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Sreekumar P, Kumaran P, Xavier AM, Varma BR, Kumar SJ. Qualitative and Quantitative Comparison of the Remineralisation Potential of Three Suitable Materials-An In vitro SMH and SEM Study. J Clin Diagn Res 2019. [DOI: 10.7860/jcdr/2019/37344.12429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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2
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Abraham B, Kumaran P, Varma BR, Xavier AM, Kumar SJ. Comparative Evaluation of The Efficacy of Aloe Vera Gel with Milk and Hank’s Balanced Salt Solution in Maintaining the Viability of PDL Cells in Avulsed Teeth. J Clin Diagn Res 2019. [DOI: 10.7860/jcdr/2019/37876.12700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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3
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Abstract
Treacher Collins syndrome (TCS) or Franceschetti syndrome is an autosomal dominant disorder of craniofacial development with variable phenotypic expression. It presents with characteristic facial appearance enabling it to be easily recognizable. A case of a 10-year-old girl having TCS is briefly described in this article. A review of the etiology, clinical features, differential diagnosis, and treatment options are also discussed.
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Affiliation(s)
- Raj Renju
- Department of Paediatric Dentistry, Amrita School of Dentistry, Kochi, Kerala, India
| | - Balagopal R Varma
- Department of Paediatric Dentistry, Amrita School of Dentistry, Kochi, Kerala, India
| | - Suresh J Kumar
- Department of Paediatric Dentistry, Amrita School of Dentistry, Kochi, Kerala, India
| | - Parvathy Kumaran
- Department of Paediatric Dentistry, Amrita School of Dentistry, Kochi, Kerala, India
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4
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Lipton G, Riddle E, Grissom L, Fitru T, Marks H, Kumar SJ. An unusual cause of low-back pain in children: a report of two cases. J Bone Joint Surg Am 2001; 83:1552-4. [PMID: 11679609 DOI: 10.2106/00004623-200110000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- G Lipton
- Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA
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5
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Bowen JR, Kumar SJ, Orellana CA, Andreacchio A, Cardona JI. Factors leading to hip subluxation and dislocation in femoral lengthening of unilateral congenital short femur. J Pediatr Orthop 2001; 21:354-359. [PMID: 11371820 DOI: 10.1097/00004694-200105000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Congenital short femur is a rare and complex deformity. For it to be treated in the most accurate way, we must know of every possible complication. The purpose of this study was to determine the factors leading to hip subluxation or dislocation in patients with an unilateral congenital short femur who underwent a femoral lengthening procedure. Forty-four patients with congenital unilateral short femora types I, II, and IIIA were seen between 1981 and 1993 at Alfred I. duPont Hospital for Children. Seventeen patients had type I, 9 patients had type II, and 18 patients had type IIIA. Twenty patients underwent simultaneous lengthening of the femur and tibia, and 24 patients had primary lengthening of the femur. Eleven patients had an epiphysiodesis of the contralateral femur for residual leg length discrepancies of <6 cm. We observed that in patients with type IIIA, the acetabular dysplasia is severe, as well as the coxa vara deformity, and is associated with progressive subluxation and dislocation of the hip with lengthening. We believe that the combined abnormality of coxa vara and bow of the femoral shaft contributes to hip subluxation and dislocation in congenital short femur in association with an acetabular dysplasia prior to the lengthening. We recommend correction of the varus bow of the femur and the neck-shaft angle to 120 degrees and the acetabular index to <25 degrees prior to lengthening of type IIIA femora.
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Affiliation(s)
- J R Bowen
- Department of Orthopaedics, Alfred I. duPont Hospital for Children, Wilmington, Delaware 19803, USA.
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6
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Abstract
We reviewed the cases of 16 patients with myelomeningocele and congenital kyphosis. Ten patients underwent kyphectomy with wire fixation and spinal fusion for severe-curve progression and problems with decubiti ulcers. The average curve magnitude at presentation for these 10 patients was 87 degrees (range 47-146 degrees); at an average follow-up of 5 + 8 years (range 2 + 9 to 9 + 9 years) after surgery, it was 60 degrees (range 15-80 degrees). A stable fusion was achieved in nine patients, and all 10 had improved status of their skin at their last follow-up. Six patients were managed by nonoperative means such as modified wheelchairs and orthoses. The average curve magnitude at the presentation for this group was 70 degrees (range 42 degrees - 93 degrees); at an average follow-up of 19 years (range 5 + 5 to 27 + 3 years), it was 106 degrees (range 65 degrees - 130 degrees). Two of these patients continue to have problems with skin breakdown. Kyphectomy enables patients to sit straighter and is the proper treatment for these patients. If operative treatment is prohibitive or denied for some reason, then suitable wheelchair modifications can enable these patients to function with reasonable comfort.
