State of the art: proximal junctional kyphosis-diagnosis, management and prevention.

Proximal junctional kyphosis (PJK) is a common problem that may occur following the surgical treatment of adult patients with spinal deformity. It is defined as the proximal junctional sagittal angle from the UIV and UVI + 2 of at least 10° AND at least 10° greater than the preop measurement. The reported incidence of radiographic PJK in the literature varies between 17 and 46%.

Adult scoliosis in patients over sixty-five years of age: outcomes of operative versus nonoperative treatment at a minimum two-year follow-up.

Study Design: Retrospective case-control study.

Objective: The purpose of this study was to compare the self-reported outcomes between operatively and nonoperatively treated patients over the age of 65 with adult scoliosis, using 4 distinct self-assessment questionnaires (SRS-22, SF-12, EQ5D, and Oswestry disability index [ODI]) and standard radiographic measurement parameters.

Summary Of Background Data: The current spine literature contains no studies that directly compare the self-reported and radiographic outcomes of operatively and nonoperatively treated patients over the age of 65 years with adult scoliosis.

Computed tomography evaluation of superior-segment facet-joint violation after pedicle instrumentation of the lumbar spine with a midline surgical approach.

Study Design: Retrospective study.

Objectives: To determine the frequency of pedicle screw violation of superior nonfused facet joints adjacent to the most cephalad pedicle screws after a midline approach for lumbar fusion.

Summary Of Background Data: Facet-joint violations have been evaluated in patients undergoing lumbar pedicle screw instrumentation and fusion with a Wiltse muscle-splitting approach, but not via the more common midline approach.

Native-valve bacterial endocarditis caused by Lactococcus garvieae.

We report a case of definite Lactococcus garvieae native-valve endocarditis. The diagnosis was suspected in a patient presenting with congestive heart failure and found to have Enterococcus hirae bacteremia, with a history of L. garvieae bacteremia 1 month prior.

Early MR imaging of lower-extremity physeal fracture-separations: a preliminary report.

Magnetic resonance imaging (MRI) was used to evaluate physeal fracture-separations in children soon after at-risk lower-extremity fractures. MRI scans taken during the "acute" period (within 10 days of fracture) resulted in a change in three of four of the Salter-Harris classifications from the injury radiographs. Twelve children had MRI scans performed in the "early" period (3-17 weeks following fracture).

Joint effusion in children with an irritable hip: US diagnosis and aspiration.

Ninety-six children with an irritable hip possibly representing septic arthritis underwent clinical and laboratory evaluation, radiography, and ultrasonography (US). Forty had normal US scans; none were later shown to have septic arthritis, although three had osteomyelitis. Fifty-six children had effusion at US.

The function of the quadriceps muscle after a fracture of the femur in patients who are less than seventeen years old.

Thirty-three patients who had been managed for an isolated, closed fracture of the femoral shaft when they were less than seventeen years old were examined at an average of thirty-three months (range, eighteen to fifty-six months) after the injury. Thirteen patients (39 per cent) had a persistent deficit in the strength of the quadriceps of the fractured limb, as identified on testing with a Cybex-II isokinetic dynamometer. Six patients (18 per cent) had a deficit according to the one-leg-hop for distance test, fourteen (42 per cent) had an average loss of ten millimeters in the circumference of the thigh, and sixteen (48 per cent) had an average loss of 10 degrees of flexion of the knee.

Osteomyelitis in children: gadolinium-enhanced MR imaging.

Fifteen pediatric patients with biopsy- or culture-proved nonspinal osteomyelitis were studied with magnetic resonance (MR) imaging. Osteomyelitis was acute in seven patients, subacute in three, and chronic in five. Four patients had subperiosteal abscesses, one had a large associated soft-tissue abscess, and one had an intraosseous (Brodie) abscess.

Vaginal microbial flora as a cofactor in the pathogenesis of uterine cervical intraepithelial neoplasia.

The vaginal microbial flora of 106 women with histopathologically confirmed cervical intraepithelial neoplasia and 79 women without disease, was evaluated for Gardnerella vaginalis, Trichomonas vaginalis, Candida albicans and other yeasts. Flora morphology was assessed by gram staining of secretions. Cervical cultures were examined for Herpes Simplex virus, Cytomegalovirus and Neisseria gonorrhoeae.

Neurologic complications after K-wire fixation of supracondylar humerus fractures in children.

A retrospective review of 143 supracondylar humerus fractures in children treated with K-wire fixation disclosed four neurologic complications after treatment. There were two late ulnar neuropraxias. One ulnar nerve injury and one radial nerve injury resulted from direct trauma during insertion of a K-wire.

MR imaging of fractures of the growth plate.

In order to assess whether MR imaging could be used to evaluate posttraumatic abnormalities of the growth plate cartilage, 28 MR imaging examinations of 26 physeal fractures were performed from 4 days to 2 years after injury. Twelve patients were studied within 6 months of the fracture. MR imaging changed the Salter-Harris classification in six.

Management of vascular injuries in displaced supracondylar humerus fractures without arteriography.

One hundred forty-three displaced (type III) supracondylar fractures of the humerus in children were treated over a 5.5-year period with 17 (11.9%) having signs of vascular impairment at the time of presentation.

Etiology and outcome of acute pelvic inflammatory disease.

We studied 71 women with the clinical diagnosis of acute pelvic inflammatory disease (PID) by laparoscopy and comprehensive microbiology in order to define the major etiologic determinants of poor fertility prognosis after tubal infection. Fifty women were found to have acute PID. Of the 50 women, 23 were pregnancy seeking and had a subsequent evaluation to determine fertility outcome.

Correlation of auxotype and protein I type with expression of disease due to Neisseria gonorrhoeae.

To explore the correlation of outer membrane protein I (PI) type and auxotype to clinical expression of infection with Neisseria gonorrhoeae, we characterized nutritional requirements by auxotyping and PI serovars by coagglutination assay with monoclonal antibodies of 325 consecutive clinical isolates of N. gonorrhoeae. The clinical status of each infected individual was determined by chart review.

Giant-cell tumor of the second cervical vertebra treated by cryosurgery and irradiation.

A 17-year-old female presented with a large, destructive, giant-cell tumor of the second cervical vertebra. The lesion was obviously life-threatening. Owing to its proximity to the spinal cord and the danger of a pathologic fracture with cord transection and because of the effectiveness of cryosurgical methods in treating giant cell tumors of long bones, we decided to attempt local freezing of the lesion using a cryoprobe via a transoral approach.