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PubMed1984

Köhler's disease of the tarsal navicular: long-term follow-up of 12 cases.

Twelve patients with Köhler's disease of the tarsal navicular were reviewed at follow-up averaging 33 years after diagnosis. All patients were asymptomatic. Neither alteration of the navicular shape nor osteoarthritis was observed radiographically. The type of treatment did not affect the time required for bone restoration, which took an average of 8 months. Weightbearing plaster casts for 3 months rendered the patients pain-free, whereas arch supports only decreased local pain, which lasted for an average of 7 months.

Casts, Surgical↗
PubMedDate not supplied

Fractures of the medial condyle of the humerus in childhood.

Fifteen cases of medial humeral condylar fracture are presented. Average patient age was 9.5 years, and the follow-up period ranged from 1 to 3 years. This type of fracture is very rare, and it seldom appears in the international literature. Treatment in our cases was based on the displaced or undisplaced nature of the fragment, i.e., the displaced fractures were operated on and fixed with Kirschner wires, whereas the undisplaced ones were immobilized in plaster casts. The treatment of choice in our series gave quite satisfactory results.

Casts, Surgical↗
PubMedDate not supplied

Larsen's syndrome: review of the literature and analysis of thirty-eight cases.

Thirty-eight cases of Larsen's syndrome in patients living on Reunion Island were analyzed, with an average follow-up of 13 years. Fourteen of these patients died of early complications secondary to dislocation of the cervical spine, tracheomalacias, heart disease, and severe respiratory infection. These children pose a problem of planning early treatment. Clubfeet must be treated conservatively early, and operation should be postponed until after knee deformities are corrected by plaster cast and/or early operation. Unilateral hip dislocations should be treated surgically in the second year of life. Treatment of bilateral hip dislocations is best neglected. Finally, the spinal status of these children must be monitored throughout their life.

Abnormalities, Multiple↗
PubMedDate not supplied

Supracondylar elbow fractures with impaction of the medial condyle in children.

We reviewed the cases of 13 children with supracondylar elbow fractures with impaction of the medial wall. The displacement was underestimated in two patients and treated as a minimally displaced fracture by simple immobilization without reduction, resulting in a cubitus varus deformity. In one patient, the correct diagnosis was made, but treatment by reduction was refused by the parents. A loss of carrying angle of 10 degrees resulted from this. Two patients referred for treatment of cubitus varus were treated elsewhere for the initial injury: one by reduction and plaster cast immobilization and the other by simple immobilization without reduction. Two children with a supracondylar fracture with buckling of the medial condyle without prominent deformity were not reduced and showed no deformity at follow-up. Six children with collapse of the medial condyle, treated by closed reduction and percutaneous pinning, all had a normal carrying angle at follow-up. We believe that this method is safe to prevent varus angulation.

Child↗
PubMed1986

Prediction of the shape and size of the maxillary anterior arch in edentulous patients.

The aims of the study were to examine the morphometric and angular relationships between the interincisive papilla and the maxillary anterior teeth, and to describe a clinical method derived from this analysis useful in sitting the upper front teeth. Plaster casts of upper jaws of adult patients with complete dentition, were selected. Two measurements were taken: the distance from the centre of the papilla to the most vestibular part of the labial surface of the anterior teeth; and the angles between the perpendicular to the median line and the line from the centre of the papilla to the most vestibular part of each tooth. The equation of the resulting parabola, corresponding to the upper frontal arch, can be applied to every maxillary dimension. Parabolas were divided into small, medium, and large, using the mean and standard deviations. Each curve was traced on a transparent base-plate shaped for intra-oral placement. In individuals with complete dentition the closest parabola to the maxillary frontal arch was selected and the distance between the lateral frenula measured. Statistical study demonstrated a correspondence between the interfrenulum distance and the parabolas. In edentulous patients the interfrenulum distance thus provides a curve useful in sitting the maxillary anterior arch.

Adult↗
PubMedDate not supplied

Fine structure of muscle in human disuse atrophy: significance of proximal muscle involvement in muscle disorders.

