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PubMed1987

Invasive aspergillosis in children.

Aspergillosis may complicate the course of the child in an immunocompromised state. When sinus or pulmonary infections present in immunocompromised children, one third of these patients are diagnosed accurately premortem as resulting from aspergillosis and two thirds remain undiagnosed. Mortality remains quite high, despite prompt treatment. Four children in our hospital during the last 4 years have had invasive aspergillosis presenting other than sinus or pulmonary infections. Each presented with extensive soft tissue infection. Three presented after traumatic devascularizing injuries to the leg in which massive soil and fecal contamination occurred. One child presented with absolute neutropenia secondary to treatment of acute lymphocytic leukemia. The child had a chest wall lesion develop at the site of an EKG electrode. All patients had a punctate black skin lesion with a halo of intense erythema surrounded by a zone of blanching. These lesions rapidly expanded. Initial extensive debridement of the lesions, combined with systemic chemotherapy with amphotericin B failed to halt the progression of the disease. Histology showed vascular invasion with hyphal forms. Each patient then responded well to radical debridement (three hemipelvectomies and one chest well resection). The child in an immunocompromised state who develops a red papule, then a black eschar with surrounding erythema, should have immediate biopsy that can easily demonstrate the characteristic hyphal forms. Early radical surgical debridement and antifungal therapy can be lifesaving. The initial debridement should include tissues well beyond any apparent involvement.

Amphotericin B↗
PubMed2002

Posterior tibial tendon transfer and tendo-Achilles lengthening for equinovarus foot deformity due to severe crush injury.

Surgical correction was performed on nine patients who had equinovarus deformity caused by severe crush injury of the leg sustained in an earthquake. The operative procedure used involved the transfer of the posterior tibial tendon to the dorsum of the foot by passing it through the interosseous membrane using a modified procedure as published in 1978. This procedure was combined with percutaneous Achilles tendon lengthening and tenotomy of toe flexors when needed. The average follow-up time after the operation was 21 months. The treatment improved the heel-toe steppage gait in all patients and all were able to walk in standard shoes. There were no complications in the postoperative period. Recurrence of varus deformity was not seen in any of the patients. They had active dorsiflexion of the foot, with a median active dorsiflexion of 5 degrees (0 to 10 degrees) and median active plantarflexion of 16.1 degrees (10 to 25 degrees) compared to the median active dorsiflexion and plantarflexion on the uninvolved side. The total range-of-motion was 21.1 degrees (10 to 35 degrees).

Achilles Tendon↗
PubMed2006

Fatigue bone injuries causing anterior lower leg pain.

UNLABELLED: Shin splints, or stress-related anterior lower leg pain, seem to arise from numerous causes, including stress fractures. We retrospectively reviewed 154 consecutive military patients who had magnetic resonance imaging during a 5-year period for stress-related anterior lower leg pain. Using magnetic resonance imaging, 143 bone stress injuries were diagnosed in 86 of the 154 (56%) patients. The incidence of bone stress injury requiring orthopaedic consultation and magnetic resonance imaging among recruits during the 5 years was 117 per 100,000 person years in military service. The bone stress injury was located in the tibia in 141 (99%) patients. Of these injuries, 80 (57%) were located in the distal (1/3) of the tibial shaft, 42 (30%) in the middle (1/3), 14 (10%) in the proximal (1/3), and five (3%) in the medial condyle. The locations of tibial stress injuries related to the magnetic resonance imaging grades. Almost all lower leg fatigue bone stress injuries were located in the tibia, and the distal lateral shaft was affected most often. When used early after onset of symptoms, magnetic resonance imaging provides accurate diagnosis to ensure appropriate treatment, especially when dealing with exercise-induced lower leg pain in physically active patients. LEVEL OF EVIDENCE: Diagnostic study, Level II (development of diagnostic criteria on consecutive patients [with universally applied reference "gold" standard]). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed1997

Cardiovascular and metabolic responses to electrical stimulation-induced leg exercise in spinal cord injury.

Electrical stimulation-induced leg muscle contractions provide a useful model for examining the role of leg muscle neural afferents during low-intensity exercise in persons with spinal cord-injury and their able-bodied cohorts. Eight persons with paraplegia (SCI) and 8 non-disabled subjects (CONTROL) performed passive knee flexion/extension (PAS), electrical stimulation-induced knee flexion/extension (ES) and voluntary knee flexion/extension (VOL) on an isokinetic dynamometer. In CONTROLs, exercise heart rate was significantly increased during ES (94 +/- 6 bpm) and VOL (85 +/- 4 bpm) over PAS (69 +/- 4 bpm), but no changes were observed in SCI individuals. Stroke volume was significantly augmented in SCI during ES (59 +/- 5 ml) compared to PAS (46 +/- 4 ml). The results of this study suggest that, in able-bodied humans, Group III and IV leg muscle afferents contribute to increased cardiac output during exercise primarily via augmented heart rate. In contrast, SCI achieve raised cardiac output during ES leg exercise via increased venous return in the absence of any change in heart rate.

Electric Stimulation↗