Biomedical subjects

M Letts

Publications and source records attributed to M Letts.

70 records · Page 4Linked to original sources

PubMedDate not supplied

Prostaglandin-induced neonatal periostitis.

Prostaglandins are being commonly used to maintain the patency of the ductus arteriosus in infants with congenital ductal-dependent heart disease. A significant and unusual side effect of this drug treatment is the symmetrical development of periostitis of the long bones. A review of neonates with congenital heart disease requiring prostaglandin treatment at the Children's Hospital of Eastern Ontario revealed five infants who developed periostitis, the earliest onset being after 14 days of prostaglandin infusion. The drug dosage varied in these infants from 0.02 to 0.10 micrograms/kg/min. The periostitis was associated with limb pain and considerable swelling of the extremities in all children. The periostitis improved on cessation of the prostaglandin infusion, and by 6 weeks after the cessation of the drug, the periostitis had decreased significantly. Periostitis seemed more dependent on the duration of administration of the prostaglandin than on the dosage of prostaglandin administered. Awareness of this entity is essential not only for the treatment team caring for these infants but also for consultant pediatric orthopaedists to avoid excessive investigation for infection, metabolic disease, or vitamin deficiencies that resemble prostaglandin-induced periostitis.

Ductus Arteriosus, Patent↗

PubMedDate not supplied

Mental readiness in surgeons and its links to performance excellence in surgery.

The purpose of this study was to assess mental factors related to surgical excellence among surgeons. In-depth interviews were conducted with 33 highly proficient surgeons involved in high- (51%) and low- (49%) mortality-risk surgery. A "Surgeon Interview Guide" was developed for eliciting relevant qualitative and quantitative data. The success elements from Orlick's "Model of Human Excellence," based on work with elite athletes, were used as the basic framework for the qualitative analysis of the interview transcripts. Of the three major readiness factors rated by the surgeons--mental, technical, and physical--surgeons rated mental readiness as most important for performance excellence in surgery; 49, 41, and 10%, respectively. Mental readiness was also the factor that showed the most significant change between successful and disappointing surgical performances (p = 0.003). The following mental factors were identified as important among highly qualified surgeons and in surgeons performing high-mortality-risk surgery: commitment, self-belief, positive imagery, mental readiness, full focus, distraction control, and constructive evaluation. Highly successful experienced surgeons perform at an exceptional level largely because of the quality of their mental skills. Residents in surgery may benefit from systematic mental training in similar mental skills. This approach has been effective in other high-performance disciplines and could likewise play a meaningful role in helping surgeons improve their mental readiness for the challenges they face.

Female↗

PubMedDate not supplied

The SAPHO syndrome in children: a rare cause of hyperostosis and osteitis.

The SAPHO syndrome is a rare constellation of signs and symptoms characterized by synovitis, acne, pustulosis, hyperostosis, and osteitis. The most common musculoskeletal complaints are hyperostosis, causing pain, tenderness, and swelling of the anterior chest wall, although any part of the axial and appendicular skeleton may be affected. There is a great degree of variability in the dermatologic involvement of this syndrome. A combination of clinical, radiographic, and pathological investigation is required to establish the correct diagnosis. No single treatment has been found to be effective, although nonsteroidal antiinflammatory drugs have been the most frequently used. Because there is no mention of SAPHO syndrome in the English orthopaedic literature, and pediatric orthopaedic surgeons may be the first caregivers to treat these children, we thought it appropriate to share our experience with a 5-year-old boy with SAPHO syndrome recently under our care.

Acquired Hyperostosis Syndrome↗

PubMedDate not supplied

Congenital synspondylism: diagnostic features.

Congenital synspondylism is a recently described condition characterized by short stature, an unusual constellation of vertebral fusions without rib anomalies and carpal coalition. A new case is described to illustrate the diagnostic features and the orthopaedic problems associated with this rare syndrome. Review of available literature shows that patients with congenital synspondylism commonly develop spinal deformity and mild respiratory compromise.

Adolescent↗

PubMedDate not supplied

Avascular necrosis of the radial head in children.

Avascular necrosis of the radial head is uncommon. A 20-year review of records at a Pediatric Trauma Center revealed eight cases of avascular necrosis of the radial head in children with an average of 10 years (range, 7-16 years). Symptoms of pain or restriction of elbow motion began at an average of 23 months after trauma in seven cases, and in one case, there was no history of trauma. Of the seven secondary to trauma, six resulted from a fall, and one from a torsional injury. The types of injuries associated with avascular necrosis of the radial head were two supracondylar fractures, a fracture of the lateral condyle, two fractures of the radius, a radial head dislocation that underwent a proximal radial osteotomy, and one with only an elbow contusion. The long-term results of radial head necrosis were poor, with three ultimately requiring radial head resection, and the remainder having considerable limitation of elbow motion. Loss of vascularity to the radial head is very analogous to avascular necrosis of the femoral head, with the late onset of incongruity, osteoarthritis, and hypertrophy of the head. It should be considered in any child with late-onset loss of elbow motion after trauma.