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Affiliation(s)
- J Martin
- Alfred I. duPont Institute, Wilmington, DE 19899
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7
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Abstract
Forty-six patients (25 male and 21 female) with arthrogryposis multiplex congenita who were seen at the Alfred I. duPont Hospital for Children between the years 1940 and 1997 were evaluated to assess the prevalence and patterns of scoliosis and the long-term results after both nonsurgical and surgical treatment methods. We found the prevalence of scoliosis to be 65.9% (32 of 46 patients). A single thoracolumbar curve was the predominant curve pattern. No congenital curve types or vertebral anomalies were seen in our group of patients. In the nonsurgical group, the mean curve was <30 degrees at follow-up. In the surgical group, the mean primary curve before spinal arthrodesis was 78.5 degrees. Three patients in the surgical group who were nonambulators have become household ambulators at the most recent follow-up. We recommend bracing in patients who are ambulators and have a curve of <30 degrees. Combined anterior and posterior spinal arthrodesis gave the best results.
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Affiliation(s)
- W Yingsakmongkol
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Choi IH, Lipton GE, Mackenzie W, Bowen JR, Kumar SJ. Wedge-shaped distal tibial epiphysis in the pathogenesis of equinovalgus deformity of the foot and ankle in tibial lengthening for fibular hemimelia. J Pediatr Orthop 2000; 20:428-36. [PMID: 10912596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fibular hemimelia is associated with an equinovalgus deformity of the foot and ankle and different degrees of wedging of the distal tibial epiphysis. This deformity is often a major problem during lengthening of the shortened tibia. To determine the significance of the wedge-shaped distal tibial epiphysis in the pathogenesis of the equinovalgus deformity of the foot and ankle during and after lengthening, we reviewed 20 patients who had undergone tibial lengthening by either the Wagner or the Ilizarov technique. The mean duration of follow-up after removal of the fixator was 5.2 years (range, 2.3-9.7 years). Three types of wedge-shaped distal tibial epiphyses were identified. A mildly wedged (type I) epiphysis was found in seven patients, a moderately wedged (type II) epiphysis was found in seven patients, and a severely wedged (type III) epiphysis, in six patients. Premature fusion of the lateral part of the distal tibial physis and growth retardation of the tibia were common after lengthening in patients with the type II or type III epiphysis. After lengthening, all patients with a type II or type III epiphysis had a recurrence or aggravation of foot deformities that existed before lengthening. This usually necessitated various secondary operative procedures to obtain a plantigrade foot. We believe that after lengthening, one should anticipate varying degrees of mild growth retardation and minimal foot deformity in patients with type I epiphysis, worsened asymmetric growth retardation and progressive foot deformity in patients with type II epiphysis, and severe growth retardation and severe foot deformity in patients with type III epiphysis.
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Affiliation(s)
- I H Choi
- Alfred I. duPont Institute, Wilmington, Delaware, USA
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Grzegorzewski A, Kumar SJ. In situ posterolateral spine arthrodesis for grades III, IV, and V spondylolisthesis in children and adolescents. J Pediatr Orthop 2000; 20:506-11. [PMID: 10912609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of the study was to analyze the results after in situ posterolateral arthrodesis without reduction in children and adolescents with Meyerding grades III and IV spondylolisthesis and in patients with spondyloptosis who had an average follow-up of 12.8 years. The study population consisted of 21 patients who underwent an in situ posterolateral spinal fusion from L4 to S1 with autogenous iliac bone graft and were immobilized in a pantaloon cast for 4 months. All patients reported improvement after the operation and had no limitation in daily activities. Only four of 21 patients complained of occasional mild pain after physical activity, which resolved with rest and did not disturb their work. After surgery there were no motor deficits, incontinence of bowel or bladder, or sexual dysfunction. Roentgenographic findings showed progression of the slip in five patients and increase of the slip angle and the displacement index in two patients. These changes happened during the first year after the operation. Progression of the slip was not associated with symptoms. There was no pseudarthrosis. In situ posterolateral arthrodesis with a large amount of autogenous bone graft followed by immobilization in a pantaloon cast yields a solid arthrodesis and provides satisfactory results.
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Affiliation(s)
- A Grzegorzewski
- Alfred I. duPont Hospital for Children, Wilmington, Delaware 19899, USA
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Meeravali NN, Kumar SJ. Comparison of open microwave digestion and digestion by conventional heating for the determination of Cd, Cr, Cu and Pb in algae using transverse heated electrothermal atomic absorption spectrometry. Fresenius J Anal Chem 2000; 366:313-5. [PMID: 11225680 DOI: 10.1007/s002160050061] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A comparison between open microwave digestion and digestion by conventional heating was carried out for the determination of Cd, Cr, Cu, and Pb in two algae matrices using transverse heated electrothermal atomic absorption spectrometry (ETAAS). A SRM GBW 08504 cabbage was also analysed. These matrices were digested with HNO3, using a quartz vessel for microwave digestion and PFA vessel for digestion by conventional heating. Cd, Cu and Cr were determined without any modifier, while magnesium nitrate and ammonium phosphate mixed modifier was used for Pb. Results obtained by both the procedures were in good agreement with each other at 95% confidence level, and for SRM GBW 08504 cabbage the values agree well with the certified values. The limits of detection obtained were 0.0004, 0.060, 0.065 and 0.054 mg/kg for Cd, Cr, Cu, and Pb, respectively, using the microwave digestion process. The RSD for Cd was 10-15% and for the other elements 5-10%.
