Pseudotumor of the distal part of the femur in a patient who had myelomeningocele. A case report.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
W B Greene
Publications and source records attributed to W B Greene.
Effect of race and gender on neurological level in myelomeningocele.
The association of race and gender with different neurological levels of myelomeningocele was studied in 251 patients. Over-all, the white to black ratio was 3.6 and the male to female ratio was 0.86. However, the proportions of whites and females were significantly increased in thoracic-level patients (white to black ratio 13.6, male to female ratio 0.43), whereas the lumbar-level patients had sex and white to black ratios equivalent to the area population. This supports the concept that thoracic-level myelomeningocele has a different pathogenesis from lumbar-level.
Black People↗
Musculoskeletal problems in association with cloacal exstrophy.
The records of all thirteen patients for whom a diagnosis of cloacal exstrophy had been recorded in our hospitals were analyzed for evidence of musculoskeletal problems. All thirteen patients had spina bifida, four had congenital scoliosis, two had congenital kyphosis, and three had non-congenital scoliosis. All had a lipomeningocele, and eleven had paralysis of the lower extremities. Hydrocephalus and its associated problems were not found, but tethered-cord syndrome was diagnosed in eleven patients. Persistent diastasis of the symphysis pubis was found in all patients. Abduction and external rotation of the hips were more than normal. Mild dysplasia was seen in six of the twenty-six hips. Deformities of the foot were common, and twelve feet had been operated on for correction. Recurrent equinovarus deformity of the foot was associated with tethered-cord syndrome in two patients.
Abnormalities, Multiple↗
Vertebral Candida infections. A case report and review of the literature.
Vertebral Candida infection in a 57-year-old woman became symptomatic three months following Candida septicemia associated with a central venous catheter. The infection was successfully treated with amphotericin B and ketoconazole. Review of the literature revealed 29 cases of Candida infection with vertebral involvement. Intravenous drug abuse and central venous catheters were identified as predisposing factors in 13 cases. An average delay from Candida septicemia until the time the patient sought treatment was 3.3 months. Antifungal agents generally resulted in resolution of the infection.
Candidiasis↗
Orthopaedic procedures and prognosis in hemophilic patients who are seropositive for human immunodeficiency virus.
Thirty patients who had hemophilia and were seropositive for the human immunodeficiency virus were evaluated. The preoperative CD4 lymphocyte count was decreased to an average of 336 x 10(9) per liter (range, 27 to 708 x 10(9) per liter). After twenty-six orthopaedic operations in patients who had no previous bacterial infection, a nosocomial infection (cellulitis in the forearm, at the site of an intravenous catheter) developed in only one patient, but five patients had an abnormal postoperative fever that was not accompanied by the expected increase in the white blood-cell count. The preoperative CD4 lymphocyte count was significantly reduced in the patients who had an abnormal elevation in body temperature (p less than 0.004). The functional result or outcome after operation was similar to that in hemophilic patients treated before 1982. Subsequent progression of infection with the human immunodeficiency virus, as determined by the CD4 lymphocyte count and the Walter Reed classification system, occurred in most patients. Acquired immunodeficiency syndrome was diagnosed in six patients. A more rapid progression to acquired immunodeficiency syndrome was seen in the patients who had a lower CD4 lymphocyte count preoperatively. Preoperative evaluation of the CD4 lymphocyte count and the response to intradermal skin-test antigens in patients who are at risk for infection postoperatively provides additional information concerning immunological competence. With these data, the possible risk of infection in patients who are seropositive for the human immunodeficiency virus can be estimated more accurately.
Acquired Immunodeficiency Syndrome↗
Unrecognized foreign body as a focus for delayed Serratia marcescens osteomyelitis and septic arthritis. Two case reports.
Explore the source record for details and available documents.
Adolescent↗
Nonsurgical management of hemophilic arthropathy.
Explore the source record for details and available documents.
Hemarthrosis↗
Roentgenographic classifications of hemophilic arthropathy. Comparison of three systems and correlation with clinical parameters.
In 105 knees, the roentgenographic classifications of hemophilic arthropathy of Arnold and Hilgartner, of Pettersson et al., and of a new system were compared. The amount of interobserver agreement (between two observers) was good for all three systems and, for all three, there was a good correlation between progressive severity of the lesion and decreasing function of the joint. The system of Pettersson et al. was better than that of Arnold and Hilgartner for grading severe arthropathy, but it was not better than the new, simplified system. The new system is a four-sign, 7-point classification, in contrast to the eight-sign, 13-point system of Pettersson et al.
Adolescent↗
In vitro spinal cord trauma.