The universal occurrence of weakness of skeletal musculature on disuse, however produced, and the paucity of published reports on the fine structural changes in human disuse atrophy, prompted the present investigation. The quadriceps muscle of a leg immobilized in plaster cast (for fracture) and of the opposite non-immobilized limb was biopsied in four adult males, after periods of immobilization from 50 to 75 days. These 8 muscle specimens were examined for histopathological changes, and muscle fibre diameters were measured by micrometry from paraffin sections. The histograms revealed a larger proportion of small fibres (less than 20 micron) and a smaller proportion of large fibres (greater than 40 micron) in the immobilized limb compared to the opposite. Thus, light microscopy showed only atrophic changes. This was confirmed by electronmicroscopy, where atrophy of few to several muscle fibres was seen in the form of loss of myofibrils, collapse and folding of the basement membrane and prominence of glycogen or muscle nuclei. The atrophic change was more severe in the immobilized limbs, but it was also noticeable in all the non-immobilized limbs. Degenerative changes, especially disorganization and breakdown of myofibrils, and fragmentation of plasma membrane, were also seen in occasional atrophied muscle fibres, again more frequently in the immobilized limb. Lipofuscin was often found accumulated in muscle fibres and occasionally in endothelial cells of intramuscular blood vessels; the latter showed prominent pinocytotic vesicles or thickened basement membrane. It is concluded that both atrophy and degeneration of fibres of proximal muscles can occur as non-specific consequences of disuse of the limb in man, that degeneration is a latter and more severe change, that muscles even of the non-immobilized leg are subjected to disuse atrophy during bed-rest, and that the proximal muscles in man seem to have a natural susceptibility to atrophy and degeneration in any muscular disorders.

Adult↗
PubMed1999

Expression of insulin growth factor-1 splice variants and structural genes in rabbit skeletal muscle induced by stretch and stimulation.

1. Skeletal muscle is a major source of circulating insulin growth factor-1 (IGF-1), particularly during exercise. It expresses two main isoforms. One of the muscle IGF-1 isoforms (muscle L.IGF-1) is similar to the main liver IGF-1 and presumably has an endocrine action. The other muscle isoform as a result of alternative splicing has a different 3' exon sequence and is apparently designed for an autocrine/paracrine action (mechano-growth factor, MGF). Using RNase protection assays with a probe that distinguishes these differently spliced forms of IGF-1, their expression and also the expression of two structural genes was measured in rabbit extensor digitorum longus muscles subjected to different mechanical signals. 2. Within 4 days, stretch using plaster cast immobilization with the limb in the plantar flexed position resulted in marked upregulation of both forms of IGF-1 mRNA. Electrical stimulation at 10 Hz combined with stretch (overload) resulted in an even greater increase of both types of IGF-1 transcript, whereas electrical stimulation alone, i.e. without stretch, resulted in no significant increase over muscle from sham-operated controls. Previously, it was shown that stretch combined with electrical stimulation of the dorsiflexor muscles in the adult rabbit results in a marked increase in muscle mass involving increases in both length and girth, within a few days. The expression of both systemic and autocrine IGF-1 growth factors provides a link between the mechanical signal and the marked increase in the structural gene expression involved in tissue remodelling and repair. 3. The expression of the beta actin gene was seen to be markedly upregulated in the stretched and stretched/stimulated muscles. It was concluded that the increased expression of this cytoskeletal protein gene is an indication that the production of IGF-1 may initially be a response to local damage. 4. Switches in muscle fibre phenotype were studied using a specific gene probe for the 2X myosin heavy chain gene. Type 2X expression was found to decrease markedly with stimulation alone and when electrical stimulation was combined with stretch. Unlike the induction of IGF-1 and beta actin, the decreased expression of the 2X myosin mRNA was less marked in the 'stretch only' muscles. This indicates that the interconversion of fibre type 2X to 2A may in some situations be commensurate with, but not under the control of IGF-1.

Actins↗
PubMed1984

Effect of immobilization of short duration on the muscle fibre size.