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Affiliation(s)
- N N Meeravali
- National Centre for Compositional Characterization of Materials, Hyderabad, India
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11
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Abstract
Children with spondyloepiphyseal dysplasia present with a disproportionate short stature, platyspondyly, scoliosis, coxa vara, and clubfeet. Extraskeletal manifestations such as retinal detachment and deafness have been reported. The authors report two patients, a mother and her daughter, aged 35 and 6 years, with findings of pseudarthrosislike lesions in the middiaphysis of both humeri. The mother had minimal symptoms that resolved spontaneously, and the child had no symptoms related to these lesions. The radiographs of the mother show complete remodeling of the lesion. The pseudarthrosislike lesion of the humerus may be one of the manifestations of spondyloepiphyseal dysplasia congentia. In time, the bone remodels completely. Because this is a relatively new radiographic finding, the authors suggest performing a radiograph of the humeri in patients with spondyloepiphyseal dysplasia congenita at least once during childhood.
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Affiliation(s)
- U Givon
- Department of Orthopaedics, Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA
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12
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Abstract
Talonavicular coalition is reported as an asymptomatic congenital anomaly of the foot that is noticed incidentally on radiographs of the foot, and is often associated with symphalangism, clinodactyly, ball-and-socket ankle joint, a great toe that is shorter than the second toe, and an autosomal dominant inheritance pattern. We describe here three patients with five involved feet. All three patients had chronic foot pain not secondary to trauma, and all five feet required treatment to alleviate the pain.
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Affiliation(s)
- S M Doyle
- Department of Orthopaedics, Alfred I. duPont Hospital for Children, Wilmington, Delaware 19803, USA
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13
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Givon U, Kumar SJ. Universal lower-extremity positioning device for the spica frame. J Pediatr Orthop 1999; 19:351. [PMID: 10344318 DOI: 10.1097/00004694-199905000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- U Givon
- Department of Orthopaedics, Alfred I. duPont Hospital for Children, Wilmington, Delaware 19899, USA
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14
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Abstract
Nine patients who presented to our institution with the chief complaint of a limp and no history of trauma were subsequently diagnosed with leukemia. A review of these patients identified clinical and laboratory findings that helped to establish the diagnosis. The presence of an antalgic gait with complaints of pain of variable intensity and duration, an irritable hip or knee, a mild to moderate elevation in body temperature, lymphadenopathy, hepatosplenomegaly, an increased erythrocyte sedimentation rate, thrombocytopenia, anemia, decreased neutrophils, increased lymphocytes, or blast cells on the peripheral blood smear should cause the physician to suspect leukemia in a limping child. Bone marrow biopsy confirms the diagnosis.
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Affiliation(s)
- H R Tuten
- Georgia Sports Medicine and Orthopaedic Clinic, Tifton, USA
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Guille JT, Kumar SJ, Shah A. Spontaneous union of a congenital pseudarthrosis of the tibia after Syme amputation. Clin Orthop Relat Res 1998:180-5. [PMID: 9646760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A 4-year-old boy with congenital pseudarthrosis of the tibia had two unsuccessful operative attempts for union. After these procedures the patient had a 6-cm leg length discrepancy and an equinovalgus foot deformity. Because of these deformities he underwent Syme amputation at the ankle and was fitted with a total contact prosthesis. Eight months after the amputation, a solid union was seen across the pseudarthrosis site, although no attempt was made to achieve union with internal fixation or bone grafting. The authors think that vertical alignment of the limb in a total contact prosthesis, along with the compressive forces of weightbearing, allowed the pseudarthrosis site to heal in the patient.
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Affiliation(s)
- J T Guille
- Department of Orthopaedic Surgery, Allegheny University Hospitals, Philadelphia, PA, USA
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16
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Abstract
We reviewed the long-term outcomes of treatment of fibrous dysplasia of the proximal part of the femur in twenty-two patients (twenty-seven femora). There were fifteen male patients and seven female patients. Patients who had monostotic disease had no involvement of the calcar femorale, fewer microfractures, less deformity, and stronger bone that could support internal fixation. Patients who had polyostotic disease had frequent involvement of the calcar femorale; more microfractures; severe deformity, including shepherd's crook deformity; and, in many instances, bone that could not support internal fixation. Twenty-two of the twenty-seven femora had a microfracture at the time of the initial presentation. At least one osteotomy was performed in four femora that had monostotic disease and in nine femora that had polyostotic disease. Curettage and cancellous or cortical bone-grafting did not appear to have any advantage compared with osteotomy alone in the treatment of symptomatic lesions, as all grafts resorbed with persistence of the lesion. At the time of the latest follow-up evaluation, no lesion had been eradicated or had decreased in size. A satisfactory clinical result was achieved in twenty patients (twenty-four femora): nine who had monostotic disease and eleven who had polyostotic disease. Two patients who had polyostotic disease and an endocrinopathy (one of whom had bilateral involvement) had an unsatisfactory result. All three femora in these two patients had a neck-shaft angle of less than 90 degrees at the time of the most recent follow-up evaluation. Varus deformity of the proximal part of the femur is best treated with valgus osteotomy and internal fixation early in the course of the disease. If the calcar of the femoral neck is involved or if the quality of the bone is such that internal fixation is not possible, a medial displacement valgus osteotomy can provide a more mechanically favorable position for healing of the microfracture.
