often, a cartilaginous coalition, which is characterized by flattening of the calcaneus and navicular at their junction. Axial (Harris) views demonstrate coalition in the middle and posterior facets, which may be cartilaginous or osseous. Lateral tomography is used to demonstrate irregularities of the anterior facet or the undersurface of the talar head. When symptomatic, a calcaneonavicular coalition with no degenerative changes of the tarsal joints is treated by resecting the bar and inserting the extensor digitorum brevis into the area from which the coalition is excised. An osseous bar is resected, or, if degenerative changes are noted, a triple arthrodesis is performed. Talocalcaneal coalition is first treated conservatively by a regimen of Plastizote shoe inserts, short-leg casts, or an ankle-foot orthosis. If conservative treatment fails to alleviate pain, a triple arthrodesis is indicated.

Adolescent↗
PubMedDate not supplied

Köhler's disease of the tarsal navicular.

Twenty patients with Köhler's disease of the tarsal navicular were treated at the Alfred I. duPont Institute between 1948 and 1974. Three patients with asymptomatic, irregular ossification of the tarsal navicular also were investigated to evaluate the various modes of therapy and the long-term effects of various treatment programs. Symptomatic or true Köhler's disease must be differentiated clinically from asymptomatic roentgenographic changes resembling Köhler's osteochondrosis. The patients showed a significant decrease in morbidity with the use of a short-leg cast for an an eight-week period. Whereas patients who were not treated in a short-leg cast had symptoms for an average duration of 15 months, treated patients had symptoms for less than three months. Notwithstanding the decrease in morbidity with the use of a short-leg walking cast, the long-term results suggest that all of our patients eventually had spontaneous reconstitution of the navicular and excellent recovery of function.

Child, Preschool↗
PubMedDate not supplied

The incidence of spina bifida occulta in idiopathic scoliosis.

A review of the roentgenograms of the spine of 100 patients with idiopathic scoliosis and 371 parents and siblings used as controls, showed an incidence of spina bifida occulta of 34 per cent and 41 per cent in their siblings. There was no increase in the incidence of spina bifida occulta in the patients with idiopathic scoliosis as compared with the control group. A review of the parents of these patients showed an incidence of spina bifida occulta of the lumbosacral area of 9 per cent in the mothers, and 13 per cent in the fathers, thus showing a decrease in the incidence of spina bifida occulta in the adult as compared with the teenager. The studies in the adult confirm the finding in the teenagers. There is no increased incidence of spina bifida occulta in idiopathic scoliosis.

Adolescent↗
PubMedDate not supplied

Rigid flatfoot.

The proper management of the rigid flat-foot requires an accurate diagnosis since the condition is treated on causal or rational basis. Calcaneonavicular coalition best seen on an oblique view of the foot may be treated by resection of the coalition with extensor digitorum brevis interposition. If the diagnosis is made sufficiently early, the resection can lead to an essentially normal foot. Coalition between the talus and the calcaneus may occur in the posterior, middle or anterior facet. The most common coalitions are seen in the middle facet area followed by those in the anterior facet with the posterior facet coalition rarely being seen. Coalitions in the area of the middle facet are usually managed nonoperatively; triple arthrodesis is used only if symptoms are not relieved by nonoperative measures. Resection of a talocalcaneal coalition in the middle facet is rarely indicated but occasionally will give relief when the coalition either presses on the medial plantar nerve or causes a mechanical disturbance of the ankle. Anterior facet coalitions should receive a trial of cast immobilization but frequently require triple arthrodesis. Other conditions such as rheumatoid and post-traumatic arthritis will frequently respond to a period of immobilization in a plaster cast. Triple arthrodesis has not been required in rheumatoid arthritis in the author's series but occasionally is necessary in the post-traumatic rigid flatfoot. Other rare causes of the rigid flatfoot should be kept in mind for a complete diagnostic evaluation since even a neoplasm (fibrosarcoma) has been reported to cause this symptom complex.

Arthrodesis↗