In 10 patients with unilateral knee joint lesions, the injured leg was immobilized for 72 h by a plaster cast reaching from the hip to the ankle. At removal of the casts, open muscle biopsies were taken from the vastus medialis muscle on both sides. The muscle specimens were stained for myofibrillar ATPase activity and muscle fibre areas were measured on transverse sections. The differences in fibre size between the two sides were registered and statistically evaluated. The reduction in fibre size on the immobilized side was 14.4% for the type 1 fibres and 17.3% for the type 2 fibres, respectively. However, these differences were not significant because of considerable variations from case to case, with an increase in fibre size on the immobilized side in three cases. It is concluded that short time post-traumatic immobilization may have variable effects on the muscle fibre size and that one single biopsy might be insufficient to disclose early disuse atrophy whereas the method may be useful in cases of longer duration.

Adenosine Triphosphatases↗
PubMed1992

Early discharge of patients following skin graft for extremity melanoma.

Wide local excision with split-thickness skin graft is generally performed for intermediary and thick primary extremity melanoma. This report summarizes the experience of treating seven extremity melanoma patients with early immobilization and discharge using plaster casting or splinting following wide local excision and split-thickness skin graft.

Adult↗
PubMed2005

Old and new risk factors for upper extremity deep venous thrombosis.

BACKGROUND: Well known risk factors for upper extremity deep venous thrombosis are the presence of a central venous catheter (CVC) and malignancy, but other potential risk factors, such as surgery, injury and hormone replacement therapy (HRT), have not yet been explored. METHODS: We performed a population-based case-control study including 179 consecutive patients, aged 18-70 years with upper extremity deep venous thrombosis and 2399 control subjects. Participants reported on acquired risk factors in a questionnaire and factor V Leiden and prothrombin 20210A mutation were ascertained. Information on CVC was obtained from discharge letters. RESULTS: Forty-two patients (23%) and one control subject (0.04%) had a CVC (ORadj: 1136, 95% CI: 153-8448, adjusted for age and sex). Cancer patients without a CVC had an eightfold increased risk of venous thrombosis of the arm (ORcrude: 7.7, 95% CI: 4.6-13.0). Other evident risk factors were prothrombotic mutations, surgery, immobilization of the arm (plaster cast), oral contraceptive use and family history, with odds ratios varying from 2.0 up to 13.1. The risk in the presence of injury and during puerperium was twofold or more increased, although not significantly. In contrast HRT, unusual exercise, travel and obesity did not increase the risk. Hormone users had an increased risk in the presence of prothrombotic mutations or surgery. Obese persons (BMI > 30 kg m(-2)) undergoing surgery had a 23-fold increased risk of arm thrombosis compared with non-obese persons not undergoing surgery. CONCLUSION: A CVC is a very strong risk factor for arm thrombosis. Most risk factors for thrombosis in the leg are also risk factors for arm thrombosis.

Adolescent↗
PubMed1984

Early prediction of long-term margin adaptation of dental amalgam restorations.

The present study assessed the predictive value of an indirect metric method for the early detection of margin defects of amalgam restorations, relative to results using a direct clinical method. The material consisted of plaster casts of amalgam restorations taken at 1- and 2-yr examinations of four different amalgam-treatment combinations. The widest margin defect of each restoration was measured in a dissection microscope equipped with a metric scale in the ocular. The ranking order obtained from the metric measurements of the different amalgam-treatment combinations after 1 and 2 yr was compared with that obtained from the direct clinical evaluation after 2 yr. Finally, the rank order of those restorations rated Alfa (no visible evidence, along the margin, of a crevice (ditch) into which an explorer will penetrate) at the 2-yr clinical examination was studied in relation to the 1-yr metric measurements. For the total material, the rank order based on the metric measurements of the margin defects of the four amalgam-treatment combinations agreed with that obtained with the clinical rating. In the 1-yr data, where the metric technique was applied only on the restorations rated Alfa at the 2-yr clinical evaluation, the order of two neighboring combinations was reversed; otherwise the same rank order was obtained. It is recommended that the clinical performance of new brands of amalgam alloy are tested in short-term, small-scale studies using the metric evaluation technique, before more extensive field studies over longer periods are instituted, in order to sort out unsatisfactory materials and treatment techniques at an early stage.

