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Biomedical subjects

N M Clarke

Publications and source records attributed to N M Clarke.

At least 37 records · Page 2Linked to original sources
PubMed1996

Torticollis secondary to ocular pathology.

We report a series of 15 children, six male and nine female, of average age 20 months, seen at a paediatric orthopaedic clinic with torticollis. Orthopaedic examination revealed a normal range of neck movement in all cases but in seven there was palpable tightness in the absence of true shortening or contracture of the sternomastoid muscle. The patients were prospectively referred for ocular examination. In five of the 15 an ocular cause for the torticollis was detected with underaction of the superior oblique muscle in three, paresis of the lateral rectus muscle in one and nystagmus in one. Another two patients were found to have an abnormal ocular examination which was thought to be unrelated to their torticollis. Three of the patients with ocular torticollis required extra-ocular muscle surgery to abolish the head tilt and one of these had a tight sternomastoid muscle. Two of the non-ocular group had surgical release of the sternomastoid muscle; in the rest, the condition either resolved with physiotherapy or required no active treatment. We recommend that all patients with torticollis and no clear orthopaedic cause are referred for ocular assessment since it is not possible clinically to distinguish ocular from non-ocular causes.

Adolescent↗
PubMed1996

Congenital dislocation of the hip in extrauterine pregnancy.

Only two cases have been reported of congenital dislocation of the hip in infants born after extrauterine pregnancies. We report a further two and discuss the management and the variable outcome. These cases seem to confirm that congenital dislocation of the hip is associated with moulding forces rather than being a teratological abnormality.

Abnormalities, Multiple↗
PubMed1995

Oculoauriculovertebral spectrum: new manifestations.

We present a case of oculoauriculovertebral spectrum (hemifacial microsomia, Goldenhar's syndrome) found shortly after birth with right iliac hypoplasia, absent right pubic and ischial ossification centres and posterior urethral valves, which have not previously been described in this spectrum.

Abnormalities, Multiple↗
PubMed1995

Developmental regulation of circulating insulin-like growth factor-binding proteins in normal pregnancies and in pre-eclampsia.

The insulin-like growth factors (IGFs) and their binding properties (IGFBPs) are believed to play important roles in the growth and development of the human fetus. They have been implicated in the pathophysiology of pre-eclampsia. In this study we have characterized the developmental regulation, in normal and pre-eclamptic pregnancies, of IGFs and IGFBPs in maternal serum, neonatal serum and amniotic fluid. In neonatal cord serum IGFBP-1, -2 and -6 decreased with increasing gestational age. In contrast, the ternary complex and its components, IGF-I, IGFBP-3 and ALS increased with gestation. We show that while ALS is an important limiting factor for ternary complex formation in the fetal circulation, there is a fraction of IGFBP-3 which is unable to form this complex. IGFs and IGFBPs in the maternal and fetal circulation were similar in normal and pre-eclamptic pregnancies.

Amniotic Fluid↗
PubMed1995

Familial congenital pseudarthrosis of the ulna.

A mother and daughter, both presented with congenital pseudarthrosis of the ulna due to neurofibromatosis. The daughter is one of identical twins, the second twin not having a pseudarthrosis. The mother's uncle also had pseudarthrosis of the tibia. This suggests a complex variable genetic inheritance pattern for pseudarthrosis in neurofibromatosis. Despite having had no treatment, the mother had minimal symptoms, minimal deformity, and no radial head dislocation.

Child, Preschool↗
PubMed1995

Recurrent irritable hip in childhood.

Between 1989 and 1992 we admitted 426 children with an irritable hip, 363 (85.2%) once and 63 (14.8%) on 143 occasions. We assessed the records retrospectively to determine whether the groups differed and in particular whether recurrence was followed by pathological sequelae. We identified no feature which distinguished between them at either presentation. The use of bone isotope scans was greatly increased in recurrent cases, without clinical benefit. No relationship between recurrence and subsequent abnormality was identified, with 22 (42%) of the recurrences taking place in the opposite hip. The only difference was a higher incidence of 'psychosocial factors' recorded in the notes of children who presented on more than two occasions. The incidence of recurrent irritable hip is larger than previously indicated and in the presence of normal radiographs and low-grade clinical signs, more detailed investigation on subsequent admission is unlikely to be helpful.

Child↗
PubMed1995

Surgical release of the 'snapping iliopsoas tendon'.

