Biomedical subjects

W B Greene

Publications and source records attributed to W B Greene.

101 records · Page 6Linked to original sources

PubMedDate not supplied

Pediatric orthopedic surgery during the residency--too much, too little?

Questionnaires sent to chairpersons of orthopedic surgery residency programs and to private practitioners were analyzed to determine how training in children's orthopedics is accomplished, to define which procedures should be taught to residents, and to describe what the private practitioner perceives as appropriate education in children's orthopedics. The amount of time spent on children's orthopedics is adequate by present standards. For most procedures, the residency directors and private practitioners were in agreement concerning what was appropriate to teach. Education during the residency continues to be the most important resource used by the practicing orthopedic surgeon in pediatric problems.

Child↗

PubMedDate not supplied

Evaluation of magnetic resonance imaging in Legg-Perthes disease: a prospective, blinded study.

Twenty-two patients (24 hips) with Legg-Perthes disease received 49 magnetic resonance (MRI) scans. The scans and corresponding radiographs were independently evaluated in a blinded fashion to assess the capabilities of, and indications for, MRI in Legg-Perthes disease. Early in the disease process, MRI often more clearly delineated the extent and location of areas of involvement than did plain radiographs. In one patient, MRI failed to indicate necrosis early in the course of the disease, but it was detected on plain radiographs. MRI can also be used to give a rough estimate of sphericity, which in some phases of the disease process is better than plain radiographs. For serially following the disease process through the natural healing course, plain radiographs were as good or better than MRI and considerably less costly.

Adolescent↗

PubMedDate not supplied

Rapid progression of hip subluxation in cerebral palsy after selective posterior rhizotomy.

Rapid progression of hip subluxation was noted in the year after selective dorsal rhizotomy in seven hips (six patients). The hips that subluxed progressed from a lateral extrusion index averaging 25% preoperatively as compared with 50% after rhizotomy. Although preexistent hip dysplasia was a predisposing factor, hips with an intermediate degree of preoperative lateral extrusion (12-25%) had variable results. Ongoing and more frequent evaluation of hip stability is necessary after dorsal rhizotomy.

Adolescent↗

PubMedDate not supplied

Etiology of late-onset tibia vara: is varus alignment a prerequisite?

One widely held theory on the pathogenesis of adolescent late-onset tibia vara is that obesity coupled with mild preexisting varus alignment produces forces sufficient to retard growth in the medial portion of the proximal tibial physis and initiates the development of the condition. Two cases are presented in which neutral mechanical alignment was clearly documented in an extremity that subsequently developed adolescent late-onset tibia vara within 19 months. We conclude that in at least some cases, preexisting varus alignment is not a prerequisite for the development of adolescent late-onset tibia vara.

Adolescent↗

PubMedDate not supplied

Crystallizing galactocele. A case report.

BACKGROUND: Galactoceles are benign cystic lesions that generally occur during pregnancy and postpartum lactation. Fine needle aspiration (FNA) yields milky fluid that is often both diagnostic and therapeutic. Cytologically, aspirates are generally noted to contain occasional foam cells and benign epithelium displaying lactational change with an abundant background of lipid micelles and proteinaceous material. CASE: A 23-year-old, black female presented with a 1.0-cm, discrete, nontender nodule involving the upper middle area of the left breast. FNA showed crystals of varying size and shape, best viewed with Diff-Quik and demonstrating metachromasia, polarization and birefringence. They were also positive with periodic acid-Schiff stain and both alizarin red S and von Kossa stain for calcium. Scanning electron microscopy revealed angulated, well-defined geometric crystals often with scalloped edges and smooth surfaces. The internal structure of the crystals consisted of electron-lucent material without periodicity or lattice formation, as observed by transmission electron microscopy and x-ray diffraction. Electron probe microanalysis identified small quantities of calcium, chlorine, potassium and sulphur within the crystals. CONCLUSION: We think that in this case the crystals represented precipitation of inspissated lactational secretions. There are several possible mechanisms of precipitation. The differential diagnosis includes other breast lesions with acellular amorphous components that may be confused with crystallizing galactocele in FNA biopsy specimens.

Adult↗

PubMedDate not supplied

Transfer versus lengthening of the posterior tibial tendon in Duchenne's muscular dystrophy.

