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At least 955 records · Page 53Linked to original sources
PubMed1994

[Involvement of the hip in systemic-onset forms of juvenile chronic arthritis. Retrospective study of 28 cases].

The objective of this work was to evaluate the course of hip disease in patients with systemic-onset juvenile chronic arthritis. 59 patients with systemic-onset juvenile chronic arthritis followed-up for a mean of 15 years (+/- 6 years) were studied retrospectively. 28 patients (47.5%) had involvement of the hip. Mean age at onset of symptoms of hip disease was 9.5 years (+/- 5 years). Hip arthritis was always preceded by other manifestations of the disease, including arthritis of other lower limb joints. Mean time interval between onset of the disease and onset of hip symptoms was 6.3 years (+/- 3 years). In 66% of cases, symptoms occurred simultaneously in both hips. Eight of nine patients with initially unilateral hip arthritis subsequently developed arthritis of the other hip; in four patients, less than one year elapsed between involvement of the two hips. Roentgenographic changes were variable and included acetabular protrusion (25%), complex cervico-cephalic and acetabular growth disorders (21%), subdislocation (18%), a short femoral neck with varus deformity (14%), and a long femoral neck with valgus deformity (14%). Avascular necrosis of the femoral head occurred in three patients. Roentgenographic evidence of repair was seen in one patient. Among the ten patients who required surgery, two had corrective osteotomy with adductor tenotomy and eight had total hip arthroplasty (of both hips in six patients) with good short- and medium-term outcomes. After arthroplasty, a single patient required reoperation in the short term, for persistent flexion contracture. Loosening of the acetabular arthroplasty required revision in two patients 5 and 10 years, respectively, after the initial procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis, Juvenile↗
PubMedDate not supplied

Influence of muscle activity on the actions of chloride channel blockers in the mouse skeletal muscle.

The purpose of this work was to investigate the effect of channel blockers in the presence and absence of nerve and/or muscle activity. 9-Anthracenecarboxylic acid (0.03 mM), a chloride channel blocker, increased both the amplitude and duration of the contractile response to direct stimulation in the mouse soleus muscle in either low Ca2+ Krebs (0.25 mM) or normal Ca2+ Krebs (2.5 mM) containing 0.1 mM 4-aminopyridine (potassium channel blocker). In addition, spontaneous contractions were induced by 9-anthracenecarboxylic acid in low Ca2+ Krebs. On the other hand, the combination of two potassium channel blockers, 4-aminopyridine (0.3 mM) plus tetraethylammonium ion (10 mM), increased the twitch amplitude but only slightly increased the contractile duration in the mouse soleus muscle in normal Krebs. The contraction-potentiating actions of 9-anthracenecarboxylic acid were inhibited by denervation, while those of 4-aminopyridine plus tetraethylammonium were not. Chronic exposure to the sciatic nerve to a lidocaine-cuff, but not to a colchicine-cuff, exhibited similar effects as denervation. Direct electrical stimulations were applied for 2 days to the soleus muscle through implanted teflon-coated multistranded electrodes in vivo, beginning immediately after denervation or cuff treatments. The contraction-potentiating effects of 4-aminopyridine plus 9-anthracenecarboxylic acid or 9-anthracenecarboxylic acid in low Ca2+ Krebs were restored in the denervated or lidocaine-cuff-treated soleus muscle by chronic direct stimulations. The membrane potential and input resistance of muscle fibres and the effects of 9-anthracenecarboxylic acid, which were altered by denervation or cuff treatment, were also partially restored by this measure. When sciatic nerves had been treated with lidocaine-cuff for 4 days and the cuff was then removed for 7 days, the contraction-potentiating effects of 9-anthracenecarboxylic acid were also restored. Four days after Achilles tenotomy, the contraction-potentiating effects of 9-anthracenecarboxylic acid were markedly inhibited. It was concluded that muscle activity controls the properties of chloride channels and that neural activity may affect the properties of chloride channels via enhancement of the muscle contraction.

4-Aminopyridine↗
PubMed1994

A new orthotic device for Chopart amputees.

The medical literature has, on the whole, passed seething criticism toward the Chopart foot amputation. The equinous, short, unbalanced stump is prone to pressure injury and the orthopaedic footwear has proved problematic. Many therapeutic modalities have been proposed, such as arthrodeses, tendon transfers, and tenotomies to improve functional ability. Many propose that the results of the Syme amputation are functionally superior and aesthetically more acceptable. The pros and cons of the Syme and Chopart amputations are discussed and a new orthotic device is suggested that improves the function of the Chopart amputation and minimizes the previously described complications.

Adult↗
PubMed1994

[A new motorized dynamic splint for the hip joint].

