Search PubMed⌕ Search

Biomedical subjects

R E McCall

Publications and source records attributed to R E McCall.

12 recordsLinked to original sources
PubMed1998

Modified luque instrumentation after myelomeningocele kyphectomy.

STUDY DESIGN: Treatment of congenital kyphosis in myelomeningocele is a difficult problem. Current thinking supports kyphectomy and postoperative internal fixation. OBJECTIVES: Since 1989, vertebral resection with modified Luque fixation has been the procedure of choice for correction of myelomeningocele kyphotic deformity at the author's institution. The study objective was to evaluate long-term results with this technique. SUMMARY OF BACKGROUND DATA: Most investigators agree that kyphotic deformity in myelomeningocele should be treated with vertebral resection. There is less uniform consensus about postoperative fixation. Reports in the literature support fixation with modified segmental instrumentation. METHODS: Sixteen patients, observed for an average of 57.2 months (range, 36-94 months), underwent vertebral resection from the proximal aspect of the apical vertebra cephalad into the compensatory lordotic curve. Fixation was segmental instrumentation wired to the thoracic spine and anterior to the sacrum. RESULTS: The average blood loss was 1121 mL (range, 450-2580 mL). Kyphotic deformity averaged 111 degrees before surgery (range, 75-157 degrees), 15 degrees after surgery (range, -18-36 degrees) and 20 degrees at latest follow-up (range, -17-83 degrees). Loss of correction was 6 degrees (range, 0-27 degrees). Postoperative immobilization was with a thoracolumbosacral orthosis for 18 months. Complications occurring in 8 of the 16 patients were transient headache, superficial wound breakdown, supracondylar femur fractures, and one late infection secondary to skin breakdown that necessitated early rod removal, resulting in some loss of correction. CONCLUSIONS: Kyphectomy is an excellent method of correcting rigid kyphotic deformity in the patient with myelodysplasia. Segmental spinal instrumentation provided three distinct advantages: rigidity of the construct, greater correction of the deformity and low-profile instrumentation.

Child↗
PubMed1997

Use of intravenous Premarin to decrease postoperative blood loss after pediatric scoliosis surgery.

STUDY DESIGN: The hemostatic effect of conjugated estrogens (Premarin, Wyeth-Ayerst Laboratories, Philadelphia, PA) has been reported in the literature, but no study has investigated its effectiveness in decreasing blood loss in pediatric spinal procedures. OBJECTIVE: To determine the effectiveness of intravenously administered Premarin in the immediate postoperative period in decreasing Hemovac drainage postoperatively. METHODS: Sixty-four adolescent patients undergoing spinal surgery, both posterior and anterior/posterior procedures, were studied. Thirty-two patients served as control subjects. The other 32 received Premarin, 1 mg/kg intravenously in the immediate postoperative period. Hemovac drainage was measured during a period of 48 hours. RESULTS: In measuring Hemovac drainage for 48 hours in both groups, there was a 37% decrease in the volume of the postoperative drainage (mL/kg) in the patients receiving Premarin postoperatively. Measurement of adjusted volumes (mL/kg) revealed a statistically significant decrease in postoperative bleeding after administration of Premarin. CONCLUSIONS: Administration of Premarin resulted in a 37% decrease in the volume of postoperative drainage (mL/kg) without complications. Premarin appears to be effective in decreasing postoperative blood loss in a pediatric postoperative spinal population.

Adolescent↗
PubMed1992

Treatment of multiple pterygium syndrome.

Multiple pterygium syndrome is a rare, inherited disorder manifested by growth retardation, facial or genital anomalies, and widespread musculoskeletal deformities. Pterygia are the predominant hallmark of the syndrome. Five children with multiple pterygium syndrome were treated from 1978 to 1987. Treatment involved both upper and lower pterygia and contractures. The results of treatment and modalities used are discussed and a protocol suggested.

Abnormalities, Multiple↗
PubMed1984

Hyperplastic callus formation in osteogenesis imperfecta following intramedullary rodding.

