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Biomedical subjects

V T Tolo

Publications and source records attributed to V T Tolo.

At least 37 records · Page 2Linked to original sources
PubMed1990

The incidence and natural history of scoliosis in Rett syndrome.

A survey on spinal deformity was conducted by means of a questionnaire mailed to the 350 American families who are members of the International Rett Syndrome Association. 258 questionnaires were completed and further information (medical records and radiographs) was received from treating physicians. Scoliosis was present in 119 patients, whose clinical details are discussed. Patients with Rett syndrome frequently develop progressive scoliotic deformities. The incidence increases with age, occurring most commonly during the second decade. Bracing to control curve progression has been largely unsuccessful for adolescent patients.

Adolescent↗
PubMed1990

Spinal deformity in short-stature syndromes.

Although almost any spinal deformity can occur in any skeletal dysplasia, there are specific spinal problems in each disorder that require periodic assessment and a particular awareness. Atlantoaxial instability frequently accompanies spondyloepiphyseal dysplasia congenita and Morquio's syndrome. Severe progressive kyphoscoliosis is found in diastrophic dysplasia. Although scoliosis can be found in many of these syndromes to some degree, it is very rare in achondroplasia. The most common deformity found in skeletal dysplasias as a whole seems to be kyphosis: cervical kyphosis in diastrophic dysplasia and thoracolumbar kyphosis in achondroplasia, pseudoachondroplasia, and many of the short-stature syndromes of metabolic etiology. Spinal stenosis is extremely common in achondroplasia, both at the lumbar and cervical areas. It is important to establish the correct diagnosis early so that the orthopaedist is able to focus on the areas at highest risk of developing spinal problems, and proceed with efficacious and timely treatment.

Dwarfism↗
PubMed1990

External fixation in multiply injured children.

External fixation treatment for selected fractures can be as readily applied to children as to adults, although only a small percentage of pediatric fractures require this method. The best situations for the use of external fixation in children are in cases of multiple organ system injuries and in fractures associated with skin loss or large wounds. In these situations, while the child's other problems are being treated, external fixation provides excellent temporary stabilization to facilitate fracture management.

Adolescent↗
PubMed1990

Vascularized fibular grafts in the treatment of congenital pseudarthrosis of the tibia.

Free vascularized fibular bone grafts were used in nineteen children, seen consecutively, who had congenital pseudarthrosis of the tibia. The average age was 5.1 years (range, 1.4 to 11.4 years). Sixteen of the patients had been treated with electrical stimulation for at least one year, and the tibia had not united. All but four patients had had at least one previous operative procedure. At an average follow-up of 6.3 years (range, 2.0 to 11.0 years), eighteen (95 per cent) of the nineteen pseudarthroses had healed. The leg-length discrepancy averaged 1.6 centimeters (range, 0 to 4.0 centimeters), but ten tibiae had residual or progressive valgus or anteroposterior malalignment despite bracing. There was minimum morbidity at the donor site.

Bone Transplantation↗
PubMed1989

Surgical treatment of adolescent idiopathic scoliosis.

The surgical management of idiopathic scoliosis requires knowledge in several areas. In selecting patients for surgical care, it is necessary to know the natural history for the type of curve present during the teenage years, as well as what can be expected of this type of curve during adult life. Preoperative evaluation must include screening for other than idiopathic causes before surgery is advised. Appropriate attention to preoperative radiographs, possible autologous blood utilization, and planning for spinal cord monitoring are essential. Finally, the ability to use a variety of techniques in spinal deformity surgery is needed, as is the knowledge of which technique or instrumentation is best in each situation. Although the surgical care of spinal deformity has become more complex and requires attention in several areas, the advances in surgical care and in spinal instrumentation allow us to correct spinal deformity more safely and predictably in a more three-dimensional manner than was feasible even a decade ago.

Adolescent↗
PubMed1988

Pseudopseudohypoparathyroidism with spinal cord compression.

We describe a patient with pseudopseudohypoparathyroidism who had an osseous tubercle on the anterolateral margin of the foramen magnum causing compression of the spinal cord. This patient had no evidence for any endocrinopathies and had no other spinal canal anomalies. We suggest that the morphologic phenotype found in patients with pseudopseudohypoparathyroidism, also known as Albright's hereditary osteodystrophy, has an associated risk for spinal cord compression due to congenital vertebral anomalies. The poor recovery of neurologic function following spinal decompression mandates prompt recognition and therapy of this condition in patients with Albright's hereditary osteodystrophy.

