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Biomedical subjects

R C Henderson

Publications and source records attributed to R C Henderson.

At least 37 records · Page 2Linked to original sources
PubMed1995

Bone-mineral density in children and adolescents who have spastic cerebral palsy.

Bone-mineral density was studied in a heterogeneous group of 139 children (mean age, nine years; range, three to fifteen years) who had spastic cerebral palsy. The evaluation included serum analyses and a nutritional assessment based on a dietary history and anthropometric measurements. The bone-mineral density of the proximal parts of the femora and the lumbar spine was measured with dual-energy x-ray absorptiometry and was normalized for age against a series of ninety-five normal children and adolescents who served as controls. Bone-mineral density varied greatly but averaged nearly one standard deviation below the age-matched normal means for both the proximal parts of the femora (-0.92 standard deviation) and the lumbar spine (-0.80 standard deviation). Ambulatory status was the factor that best correlated with bone-mineral density. Nutritional status, assessed on the basis of caloric intake, skinfolds, and body-mass index, was the second most significant variable. The pattern of involvement, durations of immobilization in a cast, and a calcium intake of less than 500 milligrams per day were additional factors of less significance. The age when the child first walked, previous fractures, use of anticonvulsants, and serum vitamin-D levels did not correlate with bone-mineral density after adjustment for covariance with the ambulatory status and the nutritional status. Serum levels of calcium, phosphate, alkaline phosphatase, and osteocalcin were not reliable indicators of low bone-mineral density.

Adolescent↗
PubMed1995

Small bowel herniation after laparoscopically assisted vaginal hysterectomy.

Laparoscopically assisted vaginal hysterectomies have been done with increasing frequency in the United States. To date, minimal complications have been noted with this procedure. The authors review a series of 90 individuals and note a three percent small bowel obstruction rate. This complication is more common in this group of patients than in patients having a standard abdominal hysterectomy. Since this operation has been commonly performed, it is often possible to convert an abdominal hysterectomy to a vaginal approach, this increase in complications is exceedingly high. The authors recommend closure of lateral abdominal wall port sites under direct laparoscopic visualization to prevent this serious complication.

Anastomosis, Surgical↗
PubMed1994

Kyphosis and fractures in children and young adults with cystic fibrosis.

The purpose of this study was to examine children and adolescents with cystic fibrosis for an increased frequency of fracture and excessive thoracic kyphosis, which may result from inadequate skeletal mineralization. In a survey of 143 patients (ages 4.7 to 21.9 years; mean, 11.3 years), the fracture rate for male patients from birth to 5 years of age was higher than for female patients and both rates were comparable with those for normal children. In contrast, female patients 6 to 16 years of age with cystic fibrosis had a higher-than-normal fracture rate and a higher rate than their male counterparts. Review of the chest radiographs showed that thoracic kyphosis correlated with age and with disease severity as judged by Brasfield scoring. In the > 15-year-old age group, kyphosis exceeding 40 degrees, the upper limit of normal, was found in 77% of the female patients and 36% of the male patients. The cause of these findings is uncertain and perhaps multifactorial, but osteopenia is likely a contributing factor. As the life expectancy of patients with cystic fibrosis continues to increase, the skeletal consequences, particularly in female patients, may become increasingly significant.

Adolescent↗
PubMed1994

Bone mineralization in children and adolescents with a milk allergy.

To evaluate the correlation between dietary calcium intake and mineralization of the immature skeleton 55 children and adolescents aged 5-14 years (mean, 9.5 years) with a positive radioallergosorbent test (RAST) for serum antibodies to cow's milk protein were evaluated. Bone mineral density (BMD) in the lumbar spine and proximal femurs were measured by dual energy X-ray absorptiometry. BMD at each site for each subject was converted to an age-adjusted Z score based on our own series of 95 normal pediatric controls. Calcium intake was determined using a detailed food frequency questionnaire administered by a nutritionist during a 30-40-min interview. Dietary adjustments to the condition varied and resulted in a wide range of calcium intakes. Calcium supplements were taken by 22% of the subjects and were included in the determination of daily calcium intake. The group of 55 subjects was divided into quartiles based on calcium intake (mean +/- S.E mg calcium/day): Group 1, 409 +/- 21, Group 2, 663 +/- 16, Group 3, 950 +/- 32, Group 4, 1437 +/- 124. Bone density Z scores in the proximal femur serially increased across the calcium intake groups (mean +/- S.E.): Group 1, -0.16 +/- 0.31; Group 2, 0.05 +/- 0.33; Group 3, 0.44 +/- 0.24; Group 4, 0.79 +/- 0.41 (P = 0.03). A similar pattern was found with lumbar spine BMD Z scores: Group 1, -0.16 +/- 0.27; Group 2, 0.10 +/- 0.21; Group 3, 0.18 +/- 0.20; Group 4, 0.30 +/- 0.25 (P = 0.05). These data add further to the evidence that dietary calcium intake is important for optimal mineralization of the growing skeleton.

Absorptiometry, Photon↗
PubMed1993

Knee flexor-extensor strength in children.