Hyperplastic callus formation has been reported in patients with osteogenesis imperfecta following fractures but not following intramedullary rodding. The present case is that of a child who developed massive hyperplastic callus following osteotomy and intramedullary rodding of all lower extremity bones. Noted complications of intramedullary rodding include refracture, delayed union, nonunion, and pin migration, and it is our belief that hyperplastic callus formation should be considered another potential complication.

Bone Nails↗
PubMedDate not supplied

Soft-tissue realignment for adolescent patellar instability.

Patellar malalignment or instability is a frequent problem in adolescents. Patients with persistent symptoms require operative correction with procedures often requiring osteotomies of the tibial tubercle. Insall described a soft-tissue procedure to correct instability in adults, and others have used this in adolescents. Short-term results have seemingly been satisfactory in the skeletally immature population. A long-term outcome study was performed to evaluate the effectiveness of soft-tissue realignment for patellar instability in adolescents. From 1980 to 1996, 54 patients (65 knees) underwent Insall proximal-distal soft-tissue realignment. No concomitant bony or other soft-tissue procedures were performed. Follow-up averaged 6 years (range, 2-15 years), assessing stability, strength, range of motion, and congruence angle on the Merchant's view. Eighty-seven percent had a good to excellent result; 8%, a fair result; and 5%, poor results.

Adolescent↗
PubMedDate not supplied

The Grice extraarticular subtalar arthrodesis: a clinical review.

One hundred forty-nine Grice procedures performed between 1955 and 1982 were reviewed. The valgus deformities were secondary to poliomyelitis, cerebral palsy, myelodysplasia, flexible flatfoot, clubfoot, congenital vertical talus, and other neuromuscular diseases. Review consisted of radiographic and clinical follow-up. Overall evaluation revealed 46% unsatisfactory results because of both graft failure and residual clinical deformity. Previous unrecognized ankle valgus and instability prejudiced the results in the myelodysplasia and flexible flatfoot. Recommendations include consideration of the Grice procedure in poliomyelitis and cerebral palsy coupled with appropriate tendon balancing, but not in myelodysplasia or flexible flatfoot in the presence of often unrecognized ankle valgus.

Arthrodesis↗
PubMedDate not supplied

Clinical experience with the reciprocal gait orthosis in myelodysplasia.

Ambulation has always been difficult for patients with myelodysplasia; however, introduction of the reciprocal gait orthosis seemingly offered increased potential as an ambulatory aid. Review of 41 patients with myelodysplasia treated with the reciprocal gait orthosis revealed that 78% reached community or household ambulator status, a marked improvement over previous results with traditional hip-knee-ankle-foot orthoses.

Braces↗
PubMedDate not supplied

Bilateral congenital dislocation of the patella.

A 19-month-old nonambulatory child with knee flexion contractures was found to have dislocated patellae. Only three previous cases of bilateral congenital dislocated patellea have been reported. Surgical treatment rationale and technique are reviewed.

Child↗
PubMedDate not supplied

Criteria for selective fusion in idiopathic scoliosis using Cotrel-Dubousset instrumentation.

Spinal decompensation after Cotrel-Dubousset (C-D) instrumentation in the King type II curve pattern has become a recognized complication secondary to progression of the unfused lumbar curve. Twenty-three patients with type II curves who underwent selective thoracic fusion according to the guidelines established by King et al. were reviewed. Mean follow-up was 19.5 months. Lumbar curves greater than 45 degrees associated with a low flexibility index were significantly more likely to develop postoperative progression of the uninstrumented lumbar curve with resultant spinal decompensation, suggesting that in these curves the King criteria for selective thoracic fusion may not be appropriate.

Adolescent↗
PubMedDate not supplied

The Bridle procedure: a new treatment for equinus and equinovarus deformities in children.

The Bridle procedure is a tritendon anastomosis between the posterior tibialis, anterior tibialis, and peroneus longus, combined with an Achilles tendon lengthening for treating equinus and equinovarus deformities. The technique avoids problems of tendon attachment to bone and tendon placement for balance. One hundred seven procedures were performed on patients with cerebral palsy with 74% excellent and good results overall. The average follow-up was 5 years 9 months. The procedure was also performed with mixed results, on smaller groups of patients with other neuromuscular diseases.

Anastomosis, Surgical↗