The authors present a new mechanical exercise splint for the hip. The appliance carries out movements in three dimensions and is used early in the postoperative period following surgical treatment of the hip and surrounding structures for continuous passive motion (CPM) treatment. When the hip is flexed, the knee bends at the same time. It is possible, however, for the part of the leg cradle that holds the lower leg to be locked in the extended position to avoid any problems for patients with arthrodesis in the knee. It is also advisable for knee movement to be blocked when the patient does exercises involving spreading and closing of the legs and inward and outward rotation. In this case the leg concerned should be bent about 10 degrees at the hip to avoid friction losses against sheets and mattress. The main indications for use of the new splint are internal fixation following acetabular fractures, periacetabular fractures, dislocation, joint fractures with dislocation of the same joint and fractures or pseudarthrosis at the upper end of the femur. Other appropriate forms of treatment are synovectomy, surgery to improve the form of the cup, including pelvic osteotomy, all kinds of transformation osteotomy, especially for hip necrosis or osteochondrosis dissecans, soft tissue surgery such as capsulotomy, tenotomy or resection following ectopic bone formation and flaccid paralysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Contraindications↗
PubMed1994

[Pathology of the knee in the hemophiliac patient].

Chronic haemophilic arthropathy of the knee is a debilitating condition that also carries the risk of rapid degeneration of the articular cartilage of the affected joint. The swelling is a combination of haemarthroses, irritative synovial effusions, synovial thickening and actual epiphyseal overgrowth that is the result of chronic hyperemia. In the knee joint the enlarged appearance is accentuated by quadriceps wasting. Replacement of deficient factor remains the cornerstone of management, followed by splinting in the position of function, synoviorthesis and surgical synovectomy (open or arthroscopic). End stage arthropathy of the knee is the most frequent cause of severe pain and disability in haemophiliacs. Our surgical experience may be divided into five categories: synovectomy, ostectomy, hamstring tenotomy, debridement and prosthetic arthroplasty. Over the last 20 years advanced arthropathy of the knee has been approached with a broad spectrum of procedures with varying success and durability. Early treatment and prevention of chronic synovitis and progressive arthropathy is the key. Where end stage arthropathy does occur and is severely disabling, durable, functional reconstruction with minimal risk must be our goal.

Chronic Disease↗
PubMed1994

Mechanical distraction for treatment of severe knee flexion contractures.

Ten patients (14 knees) with severe knee flexion contractures were treated by gradual mechanical distraction using either the Ilizarov or Orthofix external fixator. Range of motion improved from an average flexion contracture of 60 degrees before surgery to 16 degrees at the follow-up evaluation. Range of motion results were graded good or excellent in five knees, fair in two knees, and poor in three knees. Average total arc of motion remained essentially unchanged when comparing the preoperative (59 degrees) with the follow-up results (63 degrees). However, the functional position of this arc improved significantly. Problems encountered included a "rebound" phenomena after frame removal, with loss of the temporarily increased total arc of motion. The role of hamstring tenotomy and radical posterior knee release remains unclear.

Adolescent↗
PubMed1993

[High myopia with esotropia fixus].

Most of the 19 cases of high myopia with esotropia fixus had the refractive error in childhood while esotropia fixus set in progressively during middle age. The eyeball was fixed in a position of marked adduction, and the forced duction test was positive. Electromyography showed normal innervation of the medial and lateral recti. Contracture of the medial rectus and thinning of the lateral rectus were observed during surgery. Histopathological examination revealed degeneration and fibrosis in the medial rectus. Etiology was not clear. Tenotomy of the medial rectus or that of the inferior rectus in addition, with fixation of the lateral rectus tendon to the lateral orbital rim produced satisfactory corrective results.

Adult↗
PubMed1993

[Surgical treatment of A-pattern strabismus with over-acting superior oblique muscles].

13 cases of A-pattern strabismus with overacting superior oblique muscles were treated with Berke's procedure. Depending on the severity of superior oblique muscle overaction, simple tenotomy or partial tenectomy of the superior obliques was performed. For cases of A-pattern strabismus < 30 prism diopters, bilateral superior oblique muscle weakening might result in overcorrection, and for cases > 40 prism diopters, bilateral superior oblique weakening should be accompanied with vertical displacement of the horizontal muscles. For patients with stereoacuity of 40 arc seconds, surgery should be refrained from in order to avoid post-operative cyclodeviation.

Adolescent↗
PubMedDate not supplied

Diminished knee flexion after hamstring surgery in cerebral palsy patients: prevalence and severity.