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Affiliation(s)
- J T Guille
- Department of Orthopaedic Surgery, Allegheny University Hospitals, Philadelphia, Pennsylvania 19102, USA
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17
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Spatz DK, Guille JT, Kumar SJ. Distal tibiofibular diastasis secondary to osteochondroma in a child. Clin Orthop Relat Res 1997:195-7. [PMID: 9418640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
An 18-month-old girl with a distal tibiofibular diastasis secondary to an osteochondroma was seen with a valgus deformity of the ankle. The patient underwent operative excision of the osteochondroma at the age of 2 years. At 13-year followup there was resolution of the diastasis, and the patient was free of symptoms. Early excision obviates the need for complex reconstructive surgery to correct ankle deformity later.
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Affiliation(s)
- D K Spatz
- Allegheny University Hospitals, Philadelphia, PA, USA
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Kumar SJ. Is health care a right. Del Med J 1997; 69:223. [PMID: 9141784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Almeida RA, Luther DA, Kumar SJ, Calvinho LF, Bronze MS, Oliver SP. Adherence of Streptococcus uberis to bovine mammary epithelial cells and to extracellular matrix proteins. Zentralbl Veterinarmed B 1996; 43:385-92. [PMID: 8885703 DOI: 10.1111/j.1439-0450.1996.tb00330.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Adherence of an encapsulated (UT 101) and a non-encapsulated (UT 102) strain of Streptococcus uberis to a bovine mammary epithelial cell line (MAC-T) and to extracellular matrix proteins (ECMP) including fibronectin, collagen and laminin was investigated. S. uberis was co-cultured at 4 degrees C with MAC-T cell monolayers. Both strains of S. uberis adhered to MAC-T cells. However, the non-encapsulated strain of S. uberis adhered better to MAC-T cells than the encapsulated strain. Preincubation of MAC-T cells with lipoteichoic acid (LTA) and/or treatment of S. uberis with antibodies directed against the carboxyl-terminal half of type 24 M protein reduced adherence of both strains of S. uberis to MAC-T cells. Adherence to ECMP was measured by incubating bis-carboxyethyl-carboxyfluorescein acetomethyl ester (BCECF-AM) labelled S. uberis in 96-well plates coated with fibronectin, collagen or laminin. Both strains adhered to ECMP, however, the encapsulated strain adhered better to ECMP than the non-encapsulated strain. Results of this investigation demonstrated that both strains of S. uberis evaluated were capable of adhering to bovine mammary epithelial cells and to ECMP. Adherence of S. uberis to mammary epithelium may be an extremely important mechanism in the establishment and progression of bovine intramammary infections.
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Affiliation(s)
- R A Almeida
- Department of Animal Science, University of Tennessee, Knoxville 37901-1071, USA
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Abstract
We analyzed forty-four patients who had osteogenesis imperfecta, in order to determine the prevalence of spinal deformities. At the time of the most recent follow-up scoliosis was present in thirty patients (68 per cent) and kyphosis, in eighteen (41 per cent). According to the classification system of Falvo et al., scoliosis progressed rapidly with growth in twelve of fifteen patients who had the congenita type of osteogenesis imperfecta and in four of thirteen who had the tarda-I type. Curves that progressed before puberty did not always continue to progress after cessation of growth. Lateral roentgenograms made at the initial examination revealed four types of vertebral body deformities: biconcave, flattened, wedged, and unclassifiable vertebrae:Biconcave vertebrae were seen characteristically in patients who had the congenita type of osteogenesis imperfecta. The presence of six biconcave vertebrae or more before puberty indicated that severe scoliosis (more than 50 degrees) was likely to develop. Biconcave vertebrae did not appear to affect the severity of kyphosis. The other types of vertebral deformities were not useful for predicting progression of spinal deformity.
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Affiliation(s)
- S Ishikawa
- Department of Orthopaedic Surgery, Alfred I duPont Institute, Wilmington, Delaware 19899, USA
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21
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Abstract
The purpose of this study was to examine the outcome of treatment of clubfeet distal to a lower extremity constriction band. Eighteen patients with 21 clubfeet distal to a lower extremity constriction band were treated during the years 1946 to 1992. Three types of bands (I to III) were defined. Three grades of feet (A to C), based on the severity of the deformity, were recognized. After treatment, the feet were classified as good, fair, or poor. At follow-up, six of 18 feet were classified as good, six as fair, and nine as poor. These results were correlated with the type of band and the grade of the foot. A grade A foot associated with type III band had the best result.