Fetal mouse spinal cord explants were harvested and allowed to grow in Maximow chambers. Normal appearing matured cultures were subjected to a brief episode of impact trauma by dropping the flat surface of 25 to 105 mg dressmaker's pins from a height of 10 cm directly onto the exposed surface of the culture. Light and electron microscopic studies at selected posttrauma intervals revealed discrete foci of necrosis preceded or accompanied by nerve fiber changes (granular axoplasm, vesicular myelin, pleomorphic spheroids) identical with those documented in spinal cord trauma in vivo. Although no inherent calcification was observed, calcium was added to some of the traumatized cultures and it was subsequently localized by pyroantimonate in the axoplasm; within mitochondria, adjacent to neurofilaments, and in the cytosol. The study indicates that the morphologic sequence of events of spinal cord trauma in vitro are similar to those observed in vivo, and that the latter may occur in the absence of vascular injury.
Animals↗
Myelopathy induced by lactic acid.
This study defines the conditions required to provoke myelopathic changes by dripping lactic acid onto the surgically exposed spinal cord of adult male rats. A severe necrotizing myelopathy was observed after 24 h, principally in the posterior half of the cord at the level of lactic acid (pH 1.8) application. A profound early effect on small blood vessel walls, appearing necrotic after 30 min to 2 h, was identified. Nerve fiber alterations (axonal stasis, granular axoplasm, axonal calcification, and vesicular myelin), identical to those appearing early in the myelopathies of trauma and calcium toxicity, were apparent. However, the pathogenesis of these alterations in this model remains unclear, because of the vascular events and the presumed alterations of calcium metabolism by the acid. Further studies are required to elucidate the precise mechanisms of these important reactions of myelinated axons to the injuries provoked by acid, calcium, and trauma.
Acidosis, Lactic↗
Bone density in myelomeningocele: the effects of ambulatory status and other factors.
Measurements were made of distal radius, mid-radius, tibia and metatarsal bone-density of 80 patients with myelomeningocele (17 thoracic, six L1/L2, 13 L3, 30 L4, 14 L5/sacral). For the upper extremity the bone density primarily was low in the thoracic patients, but in the tibia and metatarsal it showed a more linear correlation with neurological levels. The effect of age was highly significant at all sites; after controlling for this, the neurological level was a significant determinant of bone density at all sites, and this effect was greater in older children. Patients with impaired ambulation had decreased bone-density in the distal radius, tibia and metatarsal, but not in the mid-radius. Race had no significant effect on density after accounting for differences in neurological level. Weight for height and multiple fractures did not correlate with bone density. Although ambulatory status (weight-bearing stresses) and neurological status (muscle stresses) are both important factors in bone density, this study suggests that the latter is a more important determinant.
Adolescent↗
Displaced olecranon fractures in adults. Biomechanical analysis of fixation methods.
Four commonly used methods of internal fixation for displaced olecranon fractures were analyzed in a biomechanical model to determine strength of fixation. A transverse osteotomy in fresh cadaver specimens was internally fixed and was tested to failure by rapid loading. Screw plus wire in combination provided the greatest strength of fixation. Energy to failure averaged 31.0 Nm for cancellous screw, 32.0 Nm for figure-of-eight wire, 35.3 Nm for Arbeitsgemeinschaft fur Osteosynthesefragen (AO) tension band, and 39.4 Nm for screw-plus-wire combination. Comparison of screw and wire in combination to screw alone or to figure-of-eight wire demonstrated a significant difference (p less than 0.05). The difference between screw plus wire and AO tension-band fixation did not achieve statistical significance (0.2 greater than p greater than 0.1).
Biomechanical Phenomena↗
Displaced olecranon fractures in adults. Clinical evaluation.
Displaced fractures of the olecranon in adults were analyzed for pain, function, range of motion, and roentgenographic appearance. With one exception, the 38 transverse or oblique fractures were treated by reduction and internal fixation. Results were best in the group treated by screw plus wire in combination (average rating, 17.7 points). Other ratings averaged 17.2 for the intramedullary screw, 16.8 for figure-of-eight wire, and 16.7 for Arbeitsgemeinschaft fur osteosynthesefragen (AO) tension-band wire. Factors associated with poorer results included postoperative displacement or malreduction greater than or equal to 2 mm and articular involvement greater than or equal to 60%. Symptomatic metal prominence was particularly common after AO tension-band wiring, occurring in 80%. All seven comminuted fractures were treated by primary excision. The one comminuted fracture with greater than or equal to 60% articular involvement that was treated by excision had a poor result because of instability.
Adolescent↗
Morphometric and autoradiographic analysis of crude synaptosomal preparations from rat cerebral cortex.
