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Biomedical subjects

I Ghanem

Publications and source records attributed to I Ghanem.

At least 19 recordsLinked to original sources
PubMed2003

Spondyloepimetaphyseal dysplasia with multiple dislocations, leptodactylic type: report of a new patient and review of the literature.

A 6-year-old boy with congenital hip dislocation, developmental delay, short stature, macrocephaly, low set ears, short neck, and hyperlaxity of the wrists and fingers is described. Radiographs disclosed mainly the presence of thoracic scoliosis, narrow interpedicular distances, metaphyseal vertical striations, very small irregular epiphyses, right hip dislocation, luxation of both elbows, and severe delay of ossification of the epiphyses and the carpal bones. These features are very close to the newly described entity: spondyloepimetaphyseal dysplasia and multiple dislocations. This patient brings to light the differential diagnosis and confirms the specificity of the radiological findings of this new entity.

Abnormalities, Multiple↗
PubMed2003

[Open reduction after failure of conservative treatment for congenital dislocation of the hip initiated before the age of six months].

PURPOSE OF THE STUDY: The aim of this study was to present the indications, technique and results of open reduction for congenital hip dislocation performed after failure of conservative treatment. MATERIAL AND METHODS: Criteria of inclusion in the series were: congenital dislocation of the hip treated conservatively before the age of six months requiring open reduction for failure of initial treatment between 1978 and 1998. During this period, 3000 hips sustained conservative treatment. The series counted 33 hips in 29 children. Mean number of different conservative methods used for one hip was 2.6. One-third of the hips had had previous surgery. Avascular necrosis was noticed in 17 cases (51.5%). Mean age at open reduction was 2 years. Pelvic (61%) and/or femoral (79%) osteotomies were combined with open reduction. RESULTS: Mean follow-up was 9.5 years. Among the complications, minor avascular necrosis was noticed in five hips without preoperative lesions. Hip joint congruency was excellent or good in 80.7% of the cases. There were no recurrent dislocations. Ten hips (32.3%) were free of avascular necrosis but 4 presented severe avascular necrosis (13%). DISCUSSION: Indications for open reduction are exceptional, attesting to the efficacy of conservative treatment. This salvage procedure achieves good results in the hands of experienced surgeons. The quality of the reduction depends not only on the intra- and extra-articular excision, but also on the stability achieved with peri-articular osteotomies. The main factor of prognosis is avascular necrosis induced by previous treatment.

Age Factors↗
PubMed2003

[Bernese periacetabular osteotomy for the treatment of the degenerative dysplasic hip].

PURPOSE OF THE STUDY: Appropriate management of degenerative joint disease in patients with dysplasic hips is a controversial issue. Non-surgical treatment is generally insufficient to achieve good long-term results and, in young patients, indications for total hip replacement, arthrodesis, or salvage procedures (Chiari, bone block) are limited. The most physiological option is to re-orient the acetabulum to cover the femoral head with a sufficient amount of joint cartilage. Several types of redirection osteotomy have been described. In the present work, we assess the clinical and radiological outcome after Ganz periacetabular osteotomy in patients with dysplastic hips who developed degenerative joints. We searched for factors influencing outcome. MATERIAL AND METHODS: This retrospective analysis was conducted in 57 patients with hip dysplasia who had undergone 64 peri-acetabular osteotomies for joint degeneration. Mean age at surgery was 31 years. The preoperative diagnosis was primary osteochondritis of the hip in 9 patients. The Merle d'Aubigné scores and VCE, VCA, HTE angles on standard x-rays were obtained before surgery and at last follow-up. The Tönnis grade for the severity of the joint degeneration was determined. In 19 patients, inter-trochanteric femoral osteotomy was performed to improve joint congruency in addition to peri-acetabular osteotomy. Clinical and radiological results were assessed at a mean follow-up of 3.5 years (range 2-6 years). The effects of age, cause of dysplasia, surgical history of the hip, severity of joint degeneration, association with femoral osteotomy, and learning curve were studied. Complications were recorded. RESULTS: On the average, the Merle d'Aubigné score improved from 13 points preoperatively to 16.5 points at last follow-up. Limping was observed for a longer period after surgery in patients who had an associated inter-trochanteric osteotomy. At last follow-up, the overall score was lower in grade 3 hips than in grade 1 and 2 hips. Serious complications were observed in the first 15 patients. There was no statistical relationship between age at surgery or surgical history of the hip and final outcome. Comparing the preoperative x-rays with those obtained at last follow-up demonstrated an improvement in the mean value for VCE (2 degrees preoperatively to 25 degrees at last follow-up), VCA (- 6 degrees to 39.5 degrees ), and HTE (25 degrees to 15 degrees ). Radiologically, the severity of joints degeneration was improved or remained unchanged in 83% of the hips (especially for grade 1 and 2 hips). DISCUSSION: In our hands, peri-acetabular osteotomy has provided good results, especially in terms of improved function and control of joint degeneration. Although this procedure is basically indicated for young patients with hip dysplasia free of joint degeneration, it would also be a useful alternative for those who have developed only moderately extensive joint degeneration (Tönnis grades 1 and 2) and a moderately excentric femoral head. Success in these patients depends on surgical experience, correct indications, and careful attention to technical details. Nevertheless, complications are not exceptional and the learning curve may be long. In our series, the main factor predictive of outcome was the Tönnis grade of joint degeneration.

