The halo-Milwaukee brace. Case series of a revived technique.

Study Design: A case series in which the halo-Milwaukee brace was used for postoperative immobilization in children with complex congenital and developmental spinal deformities.

Objectives: To describe the use of halo-Milwaukee orthosis in a pediatric population for stabilization of the cervical and upper thoracic spine.

Summary And Background Data: Postoperative immobilization of the neck and upper thorax can be achieved with cervical orthoses, cervicothoracic lumbar orthosis, halo cast, Minerva jacket, or halo vest.

Lumbar spine duplication presenting as adolescent scoliosis. A case report.

Study Design: A report of a case of lumbar spine duplication with the clinical appearance of adolescent scoliosis.

Objective: To increase knowledge about the pathogenesis and treatment of lumbar spinal duplication.

Summary Of Background Data: Although there have been other reports of lumbar spine duplication of this magnitude, these malformations typically are associated with severe neurologic abnormalities (dicephalus, myelomeningocele) or gastrointestinal abnormalities (omphalocele, neurenteric fistulas).

Myositis ossificans in a young child mimicking monoarthritis of the hip.

This report describes apparent acute monoarthritis of the left hip in a 6-year-old boy that was caused by myositis ossificans (MO). His initial presentation, with pain on movement of the left hip and an elevated sedimentation rate, led to consideration of an infection or inflammatory process affecting the left hip. Initial evaluation, including MRI and muscle biopsy, did not successfully lead to a diagnosis.

Motor responses to FES electrodes in a growing limb.

A canine model was used to investigate the chronic performance of surgically implanted electrodes in a growing limb. Seven skeletally immature dogs were implanted with epimysial and intramuscular electrodes. Recruitment characteristics for each electrode, including the activation threshold, spillover muscle threshold, peak force, and force at spillover were recorded with tendon force transducers placed on the tendon of the target muscle and the first spillover muscle.

Neurologic and vascular complications of scoliosis surgery in patients with Ehlers-Danlos syndrome. A case report.

Study Design: Case reports.

Objectives: Description of neurologic and vascular complications of scoliosis surgery to children and adolescents with ehlers-danios syndrome.

Summary Of Background Data: There have been no previous reports of neurologic and vascular complications of scoliosis surgery in patients with Ehlers-Danlos syndrome.

Modified Mitchell bunionectomy for management of adolescent hallux valgus.

This retrospective review was performed to determine results and to present a new operative method, a modified Mitchell procedure, used to treat 13 adolescents with a total of 21 bunions. The average age of the patients was 14 years, 6 months. The average clinical followup period was 31 months.

Protrusio acetabuli: its occurrence in the completely expressed Marfan syndrome and its musculoskeletal component and a procedure to arrest the course of protrusion in the growing pelvis.

Protrusio acetabuli [center-edge (C/E) angle > 60 degrees, teardrop collapsed, and pelvis invaded by acetabulum beyond ilioischial line (Köhler's)] was identified in 22 patients with classic Marfan syndrome. All had a preponderance of the syndrome's cardinal features (positive pedigree and musculoskeletal, ocular, and cardiovascular manifestations). Fifty-two immature patients with the syndrome's skeletal expressions predominating were studied for deep acetabuli.

Treatment of severe torsional malalignment syndrome.

Over a 7-year period (1984-1991), nine patients (aged 10-18 years) with 13 involved extremities were operatively treated for symptomatic severe torsional malalignment of the lower extremity and associated patellofemoral pathology. Physical examination and analysis of gait revealed severe rotational deformity characterized by excessive femoral anteversion and external tibial torsion. The cosmetic and functional pathologic effect of this torsional malalignment was centered about the knee joint.

The value of the measurement from T5 to T12 as a screening tool in detecting abnormal kyphosis.

Because vertebral endplates above T5 are not consistently seen on standard lateral radiographs, we assessed the reliability of measuring from T5 to T12 to detect abnormal kyphosis in children. Sixty-nine subjects were included, with 43 normal controls. Propst-Proctor and Bleck reported the normal measurement of T5-T12 to be between 20 and 33 degrees.