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Affiliation(s)
- N J Allington
- Alfred I. duPont Institute, Wilmington, Delaware 19899, USA
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22
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Abstract
Fifty-five boys with seventy-eight congenitally dislocated hips were treated between 1965 and 1990. The patients were divided into three groups according to the initial treatment. Group I included thirty hips (twenty-two boys) that had been treated initially with a Pavlik harness. Two hips (7 per cent) had a successful outcome, and twenty-eight (93 per cent) needed additional methods of treatment. Group II included forty-two hips (twenty-nine boys) that had been treated initially with closed reduction and immobilization in a hip-spica cast. After the closed reduction, twenty-nine hips (69 per cent) were considered stable, although fifteen (52 per cent) of them needed a secondary procedure because of residual subluxation or persistent acetabular dysplasia. Thirteen hips (31 per cent) were considered unstable after the closed reduction and subsequently had an open reduction. Group III included six hips (four boys) that had been treated initially with open reduction. Two of these hips redislocated after the open reduction, and they were reduced with an additional open reduction. A pelvic osteotomy was later performed to treat persistent acetabular dysplasia in these two hips. Two hips that had been treated with an open reduction and concomitant pelvic and femoral procedures did not need additional treatment. This study demonstrates that boys who have congenital dislocation of the hip do not always respond well to treatment and constitute a high-risk group.
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Affiliation(s)
- J L Borges
- Alfred I. duPont Institute, Wilmington, Delaware 19899, USA
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23
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Abstract
STUDY DESIGN Fourteen patients who had symptomatic dysplastic spondylolisthesis with an intact pars interarticularis underwent posterolateral spinal fusion. Patients initially had low back pain, tight hamstrings, and limited forward bending. In addition, four patients had signs of progressive cauda equina or nerve root impingement. In 10 patients (71%), preoperative degree of slippage was more than 50% (mean, 72%). METHODS Ten patients underwent in situ posterolateral spinal fusion, and four patients with progressive neurologic symptoms had posterior decompression followed by in situ posterolateral spinal fusion. RESULTS All patients had solid fusion at last follow-up. A pseudoarthrosis developed in one patient, which healed after a second operation. Roentgenographic progression of the slip after fusion was rare. CONCLUSIONS This study demonstrated that for dysplastic spondylolisthesis in children and adolescents, in situ posterolateral spine fusion yields satisfactory results. In addition, in the presence of progressive cauda equina or nerve root impingement, posterior decompression may be necessary.
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Affiliation(s)
- S Ishikawa
- Alfred I. duPont Institute, Wilmington, Delaware
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24
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Abstract
A radiolucent spine frame for obtaining intraoperative spine radiographs while performing surgery for scoliosis has been designed at the Alfred I. duPont Institute and is described here. This frame, constructed of strong radiolucent plastic compounds, is easy to use and maintain.
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Affiliation(s)
- S J Kumar
- Alfred I. duPont Institute, Wilmington, DE 19899
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Suthahar DR, Malathi S, Vidyanathan V, Ranjan R, Kumar SJ, Ramathilakam S, Dinakaran N, Jayanthi V. Oesophageal manometry in noncardiac chest pain. Trop Gastroenterol 1994; 15:87-97. [PMID: 7831722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Chest pain of oesophageal origin is an important differential diagnosis in patients with cardiac chest pain. A preliminary survey of 40 patients with noncardiac chest pain (NCCP) revealed oesophageal motility disorder in 47.5%; achalasia cardia being the most frequent disease (47.3%). 15.8% of these patients with motility disorder had features of progressive systemic sclerosis and another 15.8% had non specific oesophageal motility disorder (variants). Compared to barium swallow, oesophageal manometry was found to be superior in the diagnosis of oesophageal motility disorder.
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Affiliation(s)
- D R Suthahar
- Department of Medicine, Kilpauk Medical College & Hospital, Madras
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26
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Matthews KR, Kumar SJ, O'Conner SA, Harmon RJ, Pankey JW, Fox LK, Oliver SP. Genomic fingerprints of Staphylococcus aureus of bovine origin by polymerase chain reaction-based DNA fingerprinting. Epidemiol Infect 1994; 112:177-86. [PMID: 8119357 PMCID: PMC2271474 DOI: 10.1017/s095026880005754x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Staphylococcus aureus (n = 75) isolated from mammary secretions of cows with subclinical and clinical mastitis from several geographic locations in the USA were examined using polymerase chain reaction-based DNA fingerprinting. DNA fingerprints were produced using a synthetic oligonucleotide primer (5'GTAACGCC3') to produce a distinct spectrum of amplified DNA fragments facilitating a high degree of resolution for differentiating S. aureus strains. PCR-based DNA fingerprinting grouped the 75 S. aureus isolates into 19 distinct profiles. The technique differentiated closely related strains within and between geographic locations. Findings suggest that certain types are found across geographic regions suggesting a common clonal type. Within herd data suggest heterogeneity among subclinical and clinical isolates of S. aureus strains. Compared to existing typing methods, PCR-based DNA fingerprinting is easy to perform and interpret. Use of PCR-based DNA fingerprinting may allow for a more detailed investigation of the epidemiology of S. aureus mastitis in dairy cows.