Acetabulum↗
PubMed2002

Congenital contractures, short stature, abnormal face, microcephaly, scoliosis, hip dislocation, and severe psychomotor retardation in two unrelated girls. a new MCA/MR syndrome?

Severe mental retardation, congenital contractures, short stature, microcephaly, ptosis, myopia, beaked nose, abnormal teeth, hip dislocation, and severe scoliosis, are described in a 16-year-old and an unrelated 24-year-old females. Results of all laboratory investigations were normal. Review of the literature, of the London Dysmorphology Data Base and POSSUM did not yield to any diagnosis. Whether these patients present a new MCA/MR syndrome is discussed.

Abnormalities, Multiple↗
PubMed2000

Upper limb lengthening.

Congenital deficiencies and developmental deformities of the upper extremity often result in complex deformities that include, to variable degrees, shortening and angulation. Because of the nonweight-bearing status of the upper extremity, these deformities are better tolerated and often of less functional significance than their counterparts in the lower extremity. The need for lengthening therefore is less common in the upper extremity than in the lower extremity. When planning a lengthening procedure to the upper limb, the surgeon must be aware of some specific indications, goals, and complications. In the final analysis, one must weigh the risk of upper limb lengthening against the benefits. In fact, there are many pitfalls, and it is not a surgery to be undertaken lightly. In the hands of experienced specialists, it can achieve excellent results. The potential complication rate is high initially, but tends to diminish with increasing experience. The authors believe that the functional, cosmetic, and psychological benefits of upper limb lengthening outweigh the risk of permanent sequelae and functional impairment in selected patients.

Bone Lengthening↗
PubMed1996

The congenital dislocated spine.

STUDY DESIGN: The congenital dislocated spine has been defined as the potentially most serious form of congenital kyphosis with an abrupt single-level displacement of the spinal canal. A retrospective chart review was conducted on 19 patients with this deformity. OBJECTIVES: To delineate the clinical and radiologic characteristics of this entity, and to analyze the outcome after treatment. SUMMARY OF BACKGROUND DATA: An anterior failure of formation was the basic feature. Kyphosis was variable. Vertebral displacement in the frontal plane was present in seven patients, and sagittal displacement was constant. Mechanical instability was seen in 17 patients. Neurologic impairment was identified in 12 patients, and congenital paraplegia was seen in eight patients. An acute paraplegia occurred after minor trauma in one patient. METHODS: Seventeen patients were treated surgically. Thirteen patients underwent complete circumferential stabilization through anterior strut grafting and posterior fusion without instrumentation, usually before age 3 years. Neurosurgical decompression was done in four patients. RESULTS: The average follow-up period was 8 years, 6 months. Nonunion of the posterior fusion mass was detected and successfully treated in five patients. A solid fusion seemed to be obtained in all patients at last follow-up evaluation. The neurologic status after neurosurgical decompression remained unchanged in three patients and was improved temporarily in one patient. CONCLUSIONS: Avoidance of neurologic morbidity requires early diagnosis and stabilization. The authors recommend early anterior strut grafting and posterior fusion. Exploration of the posterior fusion mass should be done systematically.