Child↗
PubMed1995

Sleeping positions and dental arch dimensions in children with suspected obstructive sleep apnea syndrome.

The present paper analyzed the association between children's sleeping positions and dental arch morphology. The sleeping patterns of 27 children, aged 3 to 10 yr, suspected of having the obstructive sleep apnea syndrome (OSAS) were studied by polysomnography (PSG) and videotape recordings under laboratory conditions. The PSG recordings were used to calculate the apnea index (AI) and the relative time spent sleeping on the back, and the videotapes to categorize distinctly different sleep and head postures. Plaster casts were made for the assessment of dental arch morphology. Sleeping predominantly on one's back, was associated with a reduced maxillary intercanine width, while prolonged head extension during sleep correlated inversely with the overjet. The subjects with the highest AI scores (> 4) had larger dental arches. We suggest that sleeping on the back causes a more posterior tongue position, reducing its moulding effect on the anterior dental arch. As nasopharyngeal airway obstruction in OSAS-patients might trigger an anterior tongue position to secure a free airway passage, there will be increased lingual pressure on the dental arches, leading to their dimensional increase.

Child↗
PubMed1997

Long-term results after surgical management of partial Achilles tendon ruptures.

Although Achilles tendon injuries are common overuse injuries in sports, the exact incidence is unknown, primarily as a result of varying definitions and diagnoses of the underlying pathological changes. Despite numerous studies of treatment of the Achilles tendon injuries, the long-term results are not well known. The results after surgical treatment of chronic partial Achilles tendon ruptures in 64 patients with a follow-up of 6 (1.5-11) years were evaluated in a retrospective study. The ruptures were divided into three groups: (I) proximal (more than 3 cm above the calcaneus), (II) distal and (III) combined (proximal and distal). All patients underwent an operation involving the excision of the devitalized tendon tissue and, in groups (II) and (III), also the excision of the deep Achilles bursa and removal of the dorsal corner of the calcaneus. The functional results were satisfactory in 43 (67%) patients and unsatisfactory in 21 (33%). The results were better in patients with proximal ruptures than in patients with either distal or combined ruptures. Males experienced better results than females. Post-operative immobilization in a plaster cast had no significant influence on the final result. Nine (14%) patients with either a distal or a combined rupture were re-operated on and in seven of them the final result was satisfactory. The conclusion of this study is that partial Achilles tendon ruptures are often difficult to treat and only two out of three patients can be expected to obtain satisfactory results after surgical treatment.

Achilles Tendon↗
PubMed1995

Effects of immobilization on the rat soleus muscle in relation to age.

A hind limb of young adult, adult and old male Wistar rats (4-5, 6-7 and 20-21 months, respectively) was immobilized for 4 weeks by a plaster cast with the knee and ankle joints in a resting position. Enzyme-histochemical, morphometrical and contractile characteristics of the soleus muscle were compared with those in age-matched controls. A pronounced decrease in muscle mass and cross-sectional muscle fibre area was found at all ages. The degree of atrophy after immobilization did not differ between different fibre types in each age group, but the decrease in fibre area was less pronounced in old animals (i.e. the fibre area was decreased by 49-64, 53-66 and 27-38% in young adult, adult and old animals, respectively). The maximum tetanus force was decreased in all age groups (by 73, 78 and 69% in young adult, adult and old rats, respectively) as was the tetanus tension (i.e. tetanus force divided by muscle fibre cross-sectional area). The contraction time of the isometric twitch was significantly altered, i.e. decreased, only in the youngest age group, although it also tended to decrease in old age. A significant increase in the number and proportion of fibre types intermediate to types I and IIA, was found in the immobilized muscle of 4-5- and 6-7-month-old animals, but not in that of old ones (i.e. the proportion of intermediate fibres increased by 14, 13 and 2% in young adult, adult and old animals, respectively). Thus, in contrast to the atrophic changes, the contractile alterations after immobilization were not markedly different between young and old age. It is further concluded that the age-related fast-to-slow muscle fibre transition that occurs in normal soleus during maturation and growth can be partly reversed by restrictions of the normal muscle activity and that the ability of the soleus to modulate its fibre-type composition in response to a change in activity may be diminished in old age.