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Affiliation(s)
- K R Matthews
- United States Department of Agriculture, Agricultural Research Service, Knoxville, Tennessee
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Abstract
Twelve patients (13 extremities) who had complete congenital absence of the tibia were treated between 1963 and 1989. Three patients (three extremities) had a knee disarticulation performed as the primary procedure because they had no quadriceps function. Nine patients (10 extremities) underwent centralization of fibula under the femoral condyles (Brown procedure). Four of these 10 extremities developed a severe flexion contracture of the knee (> 25 degrees) and underwent subsequent knee disarticulation. One patient with a short stump secondary to an ipsilateral proximal femoral focal deficiency had a femorofibular arthrodesis. Five of these 10 extremities had a satisfactory result when reviewed at an average follow-up of 18 years. The patients were evaluated in reference to gait, range of motion (ROM) of the knee, quadriceps strength, prosthetic needs, and peer group sports activities. A strong quadriceps (> grade 4) was noted in all five patients who had a satisfactory result. Flexion contracture of the knee, when < 25 degrees, did not compromise the result.
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Affiliation(s)
- D Christini
- Alfred I. duPont Institute, Wilmington, DE 19899
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28
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Synder M, Kumar SJ, Stecyk MD. Split tibialis posterior tendon transfer and tendo-Achillis lengthening for spastic equinovarus feet. J Pediatr Orthop 1993; 13:20-3. [PMID: 8416348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Twenty-one patients with a minimum follow-up of 2 years who underwent combined split tibialis posterior tendon transfer and tendo-Achilles lengthening for equinovarus foot deformities were evaluated. The results in 15 of 18 ambulatory patients were graded as excellent or good; patients had marked improvement of their equinovarus foot deformity in both stance and swing phases of gait and became brace-free postoperatively. All non-ambulatory patients had a plantigrade foot. The complication rate was low, and patient satisfaction with the procedure was very high. In three patients, however, the procedure failed because of technical errors. We address the causes of failure and methods to avoid these errors. Preoperative computerized gait analysis does not appear to be essential in achieving a good result.
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Affiliation(s)
- M Synder
- Alfred I. duPont Institute, Wilmington, DE 19899
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Abstract
Ten children (11 hips) who underwent triple innominate osteotomy between the ages of 11 and 16 years for treatment of symptomatic acetabular dysplasia and who had > 10 years of follow-up since operation were reviewed to determine if satisfactory results reported in an earlier review were maintained. The mean length of follow-up was 12 years (range 10-16 years). All hips were examined roentgenographically, and functional assessment was made with the Iowa hip scoring system. Ten of the 11 hips improved roentgenographically and eight improved functionally after operation. One hip required replacement arthroplasty 16 years after triple innominate osteotomy.
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Affiliation(s)
- J T Guille
- Alfred I. duPont Institute, Wilmington, DE 19899
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Abstract
We reviewed 16 children with 16 displaced fractures of the femoral neck associated with complications. One was a transepiphyseal fracture, 12 were transcervical fractures, and three were basocervical fractures. The mean age at time of fracture was 11 years 7 months (range, 4 years 6 months to 16 years), and the mean length of follow-up after fracture was 6 years 11 months (range, 2-24 years). Complications in this series were avascular necrosis (AVN) (14 patients), nonunion (seven patients), premature physeal closure (15 patients), chondrolysis (seven patients), and coxa vara (two patients). Avascular necrosis, nonunion, and chondrolysis were associated with a poor outcome. Coxa vara or premature physeal closure alone was not responsible for a poor result.
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Affiliation(s)
- E Forlin
- Alfred I. duPont Institute, Wilmington, Delaware 19899
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Kumar SJ, Guille JT, Lee MS, Couto JC. Osseous and non-osseous coalition of the middle facet of the talocalcaneal joint. J Bone Joint Surg Am 1992; 74:529-35. [PMID: 1583047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sixteen patients (eighteen feet) who had a coalition of the middle facet of the talocalcaneal joint had operative resection of the coalition because nonoperative treatment, such as casts, failed to relieve the symptoms. The patients were symptomatic for an average of one and a half years (range, four months to two years) before they were seen by us. The average age at the time of the operation was fourteen years (range, seven to nineteen years). Three feet had resection with no material interposed, six had resection with interposition of fat, and nine had resection with interposition of half of the tendon of the flexor hallucis longus muscle. The average length of follow-up was four years (range, two to eight years). The result was excellent for eight feet, good for eight feet, and fair for one foot; for one foot, the result was poor because the coalition recurred. Three types of coalition were identified on preoperative computed-tomography scans that correlated with the operative findings. Type I was an osseous bridging of the middle facet joint (five feet). Type II (cartilaginous coalition) was marked narrowing of the middle facet joint with cortical irregularity (three feet). In Type III (fibrous coalition), there was only slight narrowing of the middle facet joint (ten feet). The type of coalition did not influence the result. Fibrous coalitions were the most difficult to detect; bone scintigraphy was used to confirm the diagnosis when other tests were equivocal. We believe that symptomatic coalition of the middle facet of the talocalcaneal joint should be treated with resection when non-operative methods fail to relieve symptoms.
