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Biomedical subjects

D H Sutherland

Publications and source records attributed to D H Sutherland.

12 recordsLinked to original sources
PubMed1990

Fascia lata and early spica casting as adjuncts in closure of bladder exstrophy.

Correction of the skeletal defect seen in the exstrophy complex consists of reconstitution of the pelvic ring. Long-term success depends upon the formation of a fibrous union between the pubes. When this union does not occur diastasis of the pubis results. Long-term urological success appears to be related to adequate pubic approximation. We used fascia lata to construct an anterior pelvic ligament between the pubic bones in 7 patients. In the 6 patients for whom followup is available the fascia lata has persisted and appears to be viable histologically on biopsy specimens obtained at a subsequent operation. Because the fascia lata holds the pubis together so well we have been able to cease Bryant's traction in children by 2 weeks and place them into a cast. This has resulted in early discharge from the hospital in all patients. For these reasons we believe that fascia lata is a useful adjunct in the armamentarium of materials used to reapproximate the pubis.

Bladder Exstrophy↗
PubMed1989

The effect of surface and internal electrodes on the gait of children with cerebral palsy, spastic diplegic type.

The purpose of this study was to determine whether surface and internal fine-wire electromyography electrodes had an effect on gait. The subjects for the experiments were 38 children with the spastic diplegic type of cerebral palsy. The children were filmed using the high-speed cinematographic technique while they walked (a) with no electrodes (unencumbered), (b) with only surface electrodes, and (c) with internal electrodes. Single stance time, step length, cadence, and walking velocity were compared with analysis of variance and Bonferroni t tests. The results included a significant decrease in cadence (-6.3% of unencumbered walking; p less than 0.05) when comparing walking with surface electrodes with walking without any electrodes. The internal electrodes caused significant decreases from normal walking in the following parameters: step length for both the measured leg (-18.6%; p less than 0.005) and the nonmeasured leg (-18.0%; p less than 0.005), cadence (-7.9%; p less than 0.02), and walking velocity (-23.5%; p less than 0.005). Internal electrodes caused significant decreases as compared with surface electrodes in the step length for both the measured leg (15.7%; p less than 0.01) and the nonmeasured leg (15.6%; p less than 0.005) and walking velocity (19.7%; p less than 0.005). Single stance phase did not change significantly in any of the comparisons. It appears that the addition of the surface electrode apparatus does change the normal gait of a subject, causing a large decrease in cadence. The measurement of gait with internal electrodes causes further change in gait, resulting in large decreases in step length and walking velocity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1978

Gait analysis in cerebral palsy.

Electromyography is the most frequently used laboratory method of assessing gait of patients with cerebral palsy. This method has shown that slow stretch testing is non-specific and that electromyograms obtained during walking are of greater value in planning treatment. If surgical treatment is necessary, only those muscles with phase reversal should be considered for transfer; lengthening is appropriate for those with phase prolongation. The addition of movement measurements and force-plate recording increases the amount of information available for analysis. Distinctions can then be attempted between primary abnormalities and compensatory mechanisms, and gait patterns with common demominators can be identified. Only by precise pre- and post-operative studies can treatment for locomotor problems be reliably assessed. Progress in the treatment of patients with cerebral palsy cannot be achieved without such objective assessment.

Cerebral Palsy↗
PubMed1977

Double innominate osteotomy.

We performed double innominate osteotomy in twenty-five patients with acetabular insufficiency resulting from congenital dislocation of the hip and other lesions. Following iliac (Salter) osteotomy, the second osteotomy was carried out medial to the obturator foramen in the interval between the symphysis pubis and the pubic tubercle. In children more than six years old, adolescents, and adults, addition of the pubic osteotomy increased the amount of acetabular rotation and coverage of the femoral head that could be achieved. An additional benefit was that the femoral head could be shifted medially, decreasing the length of the femoral lever arm. The improvement in center-edge angle in the twenty-five patients averaged 27 degrees, and the acetabular index decreased an average of 19.5 degrees. The center of the head shifted medially an average of 1.5 centimeters. Hip stability was achieved in twenty-three of the patients.