Isokinetic measurements of knee flexion extension in children and adolescents are a useful means of quantifying strength. In the routine clinical situation with a unilateral problem, evaluation of the affected extremity is usually based on comparisons with the unaffected side. To interpret these results, there must be an appreciation for normal side-to-side differences. Twenty-one normal, healthy children (ages 6-16 years) were evaluated using a Cybex II isokinetic dynamometer at 90 and 240 degrees/sec. In children who were able to generate peak torque values greater than 50 ft-lbs, the side-to-side differences in peak torque averaged 11 +/- 12% (mean +/- SD). A similar amount of variability has been reported with adults. For children with whom peak torque values were less than 50 ft-lbs, the side-to-side differences were much greater (mean = 22 +/- 19%). The stronger leg was equally likely to be on the nondominant side as the dominant side. Side-to-side variability was slightly decreased if the mean of several repetitions was used for comparisons rather than comparing just the single highest peak torque values.

Adolescent↗
PubMed1992

Tibia vara: a complication of adolescent obesity.

Tibia vara is characterized by inhibited growth of the medial portion of the proximal tibial growth plate, leading to progressive bowleg deformity. Twenty-nine adolescent patients with this condition were reviewed: all were black, 27 (93%) were male, and 19 (66%) had only one side affected. Progressive deformity rather than knee discomfort was the most common presenting complaint. The deformity reportedly developed rapidly during the adolescent growth spurt. The body weights of these patients exceeded the 95th percentile for age and gender by an average of 43 kg. The absence of significant symptoms and a body habitus that obscured the deformity often resulted in delayed diagnosis. Physicians involved in the care of obese black male adolescents should carefully examine them for tibia vara, which has a reported prevalence of 2% to 3% in this population. Treatment options are severely restricted if the condition is not diagnosed early.

Adolescent↗
PubMed1992

Residual bone-mineral density and muscle strength after fractures of the tibia or femur in children.

This study compared the bone-mineral density in the proximal part of the femur and the flexion and extension strength of the knee in the fractured and the non-fractured limbs after an uncomplicated fracture of the tibia or femur in children. Thirty-eight children, whose ages ranged from two to fifteen years at the time of the injury, were evaluated at an average of 2.3 years after the injury. The mean difference in bone-mineral density between the fractured and non-fractured limbs was 3.3 per cent (p = 0.004). There was no significant difference between the bone-mineral density of the limbs that had been immobilized for less than four weeks and that of the contralateral, non-fractured limbs. However, the mean difference between the bone-mineral density of the limbs that had been immobilized for more than eight weeks and that of the contralateral limbs was 4.3 per cent (p = 0.006). There was little or no relationship between the time since the injury and the difference in bone-mineral density between the two limbs of the patient at the intervals of follow-up that were studied. No residual weakness in flexion and extension of the knee was detected, and no relationship was established between the limb-to-limb differences in strength and the limb-to-limb differences in bone-mineral density. The residual bone-mineral deficit was found to be minimum after an uncomplicated fracture. This difference, while statistically significant, is unlikely to be clinically important in the long term. However, the fact that there was a deficit raises a potential concern for children who have more severe or repeated injuries.

Adolescent↗
PubMed1992

Adolescent tibia vara: alternatives for operative treatment.

We reviewed the cases of fifteen obese patients (twenty-one extremities) who had had adolescent tibia vara and had been followed for at least two years. Of the nine patients (eleven extremities) who had been initially managed with lateral tibial hemiepiphyseodesis, eight (ten extremities) were skeletally mature at the time of the review (mean duration of follow-up, five years). The mechanical alignment was judged to be excellent in three of these ten extremities, fair in three, and poor in four. Excellent mechanical alignment was defined as a value within the reported normal range of 5 degrees of varus to 2 degrees of valgus. A poor result was defined as alignment that was more than 5 degrees outside the normal range. After secondary operative procedures, three of the extremities for which the result had been poor and one for which it had been fair had excellent alignment. Five of the nine patients had bilateral involvement. Two of them were managed with bilateral tibial hemiepiphyseodesis; two, with contralateral proximal tibial osteotomy; and one had a mild deformity on the contralateral side that was not treated. Six extremities in six patients (two of whom had a contralateral hemiepiphyseodesis) were managed primarily with proximal tibial osteotomy and were evaluated an average of seven years postoperatively. Two additional patients were managed with proximal tibial osteotomy because of residual varus deformity after the hemiepiphyseodesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Meniscectomy in children and adolescents. A long-term follow-up study.

