Avascular necrosis of the talus after a minimally displaced neck of talus fracture in a 6 year old child.
Explore the source record for details and available documents.
Child↗
Biomedical subjects
F E Dowling
Publications and source records attributed to F E Dowling.
Left thoracic curve patterns and their association with disease.
STUDY DESIGN: Analysis of clinical database material collected prospectively. OBJECTIVE: Examination of the association between lateralization of scoliotic curves and the existence of underlying disease. SUMMARY OF BACKGROUND DATA: It has been suggested that left thoracic scoliosis configurations are intrinsically pathologic, whereas the more usual right curve is, in a sense, "normal." METHODS: Research-based records were analyzed. Scoliosis configuration, patient gender, and diagnostic group were correlated. The results were interpreted within a biologic framework. RESULTS: Congenital and infantile idiopathic scoliosis showed a random right-left curve distribution. In older age groups, boys were more likely to have a left thoracic curve and to have underlying disease, but there was no association between the two. In girls, occurrence in childhood itself and left thoracic patterns within that group were associated with disease. Nevertheless, most curves were in the right thoracic pattern, regardless of cause. CONCLUSIONS: Although an association exists between left thoracic curves and disease, it is not strong enough to determine who should be intensively investigated, to the exclusion of other clinical findings, and it seems inappropriate for a different approach to be adopted on the basis of scoliosis pattern alone. Gender in males and age at occurrence in females are more important risk factors than in scoliosis configuration. All new cases of scoliosis treated by a physician warrant equally meticulous assessment, with more sophisticated investigative techniques where indicated by the complete clinical picture, of which curve lateralization is only a part. Biologic theories of left and right are more capable of dealing with the phenomenon of scoliosis lateralization than are simple mechanics or concepts of specific diseases.
Adolescent↗
Spontaneous regression of tumoral calcinosis in an infant: a case report.
A case of tumoral calcinosis presenting as a supraclavicular mass in an infant is reported. After confirmation by incisional biopsy, the lesion spontaneously resolved without further surgical or medical treatment. This phenomenon has not been described previously in a child with this condition.
Biopsy↗
Correction of soft tissue contractures of the wrist using the Ilizarov technique.
The Ilizarov technique can allow new histiogenesis of soft tissue as well as bone. Three cases of wrist contracture successfully treated by this method are described. One patient had transient superficial pin site infections. There were no other complications. At 2 years follow-up there was no recurrence of contractures.
Adolescent↗
Scoliosis and developmental theory: adolescent idiopathic scoliosis.
STUDY DESIGN: Statistical analysis of maturity and asymmetry criteria in adolescent idiopathic scoliosis. OBJECTIVES: To explore the hypothesis that scoliosis is a manifestation of developmental destabilization under physiologic stress. BACKGROUND: Advances in genetics and theoretical biology have broadened the understanding of morphogenesis and the controlling mechanisms for the development of the adult form. The morphologic genome can be viewed as a cybernetic control system, and the homeobox genes can be viewed as the master controls for the specific subroutines. Deformity will occur from a faulty "program" or a disturbance in the running of that program. An early and subtle indication of such an occurrence is failure of bilateral symmetry. METHODS: An analysis of variance in Cobb angle, age at diagnosis, and apical site in 327 girls with spinal curves 5 degrees or greater according to prospectively maintained scoliosis screening records was performed. Dermatoglyphics were compared in 114 female control individuals and 164 female patients with adolescent idiopathic scoliosis (minimum Cobb angle, 10 degrees), and then by subdivision into school screening (n = 86) and general clinic referrals (n = 78). RESULTS: Girls from the screening program (from the years 1979-1990) had statistically significant associations between age and apical vertebra, suggesting an age-deformity relationship independent of maturation and growth spurt. Girls with adolescent idiopathic scoliosis from a later cohort, both screened and unscreened, had increased directional asymmetry, as previously reported. There was a statistically significant increase in fluctuating asymmetry in general clinic referrals when compared with school screening referrals. CONCLUSIONS: Developmental instability can explain adolescent idiopathic scoliosis as part of wider developmental theory without the necessity of a disease process in the etiology. The differences between screening and general clinic referrals suggest the need for natural history studies, and treatment protocols also should consider the provenance of the individuals described.
Adolescent↗
Fluctuating asymmetry and vertebral malformation. A study of palmar dermatoglyphics in congenital spinal deformities.