Adolescent↗
PubMed1996

[Contralateral preventive screwing in proximal femoral epiphysiolysis].

PURPOSE: The incidence of bilaterality in slipped capital femoral epiphysis (SCFE) ranges, in the literature, from 19 per cent to 80 per cent. The role of contralateral pinning is to prevent late slipping of the femoral epiphysis and its complications. The purpose of this study is to assess the usefulness of routine preventive contralateral pinning in SCFE, and to evaluate its complications. MATERIAL AND METHODS: We reviewed retrospectively 74 consecutive patients treated for unilateral SCFE by associated routine preventive contralateral pinning. The age at surgery ranged from 10 years and 6 months to 16 years and 10 months. The osteosynthesis was achieved by a single cannulated holothreaded screw with a cross grooved head, with or without the use of washers. RESULTS: An accidental pin penetration was noted in 4 cases. The epiphyseal position of the screw was satisfactory in 56 cases. The patient was allowed to walk the second or third day after surgery with the use of crutches. All our patients were reviewed after the end of squeletal growth. The follow-up ranged from 2 to 12 years and 8 months. The age at which the patient was last seen ranged from 15 years and 7 months to 27 years. Two major complications were noted: a femoral fracture at the level of the screw penetration in one case, and secondary slipping of the epiphysis after premature removal of the screw in two cases. The removal of the screw was considered to be very difficult in 10 cases. A relative overgrowth of the greater trochanter was noted in 8 cases, and was of no clinical significance. No infection was noted. At last follow-up, the shape of the femoral head and the function of the hip were normal in all cases except for one hip where severe coxa vara developed because of a secondary slip after premature removal of the screw. DISCUSSION: There is a lot of controversy about the real necessity of routine preventive contralateral osteosynthesis in SCFE. In our experience this surgery succeeded in reducing the incidence of secondary contralateral slipping. The two cases in our series could have been prevented by an accurate timing of screw removal. The complications of this procedure are rare, and it could be done during the same operative time as the SCFE side's. The only case of femoral fracture was secondary to a violent car accident. CONCLUSION: The routine prophylactic controlateral osteosyntheis in SCFE, using a single screw is a safe procedure and allows to reduce the incidence of bilaterality.

Adolescent↗
PubMed1996

[The foot in hereditary motor and sensory neuropathies in children].

PURPOSE: Although Charcot-Marie-Tooth disease (CMT) is known to be the most common neuromuscular cause of pes cavovarus, other paralytic deformities of the foot may be present with hereditary motor and sensory neuropathies (HMSN). The purpose of our review is to analyze these foot deformities and to assess the results of the different therapeutic methods used. MATERIAL AND METHODS: We evaluated 66 patients who had HMSN and had a total of 127 foot deformities. Fifty three patients had CMT, 6 patients Déjerine Sottas disease (DS), and 7 patients had an unclassified HMSN. The average age at diagnosis was of 9 years and 11 months. There were 35 males and 31 females. The deformity was unilateral in 5 cases. In 50 bilateral cases, the severity of the deformity was not similar in both feet. In three bilateral cases, the deformity was completely asymmetrical. The chief complaint was mainly deformity in all cases, followed by subtalar or ankle instability in 57 cases. There were 105 cases of cavus or cavovarus, and 22 cases or valgus or planovalgus deformity (8 of which changed spontaneously to cavovarus). A non surgical treatment was undertaken in 57 cases for minor deformity. Soft tissue release with or without osteotomies was done in 39 cases, and triple arthrodesis in the remaining 31 cases. A clawtoe deformity was treated operatively in 14 cases. RESULTS: The mean follow-up period was 6 years and 9 months for non operated feet and 7 years and 10 months for operated feet (all of the surgically treated feet were reviewed after the end of growth). Three patients of the non operated group and 8 patients of the surgically treated feet underwent triple arthrodesis for a recurrence of the deformity. Thirty nine per cent of the feet which underwent triple arthrodesis (a total of 42 feet) were considered to have fair or bad result at 6 years and 3 months follow-up period. DISCUSSION AND CONCLUSION: The foot deformity in HMSN is of a wide variety. A valgus flat foot is not uncommon, especially in DS and unclassified neuropathies. The young age of the patient is not a contrindication to surgical management. Even if minor previous surgeries do not always succeed in avoiding recurrence of the deformity, they nevertheless prepare the foot fort a possible triple arthrodesis, that will be done in better anatomical conditions.