Complications and long-term outcome of upper cervical spine arthrodesis in patients with Down syndrome.

Study Design: A retrospective review of 15 patients with Down syndrome who had undergone arthrodesis of the upper cervical spine for instability.

Objectives: To determine the complication rate and long-term outcome after posterior cervical arthrodesis for upper cervical instability in patients with Down syndrome.

Summary Of Background Data: Atlantoaxial instability is common in patients with Down syndrome, and fusion of the upper cervical spine has been recommended for patients who have instability, with or without myelopathy.

Negative transactivation of cAMP response element by familial Alzheimer's mutants of APP.

In familial Alzheimer's disease (FAD), missense point mutations V642I/F/G, which co-segregate with the disease phenotype, have been discovered in amyloid precursor APP695. Here, we report that three FAD mutants (FAD-APPs) negatively regulated the transcriptional activity of cAMP response element (CRE) by a G(o)-dependent mechanism, but expression of wildtype APP695 had no effect on CRE. Experiments with various Galpha(s) chimeras demonstrated that Phe-APP coupled selectively to the C-terminus of Galpha(0).

Pediatric orthopaedic mission to Colombia: taking care of the children.

This team of nurses and doctors donated a week's vacation, the cost of their airline tickets, and many hours of preparation to help more than 200 children who could not afford orthopaedic care in Colombia. During the outreach mission, Colombian health care staff worked closely with the American team to exchange knowledge of orthopaedic skills and surgical techniques. The impact that members of this team have on the care of these needy children makes the countless hours of preparation for the mission and the work in Colombia very worthwhile.

The effect of perioperative and postoperative caudal block on pain control in children.

Ten paediatric patients (ASA status 1) who had bilateral club foot deformities and underwent bilateral posterior medio-lateral release within a two week interval (one foot operated each time) were assigned to one of two groups in a double-blind manner. Group one received caudal bupivicaine (0.25%) 2 mg.

Quantitative comparison of grasp and release abilities with and without functional neuromuscular stimulation in adolescents with tetraplegia.

In this study, a functional neuromuscular stimulation (FNS) hand system designed by Case Western Reserve University (CWRU) was implemented in 5 adolescents with C5 tetraplegia and hand function with FNS was evaluated and compared to tenodesis abilities using a grasp and release test designed specifically for this purpose. The test involved the unilateral acquisition, movement and release of 6 objects of various sizes and weights. During a single test session, five 30-second trials were performed with each object with and without the FNS system where the number of completions and failures were recorded for each trial.

In situ fixation of the slipped capital femoral epiphysis with a single screw.

We made a retrospective analysis of a consecutive series of patients with slipped capital femoral epiphyses (SCFE) surgically treated at the Shriners Hospitals for Crippled Children at Lexington, Kentucky. The clinical outcome was correlated to the number of pins and the incidence of chondrolysis, ischemic necrosis, and progressive slipping after the initial fixation. An evaluation made of the Walters-Simon theoretic pin penetration formula was of no value in this series.

Growth hormone treatment for burned children.

Several growth hormones show promise in the treatment of burn injuries, particularly for paediatric patients. Animal studies and clinical trials indicate that growth hormones help modulate the devastating effects of the hypermetabolic response to burn injury and improve wound healing. Recombinant human growth hormone (rhGH) has been shown to reduce loss of body weight, stimulate protein synthesis, increase epithelial cell proliferation, and accelerate wound healing.

In vivo coupling of insulin-like growth factor II/mannose 6-phosphate receptor to heteromeric G proteins. Distinct roles of cytoplasmic domains and signal sequestration by the receptor.

We examined the signaling function of the IGF-II/mannose 6-phosphate receptor (IGF-IIR) by transfecting IGF-IIR cDNAs into COS cells, where adenylyl cyclase (AC) was inhibited by transfection of constitutively activated G alpha i cDNA (G alpha i2Q205L). In cells transfected with IGF-IIR cDNA, IGF-II decreased cAMP accumulation promoted by cholera toxin or forskolin. This effect of IGF-II was not observed in untransfected cells or in cells transfected with IGF-IIRs lacking Arg2410-Lys2423.

