1/19. Abduction contracture of the hip in children. Nine cases of abduction contracture of the hip in children from contracture of the gluteus maximus muscle are reported. Division of the aponeurosis glutens maximus over the greater trochanter always permitted full adduction. ( info) |
2/19. Secondarily infected total joint replacements by hematogenous spread. Three fatal cases of infections that followed total joint replacement are repoarted, in each of which a hematogenous source of infection was identified. There also were five non-fatal cases presumable arising hematogenously which were reported in the literature. It is emphasized that concomitant disease, including active rheumatoid arthritis, may predispose to this complication. ( info) |
3/19. Use of a prone transfer technique in patients with severe hip-flexion restrictions: a report of 3 cases. We report 3 cases in which the prone transfer technique improved the functional status of patients with postoperative restriction of hip flexion. All 3 patients, who had undergone a different type of surgery, were unable to get out of bed without a tilt table, and therefore could not be discharged home. The prone transfer technique enables patients to move from a lying to a standing position with or without the use of a flat board. All 3 patients were discharged home when they could perform this transfer without assistance. It required 10 to 18 sessions of therapy training, which took place in 5 to 9 days. With advancements in surgical techniques, postoperative joint-motion restriction may be seen more frequently in community settings. Prone transfer may provide a low-cost, low-technologic way to mobilize patients with hip-flexion restriction. ( info) |
| Two patients with hemangioendothelioma and elevated plasma vascular endothelial growth factor (VEGF) levels are presented. A reduction in the plasma VEGF level after therapeutic intervention correlated with a successful clinical response. Conversely, a stable plasma VEGF level correlated with therapeutic failure. ( info) |
5/19. paraplegia and congenital contractures as a consequence of intrauterine trauma. We present a newborn infant with paraplegia and contractures of the lower limbs, consistent with neurologic injury rather than malformation. The mother was involved in a severe motor vehicle accident during the sixth month of pregnancy. We propose that this infant's injuries are a result of that accident. ( info) |
| I believe meningomyelocele is not vanishing, but is a new and diminishing disorder. prenatal diagnosis will be accepted only by a portion of most communities if abortion is the only alternative to the delivery of an impaired child. I believe participation in neural tube screening programmes can be increased by offering improved pregnancy outcome with concomitant prelabor caesarean section in addition to termination. Regardless, the prevalence at birth of children with myelomeningocele will decrease both in total numbers and in the severity of the expressed lesion. The resultant rarity will require collaboration between centers to evaluate treatment. The developing International Myelodysplasia Study Group using a Patient Data Management System and computer-assisted analysis is a model of successful collaboration that allows better exploration of the multiple variables that contribute to the well-being of children with open neural tube defects of the spine. ( info) |
7/19. A new case of Ullrich's disease. A new case of congenital, hypotonic-sclerotic muscular dystrophy is presented. The patient showed congenital hyperlaxity and looseness of distal joints, muscle weakness, and spur-like protrusion of the calcaneus. Afterwards rapid progressive contractures of both knees and hip joints developed. Muscle biopsies revealed unequivocal dystrophic abnormalities and small atrophic fibers with numerous foldings of basal lamina suggestive of a neurogenic lesion. The disease presents clinical variability but the diagnosis is possible when a newborn shows: no dominant family history, slender body, marked distal joint laxity and hyperflexibility, proximal joint contractures and normal or slightly increased serum enzymes. ( info) |
8/19. Olivo-ponto-cerebellar atrophy with muscular atrophy, joint contractures and pulmonary hypoplasia of prenatal onset. The clinical and pathological features of a female neonate with congenital joint contractures and pulmonary hypoplasia are described. Neuropathological examination revealed a widespread neuronal degeneration with a predominantly olivo-ponto-cerebellar distribution and muscle pathology consistent with neurogenic atrophy. This is the first reported case of congenital joint contractures and pulmonary hypoplasia with pathologically documented olivo-ponto-cerebellar degeneration. The observation further illustrates that the so-called fetal akinesia sequence or Pena-Shokeir I syndrome is an aetiologically non-specific symptom complex that can be caused by a number of underlying mechanisms. ( info) |
9/19. For whom the bells knell. A 72-year-old widowed woman known to have an organic brain syndrome was hospitalised owing to gangrene of her lower limbs. The gangrene had been caused by an adduction contracture of her hip resulting in pressure on the medial surface of her left leg. In addition she had pressure sores over both trochanters and the sacrum. The smell of putrefication could be sensed from a distance and on examination large white worms could be seen slithering in the decomposing tissue. The patient was pyrexial, oblivious of her surroundings, and without pain. Surgery--limb amputations--would not restore the patient to a cognitive state nor improve here quality of life, but abstinence posed an inherent threat of sepsis, and revulsion to the attendants. The sacral pressure sore was so large that surgical closure was impossible. The question of surgical intervention is discussed. ( info) |
10/19. Unreduced anterior dislocation of the hip in a child. A case of unreduced anterior hip dislocation from trauma is reported, and the literature is reviewed. This is the fourth such case reported in a child. ( info) |