Adolescent↗
PubMed1996

[Contribution of Ilizarov's equipment in the treatment of congenital pseudarthrosis of the lower limb].

INTRODUCTION: Risks and benefits of using Ilizarov apparatus in the treatment of congenital tibial or fibular pseudarthrosis (CTFP) are presented in this retrospective study. MATERIALS AND METHODS: We reviewed with an average follow-up of 3 years and 4 months, the outcome of twenty consecutive patients treated between 1985 and 1993, for a CTFP using the Ilizarov apparatus. Sixteen patients were treated for non union of both tibia and fibula, 1 patient for an isolated non union of the fibula, and 3 patients for correction of a previously treated, malunited pseudarthrosis. The apparatus was used in four different ways: Realignement, end to end compression, and leg lengthening in 14 cases, Simple external fixation in association with another method of treatment in 2 cases, Progressive correction of malunion in 3 cases, Progressive diaphyseal reconstruction in 1 case (fibula). RESULTS: The mean fixation duration was 7.3 months. Union was achieved with the initial treatment in 11 out of 20 cases (including the 3 cases of malunion correction). Bone grafting was used in 7 out of the 9 remaining cases, and led to bone healing in 3 of them. Five complications were encountered: deep infection in 1 case, repeated stress fracture in 1 case, repeated fracture of the pins in 1 case, malunion in 6 cases, and less than 3 cm leg length discrepancy in 4 cases. DISCUSSION: Ilizarov external fixator is an efficient solution for many cases of CTFP, in which healing did not occur with other methods of treatment. The best indication for its use are the normotrophic and the hypertrophic types of non union (Apoil II), after the age of 4 or 5. Secondary massive bone grafting is to be considered in some cases, since it can either achieve bone union or strengthen it. The major disadvantage of this method is the lack of excision of the dystrophic tissue at the non union site. So, even after the non union is healed, the bone remains dystrophic and fragile, and necessitates a permanente protective orthosis, until the end of bone growth.

Adolescent↗
PubMed1996

Treatment of severe flexion deformity of the knee in children and adolescents using the Ilizarov technique.

We have used the Ilizarov technique for severe flexion deformity of the knee in 11 patients (13 knees) between 1986 and 1994 and have followed them up for an average of 4.1 years. The age of the patients at operation ranged from 1.7 to 18.8 years. The femoral and tibial components were connected by two anterior hinges, medial and lateral, and two posterior distraction rods. The deformity was corrected to a femorotibial lateral shaft angle of less than 20 degrees. A permanent orthosis was applied after removal of the fixator. Fractures occurred in four patients and paralysis of the common peroneal nerve in another. There was a recurrence of the deformity in four patients. At the last review all patients were able to walk on their operated leg with or without an orthosis. We have found the Ilizarov method to be helpful in correcting severe fixed flexion deformity of the knee, with relatively few complications, but the basic principles of the method must be carefully followed.

Adolescent↗
PubMed1996

[Extra osseous tumors of the spine in children and adolescents. Spinal complications].