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Affiliation(s)
- S J Kumar
- Alfred I. duPont Institute, Wilmington, Delaware 19899
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Abstract
Five severely displaced transepiphyseal fractures of the neck of the femur in five very young children were treated nonoperatively with a spica cast. Four of these fractures healed in varus, but two with an open proximal femoral physis corrected with growth. One fracture had an 18-month delay in diagnosis and treatment, but subsequently healed after a valgus osteotomy of the proximal femur and bone grafting. There was no case of avascular necrosis. We recommend initial nonoperative treatment with hip spica cast immobilization for this type of fracture in the very young child. If correction of residual coxa vara or limb length discrepancy is indicated, it may be done later.
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Affiliation(s)
- E Forlin
- Alfred I. duPont Institute, Wilmington, Delaware 19899
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Kumar SJ, Forlin E, Guille JT. Epiphyseometaphyseal cupping of the distal femur with knee-flexion contracture. Orthop Rev 1992; 21:67-70. [PMID: 1565514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
An 11-year-old child with a history of receiving megadoses of vitamin A as an infant, and a 4-year-old child with a history of fulminant staphylococcal septicemia with multiple joint involvement presented with recalcitrant knee-flexion contractures. Roentgenography revealed epiphyseometaphyseal cupping (ie, epiphyseal invagination) of the distal femur. Osteotomy resulted in only temporary correction. Our experience suggests that in the skeletally immature child, skin traction, physical therapy, splinting, and, in some instances, two-pin tibial traction should be the treatments of choice.
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Affiliation(s)
- S J Kumar
- Alfred I. duPont Institute, Wilmington, Delaware
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Mandell GA, Harcke HT, Kumar SJ. Developmental disorders of the extremities. Top Magn Reson Imaging 1991; 4:21-30. [PMID: 1764255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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36
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Mandell GA, Harcke HT, Kumar SJ. Osteoid lesions of the extremities. Top Magn Reson Imaging 1991; 4:66-76. [PMID: 1764259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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37
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Mandell GA, Harcke HT, Kumar SJ. Chondroid lesions of the extremities. Top Magn Reson Imaging 1991; 4:56-65. [PMID: 1764258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Mandell GA, Harcke HT, Kumar SJ. Miscellaneous disorders of the extremities. Top Magn Reson Imaging 1991; 4:77-90. [PMID: 1764260 DOI: 10.1097/00002142-199112000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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39
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Mandell GA, Harcke HT, Kumar SJ. Congenital disorders of the extremities. Top Magn Reson Imaging 1991; 4:1-20. [PMID: 1764254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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40
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Mandell GA, Harcke HT, Kumar SJ. Avascular necrosis and related conditions. Top Magn Reson Imaging 1991; 4:31-44. [PMID: 1764256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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41
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Mandell GA, Harcke HT, Kumar SJ. Fibrous lesions of the extremities. Top Magn Reson Imaging 1991; 4:45-55. [PMID: 1764257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
We present the long-term results of Pavlik harness treatment in 61 patients with 74 affected hips. At the beginning of treatment, the hips were either dislocated and reducible or dislocated and irreducible. The average age of patients at follow-up was 12 years (range, 10-16 years). At 3- and 5-year follow-up, all of the hips appeared radiographically normal. However, at latest follow-up, 17% of the hips demonstrated changes in the acetabulum (an upward tilt of the outer portion of the acetabular roof or sclerosis in this area). This study emphasizes the importance of continued follow-up until patients treated for congenital dislocation of the hip reach skeletal maturity.
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Affiliation(s)
- J J Tucci
- Alfred I. duPont Institute, Wilmington, DE 19899
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Caro PA, Marks HG, Keret D, Kumar SJ, Guille JT. Intraspinal epidermoid tumors in children: problems in recognition and imaging techniques for diagnosis. J Pediatr Orthop 1991; 11:288-93. [PMID: 2056075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Iatrogenic intraspinal epidermoid tumors are very rare. The similarity of the clinical manifestations of the tumor with other childhood problems can pose a problem in diagnosis. In addition, because of the lag in time between the lumbar puncture and the development of a symptomatic tumor, this relationship is overlooked and can cause a delay in diagnosis, as in the present report of four children. Magnetic resonance imaging was found to be superior to myelography in defining the tumor and its relationship to other structures inside the dural sac. All patients underwent surgical excision, with subsequent resolution of symptoms.
