Cost-effectiveness of the McGill interactive pediatric oncogenetic guidelines in identifying Li-Fraumeni syndrome in female patients with osteosarcoma.

Background: Li-Fraumeni syndrome (LFS) is a penetrant cancer predisposition syndrome (CPS) associated with the development of many tumor types in young people including osteosarcoma and breast cancer (BC). The McGill Interactive Pediatric OncoGenetic Guidelines (MIPOGG) decision-support tool provides a standardized approach to identify patients at risk of CPSs.

Methods: We conducted a cost-utility analysis, from the healthcare payer perspective, to compare MIPOGG-guided, physician-guided, and universal genetic testing strategies to detect LFS in female patients diagnosed at an age of less than 18 years with osteosarcoma.

Long-term follow-up of the flexor carpi ulnaris transfer in spastic hemiplegic children.

A retrospective study was performed on 25 patients with cerebral palsy who underwent transfer of the flexor carpi ulnaris to the radial wrist extendors. The mean age at the time of surgery was 8 years 1 month. The mean follow-up was 8 years 7 months.

Occult subluxation of the subtalar joint in clubfoot (using computerized tomography).

Routine radiographic analysis does not visualize the posterior aspect of the hindfoot (posterior facet of the talocalcaneal joint). To help evaluate patients with persistent hindfoot abnormalities, computerized tomographic coronal sections in 22 clubfeet were studied. Seventeen feet (77.

The role of computed tomography and radionuclide scintigraphy in the localization of osteomyelitis in flat bones.

The combined use of radionuclide scintigraphy and computed tomography is recommended for evaluating children with laboratory and clinical data suggestive of flat bone osteomyelitis despite normal conventional radiographs. In addition, computed tomography may be helpful in the presence of abnormal radiographs in determining the exact location of the focus of osteomyelitis and the most suitable route for appropriate drainage or to obtain culture material.

Scintigraphic localization of bone lesions during surgery.

Nuclear medicine provides several methods for increasing the accuracy of surgical removal of bone lesions with focally increased uptake. In this paper, three intraoperative procedures are discussed: remote control by imaging, intraoperative control by imaging, and intraoperative control by scintillation probe. All techniques require preoperative injection of bone imaging tracer.

Evaluation of tarsal coalition by computed tomography.

Three cases of talocalcaneal and two calcaneonavicular tarsal coalitions were evaluated with plain radiography and computed tomography (CT). Four of five of the patients' plain films were read as normal. Two of three patients had a Harris view performed for the talocalcaneal middle facet coalitions.

Computed tomography in the evaluation of the gluteal region.

The role of computed tomography (CT) in the evaluation of the gluteal region was assessed. Six cases of gluteal masses were studied preoperatively by CT; several were also studied with conventional radiographic methods, including barium enema, cystogram, and intravenous urogram. Our case material included an epithelioid sarcoma, Ewing's sarcoma, endodermal sinus tumor, cystic hygroma, neurofibromatosis, and a normal variant.

Hip CT in congenital dislocation: appearance of tight iliopsoas tendon and pulvinar hypertrophy.

The iliopsoas tendon can interpose between the femoral head and the acetabulum, preventing reduction or stability of reduction of a dislocated hip by a closed method. The tendon produces an infolding of the capsule and labrum. This infolding of the capsule and labrum creates an "isthmus" between the capital and the acetabular parts of the capsule.

Radiographic changes in unicameral bone cysts following direct injection of steroids: a report on 14 cases.

Twelve children (9 boys and 3 girls, ages 1 1/2-12 yrs.) with unicameral bone cysts were treated with triamcinolone acetonide (4 patients) or methylprednisolone acetate (8 patients) injected directly into the cyst cavity. Postinjection radiographic changes that indicate healing were noted in eight patients and included: reduced size of the cyst cavity, increased internal density, cortical thickening, and remodeling in the vicinity of the cyst.

CT determination of femoral torsion.

Femoral torsion has been measured in infants and children by computed tomography. The method requires two scans, one through the femoral neck, another through the femoral condyles. A specially designed device and packing about the knees assures immobilization of the legs.

Premature closure of the triradiate cartilage. Report of a case.

A case of early closure of the triradiate cartilage, probably secondary to neonatal septic arthritis of the right hip, is reported. Tomograms of the hip showed the triradiate cartilage closed posteriorly, with the anterior portion still open. These findings were confirmed at operation.

Physeal injuries of the ankle in children: classification.

Seventy-one cases of ankle fractures in children were studied. An analysis of the fracture lines involving the distal tibial and fibular epiphyses were done. A new classification is proposed based on the position of the foot at the moment of trauma and the direction of the abnormal force.

Plastic bowing, torus and greenstick supracondylar fractures of the humerus: radiographic clues to obscure fractures of the elbow in children.

The anterior humeral line is a valuable aid in the search for supracondylar fractures in children. When it is abnormal other signs of fracture should be carefully sought. The AHL was normal in only 5.

Injuries of the medial epicondylar ossification center of the humerus.

The complex nature of the ossification centers makes elbow injuries in a child or adolescent difficult to evaluate. The medial epicondylar ossification center is involved in a significant proportion. Injuries vary from simple avulsions to wide displacement with entrapment in the elbow.

Pathology of the limbus in untreated teratologic congenital dislocation of the hip. A case report of a ten-month-old- infant.

A dislocated hip in a 10-month-old infant with multiple congenital anomalies was examined postmortem. The true acetabulum was filled with areolar tissue and the acetabular articular cartilage was covered by fibrous pannus. The secondary acetabulum consisted of fibrous capsular tissue lined by synovial cells.

[Treatment of flexion-pronation contracture of the wrist in hemiplegic children].

Thirty-three cases of infantile spastic hemiplegia have been treated surgically for wrist deformity in flexion, pronation and ulnar deviation. The authors used Green's technique in most of the cases (transplantation of flexor carpi ulnaris to the extensores carpi) either in isolation or in association with lengthening of the pronator teres. The indications for surgery are given and the details of surgical technique and postoperative care are described.