PURPOSE OF THE STUDY: The delay in diagnosis of spinal tumors is not rare. The chief complaint may include pain, walking disability, and spinal or limb deformities. The purpose of our study is to analyze the spinal deformities associated with non osseous intraspinal tumors, to assess the complications of treatment, and to set out a preventive protocol. MATERIALS: We reviewed retrospectively 40 consecutive cases of non osseous intraspinal tumors treated between 1972 and 1991. There were 32 intradural, 2 extradural, and 6 intra and extradural combined tumors. At the first consultation, the age ranged between 4 months and 15 years, and only 16 patients showed neurologic deficit. Spinal deformity existed in 9 patients, 7 of which had no neurologic deficit. All the tumors were treated surgically. Laminectomy was done in 28 cases, and osteoplastic laminotomy in 12 cases. The number of levels included in the laminectomy ranged from 3 to 18. Bilateral arthrectomy at least at one level was undertaken in 15 cases. A postoperative brace was worn in all cases for an average period of 4 months. An adjuvant radiotherapy was undertaken in 12 cases for an incomplete resection. METHODS: The incidence and pattern of spinal deformity was assessed before tumor treatment and ultimately after laminectomy or osteoplastic laminotomy (or laminoplasty). RESULTS: Among the 9 cases with preexisting spinal deformity, the curve magnitude increased after laminectomy in 4. A kyphotic, kyphosoliotic or scoliotic deformity developed in 18 cases after surgery for tumor resection. Among these 18 patients, only one had had an adequate osteoplastic laminotomy. The treatment of spinal deformities was surgical in 12 cases, and done by either posterior or anterior and posterior combined arthrodesis. DISCUSSION: Spinal deformity may be the main complaint of a patient who has intraspinal tumor. Prevention of postlaminectomy spinal deformity is mandatory, and could be done by osteoplastic laminotomy and the use of a brace during a minimum period of 4 to 6 months after surgery. CONCLUSION: Diagnosis of intraspinal tumors in children and adolescents should be done early, and laminoarthrectomy should be replaced by osteoplastic laminotomy.

Adolescent↗
PubMed1995

[Comparison of evaluation methods of the results of congenital clubfoot treatment].

INTRODUCTION: An ideal method for the assessment of the results of treatment in congenital clubfoot should take into account the morphology of the foot and its function, the personal satisfaction of the patient of his parents, interexaminer variability, and be applied for any type of treatment. MATERIAL AND METHODS: We evaluated at- end of growth the results of treatment of 35 patients with unilateral clubfoot, and analyzed them according to 13 different rating scores already published in the literature. The material was divided in 3 groups; 15 feet having undergone multiple surgeries, 10 feet having had only one posteromedial release procedure, and 10 feet having been treated nonoperatively. RESULTS: None of the 13 reviewed rating methods seems to be ideal. The results of treatment, for one taken foot, were often different from one method to the other. DISCUSSION: The high number of rating scores published in literature, is the direct evidence that there is no concensus in the evaluation of the results of treatment in congenital clubfoot. A unanimous new method should be created and should fill all the prerequisites of the ideal method, described above. Some criteria are very important to consider: A iatrogenic deformity or disability, i.e. severe lateral translation of the foot, acquired convex foot, or calcaneus foot, should be severely penalized; hopping on one foot should be the test used to evaluate the strength of triceps surae muscle in children above 5 years of age ; Radiological evidence of talonavicular dislocation is a very important long term prognostic element. CONCLUSION: A new unanimous method for the assessment of the results of clubfoot treatment is necessary. It should be simple, easy to teach, and easy to use.

Clubfoot↗
PubMed1995

[Distal intra-articular resection of the calcaneus in the treatment of severe or recurrent congenital clubfoot].

