INTRODUCTION: The 1991 earthquake in the Limón area of Costa Rica presented the opportunity to examine the effectiveness of a decade of disaster preparedness. HYPOTHESIS: Costa Rica's concentrated work in disaster preparedness would result in significantly better management of the disaster response than was evident in earlier disasters in Guatemala and Nicaragua, where disaster preparedness largely was absent. METHODS: Structured interviews with disaster responders in and outside of government, and with victims and victims' neighbors. Clinical and epidemiologic data were collected through provider agencies and the coroner's office. RESULTS: Medical aspects of the disaster response were effective and well-managed through a network of clinic-based radio communications. Nonmedical aspects showed confusion resulting from: 1) poor government understanding of the roles and responsibilities of the central disaster coordinating agency; and 2) poor extension of disaster preparedness activities to the rural area that was affected by the earthquake. CONCLUSION: To be effective, disaster preparedness activities need to include all levels of government and rural, as well as urban, populations.

Costa Rica↗

PubMedDate not supplied

Natural history of knee contractures in myelomeningocele.

The natural history of knee contracture was determined in a prospective study of 850 myelomeningocele (MM) patients, ranging in age from neonate to 23 years, excluding patients after knee surgery. Fixed flexion contracture of 10 degrees at birth decreased by age 9 months but increased thereafter if the patient's MM level was higher than L3. In the thoracic/L1-L3 level patients, the mean fixed flexion contracture was 18 degrees with and 17 degrees without knee flexor spasticity. Range of knee flexion remained at 126 degrees until age 3 years, and decreased thereafter if the patient's MM was higher that L3. This study demonstrates that muscle imbalance and spasticity play a minimal role in development of knee contracture.

Adolescent↗

PubMedDate not supplied

Lower extremity alignment in children with spina bifida.

Our purpose was to describe the natural history of lower extremity alignment in spina bifida patients. We prospectively evaluated all spina bifida patients seen at the Children's Hospital in Seattle since 1971 and at the Royal Children's Hospital in Melbourne since 1979. Serial examinations were performed on 434 patients, ranging from birth to 23 years of age. The lower limbs of children with spina bifida had neutral alignment at birth that gradually increased to 6 degrees of valgus--a pattern different from normal children. Valgus greater than 10 degrees was observed in only 6% of patients, and the degree of angular deformity was not affected by walking, the use of an above-knee orthosis, or neurosegmental level. An above-knee orthosis to prevent malalignment does not appear to be warranted and continued ambulation does not significantly contribute to lower extremity deformity.

Adolescent↗

PubMedDate not supplied

Pathophysiology of isolated lateral ventriculomegaly in shunted myelodysplastic children.

Eight myelodysplastic children developed isolated lateral ventriculomegaly following shunt insertion for progressive hydrocephalus after closure of a myelomeningocele. In all patients a low-pressure distal slit valve (Uni-shunt) system preceded development of an isolated contralateral ventricle. Six of 8 children required a second contralateral shunt for a symptomatic isolated ventricle. Magnetic resonance imaging demonstrated a collapsed ventricle ipsilateral to the shunt secondary to distortion of the foramen of Monro. This was clearly depicted using three-dimensional color reconstructions of the ventricular anatomy. Low-pressure distal slit valves should be avoided in myelodysplastic children to prevent postshunt ventricle isolation.

Cerebral Ventricles↗