STUDY DESIGN: Prints of palmar dermatoglyphics (epidermal ridges) of individuals with congenital vertebral anomaly were compared, using symmetry criteria, with those of healthy control individuals. Asymmetries have been reported in adolescent idiopathic scoliosis and, from other centers, in other congenital anomalies, such as cleft lip and palate. Application of these methods to congenital vertebral anomaly seemed promising. OBJECTIVES: To challenge the hypothesis that, in congenital vertebral anomaly, epigenesis was disrupted by nonspecific physiologic stress during the embryonic period, resulting in anatomic malformations. SUMMARY OF BACKGROUND DATA: Dermatoglyphics (palmar epidermal ridges) are formed at the end of the embryonic period under genetic control and do not change thereafter. They thus give an indication of the stability or otherwise of development at that early stage. This led to the hypothesis that congenital vertebral anomaly results from destabilization of genetic developmental control in the embryonic period. METHODS: The dermatoglyphics of 126 healthy control individuals and 99 people with congenital vertebral anomaly were compared quantitatively, using right-left differences of atd angles and ab, bc, and cd ridge counts. RESULTS: Fluctuating asymmetry (a significantly increased variance about the mean) was observed in individuals with congenital vertebral anomaly. This is a measure of instability of genetic development processes and the increased probability that these processes will be destabilized by environmental stress during ontogeny. They also showed an increased incidence of ridge dissociation, suggestive of a generalized insult during the embryonic period. CONCLUSIONS: These findings suggest that congenital vertebral anomalies arise from a nonspecific insult during the embryonic period that destabilizes the developmental control systems and may result in congenital malformations of any organ undergoing concurrent epigenesis.
Child↗
Adolescent idiopathic scoliosis and cerebral asymmetry. An examination of a nonspinal perceptual system.
STUDY DESIGN: This study analyzed the asymmetry of a nonspinal sensory system, comparing healthy children and those with adolescent idiopathic scoliosis. OBJECTIVES: To test the hypothesis that differences in neurologic functioning that have been observed in idiopathic scoliosis are confined to motor organization and that the etiology thus is a defect solely of the motor cortex. SUMMARY OF BACKGROUND DATA: Recent reports associating scoliosis convexity with equilibrium control, central processing, handedness, and motor lateralization have suggested that idiopathic scoliosis is connected causally with the motor cortex. METHODS: Dichotic listening tests were performed on 20 healthy children and 31 children with adolescent idiopathic scoliosis. This tests perceptual asymmetry, and thus the organization of cognitive processing in the brain, a higher function that is not associated with posture or motor function. RESULTS: Subjects with scoliosis were significantly more lateralized for linguistic processing than the control group, indicating they had a greater degree of left-right asymmetry throughout their cortical organization. CONCLUSION: In adolescent idiopathic scoliosis, the organization of the entire brain was more strongly lateralized than in subjects without scoliosis. It is unlikely that this caused or was caused by the spinal curvature. Subjects with adolescent idiopathic scoliosis showed generalized asymmetry of many functions and structures. An examination at the level of morphology and development is proposed.
Adolescent↗
School scoliosis screening and the United States Preventive Services Task Force. An examination of long-term results.
STUDY DESIGN: Analysis of scoliosis screening in Dublin (1979-1990) of patients who passed significant levels (25 degrees and 40 degrees) and received orthotic treatment or surgery. OBJECTIVES: To reexamine the basis of school scoliosis screening. SUMMARY OF BACKGROUND DATA: The United States Preventive Services Task Force questioned the validity of school screening for adolescent idiopathic scoliosis because there is insufficient scientific evidence to justify it. METHODS: New entrants (1986-87) to the screening program were used to test the validity of the screening methods. The total screened population, proportions reaching significant Cobb angles or undergoing treatment, were compared across the time period. RESULTS: The sensitivity of the forward bend test in detecting or predicting 40 degrees scoliosis was 0.83, the specificity was 0.99, and the predictive value was 0.08. The proportion prescribed braces declined significantly (P < 0.01), but there was no significant change in those with scoliosis greater than 24 degrees (0.18%) or 39 degrees (.08%) nor was there a significant change in the numbers needing surgery (.045%). CONCLUSIONS: The incidence of significant scoliosis and of surgery is low and independent of changes in bracing policy. The validity of screening to cause significant change in prevalence must be challenged.
Adolescent↗
Adolescent idiopathic scoliosis as developmental instability.