Ambulation with parapodia and reciprocating gait orthoses in pediatric spinal cord injury.

The use of parapodia and reciprocating gait orthoses (RGOs) was reviewed in 41 children and adolescents with spinal cord injuries. Compared with users of RGOs, users of parapodia were younger when injured and when the orthotic was first used, were more likely to be household ambulators and to have higher neurological levels, and were unlikely to continue their use of the parapodium after early school age. Hip contractures that required surgical releases or contributed to discontinuation of orthotic usage were present in six of 26 parapodium users and 12 of 22 RGO users.

Operative treatment of bone overgrowth in children who have an acquired or congenital amputation.

Fifty-three children who were less than thirteen years old were followed for a median of seven years and ten months (range, two years and nine months to fourteen years and six months) after operative treatment for overgrowth of the tibia or humerus after amputation. During the thirty-one years in which these children were managed, three operative techniques were used in successive periods. Thus, the fifty-three children could be divided into three groups: thirty-one who had had a resection and revision, nine in whom the bone had been capped with a synthetic device, and thirteen in whom the bone had been capped with an autogenous tricortical bone graft from the iliac crest.

The acetabular response to proximal femoral varus rotational osteotomy. Results after failure of post-reduction abduction splinting in patients who had congenital dislocation of the hip.

The acetabular response to proximal femoral varus rotational osteotomy was studied radiographically in twenty-eight patients who had had thirty-three congenitally dislocated hips. All of the patients had previously been managed with open or closed reduction followed by use of a spica cast and had worn an abduction orthosis for at least one year after the reduction. The indications for the femoral osteotomy were a persistently increased acetabular index or subluxation, or both.

Latex allergy in children and adolescents with spinal cord injuries.

The incidence of latex allergy in children and adolescents with spinal cord injuries was investigated using history and laboratory testing. Among 67 individuals with spinal cord injuries, four had histories of latex allergy, and two of these also had positive laboratory tests. There were eight individuals without a history of latex allergy who had positive laboratory tests.

Acquired radial clubhand deformity due to osteomyelitis.

We reviewed nine cases of acquired radial clubhand due to osteomyelitis. Goals were cosmetic improvement, maintenance of any wrist mobility, and a stable, painless wrist and forearm. All patients achieved these goals, although residual forearm shortening ranged from 4-8 cm.

The structure of the rat aggrecan gene and preliminary characterization of its promoter.

Aggrecan is a major structural component of cartilage extracellular matrix and a specific gene product of differentiated chondrocytes. cDNA clones have been used to isolate rat aggrecan genomic clones from phage and cosmid libraries, producing over 80 kilobases (kb) of overlapping DNA containing the complete rat aggrecan gene, including 12 kb of 5'- and 8 kb of 3'-flanking DNA. DNA sequencing shows 18 exons, most of which encode structural or functional modules; exceptions are domains G1-B and G2-B, which are split into two exons and the G3 lectin domain, which is encoded by three exons.

Heel cord advancement in children with spastic equinus deformity.

Heel cord advancement has been advocated for treatment of spastic equinus deformity. Transferring the gastrosoleus anteriorly weakens it by changing the lever arm rather than the resting length. A retrospective review of 90 children with 122 limbs undergoing heel cord advancement revealed 11% excellent, 53% good, and 35% poor results (average follow-up 9.

Reliability of percutaneous intramuscular electrodes for upper extremity functional neuromuscular stimulation in adolescents with C5 tetraplegia.

Chronically indwelling percutaneous intramuscular electrodes were implanted in the upper extremity muscles of five adolescents with C5 or C5-6 tetraplegia in an effort to provide lateral and palmar prehension using the neuroprosthetic system designed by Case Western Reserve University. The responses from 177 electrodes were evaluated at 3-month intervals and included measurements of electrical impedance and an assessment of recruitment properties. Electrode failures were categorized as breakage, an altered stimulated response or adverse sensation during stimulation.