Adolescent↗

PubMedDate not supplied

Cerebral microembolization during pediatric scoliosis surgery: a transcranial doppler study.

SUMMARY: The goal of this study was to identify cerebral microemboli during scoliosis surgery and their potential relationship with visual alterations. Transcranial Doppler identified high-intensity transient signals (HITS) during surgery in both middle cerebral arteries, and ophthalmologic examination assessed their potential effects on the visual system. Thirteen children (age 13-17 years) undergoing surgery for scoliosis or kyphosis with spine curvature >45 degrees were studied. HITS were identified in 92%. Eleven patients had a total count of <15 HITS, but in the remaining two the count was unexpectedly high (63 and 265 HITS). Echocardiography in these two patients indicated the presence of an atrial right-to-left shunt. Uneventful preoperative and postoperative visual function was found in 11 patients. One patient had preoperative blindness and in another ophthalmologic complications developed not related to microembolization. Scoliosis surgery is frequently associated with low counts of cerebral microemboli. It appears that such low embolic counts have no effects on postoperative visual function as determined clinically. Some patients may show high rates of microemboli, which may be related to the presence of right-to-left cardiac shunts. The impact of these signals on brain function remains to be investigated.

Adolescent↗

PubMedDate not supplied

In-line skating injuries in children: a 10-year review.

In-line skating is an increasingly popular recreational activity for both children and adults. As with any high-speed sport, traumatic injury is an associated hazard. It was the purpose of this study to focus on the injuries in children associated specifically with in-line skating with an emphasis on education and prevention. During a 9-year period, 331 injuries were identified, with 105 families completing an in-depth epidemiologic questionnaire. Sixty-one percent of the victims were boys, with an overall average age of 12 years. The upper extremity was most commonly injured (64%); the head and neck area was injured in 16% and the lower extremity in 20%. Fractures represented 38% of all injuries, with inexperience appearing to be the most common cause. An analysis of preventive strategies for childhood in-line skating was undertaken using Haddon's 10 basic preventive principles. Educational programs regarding instruction in in-line skating and the value of protective equipment need to be part of the school curriculum.

Adolescent↗

PubMedDate not supplied

Spinal cord concussion in pediatric athletes.

Children with a narrowed canal secondary to spinal stenosis or congenital malformation may be predisposed to spinal cord concussion when the canal is further narrowed in hyperflexion or hyperextension. Review of the medical records of the Winnipeg and Ottawa Children's Hospitals disclosed 12 children who had been treated for transient sensory or motor loss after a spinal injury. Measurements of the spinal canal were compared with standard normal measurements, and the spinal canal width was expressed as a percentage of the vertebral width (the Torg ratio). This study shows that narrowing of the spinal canal is an inconsistent predisposing factor to spinal cord concussion in children. A poor correlation between the Torg ratio and comparison with a series of normal control canal widths was noted.

Adolescent↗

PubMedDate not supplied

Galeazzi-equivalent injuries of the wrist in children.

Fracture of the distal radius with dislocation of the distal ulna, the so-called Galeazzi fracture, is uncommon in children. A variant, the "Galeazzi-equivalent fracture" involving a separation of the distal ulnar growth plate with displacement of the ulnar metaphysis was shown to be more common than the "classic" Galeazzi fracture in a 15-year review of this fracture pattern at the Children's Hospital of Eastern Ontario. An analysis of outcome of 10 fractures showed less favorable results in the six Galeazzi-equivalent fractures compared to the four classic Galeazzi injuries, with one child sustaining a complete growth plate arrest of the distal ulna secondary to an equivalent injury. Recognition of the Galeazzi-equivalent fracture pattern is sometimes difficult. To define the various fracture patterns in an attempt to facilitate diagnosis and management, a classification of the Galeazzi injury complex in children has been devised. Reduction of all Galeazzi injury patterns is best accomplished with the forearm in full supination in an above-elbow cast.

Adolescent↗

PubMedDate not supplied

Fractures of the triquetrum in children.

Fractures of the triquetrum are a more common cause of posttraumatic wrist pain in children than is usually appreciated. These fractures are often very subtle "flake" avulsion or impingement fractures requiring good oblique radiographs for recognition. The incidence is probably much higher because many fractures go undiagnosed as a wrist "sprain" or type I epiphyseal injury of the distal radius and ulna. An outcome study of carpal injuries at the Children's Hospital of Eastern Ontario, a regional pediatric trauma center, disclosed 15 children who had sustained a triquetral fracture. Three were initially missed, and most were flake fractures. An average follow-up of 4 years showed only two patients with complaints of wrist stiffness and discomfort with hyperextension of the wrist. The increased ligamentous laxity of the wrist in children may actually predispose to triquetral injury by causing ulnar impingement of the triquetrum with ulnar deviation and extension of the wrist. Pain in a child's wrist just distal to the ulna, the "triquetral point," should arouse suspicion of a fracture of the triquetrum.

Adolescent↗

PubMedDate not supplied

Mechanical evaluation of four- versus eight-pin halo fixation.