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Affiliation(s)
- P A Caro
- Alfred I. duPont Institute, Wilmington, DE 19899
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44
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Harcke HT, Kumar SJ. The role of ultrasound in the diagnosis and management of congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 1991; 73:622-8. [PMID: 2013607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- H T Harcke
- Department of Medical Imaging, Alfred I. duPont Institute, Wilmington, Delaware 19899
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45
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Mandell GA, Harcke HT, Hugh J, Kumar SJ, Maas KW. Detection of talocalcaneal coalitions by magnification bone scintigraphy. J Nucl Med 1990; 31:1797-801. [PMID: 2121915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Fibrocartilaginous talocalcaneal coalitions are very difficult to identify on plain radiography in symptomatic children and adolescents before gross ossification occurs. Computed tomography (CT) has been successful in identifying osseous and some fibro-osseous coalitions. In this series, magnification imaging of the tarsus on bone scintigraphy in the medial-lateral projection correctly identified talocalcaneal coalitions, seven of the nine bars were fibrous or fibro-osseous. Three of the fibrous lesions were equivocal or normal on conventional radiography and CT. Physiologic accumulations of activity in the growing hind foot are also presented from a control pediatric population. Magnification scintigraphy of the hind foot is offered as an adjunct to plain radiography and CT in the diagnosis of elusive nonosseous subtalar bars.
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Affiliation(s)
- G A Mandell
- Department of Medical Imaging, Alfred I. duPont Institute, Wilmington, Delaware 19899
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46
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Choi IH, Kumar SJ, Bowen JR. Amputation or limb-lengthening for partial or total absence of the fibula. J Bone Joint Surg Am 1990; 72:1391-9. [PMID: 2229119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Thirty-two patients who had ablation of the foot by the Syme or Boyd technique for partial or total absence of the fibula, with subsequent fitting of a prosthesis, were compared with eleven patients who had lengthening of the lower limb by the Wagner method, to assess the long-term results of each procedure. The final results were evaluated on the basis of pain, limp, limb-length discrepancy, level of physical activity, and satisfaction of the patient. Of the thirty-two patients who had an amputation, twenty-eight (88 per cent) had a satisfactory result, compared with only six (55 per cent) of the eleven patients who had limb-lengthening. The amount of inequality between the lower limbs was classified as follows: Group I--the foot of the shorter extremity was at the distal third of the contralateral, normal limb, and the percentage of shortening was 15 per cent or less; Group II--the foot of the shorter extremity was at the level of the middle third of the contralateral, normal limb, and the percentage of shortening was between 16 and 25 per cent; and Group III--the foot of the shorter extremity was at the level of the proximal third of the contralateral, normal limb, and the percentage of shortening was greater than 26 per cent. Lengthening was best suited for patients in Group I who had stable hips, knees, and ankles and a plantigrade foot. Patients in Groups II and III were best served by ablation of the foot and fitting of a prosthesis.
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Affiliation(s)
- I H Choi
- Alfred I. duPont Institute, Wilmington, Delaware 19899
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47
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Abstract
We report 18 cases of pain and tenderness in the mid-part of the patellar ligament in athletes. The condition may be disabling, but it responds to surgery. Ultrasound and CT scans were positive in all 17 confirmed cases, but ultrasound gave a better distinction between the cysts, granulation tissue, metaplasia, mucoid degeneration and congenital defects found at operation.
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Affiliation(s)
- J B King
- London Hospital Medical College, England
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48
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Kumar SJ, Keret D, MacEwen GD. Corrective cosmetic supramalleolar osteotomy for valgus deformity of the ankle joint: a report of two cases. J Pediatr Orthop 1990; 10:124-7. [PMID: 2298888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Valgus deformity of the ankle joint can cause pain in walking and a significant gait disturbance because of the altered ankle mechanics and the secondary planovalgus deformity of the foot. A technique of supramalleolar osteotomy that is cosmetically better than a closing wedge osteotomy for correction of this condition is described in two patients with hereditary multiple exostoses. The osteotomy is inherently stable, and minimal or no internal fixation is needed.
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Affiliation(s)
- S J Kumar
- Department of Medical Education, Alfred I. duPont Institute, Wilmington, DE 19899
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49
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Gonzalez P, Kumar SJ. Calcaneonavicular coalition treated by resection and interposition of the extensor digitorum brevis muscle. J Bone Joint Surg Am 1990; 72:71-7. [PMID: 2104855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Seventy-five feet in forty-eight patients that had calcaneonavicular coalition were evaluated at two to twenty-three years after resection of the coalition and interposition of the extensor digitorum brevis muscle. The result was excellent or good in fifty-eight feet (77 per cent). Three feet that were rated initially as having a fair result improved over time, and at the last follow-up the result in those feet was rated as good. Only five feet (7 per cent) had a poor result. The best results were in patients who had a cartilaginous coalition and who were less than sixteen years old at the time of operation.
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Affiliation(s)
- P Gonzalez
- Alfred I. duPont Institute, Wilmington, Delaware 19899
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50
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