A review of pre- and postoperative prone knee flexion (PKF) data after isolated hamstring tenotomy for 52 patients with cerebral palsy (CP) at an average follow-up of 3 years 4 months showed the frequency of diminished knee flexion to be 71%. Twenty-three percent of the knees actually had improved flexion, whereas 6% were unchanged. On the average, patients' flexion decreased 14.4 degrees from a preoperative PKF of 131.5 degrees to 117.1 degrees postoperatively (p < 0.0001). Only 11.5% of patients had PKF < 90 degrees at most recent follow-up, however; only 1.9% had PKF < 60 degrees. Thirteen percent of ambulators eventually required a rectus femoris transfer to correct "stiff-legged gait."

Adolescent↗
PubMed1995

[Value of pelvic osteotomy in the management of the hip in children with cerebral palsy].

PURPOSE OF THE STUDY: The authors analyzed the effectiveness of pelvic osteotomy for the treatment of hip dislocation or subluxation in CP children. MATERIAL: Fifteen pelvic osteotomies were performed on 11 children aged 30 months to 12 years (mean age 6 years). Seven children suffered from Little's disease. Follow-up averaged 10 years (from 2 to 16). Six children were reviewed at the end of growth (9 cases). METHODS: A Salter or triple osteotomy with adductor release was performed. Four cases had also a proximal femoral osteotomy. RESULTS: Following surgery, the mean Reimers' percentage decreased from 55 to 0 per cent. Correction was perfect in 11 cases, incomplete in 4 but excentration remained under 20 per cent. At the end of growth, 6 out of 9 hips remained stable without any further surgery, 2 hips developed slight excentration (less than 20 per cent) and one recurrent subluxation was treated by proximal femoral osteotomy. Six hips remained stable but their growth was not ended at last review. DISCUSSION: This surgical procedure is compared to others described in literature. Pelvic osteotomy with tenotomy improves acetabular cover and corrects muscle imbalance. Its risks seem overestimated in the literature. Both pelvic and femoral osteotomies are useful in specific cases. CONCLUSION: Triple or Salter osteotomy with adducter release seems to be a useful procedure to restore good hip morphology at the end of growth. No posterior dislocations following this osteotomy were seen in spite of the important correction. Proximal femoral osteotomy is not always necessary.

Cerebral Palsy↗
PubMed1996

[Lateral humeral epicondylitis. A postoperative evaluation].

From 1.1.1982 to 31.12.1941 45 patients with 50 elbows were operated at Holstebro Central Hospital under the diagnosis epicondylitis lateralis humeri. The material consisted of 29 females and 16 males with an average at operation of 41.1 years (21-61 years). At that time the patients had had symptoms for approximately 2.8 years (0.5-25 years), and they had all received conservative treatment without effect. Forty-seven patients were operated with a tenotomy of caput commune extensorum, and three patients had a lengthening of the m. extensor carpi radialis performed. At follow-up at an average of 83.1 months postoperatively (16-127 months) 61% were working whereas none of them had been working preoperatively. Forty-six per cent were satisfied with the result. These results do not differ from what other authors have found, and today it seems that everybody agrees that only patients who have tried conservative treatment without improvement should be offered an operation. In a study recently published, histopathologic examination of the tissue of those patients who had no effect of conservative treatment showed degenerative changes rather than inflammatory changes, and this could be a reason why some patients have no effect of immobilisation and treatment with nonsteroidal antiinflammatory drugs.

Adult↗
PubMed1996

[Treatment of clubfoot].

48 patients (70 club-feet) were reviewed clinically between the age of 4 and 14 years. The primary treatment had been serial plaster casts in the case of 43 feet and additional neonatal tenotomies in 27 feet. Operative treatment after the neonatal period was performed on 53 feet (75%) at a median age of ten months (2-60 months). Surgical procedures were posterior release in 29 and postero-medial release in 24 feet. Further surgery was required in the case of 18 feet. Satisfactory results (excellent and good) were obtained for 42 feet (60%), but fair results for 17 feet (24%) and poor results for 11 feet (16%). The results were significantly better when the release operation was performed before the patient was 2 years of age.

Adolescent↗
PubMed1977

Congenital clubfoot: pathomechanics, Radiographic analysis, and results of surgical treatment.

Twenty-one patients with resistant or relapsed clubfeet, ranged in age from four months to 7 years, and all had initially been treated with plaster by board certified orthopaedic surgeons. Surgery was recommended only after an Achilles tenotomy failed to bring the foot into dorsiflexion after approximately four months of age. Surgical correction was based upon the derotation and dorsiflexion of the talus in the ankle mortise. The criteria for a satisfactory result were: no recurrence of the equinus or varus; neutral position of the heel; dorsiflexion of the ankle to at least neutral; a fairly straight forefoot so that the center line of the foot bisected either the second or third toes or passed no further laterally than the third and fourth toes. Of the 33 feet surgically treated, 28 had satisfactory results following the first procedure, and five required additional procedures.