Transfer of the posterior tibialis tendon to the dorsum of the foot was compared with lengthening of this tendon in 15 patients with Duchenne's muscular dystrophy. Patients undergoing tendon transfer (N = 9) had a longer operating time and two perioperative complications, but retained plantigrade posture of their feet even after walking ceased. By contrast, lengthening of the posterior tibialis tendon (N = 6) was associated with a recurrent equinovarus foot deformity that frequently interfered with shoe wear. Although transfer of the posterior tibialis is out of phase and technically more demanding, the unique prolongation of posterior tibialis strength in Duchenne's muscular dystrophy makes this operation a better option for these patients.

Adolescent↗

PubMedDate not supplied

Silicone breast implants: pathology.

Questions as to the bioreactivity of silicone breast implants (SBIs) have recently been intensely scrutinized, most notably by the media and legal system. Pathologists must be aware of the controversy and treat each SBI and associated tissue as a potential lawsuit. Grossly, silicone is a clear, viscous substance that may be observed either within or extruding from a silastic bag. By light microscopy, silicone is a nonstainable, nonpolarizable, refractile substance. Thicker sections, especially when viewed by non-Köhler illumination, phase-contrast, and darkfield microscopy will enhance visualization. Ultrastructurally, silicone is an electron-dense, amorphous substance often located within phagocytic vacuoles or extracellularly within the stroma. Correlating electron probe microanalysis allows for reliable identification. In most cases, a fibrous capsule surrounds the SBI, with the interface lining varying from a virtually acellular to a synovial-like lining composed of phagocytic and secretory cells. Silicone can often be identified within the fibrous capsule and also in distant tissues biopsied for suspected autoimmune disorders, such as synovium, skin, and lymph nodes, often without ultrastructural evidence of cytologic effects. This study has demonstrated that silicone accumulates at distant tissue sites due to preexisting inflammation acting as a stimulus. Thus, silicone is not a primary inducer of inflammatory disease processes. These findings are supported by various large epidemiologic studies.

Animals↗

PubMedDate not supplied

Osteomyelitis of the patella in children.

The early diagnosis of osteomyelitis of the patella in children can be difficult due to the rarity of this infection and to the vagaries of presentation which may be either acute with systemic signs or insidious with mild local signs. We present four cases of patellar osteomyelitis to illustrate the spectrum of this disorder. There should be a high index of suspicion with persistent pain and swelling above the knee, septic prepatellar bursitis, and septic knees that do not respond to conventional management. Management parallels treatment of osteomyelitis of other bones.

Child↗

PubMedDate not supplied

Variability in radiographic measurement of bowleg deformity in children.

The tibial metaphyseal-diaphyseal (MD) and tibial-femoral (TF) angles were measured on the radiographs of 33 knees in young children (aged 12-36 months) with bowleg deformity. Four observers of differing experience measured the films in a blinded fashion to determine the intraobserver and interobserver variability of these measurements. The clinical implications of these variabilities are described. Very little instruction and experience is necessary to make these measurements correctly and precisely. Measurement of the MD angle was superior to measurement of the TF angle. Contrary to published opinion, rotation can have a small but potentially significant effect on the measured MD angle.

Anthropometry↗

PubMedDate not supplied

Salmonella osteomyelitis and hand-foot syndrome in a child with sickle cell anemia.

Hand-foot syndrome and Salmonella osteomyelitis are characteristic problems in children with sickle cell anemia. Salmonella osteomyelitis presenting as hand-foot syndrome is unusual and causes diagnostic difficulties. A recent case illustrates the diagnostic dilemmas and suggests appropriate screening studies for the child with sickle cell anemia and atypical hand-foot syndrome.

Anemia, Sickle Cell↗

PubMedDate not supplied

A comparative study of bilateral versus unilateral congenital dislocation of the hip.

The presentations, treatment requirements, results, and complications of 50 patients with bilateral congenital hip dislocation were evaluated and compared with a similar group of unilateral dislocations. Diagnosis was significantly delayed in the bilateral dislocations. The only consistent sign on initial clinical examination of the bilateral group was the symmetrical restriction of hip abduction. Treatment requirements were similar for the unilateral and bilateral dislocations, and in fact, the unilateral dislocations were more likely to undergo reconstructive procedure after successful closed reduction. Overall results, when based on age at diagnosis, were similar for the two groups. In both groups, females required less treatment and were more likely to have a good result. The complication of avascular necrosis was seen more frequently in the unilateral dislocation, while the bilateral dislocation had a higher incidence of inadequate reconstructive operations.

Child↗