Predictive accuracy of risk scales following self-harm: multicentre, prospective cohort study.

Scales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use is lacking.To evaluate the performance of risk scales (Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS scale, Modified SAD PERSONS scale, Barratt Impulsiveness Scale); and patient and clinician estimates of risk in identifying patients who repeat self-harm within 6 months.

Congenital radioulnar synostosis.

Congenital radioulnar synostosis can be severely disabling, especially if it is bilateral or if severe hyperpronation exists. Functionally, patients with severe deformity have trouble getting a cup to the mouth, using eating utensils, or accepting objects in an open palm. Of 33 patients (17 bilateral and 7 unilateral) underwent derotational osteotomy, with the majority being performed through the synostosis held with, an intramedullary wire and secondary transfixing device.

Osteotomy of the fusion mass in scoliosis.

The value of an osteotomy of the fusion mass in attaining realignment of the spine when a lateral shift of the trunk over the pelvis has developed in the frontal plane was studied in fifty-five patients. All had had a previously fused but progressive spinal deformity. The indications for osteotomy were progression of the curve, imbalance of the trunk, pain, deteriorating cardiopulmonary function, or pseudarthrosis, or a combination of these conditions.

Chondrosarcoma in children and adolescents.

Chondrosarcoma is rare in children. Only 12 patients with a diagnosis of chondrosarcoma were treated at Children's Hospital Medical Center in Boston during the period from 1957 to 1980. Pediatric chondrosarcoma has a relatively rapid onset, manifested by pain, a palpable mass and neurological symptoms with the lesion localized in the spinal column.

Combined anterior and posterior fusion in seventy-three spinally deformed patients: indications, results and complications.

Seventy-three patients with complex spinal deformities undergoing combined staged anterior and posterior fusion were analyzed. The indications for the combined approach were (1) severe kyphosis with or without neural compromise; (2) major thoracolumbar or lumbar curves with trunk imbalance or marked pelvic obliquity; (3) severe congenital scoliotic curves associated with hemivertebrae or anterior unsegmented bars; (4) absent posterior elements, e.g.

Lengthening of the lower extremity by the Wagner method. A review of the Boston Children's Hospital Experience.

Thirty-eight patients underwent forty lengthenings of the lower extremity between October 1972 and January 1979. There were twenty-four femoral and sixteen tibial lengthenings. The average length gained was 6.

Spinal deformity in children treated for neuroblastoma.

Of seventy-four children who were treated at a mean age of seventeen months for neuroblastoma and survived more than five years, fifty-six (76 per cent) had spinal deformity due either to the disease or to the treatment after a mean follow-up of 12.9 years. Of these fifty-six, 50 per cent had post-radiation scoliosis (mean, 18 degrees; range, 5 to 79 degrees), and 16 per cent had post-radiation kyphosis, most frequently at the thoracolumbar junction (mean, 39 degrees; range, 13 to 61 degrees), at the time of follow-up.

Congenital pseudarthrosis of the tibia.

Forty cases of congenital pseudarthrosis of the tibia were reviewed. The results were assessed so as to emphasise function rather than simply the presence or absence of union. At the time of review, 14 patients had undergone amputation; eight others had non-union or tenuous union.

Childhood Urologic Cancer Therapy Related Sequelae and Their Impact on Management.

Multidisciplinary treatment for childhood urologic cancer has resulted in improved survival. However, the sucessful results may be marred by the appearance of therapy-related sequelae. Thus, radiation therapy has produced spine deformities (kyphosis and scoliosis), ovarian failure, renal disease and abnormalities in the skin, subcutaneous tissue, and muscle.

Diastematomyelia and structural spinal deformities.

Sixty patients with diastematomyelia were seen over a thirty-year period and congenital scoliosis was found in 60 per cent. All of the patients had associated vertebral abnormalities and most (87 per cent) had a neural deficit. Myelography was helpful in the diagnosis, particularly prior to any procedure that might cause traction on the spinal cord.

Alterations in serum lipid concentrations following skeletal trauma.

Serial studies of 118 patients following fractures of the pelvis or lower extremity demonstrated a significant association between hypoxemia and the serum concentration of nonesterified free fatty acids. Serum lipase levels were similar but not as significant. No differences were noted in the serum concentrations of either triglycerides or cholesterol.

Irradiation induced kyphosis.

Eighty-one patients with Wilms tumor treated by irradiation and chemotherapy were studied. Despite the fact that multiple portals for irradiation were used, each crossing the midline, the amount of irradiation delivered to different parts of the vertebral body varied and it was this variation in delivered dose which produced axial skeletal deformities in 70% of the patients. Of the 57 patients with these deformities 32 had scoliosis, 22 kyphoscoliosis and 3 patients pure kyphosis; 12 patients had a kyphotic deformity of over 25 degrees, 7 patients requiring surgical correction.

Neurofibromatous scoliosis. Natural history and results of treatment in thirty-seven cases.

Of 400 patients with the diagnosis of neurofibromatosis on their hospital records, 141 actually had the disease. The presence of at least two of the following features was considered diagnostic: positive family history; positive biopsy; a minimum of six cafe-au-lait spots, each with a diameter of at least 1.5 centimeters; and multiple subcutaneous neurofibromas.

Skeletal alterations following irradiation for Wilms' tumor: with particular reference to scoliosis and kyphosis.

The roentgenographic changes in the axial skeleton after irradiation for Wilms' tumor were studied in eighty-one patients. In addition to the initial alterations found in the individual vertebrae within the field of irradiation, spinal deformity subsequently developed in fifty-nine patients (pure scoliosis in thirty-eight, kyphoscoliosis in nineteen, and pure kyphosis in two). Unitl the adolescent growth spurt these deformities tended to remain slight, but some progression did occur.

Skeletal growth and development of the achondroplastic dwarf.

Certain patterns in growth and development can be seen in the typical achondroplastic dwarf. Height is approximatley 5 standard deviations below average size for age through the age of 14. Sitting height is within normal limits at all ages.

Alterations in pulmonary function, coagulation and fat metabolism in patients with fractures of the lower limbs.

If the underlying pathology of the syndrome of fat embolism is the presence of circulating emboli of neutral fat with adherent platelets and red blood cells, then one could expect certain changes in normal vascular cellular elements and fat metabolism, with resultant alterations in pulmonary function. In our series of 118 patients with fractures of the lower limbs we found that more than half of them exhibited hypoxemia as well as a decrease in the hematocrit and platelet counts with a concomitant increase in platelet adhesiveness. In addition, those patients with hypoxemia showed increased fibrinogen degenerative product levels indicating an increased fibrinolysis.