Biomedical subjects
J V Banta
Publications and source records attributed to J V Banta.
Urinary zinc and metallothionein in children with spina bifida.
Defective embryonic cellular zinc utilization may contribute to abnormal neural tube formation and such a defect may be detectable in children with spina bifida (SB). To investigate this possibility, we examined urinary excretion of zinc and metallothionein (Mt), a cytoplasmic metal-binding protein, in 10 girls and 6 boys (ages 6 months to 19 years) with SB and 16 age-matched control subjects. Mean urinary zinc and Mt concentrations in the SB group were 65% and 72% greater than controls, respectively (p less than 0.05). There was was no evidence of renal dysfunction as judged by urinary creatinine and total protein excretion in the SB children. Increased excretion of zinc and Mt in some children with SB may reflect one or more underlying defects of zinc utilization.
Displaced femoral neck fractures at the bone-screw interface after in situ fixation of slipped capital femoral epiphysis.
Two patients had displaced femoral neck fractures at the bone-screw interface after in situ fixation of slipped capital femoral epiphysis. Both fractures required closed reduction and internal fixation. Inadvertent derotation of the femur occurred in both patients and allowed fixation of the fracture through the intramedullary canal of the femoral neck without anterior penetration of the pins into the joint; a nonunion occurred in this patient. The other patient developed chondrolysis and avascular necrosis. Because the femoral neck is vulnerable to stress fractures in young adults, there is some question whether pins placed anteriorly through the femoral neck cortex should be removed.
Pes cavovarus as a late consequence of peroneus longus tendon laceration.
Peroneal weakness has been implicated as a cause of cavovarus foot in neuromuscular disease. The effect, however, of isolated peroneus longus deficiency has not been studied. We report the late development of a cavovarus foot in a child with isolated laceration of the peroneus longus tendon. The importance of this specific tendon in the maintenance of foot balance is discussed.
Cost of skin care in the myelomeningocele population.
This study was undertaken to illustrate the magnitude of the skin breakdown problem in children with myelomeningocele. Seventy-five of the 650 spina bifida patients treated at the Newington Children's Hospital during a 13-year period comprised our final study group. The criterion for inclusion was hospitalization solely for treatment of skin breakdown. Multiple parameters were reviewed. Skin breakdown remains prevalent in this patient population, despite significant improvements in patient care. These improvements are readily demonstrated by (a) an increase in age at time of admission, (b) a significant reduction in average length of hospital stay, and (c) more aggressive admission policies with earlier operative intervention. More than two million dollars and the equivalent of 17 years in hospital days were needed to treat these patients during the 13-year study period.
Charcot arthropathy in spina bifida.
This multicenter study was undertaken to identify the prevalence of Charcot arthropathy in the spina bifida population; to evaluate the relationship of neurosegmental level, ambulatory level, and distribution of joint involvement; and to assess treatment results and make treatment recommendations. Sixteen patients were identified with Charcot arthropathy based on clinical and radiographic criteria ranging in age from 9 to 42 years. There were 15 ankles, seven knees, and four hips identified with Charcot arthropathy. Six patients underwent surgery and modification of orthoses, eight had a modification of orthoses only, one had no modification, and one was lost to follow-up. Mean follow-up was 4 years and 9 months (with four good, 17 fair, and five poor results). The best results were seen in 13 compliant patients with a brace modification, whereas poor results were seen in three patients with poor brace compliance. Based on our study, we have noted the prevalence of Charcot arthropathy in spina bifida to be one in 100 cases.
Pancreatitis following scoliosis surgery in children and young adults.
Forty-four patients undergoing single-stage surgery for scoliosis were monitored for biochemical and clinical evidence of pancreatitis. Six patients (14%) developed elevation of both serum amylase and lipase levels. Four of these had symptoms or signs suggestive of pancreatitis. Mean intraoperative blood loss was significantly higher in the group with pancreatitis. No significant differences were noted with regard to age, surgical technique, degree of initial or residual deformity, or length of surgery. The patients with pancreatitis required a longer average period of fasting time. Patients with prolonged ileus or abdominal pain after scoliosis surgery should be investigated for possible pancreatitis.
Scoliosis surgery: a risk factor for cholelithiasis?
Scoliosis surgery has been associated with pancreatitis and acalculous cholecystitis, and also has been implicated as a risk factor for cholelithiasis. A prospective study of 36 children and adolescents undergoing scoliosis surgery was performed using ultrasound to determine the incidence of cholelithiasis following spine surgery. The patients underwent abdominal ultrasound exams preoperatively, immediately postoperatively, and then at intervals following surgery with 2-5-year follow-up. Four of 36 patients (11.1%) (one male, three female) developed gallstones, although all had been free of gallstones after surgery. The gallstones appeared between 2 + 5 and 5 years after surgery. Those with gallstones were not different from those without with respect to 14 factors. It is concluded that scoliosis surgery is not a risk factor for gallstones, because of the delay in onset of cholelithiasis after surgery. Furthermore, the prevalence of gallstones in this study sample is not greater than that reported in historical control studies of European young adults.