Achilles Tendon↗
PubMedDate not supplied

Fibrillogenesis in tendon healing: an experimental study.

The aim of this study was the histochemical, immunohistochemical and ultrastructural analysis of reparative fibrillogenesis in experimental lesions of Achilles' tendon. Subtotal tenotomy of Achilles' tendon was performed in twenty Wistar rats. The scar tissue was analysed 2, 4, 7, 14, 21, 30, 45 and 60 days post-operatively. Histochemical, (resorcin-fuchsin, aldehyde-fuchsin, iron haematoxylin and Fullmer and Lillie's methods) immunohistochemical (antibody against collagen I, II and elastin) and ultrastructural analyses were performed. Three phases in the healing process were distinguished: 1) inflammatory, 2) proliferative, and 3) remodelling phase. The inflammatory phase was characterised by haematoma, fibrin deposition, inflammatory cells, fibroblasts, beginning of collagen fibrillogenesis (200-400 A ø fibrils) and oxytalan fibrils. The proliferative phase was characterised by angiogenesis and fibroblast proliferation. Collagen fibres displayed a random arrangement and had a diameter of 400-600 A. Immature elastic fibres reached maximum tissutal concentration. In the remodelling phase, hypocellularity, normal vascularisation, tendon crimps, collagen fibres (800-1,000 A ø), elastic fibres with increased elastin deposition and reduction in oxytalan fibres were observed. In the course of the healing process collagen and elastic fibre fibrillogenesis exhibited consistent quantitative and qualitative variations (i.e. differences in the type and diameter of fibrils). The present study suggests that, together with other matrix macromolecules, also elastic fibres (oxytalan, elaunin and mature) are synthesised in significantly higher amounts during reparative fibrillogenesis and play a role in cell-matrix interaction.

Achilles Tendon↗
PubMed1976

Electromyographic studies in calves with spastic paresis.

As part of the investigation into the cause of spastic paresis in cattle, electromyographic studies were done in a number of calves with spastic paresis of one limb and in a number of normal calves. The calves with spastic paresis were also studied at various intervals after total neurectomy of the tibial nerve or tenotomy of the Achilles tendon structure. A marked increase in activity was perceptible in a number of muscles but characteristic changes in the EMG were not observed.

Achilles Tendon↗
PubMedDate not supplied

Treatment of congenital dislocation of the hip. Results of closed reduction and immobilization in the hip spica cast.

Treatment of congenital dislocation of the hip (CDH) by closed reduction and immobilization in the hip spica cast is one of the accepted methods for use in patients under one year of age. We report 74 congenitally dislocated hips treated with premanipulation skin traction, closed reduction under anesthesia, adductor tenotomy and immobilization in the hip spica cast. Satisfactory results were obtained in 60 hips. In seven hips, avascular necrosis of the capital femoral epiphysis was observed with careful management, closed reduction and immobilization in a spica cast provides good results for treatment of CDH.

Casts, Surgical↗
PubMed1997

[Focal myositis in children. Apropos of a case].

An eleven year old boy presented with localized swelling of the left calf which had been developing for more than 5 years. Another smaller mass was found in the pretibial area. There was an invincible equinus deformity of the foot. Surgical biopsies revealed characteristic histological features of focal myositis showing necrotic and regenerating muscle fibers, randomly distributed, with inflammatory infiltration. An intense fibrotic reaction was observed. This constitutes to our knowledge the first reported case of focal myositis in which development of muscle sclerosis was so important that it was necessary to perform tenotomies one year after excision of the principal tumor in order to restore normal gait. A nearly two-years follow-up does not give evidence of recurrent lesion.

Achilles Tendon↗
PubMed1997

[The "short Achilles tendon" syndrome: a new entity of the diabetic foot].

The "short Achilles tendon" syndrome, characterised by limited dorsiflexion of the tibiotarsal joint, is not well-known but could be a disposing factor for trophic disorders and plantar ulcer related to hypersupport in the diabetic subject. We report two cases of multicomplicated diabetic patients treated during several months for plantar ulcer superinfected with underlying osteoarthrits, whose course became rapidly favourable after tenotomy of the Achilles tendon. This simple surgical act can be performed in ambulatory conditions under local anaesthesia. Functional disability is negligible. The benefit of this treatment as part of the curative or preventive therapeutic arsenal for care of the diabetic foot remains to be evaluated.

Achilles Tendon↗