We report 22 patients (19 women and three men) of mean age 20.8 years who had painful snapping sensations in the groin. Most were able to reproduce the click by extending the affected hip from a flexed, abducted and externally rotated position and most were tender in the adductor triangle. Plain radiographs and an arthrogram were normal. A clinical diagnosis of subluxation of the iliopsoas tendon was made. Conservative management failed in 14 patients, two of whom had bilateral pain. All 14 had surgical release of the iliopsoas tendon through a medial approach. At follow-up (mean 17 months) the click had resolved in ten hips, was occasional but painless in five and unchanged in one. The syndrome of a painful 'snapping' psoas may result in disproportionately disabling symptoms. It may be diagnosed on clinical grounds and effectively treated, when severe, by release of the iliopsoas tendon.

Adolescent↗
PubMed1994

Subcutaneous granuloma annulare: four cases and review of the literature.

Subcutaneous granuloma annulare (SGA) produces benign nodules in otherwise healthy children. The histology of the lesions may be indistinguishable from rheumatoid nodules. However, in children the lesion of SGA is not accompanied by connective-tissue disease. We report 4 patients with SGA. There were three girls and one boy ranging in age from 4 to 15 years. All the children presented with a solitary lesion on the lower limb. A cutaneous lesion was also present in case 4. In only one patient (case 4) was there a history of trauma. There was no relevant past medical history. Routine laboratory tests were normal (including ESR and auto-immune profile). A computed tomography (CT) scan with intravenous contrast was performed in all patients. The CT features were those of soft tissue masses of variable attenuation and enhancement with inconsistent infiltration into surrounding fat. There appear to be no specific CT features which distinguish this benign lesion from a more sinister one. Excisional biopsy was performed in all cases. In children, SGA should be included in the differential diagnosis of soft-tissue masses, particularly in the lower extremity.

Adolescent↗
PubMed1994

Management of irritable hip: a review of hospital admission policy.

The case notes of all children admitted during the preceding five years for observation with painful hips (509 patients) were analysed to determine significant diagnostic factors and thus to design and admission policy. Most orthopaedic disorders (62 patients) were apparent on the initial radiographs, with the important exception of osteomyelitis/septic arthritis (21 patients). The remaining 426 patients were diagnosed by exclusion as having an irritable hip. The latter two groups were similar with respect to age, sex, and duration and nature of symptoms. A number of clinical features and laboratory investigations recorded within 12 hours of admission, however, were shown to have significant discriminative value. These were severe spasm, tenderness, pyrexia > or = 38 degrees C, and an erythrocyte sedimentation rate of > or = 20 mm/hour (the white cell count was not significant). Combination of any two of these produced a specificity and sensitivity for sepsis of 91% and 95% respectively (95% confidence interval 0.64 to 0.97). A protocol designed from this data analysis is now being tested and is expected to result in a significant reduction in admission rates.

Bacterial Infections↗
PubMed1994

Ultrasound imaging and secondary screening for congenital dislocation of the hip.

We report the preliminary results of a continuing prospective evaluation of a screening programme for congenital dislocation of the hip (CDH) which uses ultrasound imaging to provide delayed selective screening to complement neonatal clinical screening. Of 26,952 births in the Southampton district, 1894 infants were referred for secondary screening because of a clinical abnormality or the presence of a predetermined risk category for CDH. Pavlik harness treatment was required for only 118 infants, giving a treatment rate of 4.4 per 1000 births. Of those referred with clinical instability, 35% did not require treatment. Dislocation or subluxation was detected in 17 of 643 infants referred only because they fell within one of three risk categories: breech presentation, foot deformity and family history. All 17 had normal clinical examinations and cases were discovered in each category. Six children presented with CDH after 12 weeks of age, giving a late presentation rate of 0.22 per 1000 births. All had normal clinical examinations within 24 hours of birth and none was in a risk category. Surgery has been required in ten children, giving a surgical treatment rate of 0.37 per 1000 births. We conclude that, in Southampton, delayed selective secondary screening with ultrasound is more effective than clinical screening alone. It targets treatment to those infants who need it, and reveals a number of dislocated and subluxed hips that would otherwise be missed.

Female↗
PubMed1993

Madelung's deformity masquerading as a bone tumour.

Madelung's deformity has classical clinical and radiological appearances; it is well recognised by both radiologists and orthopaedic surgeons. In this paper we report on two Madelung's deformities demonstrated on wrist radiographs that were misinterpreted as bone tumours, the patients having presented with unrelated trauma. Two further cases demonstrating similar features are illustrated. The radiological diagnosis of Madelung's deformity and its differential diagnosis is discussed.

Bone Diseases, Developmental↗