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Biomedical subjects

E A Millar

Publications and source records attributed to E A Millar.

At least 19 recordsLinked to original sources
PubMed1989

Chondro-osseous growth abnormalities after meningococcemia. A clinical and histopathological study.

The cases of nine children who survived the acute stage of meningococcal septicemia and secondary disseminated intravascular coagulation were reviewed. All of the children had major orthopaedic problems as a result of the acute disease. Detailed histological studies were performed on specimens of bone and cartilage, obtained when these patients had either acute amputation for gangrene or subsequent revision for a chondro-osseous deformity. In the specimens that were obtained from the children who had acute gangrene, the histological changes included small-vessel thrombi, osteonecrosis, subperiosteal new-bone formation, cortical disruption, cellular disorganization in the physis, and medullary inflammation. These findings were compatible with a combination of inflammation (acute osteomyelitis) and ischemia. In the specimens that were obtained during revision of the amputation, three years or more after the initial infectious or ischemic process, the clinically relevant findings involved the epiphyses and physes. The growth plates showed variable permanent ischemic damage. Bone bridges connecting the epiphysis and metaphysis were observed in various stages of formation, including several early bridges with involvement of only the physis and metaphysis. Endosteal and cortical bone, in contrast, showed complete recovery with no evidence of permanent ischemic damage. We concluded that children who survive meningococcal septicemia are at high risk for complex orthopaedic problems, both acute and chronic. The disseminated intravascular coagulation and focal infections of the acute phase are primarily responsible for the vascular injuries to the growing chondro-osseous tissues. Ischemic changes also selectively involve the physeal circulation, but may take several years to adversely affect longitudinal and transverse growth of bone.

Adolescent↗
PubMed1989

Congenital longitudinal deficiency of the tibia.

Fifty-seven patients (seventy-one limbs) who had congenital longitudinal deficiency of the tibia (tibial hemimelia) were retrospectively categorized according to radiographic type (Types 1 through 4, as described by Jones et al.). At an average follow-up of nine years, fifty-six of fifty-seven patients walked independently. An ablative surgical procedure was performed on sixty-one of the seventy-one lower extremities. According to the classification of Jones et al., fifty-four limbs had a Type-1 (a or b) or Type-2 deficiency. In twenty-two of these extremities, disarticulation of the knee was performed; in twenty-five, a Syme amputation; and in one, a Chopart amputation. The ipsilateral foot was retained in six extremities that had a severe Type-1 or Type-2 deficiency. Medial transfer of the fibula (the Brown procedure) generally yielded less than satisfactory results; in ten of fourteen extremities, one or more additional operations were needed. Seventeen extremities were classified as having a Type-3 or Type-4 deficiency; Syme amputation was done in nine and Chopart amputation, in four. Despite satisfactory reconstruction of the ankle, a Syme amputation was necessary in most extremities that had a Type-4 deficiency because a major leg-length discrepancy was projected. In four limbs that had a Type-3 or Type-4 deficiency, the foot was retained.

Adult↗
PubMed1987

Thoracic suspension: quantitative effects upon seating pressure and posture.

Seating pressure in 10 subjects using a thoracic suspension orthosis was studied quantitatively. Anterior, posterior, and ischial pressures were measured bilaterally both unsuspended and during a 90 to 120 minute interval while suspended. Significant decreases in seating pressure were noted following suspension, with a mean decrease of 59.8%. Significant changes in lateral support were noted with suspension, as was a reduction in both the absolute pressure and relative distribution of pressure to the ischial areas. Relative redistribution of pressure in the anterior-posterior direction was related to leg support condition. All subjects who presented with pressure sores healed subsequent to thoracic suspension. Those with spinal curvature showed a 10 to 20 degree correction immediately following suspension. This correction generally was not maintained, however, in a temporal analysis. The data indicates that thoracic suspension can effectively reduce seating pressure and alter lateral posture, while leg support condition has a greater effect upon anterior-posterior pressure distribution. The use of a seat cushion to prevent subject swinging while suspended did not adversely affect the overall suspended pressures in this study, although the subjects without seat cushions showed lower overall suspended pressures.

Adolescent↗
PubMed1987

Sacral ribs. A case report.

Supernumerary ribs are a rare anatomic curiosity usually discovered as an incidental finding on routine radiographs. The occurrence of sacrococcygeal ribs are extremely rare. Sacral ribs develop as a consequence of the failure of the rib anlage to fuse with the vertebral centers. The present case is unique from previous reports because of the associated scoliosis and hypoplasia of the ipsilateral gluteal musculature and foramina within the accessory rib.

Adolescent↗
PubMed1987

The malignant potential of enchondromatosis.