Thirty-nine patients treated with total meniscectomy younger than 16 years of age were studied. The average follow-up period was 21 years; 71% of the patients reported pain; 68%, stiffness; 54%, swelling; and 41%, giving way. Approximately half the patients described progression of symptoms, but only 27% were asymptomatic. Only 10% noted limitations at work, but 62% had limitations in sports. Twelve percent have had further knee surgery. Forty-nine percent received unsatisfactory subjective/functional ratings. On physical examination, 25% of patients had range of motion loss of greater than 5 degrees, 22% had thigh atrophy of greater than 1 cm, and 20% developed substantial instability. Overall, 27% received unsatisfactory objective ratings. Ninety percent of patients had abnormal roentgenograms. Changes occurred predominantly in the meniscectomized compartment. Forty-four percent of patients had unsatisfactory roentgenographic ratings. Overall ratings indicated that 63% of patients' results rated unsatisfactory. More unsatisfactory results occurred in patients with a follow-up period of longer than 26 years, in those with substantial instability, and in males. Few differences existed between medial and lateral meniscectomies or with increasing durations of symptoms preoperatively.

Adolescent↗
PubMed1991

Posttraumatic necrosis of the talus: the Hawkins sign versus magnetic resonance imaging.

Magnetic resonance imaging (MRI) is reported to be more sensitive than plain radiographs, computed tomography, or radionuclide bone scanning in detecting osteonecrosis. Few cases of MRI scans falsely negative for osteonecrosis have been reported. A 36-year-old man with posttraumatic necrosis of the body of the talus proven by biopsy had three serial MRI scans that were interpreted as showing the talus to be viable. Eight weeks after injury, the plain radiographs did not show subchondral resorption of bone in the talus (Hawkins sign) and, thus, did correctly indicate necrosis. Most likely a non-union of the talus neck fracture resulted in the false-negative MRI scans.

Adult↗
PubMed1991

Assessment of the mechanical axis in adolescent tibia vara.

To assess precision of measurement, the mechanical axis was determined by two independent observers on 52 radiographs of 15 obese patients with adolescent tibia vara. Special, but simple, modifications in radiographic technique are described that allow simultaneous exposure of the hip, knee, and ankle joints. Even in this challenging population, assessment of the alignment of the lower extremity is possible with excellent precision using the mechanical axis. In 42 of the 52 radiographs, the two independent observers differed by less than or equal to 1 degree. The mechanical axis is superior to measurement of the tibial-femoral shaft angle for evaluation of lower extremity alignment.

Adolescent↗
PubMed1990

Bilateral simultaneous fractures of the femoral neck: case report.

A case of bilateral fractures of the femoral neck resulting from high-voltage electric injury is reported. Surgeons caring for patients with electrical injuries must be aware of the possibility of this injury as well as other skeletal injuries which may result from muscle contraction or falls related to electric shock. Without vigilance for these injuries, diagnosis may be delayed.

Accidents, Occupational↗
PubMed1990

Tophaceous gout simulating infection about a stainless steel plate.

A 55-year-old man developed acute symptoms suggestive of a late, deep infection 8 years after uncomplicated open reduction and internal fixation of fractures to the left ulnar and radial shafts. At the time of surgical debridement, tophaceous material was found surrounding the radial plate. Acute tophaceous gout surrounding fracture fixation devices has not been previously reported and is difficult to distinguish from a deep infection.

Acute Disease↗
PubMed1989

The long-term results of nonoperatively treated major pelvic disruptions.

Twenty-six patients with major anterior-posterior pelvic disruptions not involving the acetabulum were reevaluated an average of 8 years (minimum 5 years) after injury. All pelvic injuries were treated nonoperatively. Subjective complaints at the time of follow-up included frequent or daily low back discomfort (50%), localized distal dysesthesias (46%), and some degree of work disability (38%). Objective neurologic deficit (42%) and a limp (32%) were often detected on examination. The amount of residual vertical displacement was measured on plain AP radiographs and graded as none, displaced less than 1 cm, or displaced greater than 1 cm. The long-term outcome correlated exceptionally well with both the amount of residual vertical displacement and the stability of the fracture.

Adolescent↗
PubMed1989

Salmonella septic and aseptic arthritis in sickle-cell disease. A case report.

A 26-year-old black male with sickle-cell disease developed a Salmonella septic arthritis in one knee and an acute, aseptic arthritis in the other knee. Salmonella is showing increasing resistance to many antibiotics. In this patient, optimal antibiotic treatment of his uncommon infection was delayed by a rare resistance to trimethoprim-sulfamethoxazole. Two pathophysiologic mechanisms could account for his acute, aseptic arthritis: sickle-cell disease with presumed synovial ischemia from sickling and reactive arthritis precipitated by a remote Salmonella infection elsewhere in the body. The authors could find no previous discussion of either of these processes in the orthopedic literature. Acute arthritis in a patient with sickle-cell disease can be a complex diagnostic and therapeutic problem.

Adult↗
PubMed1979

Histofluorescence techniques provide evidence for dopamine-containing neuronal elements in canine kidney.

Changes induced by hydrochloric acid in the excitation spectrum of catecholamine fluorophores associated with the innervation of the canine renal vasculature show that there are neuronal elements at the glomerular vascular poles containing predominantly dopamine. In contrast, the catecholamine fluorescence in the periadventitial layer of the arcuate arteries is derived from norepinephrine. The dopamine-containing structures may represent the prejunctional counterpart to the pharmacologically identified dopamine receptors in the renal vasculature. As such, this system may be involved in the normal regulation of renal blood flow and renin release.

Animals↗