Acetabulum↗
PubMed1975

Rectus femoris release in selected patients with cerebral palsy: a preliminary report.

Two theories concerning the effects of surgical release of the proximal origins of the rectus femoris in spastic patients are (1) that release reduces hip flexion contracture and lumbar lordosis and diminishes crouch, and (2) that release primarily enhances early swing-phase knee flexion. A series of eight patients with pre-operative electromyography and pre- and post-operative dynamic knee measurements are reviewed. In these patients, back-knee thrust did not improve because it was not caused by rectus contracture. The effect upon hip was also variable: two patients had increased hip flexion and a third had diminished hip flexion after release. In six of the eight patients knee flexion was improved in early swing phase. Improvement from surgery can be expected when rectus spasticity is sufficient (1) to interfere with the initiation of swing phase, and (2) to decrease the amplitude of knee flexion. Little change occurred in the patients who did not have these functional deficits. A review of the cases supports the primary knee effect theory of Silfvenskiöld; however, insufficient information was obtained from this series to rule out hip and pelvic changes.

Adolescent↗
PubMedDate not supplied

Clinical and radiographic outcome of patients treated with double innominate osteotomy for congenital hip dysplasia.

In this study, 21 patients who had undergone double innominate osteotomy for congenital hip dysplasia (CDH) were studied to determine if significant improvements in clinical and radiographic indexes were present at follow-up. Quantitative data reflecting functional status, pain level, and range of motion were obtained and analyzed statistically, as were standardized measurements from preoperative and postoperative radiographs. Statistically significant improvements at follow-up were observed in pain level, functional status, acetabular index, center-edge angle, and relative lateral displacement. Significant correlations were found between the postoperative functional score and several clinical indexes, but none were found between radiographic indexes and the final functional score.

Adolescent↗
PubMedDate not supplied

Proximal hamstring lengthening in the sitting cerebral palsy patient.

We retrospectively studied 62 nonambulatory children with spastic quadriplegic cerebral palsy who underwent proximal hamstring lengthening to improve hip and spine positioning. Preoperatively, all had hamstring contracture, with difficulty sitting due to hip extensor thrust and increased kyphosis. Thirty-five patients with follow-up greater than or equal to 2 years were studied using a modified Reimer scale to assess sitting ability. Sitting ability improved significantly (p less than 0.01) postoperatively, along with popliteal angle (p less than 0.001) and straight leg raising (p less than 0.001). Proximal hamstring lengthening is effective in treating severe hamstring contractures in the wheelchair-bound child with cerebral palsy.

Adolescent↗
PubMedDate not supplied

Treatment of stiff-knee gait in cerebral palsy: a comparison by gait analysis of distal rectus femoris transfer versus proximal rectus release.

Two groups of patients with cerebral palsy (CP) were studied pre- and postoperatively by gait analysis after proximal release or distal transfer of the rectus femoris for treatment of knee stiffness in swing phase. In the first group studied, 12 patients underwent proximal rectus femoris muscle release. In the second group, 10 patients underwent distal rectus femoris transfer. After surgery, peak knee flexion was increased 9.1 degrees in swing phase by proximal rectus release and 16.2 degrees by distal rectus transfer. Hip motion throughout the gait cycle was not significantly affected by either operation, and no tendency for a crouch gait was observed after either procedure.

Adolescent↗
PubMedDate not supplied

Intramuscular pressure during walking: an experimental study using the wick catheter technique.

Experimental studies have shown previously that intramuscular pressure is directly related to muscle tension. A wick catheter study of intramuscular pressure in the human tibialis anterior was performed to investigate dynamic changes in walking and in other selected activities. In walking, peak intramuscular pressure of 50 mm Hg occurred in the swing phase as the foot was lifted and continued in early stance phase during deceleration of the foot. Passive stretching of the tibialis anterior muscle produced an increase to 35 mm Hg with no EMG activity. Active contraction against heavy resistance produced a rise in intramuscular pressure to 107 mm Hg. In contrast to electromyography, intramuscular pressure represents both the active and passive components of muscle tension.

Catheterization↗