In a tri-institutional, retrospective study with long-term follow-up, forty-four patients who had multiple enchondromas were identified. Thirty-seven patients did not have hemangiomas (Ollier disease) and seven did (Maffucci syndrome). Of the thirty-seven patients who had Ollier disease, a low-grade chondrosarcoma developed in four; an astrocytoma, in one; and a granulosa-cell ovarian tumor, in one. In four of the seven patients who had Maffucci syndrome, there were six low-grade chondrosarcomas, one high-grade osteosarcoma, one pancreatic adenocarcinoma, one biliary adenocarcinoma, and one astrocytoma. None of the patients in either group died of the skeletal sarcoma, but four of five patients who had a non-skeletal malignant lesion died. From life-table analyses of these patients, we estimated that the incidence of secondary chondrosarcoma in patients who have Ollier disease is about 25 per cent at the age of forty years, and that malignant degeneration is almost a certainty in patients who have Maffucci syndrome. We concluded that periodic surveillance of the brain and abdomen for occult malignant lesions is indicated in patients who have enchondromatosis.

Adolescent↗
PubMed1986

Distal femoral epiphysis: normal standards for thickness and application to bone dysplasias.

Flattening of the epiphysis of the long bones is seen in several bone dysplasias. It is the hallmark of multiple epiphyseal dysplasia and is an important sign in the diagnosis of spondyloepiphyseal dysplasias, diastrophic dysplasia, and pseudoachondroplastic dysplasia. The goal of this study was to determine norms for the height of the distal femoral epiphysis and to apply these standards to patients with bone dysplasias. Ratios of the distal femoral epiphysis height to both the distal femoral metaphysis width and the distal femoral epiphysis width were obtained from 640 radiographs of healthy children of different ages. Application of these standards to 41 patients with the bone dysplasias mentioned above proved useful in ascertaining decreased height of the distal femoral epiphysis. These standards are of particular value in subtle or early cases in which the thinning of the epiphysis may not be apparent upon simple observation. Obtaining three simple measurements from the anteroposterior knee radiographs allows determination of the presence or absence of flattening of the epiphysis.

Adolescent↗
PubMed1984

Influence of age, sex and osteogenesis imperfecta on count, protein content, and monoamine oxidase activity of human thrombocytes.

We determined the effect of count, age (2 to 24 year), sex, and osteogenesis imperfecta (OI) on the protein content and monoamine oxidase activity in human platelets. The reaction rate in presence of paramethoxybenzylamine was assessed in a sensitive and continuously recording spectrophotometric system. Platelets harvested from control subjects and OI patients displayed significant inverse linear correlations between count and protein content; there was near-constancy of the products of the two variables. The effects of age, sex, and osteogenesis imperfecta on protein content, count, and MAO activity were assessed by multivariate analysis of variance. It was found that, with increasing age, the count increased linearly and the protein content decreased. In patients with OI the protein content was depressed and monoamine oxidase activity elevated regardless of whether the latter was calculated on the basis of pellet protein or of count. The data suggest that, in osteogenesis imperfecta, thrombocytic monoamine and protein metabolism deviate from that of controls.

Adolescent↗
PubMed1984

Congenital coxa vara. A retrospective review.

Forty-two cases of coxa vara were retrospectively reviewed. All 42 cases were classified based on their history and roentgenographic appearance. Twenty-two cases of true congenital coxa vara were identified and are the primary focus of this review. In this study we have introduced the Hilgenreiner epiphyseal (HE) angle as measured on standard AP roentgenograms of the hip. Retrospectively, this angle was measured to aid in deciding candidacy for surgery, as well as a means of determining the amount of surgical correction necessary to prevent a recurrence of the deformity. The indication for surgery should be an HE angle of greater than 60 degrees. HE angles of less than 60 degrees and greater than 45 degrees represent a "gray zone" and should be observed. HE angles of less than 45 degrees will generally correct spontaneously without surgery.

Adolescent↗
PubMed1984

Dysplasia of the knee associated with the syndrome of thrombocytopenia and absent radius.

We studied the cases of twenty-one patients with the syndrome of thrombocytopenia and absent radius. Patients with this syndrome usually have associated intra-articular dysplasia of the knee joint bilaterally, causing genu varum and a flexion and torsional deformity that become manifest in the first or second year of life. Usually there is progression of the deformities during growth and therefore treatment with braces or operations, or both, will frequently be needed. Despite correctional osteotomy, the varus angulation and internal tibial rotation have a natural tendency to recur, possibly because of the intra-articular deformity that involves the femoral and tibial condyles. After skeletal maturity has been reached, minimum progression of the deformity has been observed.