Adolescent↗
PubMed1988

Nutritional deficiencies after staged anterior and posterior spinal reconstructive surgery.

The nutritional status was analyzed in 37 patients being treated with staged anterior and posterior spinal reconstructive procedures. Using stringent criteria for nutritional and immunologic incompetency, 31 patients (84%) became malnourished during hospitalization. Although the serum albumin on admission had been normal for all patients, it became significantly depressed in 77% following anterior and posterior spinal procedures. In a similar fashion, the total lymphocyte count became significantly depressed in 92%. The postoperative complications were clearly more extensive in patients who were malnourished and immune-deficient using these criteria--15 patients with urinary tract infections, four patients with bacterial sepsis, four patients with wound infections, and four patients with pneumonia (vs. one with a wound infection in the adequately nourished group). The length of hospitalization following the second operative procedure was significantly longer in the malnourished group: 16.2 days versus 12.4 days (p less than 0.05). The main purpose of this study is to create awareness of the ongoing nutritional demands placed on patients treated by two-stage spinal reconstruction surgical procedures. More aggressive nutritional intervention can reduce postoperative complications and length of hospital stay and improve the speed of functional recovery.

Adolescent↗
PubMed1986

A comparison of nitroglycerin and nitroprusside for inducing hypotension in children: a double-blind study.

Intravenous nitroglycerin (NTG) and sodium nitroprusside (SNP) were compared as hypotensive agents in anesthetized children and adolescents. The drugs were studied in a prospective, randomized, double-blind fashion in 14 patients anesthetized with nitrous oxide: oxygen, morphine, and thiopental. NTG in doses as high as 40 micrograms X kg-1 X min-1 was ineffective at decreasing mean arterial pressure (MAP) below 55 mmHg or causing a decrease in MAP greater than one-third of baseline values. SNP was uniformly successful at inducing hypotension in all patients, including those patients in whom NTG failed. The dose of SNP required to induce hypotension was 6-8 micrograms X kg-1 X min-1. Both NTG and SNP decreased systemic vascular resistance, although SNP did so to a much greater degree than NTG (64% vs. 29%; P less than 0.01). Only SNP increased cardiac index significantly (2.27 +/- 0.35 to 4.44 +/- 1.36; P less than 0.003). Both drugs reflexly increased heart rate, necessitating the use of intravenous propranolol (range from 1 to 3 mg) in all patients. Both drugs produced small decreases in arterial oxygen tension and increases in the average alveolar-arterial oxygen tension gradient (SNP, 44 +/- 13 vs. NTG, 41 +/- 6). SNP use was associated with a slight metabolic acidosis (pH = 7.38 +/- 0.01; base excess [BE] = -6 +/- 1). Neither drug produced any other untoward reaction. SNP appears to be the agent of choice for the reliable and sustained induction of deliberate hypotension in children and adolescents.

Adolescent↗
PubMed1984

Macrodactyly.

Explore the source record for details and available documents.

Female↗
PubMed1983

External skeletal fixation in children's fractures.

Fourteen children with acute fractures, mostly open fractures, were treated with Hoffmann external fixation as a part of their fracture care. Thirteen fractures involved the tibia and one the femur. The average follow-up of these children was 17 months. The Hoffmann device was used for 6 to 20 weeks with an average of 11 weeks. One-half of the children had purulent drainage at some time during their treatment although no chronic infections resulted. Fracture union was present after 12 to 52 weeks with a median of 17 weeks. Three refractures occurred after apparent union. The only final angular deformity was in one patient with 6 degrees of varus. Three patients had leg length discrepancies of 2 cm or more. Four patients had overgrowth of the injured limb of 1.0 to 3.0 cm. Range of motion was not permanently impaired by the Hoffmann device. Use of the Hoffmann device for external skeletal fixation is recommended in children with open fractures with skin loss or burns, in children with head injury with resultant increased motor tone, and in polytrauma patients to facilitate patient care and transport for diagnostic and therapeutic procedures.

Accidents, Traffic↗
PubMed1979

Unsuspected atlas fracture and instability associated with oropharyngeal injury: case report.

A case of oropharyngeal injury associated with an unsuspected direct atlas anterior arch fracture is presented. Instability at the occipito-atlanto-axial joints developed because of the coexistence of a rather common congenital defect of the posterior atlas arch. Awareness of the frequency of congenital atlas anomalies and the possibility of direct cervical spine injury with pharyngeal trauma will aid early recognition of this problem and allow early effective treatment.

Adolescent↗