Morphometric and autoradiographic studies have been made of a crude synaptosomal preparation, which has been used extensively for membrane transport studies. When filters are used to separate membrane bound structures from incubation medium, the structures which survive filtration are those that are entrapped within the matrix of the filter structure. The population of membrane bound structures differs when one compares pellets of the preparation to sections of loaded 0.45 and 0.65 micron pore size filters. Both the relative numbers of synaptosomes, mitochondria, and other membrane bound structures (OMBS) and the mean size of each of the structures differ for pellet, 0.45 micron, and 0.65 micron filters. The percentage of total membrane bound volume attributable to synaptosomes increases from 28 in the crude preparation to 40 in 0.45 micron filters and 61 in 0.65 micron filters. The total volume of synaptosomes entrapped by differing pore size filters roughly correlates with the amount of substrate uptake. Neither mitochondrial volume nor the volume of other membrane bound structures was found to correlate with uptake. These results indicated that only the synaptosomes contribute measurably to this function. Autoradiographic studies confirm this conclusion. EM autoradiography following loading of the synaptosomal preparation with tritiated glutamate or GABA showed about 81% of the grains to be associated with synaptosomes. It is concluded that crude synaptosomal preparations may be used without further purification for membrane transport studies with unambiguous results.
Animals↗
Surgical aspects of limb deformity in hypophosphatemic rickets.
Our assessment of the surgical correction of bowleg deformity in eight patients with sex-linked dominant hypophosphatemic rickets showed the best results in patients having staged, proximal tibial osteotomies at completion of growth. Lack of medical therapy was associated with recurrent genu varum or markedly delayed union. Undercorrection may be prevented by using the hip-knee-ankle axis to plan the realignment procedure.
Bone Diseases, Developmental↗
Hypophosphatemic rickets: still misdiagnosed and inadequately treated.
We studied the presentation and results of medical therapy in 25 children with sex-linked dominant hypophosphatemic rickets. The average age at diagnosis was 3.8 years. Reasons for the delay included misdiagnosis and failure to recognize the normal range of serum phosphorus levels in children. Early diagnosis and treatment (before age 1) was associated with normal alignment of the lower limbs. Combination therapy with phosphate and vitamin D2 improved growth and bone mineralization, but did not change the height percentile or limb alignment. Limited use of calcitriol (1,25-dihydroxyvitamin D3) was not helpful in the adolescent but was associated with limited height increase in two younger children. Early diagnosis and medical therapy should prevent bowing of the legs.
Adolescent↗
Ultrastructural pathology of nerve fibers in calcium-induced myelopathy.
Calcium has been proposed as a mediator of nerve fiber degeneration following traumatic injury of the spinal cord. It induces a spongy, necrotizing myelopathy similar in its evolution to that observed in experimental spinal cord trauma. The current study was undertaken to determine the ultrastructural changes in the central nervous system (CNS) nerve fibers associated with calcium-induced myelopathy. A 10% calcium chloride (CaCl2) solution (pH 7.4) was slowly dripped on the dorsal surface of the surgically exposed lower thoracolumbar spinal cord of adult male Sprague-Dawley rats. The posterior and lateral columns of the spinal cords were fixed and processed for electron microscopy. Controls consisted of tissue from normal and sham-operated animals, as well as those receiving equal volumes and osmolarities of sodium chloride (NaCl), magnesium chloride (MgCl2), and potassium chloride (KCl) at the same pH. In the CaCl2 treated animals, spongiosis of increasing severity developed in white matter, as the result of periaxonal, adaxonal and intramyelinic swelling. Vesicular demyelination was consistently observed, beginning within one hour (h) and progressing with increasing severity up to 24-72 h. Axonal changes included pleomorphic spheroids, granular degeneration and intra-axonal calcification. The ultrastructural changes in the nerve fibers provoked by calcium were indistinguishable from those previously reported in experimental spinal cord trauma. These observations strengthen the hypothesis that calcium initiates the nerve fiber degeneration following spinal cord injury.
Animals↗
Postoperative pulmonary function in children. Comparison of scoliosis with peripheral surgery.
We measured lung volumes, forced expirograms, and arterial blood gases in 2 groups of elective pediatric surgical patients (mean age, 11.4 +/- SD 2.8; n = 11, 12 operations) the day prior to surgery (control) and between the first and eighth postoperative days. The patients were Group I: peripheral surgery (n = 6) and Group II: reconstructive surgery for scoliosis (n = 5). The preoperative lung volumes and forced expiratory volume in one second were within the predicted normal range in both groups, except for a reduction in total lung capacity (TLC) and vital capacity (VC) in Group II. The postoperative lung volumes in Group I were not significantly different from the preoperative volumes. In group II, on postoperative Days 2 and 3, the lung volumes as a percent of preoperative volumes (mean +/- SEM) were VC, 44 +/- 11; functional residual capacity (FRC), 81 +/- 6; residual volume, 124 +/- 10; TLC, 61 +/- 10. Although the mean FRC returned to the preoperative volume by postoperative Days 5 and 6, the VC and its components remained reduced on postoperative Days 5, 6, and 8. We conclude that postoperative lung volume abnormalities are related to the site and magnitude of surgery and associated phenomena, such as pain, and preoperative respiratory function abnormalities.
Adolescent↗