Adolescent↗
PubMed1983

Abnormalities of the spine in relation to congenital upper limb deficiencies.

A retrospective study was performed to determine the incidence of spinal abnormalities in patients with skeletal defects of the upper extremities. The incidence of scoliosis in the patient population studied was 16%, and spinal abnormalities of all types were present in 18% of the population. Patients with bilateral amelia had a 100% incidence of scoliosis. Those patients with unilateral amelia had a 50% incidence of scoliosis. Patients with ulnar and radial hemimelias had an incidence of scoliosis of 20 and 13%, respectively. The transverse complete and partial hemimelics had an 18% incidence of scoliosis and the phocomelic group had an incidence of 11%. The patient population studied had an increased incidence of scoliosis compared with the general population. The patients with amelia had a particularly high incidence of scoliosis. There was no relationship between the side of the deficiency and the direction of the curve. The age of onset was not found to be related to the progression of the curve. The results of bracing were poor, due to patient rejection of the brace. All patients with upper limb deficiencies warrant close observation throughout growth for the development of scoliosis.

Adolescent↗
PubMed1983

The Syme amputation in patients with congenital pseudarthrosis of the tibia.

Eight patients with congenital pseudarthrosis of the tibia had a Syme amputation and were followed for an average of 5.9 years. The average age at amputation was 8.2 years, and an average of 3.8 surgical procedures were performed prior to the amputation in each patient. None of the pseudarthroses healed, but in spite of that the Syme amputation can be recommended when amputation is necessary. With a simple orthosis, the child can then engage in normal activities. The operation provides a longer stump than do conventional amputations, as well as better skin coverage and more potential for further growth of the tibia from the distal epiphysis.

Adolescent↗
PubMed1983

Arthrorisis by means of a subtalar polyethylene peg implant for correction of hindfoot pronation in children.

A modified subtalar arthrorisis is obtained by implantation of an endoprosthesis manufactured from ultrahigh molecular weight polyethylene. It is fashioned into the shape of a peg and implanted into the dorsal surface of the calcaneus just anterior to the posterior facet of the subtalar joint and fixed with polymethylmethacrylate. The purpose of the implant is to eliminate abnormal pronation, correct heel valgus, and produce an increase of the medial longitudinal arch in the growing child.

Calcaneus↗
PubMed1982

Orthopaedic management of lumbosacral agenesis. Long-term follow-up.

Twenty-two patients with lumbosacral agenesis were treated at the Shriners Hospital for Crippled Children, Chicago Unit, from 1953 to 1979. At the time of this study, ten of the patients were skeletally mature after an average follow-up of 24.1 years. Two patients had died, twelve could be examined, and eight who were unable to return for examination responded to a questionnaire. Eleven of the patients had diabetic mothers. Of the orthopaedic problems in these patients, knee-flexion contractures with popliteal webbing were the most difficult to correct. These deformities varied in severity with the level of the agenesis and the resulting loss of motor power. Other problems were dislocations and flexions contractures of the hips, scoliosis, equinovarus deformities of the foot, and instability at the spinal-pelvic junction. When there was inadequate quadriceps function it was difficult to correct knee-flexion contractures and to prevent them from recurring. For severe knee deformity, knee disarticulation and prosthetic fitting were the most effective treatment. Spinal-pelvic instability was not a problem in eighteen of the twenty surviving patients. Unreduced dislocated hips also did not cause any problems.

Abnormalities, Multiple↗
PubMed1981

Depression in children admitted to hospital for orthopaedic procedures.

One hundred children between the ages of 7 and 12 admitted to a hospital for orthopaedic procedures were studied to determine the frequency of depression, according to the DSM III diagnostic criteria for major depressive disorder. Of the total sample, 23 showed evidence of depression. Loss of interest or pleasure was the most frequent symptom. Significantly more parents of these depressed children were themselves found to have adjustment or emotional problems. The authors emphasize the importance of paying special attention to this high risk group of child patients because of their propensity to depression and other emotional disorders.

Child↗
PubMed1978

The spine in osteogenesis imperfecta.

A high incidence of spinal curvature, approaching 80 per cent in patients more than twelve years old, was found in a large series of patients with osteogenesis imperfecta. Curves showed early progression and a predictable pattern. In the age range between one and five years the incidence of scoliosis was 26 per cent; thereafter, it rose precipitously. The degree of curvature was greater in the older children. The Milwaukee brace was ineffective in the treatment of the scoliosis and the complications of its use were detrimental. In several patients it deformed the rib cage. It had little or no effect on the progression of the curve. The incidence and degree of curvature was related to the type of bone present. Patients with chest deformities and those who were not ambulatory seemed to have a predilection for scoliosis.

Bone and Bones↗