Fixation of the halo device in the skulls of young children is sometimes compromised because of a thinner cortex and the increased jarring and trauma that small children experience during their everyday activities of life at that age. To assess the increased fixation that an eight-pin halo fixation would provide over the more standard four-pin fixation, the stiffness of fixation of a halo orthosis was evaluated in four dried human cadaver skulls. Two different fixation systems were used: the first one with four pins in the standard locations and the second with four additional pins. A compressive force was applied to the halo ring at a constant rate of 1.27 mm/min. Load and deflection data were recorded simultaneously until a force of 400 N was reached. Results for the two-pin systems were analyzed and compared statistically by using paired t tests. Statistically significant differences were established between the two sets of results with the 8-pin system providing an increase of 24.2% in the stiffness of fixation.

Biomechanical Phenomena↗

PubMedDate not supplied

Fractures of the capitellum in adolescents.

Fractures of the capitellum are rare in children. The treatment of these injuries has been controversial. At a major pediatric trauma center, seven capitellar fractures were seen in children between 1988 and 1994. The average age of the children was 14.7 years (range, 11-17). Six of these fractures were type I injuries, with large anterosuperior fragments that required operative reduction and internal fixation in five cases. Internal fixation methods used were K wires in three patients, Herbert screws in one patient, and cannulated screws in one patient. The remaining type I fracture was treated with a closed reduction. The seventh fracture was a type II fracture, treated nonoperatively. Five children did well with their respective treatments, but one required reoperation to remove an exostosis block to flexion. Accurate open reduction and internal fixation for the displaced capitellar fracture in children is an effective treatment to restore normal elbow function.

Accidental Falls↗

PubMedDate not supplied

Neonatal gangrene of the extremities.

Vascular insufficiency of a peripheral limb is a well-recognized and serious complication occurring in newborn infants. A 15-year review of a Level III neonatal intensive care unit at The Children's Hospital of Eastern Ontario revealed 10 infants who had a vascular insult to a limb necessitating the amputation of a portion of the limb. Predisposing factors to vascular occlusion were prematurity, polycythemia, umbilical artery catheterization, and intensive care treatment for other life-threatening illnesses. The lower extremity was most commonly affected, requiring below-knee amputations in two infants, knee disarticulation in one, and toe amputations in five. The remaining infants required an elbow disarticulation and amputation of the fingers, and one child had a massive ischemic contracture of the lower limb. Care should be taken not to amputate prematurely and await definitive demarcation of the gangrenous portion. Amputation should be designed to preserve growth plates wherever possible to ensure an adequate stump for prosthetic fitting in the older child.

Algorithms↗

PubMedDate not supplied

Recurrent posterior shoulder dislocation in children: the results of surgical management.

Recurrent posterior dislocation of the glenohumeral joint in children is rare. Because very few studies in the literature deal with the surgical management of this problem or guidelines for patient selection for surgery, we reviewed the outcomes of surgical management of six patients aged 9-17 years. Of the seven shoulders repaired, three underwent a posterior bone block and four a glenoplasty, all augmented with a posterior Putti-Platt type capsulorrhaphy. Only one child required reoperation 3.5 years after the initial surgery. All patients had pain-free full use of the affected shoulder, and all shoulders were clinically stable at long-term follow-up averaging 9.4 years. By using the available literature and the results of this study, we developed a series of guidelines for the selection of children with recurrent posterior dislocation of the shoulder for surgical repair.

Adolescent↗

PubMedDate not supplied

Injuries caused by water tubing.

Water tubing (the pulling of an inner tube behind a power boat) is growing in popularity and unfortunately is becoming an increasing source of pediatric trauma. This is related to the lack of control of either the driver or the rider in directing the inner tube away from objects in the water or along the shore. Because of the severe trauma from this increasingly popular sport, we thought it appropriate to review our experience at a major pediatric trauma center to draw attention to this increasing cause of injury in children and to develop guidelines to reduce such injuries. A retrospective review of children admitted over a 10-year period revealed eight children who required admission to hospital for injuries sustained in water tubing. Five patients sustained fractures, one a splenic contusion, and two atlantoaxial rotatory subluxation. A set of safety guidelines for water tubing has been developed in an attempt to minimize the dangers to children who wish to pursue this sport.

Adolescent↗

PubMedDate not supplied

Air bags and children: a potentially lethal combination.

Air bags have been responsible for saving thousands of lives since their introduction in the early 1970s. Now, however, it has become apparent that under certain conditions, these restraint mechanisms designed to save lives have in fact been the cause of needless morbidity and mortality in children. We reviewed 13 children injured by air bags in Canada, where seat belt wear is mandatory for all occupants. Although 12 of the children sustained relatively minor air bag trauma, one child was killed by the air bag deployment, sustaining an occipital-C1 dislocation. The pediatric population is at particular risk as many parents continue to unwittingly place their children in the front seat and thus in jeopardy of sustaining air bag-induced injuries should a collision occur.

Accidents, Traffic↗