Adenosine Triphosphatases↗
PubMed1998

A morphometric analysis of the posed smile.

A fundamental goal of orthodontics is to improve the smile, but no objective criteria exist to assess the lip-teeth relationship, establish objectives of treatment or measure treatment outcome. Here we propose a method to digitally measure the smile characteristics of orthodontic patients. Specifically, the 'posed smile' is measured. By definition the posed smile is voluntary and not elicited by an emotion. It can be a learned greeting or a signal of appeasement and can be sustained. The posed smile is reliably repeatable. The multimedia computer program for smile measurement we developed was based on studies of the utility of the smile photograph and the assessment of the lip-teeth characteristics of the posed smile in treated and untreated patients. On the computer screen a grid, or smile mesh, employs horizontal and vertical lines to measure eleven attributes of a smile. Not all orthodontically 'well-treated' patients with exemplary plaster casts exhibit desirable anterior tooth display while smiling. We suggest that the photographic analysis of an unstrained posed smile might be a standard orthodontic record.

Child↗
PubMed1977

The influence of activity on muscle size and protein turnover.

1. The effects of the loss of normal activity can be studied in muscles held in a shortened position by immobilizing the ankle in a plaster cast. Since the innervation remains intact with this procedure, removal of the restraining case allows normal activity to be restored. The soleus and plantaris muscles grew as a function of time after the return of normal activity and these changes in tissue size are explained by changes in the average rates of protein synthesis and protein break-down as measured by sensitive in vitro techniques. Activity stimulates protein synthesis and inhibits protein break-down of the soleus muscle, thus enabling the tissue to accumulate protein. Blockage of de novo synthesis of RNA, but not DNA, severely restricted the normal, rapid enhancement of protein synthesis after thr return of activity. 2. The return of isotonic activity to the extensor digitorum longus muscle after immobilization in a lengthened position failed to fully compensate for the loss of the growth-promoting influence of stretch and the tissue gradually returned to the size of the control muscle. During the recovery process the higher rate of protein turnover and RNA concentrations of the immobilized muscle returned to the lower values of the control.

Animals↗
PubMed1979

Dependence of motoneurone properties on the length of immobilized muscle.

1. The soleus muscle of adult cats was fixed in a shortened or lengthened position for 2 weeks by immobilizing the leg with a plaster cast. To eliminate the effects of reflex activity arising from the muscle, the lumbosacral dorsal roots were sectioned on the side of leg immobilization.2. The soleus muscle showed a significant decrease in weight after immobilization in a shortened position. Immobilization of the muscle in a lengthened position produced no significant changes in its weight.3. Two weeks after transection of the throacic spinal cord, the soleus muscle showed a significant decrease in weight. This decrease was prevented by immobilization of the muscle in a lengthened position. Immobilization in a shortened position caused no further muscle atrophy in cord-transected animals.4. Soleus motoneurones showed a significant decrease in the duration of after-hyperpolarization (a.h.p.) 2 weeks after immobilization of the muscle in a shortened position, whereas immobilization of the muscle in a lengthened position caused no significant changes in the duration of a.h.p.5. A decrease in the duration of a.h.p. of soleus motoneurones induced by cord transection was significantly prevented by immobilization of the muscle in a lengthened position but not by immobilization in a shortened position.6. In a variety of experimental conditions, the mean duration of a.h.p. of soleus motoneurones was significantly correlated with the soleus muscle: body wt. ratio.7. It is concluded that certain motoneurone properties depend upon the condition of the innervated muscle and that the primary factor responsible for the trophic influence is metabolic change in the muscle rather than contractile activity itself.

Animals↗
PubMed1983

'Windswept deformity'.

We describe 8 children with 'windswept deformity'--a valgus deformity of 1 knee in association with a varus deformity of the other. The disease is a physeal osteochondrosis and conservative treatment with serial corrective plaster casts is as effective as corrective osteotomies.

Child↗