INTRODUCTION: Secondary adaptive bone changes and joint distorsions in clubfoot may present a barrier to adequate correction of the deformity. The purpose of our study is to show how the lateral excision of the calcaneus distal part as described by Lichtblau, in combination with an appropriate medial release allows better correction of forefoot deformity, with less recurrence rate. MATERIAL AND METHODS: Between 1974 and 1982, 43 feet in 38 patients underwent this type of surgery. Lateral excision o the calcaneus was decided preoperatively in 34 feet, for recurrence of the forefoot deformity following previous surgery. In the remaining 9 feet, this lateral excision was decided intraoperatively, because of an uncomplete correction of the fore part of the foot, despite an adequate posteromedial release. The resected angle from the distal intra-articular part of the calcaneus varied from 10 to 30 degrees with an average of 15 degrees. RESULTS: All our results were evaluated at end of growth. Mean age at follow-up was 15 years and 4 months, with an average period of 10 years and 7 months following surgery. The average forefoot adduction moved from 21 degrees preoperatively to 1 degree at last follow-up. The clinical calcaneocuboid mobility was preserved in 37 cases. Four types of complications were encountered in 7 patients: pain in 5 cases, calcaneocuboid fusion in 6 cases, recurrence of deformity in 2 cases, and overcorrection in 5 cases; this last complication was related to intraoperative overcorrection rather than a progressive deterioration of the result, and had no clinical significance. No overcorrection was seen after calcaneocuboid fusion. We have found no relation between age at surgery, and the incidence of calcaneocuboid fusion, but the two cases operated on children under one year old, ended up with a bad result. DISCUSSION: The resection of a single side of a joint may permit normal joint function to be retained. The resected cartilage is replaced by a fibrocartilage that resembles the original articular cartilage, provided the resected defect is deep enough to allow vascularization from the underlying bone. CONCLUSION: The success of this method depends on an accurate surgical technique, as described by its promoter. It can be of great help in severe and complicated clubfeet. It achieves the goal with a calcaneocuboid function often preserved.

Calcaneus↗
PubMed1994

Posterior spinal fusion in neuromuscular scoliosis using a tibial strut graft. Results of a long-term follow-up.

STUDY DESIGN: Risks and benefits of using a tibial graft for posterior spinal fusion in neuromuscular scoliosis were evaluated in a long-term follow-up study. A consecutive series of 72 patients underwent posterior spinal fusion for neuromuscular scoliosis. OBJECTIVES: Radiologic outcome was assessed to evaluate the quality of the spinal fusion. Patients were followed serially to detect donor site complications. Mean follow-up was 17 years and 8 months (minimum: 6 years, 6 months). SUMMARY OF BACKGROUND DATA: Mean age of the patients at the time of surgery was 15 years. Progression of the curvature was minimal at last follow-up (mean progression at last follow-up: lumbar curve, 4.5 degrees; thoracic curve, 5.3 degrees). Concerning donor site complications, four patients had a leg length discrepancy of less than 2 cm at last follow-up. This complication was related to tibial overgrowth at the donor site. METHODS: Solid fusion was defined in this long-term study as the absence of modification of the radiologic aspect at last follow-up in addition to the presence of a massive contagious trabecular fusion mass. RESULTS: The fusion appeared to be solid in all patients. No obvious pseudarthrosis could be documented. The constant successful outcome differs significantly from spinal fusion that uses bank bone. The absence of stress fracture was correlated to the low level of constraint in this essentially nonambulatory population. CONCLUSION: This experience indicates that the tibial graft deserves consideration in posterior spinal fusion for neuromuscular scoliosis.

Adolescent↗
PubMed1993

Human leukocyte antigen in hydatidiform mole.

OBJECTIVE: To find any possible association between human leukocyte antigen (HLA) as a genetic marker and the development of hydatidiform mole (HM). METHOD: The lymphocyte microtoxicity technique was used to study the HLA antigens in 3 groups: 18 women with hydatidiform mole and their husbands (study group), 300 normal women (first control group), and 20 normal pregnant women and their husbands (second control group). RESULT: Hydatidiform mole is more frequent in women having HLA A1. The disease is more common in couples with partial compatibility of the B locus. CONCLUSION: HM occurs more frequently in women with certain HLA antigens and when the husband and wife have partial compatibility at the B locus.

Case-Control Studies↗
PubMed1992

Serum nickel, copper and zinc in Norplant users.

Changes in serum nickel, copper and zinc were evaluated in 45 Norplant users. Two groups were selected for this study. Group I included 15 regularly menstruating females as controls and as short-term users (90 days after Norplant insertion). Group II included 30 Norplant users for one year or more as long-term users. These elements were determined by atomic absorption spectrophotometry. Serum nickel showed no significant change in short-term nor in long-term users when compared to the control group or to each other. Serum copper and zinc revealed a significant increase in short-term users for a short period of time, which returned to normal levels in long-term users. There was disappearance of the cyclic changes in serum copper and zinc concentrations on comparing their levels in ovulatory to non-ovulatory Norplant users. The use of Norplant has no deleterious effects on serum levels of nickel, copper and zinc.

Adult↗