Adolescent idiopathic scoliosis is the most common spinal deformity affecting children, with a prevalence from mass screening programmes of 1-3%. Despite centuries of study, it remains a problem with no generally accepted theory of aetiology, and disagreement on its natural history and management. Because the deformity consists ultimately of gross left-right asymmetry, a study was undertaken to test the hypothesis that it might be a manifestation of developmental instability. Palmar dermatoglyphics in 112 normal subjects, 62 with non-scoliosis trunk asymmetry and 85 with defined adolescent idiopathic scoliosis were examined and both the absolute right-left difference and the ratio of this to the total were considered. There was increased fluctuating asymmetry of atd difference in those with any asymmetry, scoliotic or not, and increased directional asymmetry of ab and cd ridge counts only in those with pure scoliosis. This suggests that, at adolescence, developmental instability may result in a loss of symmetry in growth, and that in the presence of an increased developmental left-right gradient, this may be of sufficient severity to be classified as deformity and come to the attention of orthopaedic surgeons. This interpretation changes the focus of many previous observations on scoliosis and raises the prospect that developmental stability in humans has relevance to problems hitherto restricted to clinical practice.
Adolescent↗
Left thoracic scoliosis configurations. Why so different?
STUDY DESIGN: Patients in the scoliosis screening database were analyzed with respect to curve convexity, severity, and outcome, using standard statistical methods. OBJECTIVES: This study assessed whether left thoracic scoliosis is always pathologic and inquired why this is the case. SUMMARY OF BACKGROUND DATA: Left thoracic scoliosis is more significant than the usual right thoracic pattern, but evidence in the literature is circumstantial. METHODS: Prospectively collected data from 1979-1990 was analyzed in the natural history database of the school screening program. RESULTS: Right thoracic pattern was observed in 421 girls, and left thoracic pattern was present in 125 girls. The minimum age at diagnosis was 10 years and the Cobb angle was > 4 degrees. Primary left thoracic patterns were statistically smaller and less progressive. CONCLUSIONS: The left pattern of scoliosis in the absence of overt neuropathology carries a benign prognosis. This contradictory observation is examined in the light of biological asymmetry.
Adolescent↗
A statistical comparison between natural history of idiopathic scoliosis and brace treatment in skeletally immature adolescent girls.
Thirty-two adolescent girls braced for late onset idiopathic scoliosis at Children's Hospital, Boston were compared with thirty-two untreated girls from Our Lady's Hospital for Sick Children, Dublin, Ireland paired on the basis of curve size and site and age at diagnosis. All were Risser 0 at diagnosis. Study period for the braced group was from brace initiation to part-time brace wearing and, for the controls, from diagnosis to last review. There was no statistically significant difference between the groups on any parameter of curve progression. This study raises questions about the efficacy of spinal orthoses in modifying the natural history of late-onset idiopathic scoliosis and removes the ethical problems inherent in a prospective trial in which the only treatment permitted to the control group is surgery.
Adolescent↗
Adolescent idiopathic scoliosis--early menarche, normal growth.
Growth has long been known to be relevant to the development and prognosis of spinal deformity and abnormalities have been considered in the etiology of idiopathic scoliosis. Age at menarche, as an indicator of puberty, in 303 girls with idiopathic scoliosis 10 degrees or more from the Dublin school screening program was 13.13 years, 0.39 years earlier than the national mean for Irish girls. This difference is statistically significant (P < 0.01). The heights of 214 of these girls aged 10-15.5 years at diagnosis and at least 14 years at follow-up, after a minimum 6 months, were compared with the national standards. It was found that, although those diagnosed at a younger age were generally taller than their peers, this was not true for those diagnosed at a later age or for anyone at final follow-up. This points to an early pubertal growth spurt in girls with adolescent idiopathic scoliosis but not to any outright abnormality of growth or development.
Adolescent↗
Fracture of the scaphoid associated with volar displacement of a lower radial epiphyseal fracture. Case report.
A 13-year-old boy fell off his bicycle and landed on his outstretched left hand, sustaining a Salter-Harris type II fracture of the lower radial epiphysis with volar displacement, and an undisplaced fracture across the waist of the left scaphoid. After manipulation, and immobilisation for six weeks, he made a complete recovery and has no residual deformity. We hypothesise that the fracture was caused by the weight of the body being taken by the relatively stiff and immobile hand, and could find no report of a similar case.
Accidental Falls↗
Pancreatitis after alar-transverse fusion for spondylolisthesis. A case report.
Acute pancreatitis complicated the postoperative care of a 16-year-old girl treated by alar-transverse fusion for spondylolisthesis. Pancreatitis was diagnosed by a marked increase in plasma amylase in conjunction with abdominal ultrasonography. Symptoms resolved with conservative treatment. Pancreatitis should be suspected when unusual abdominal symptoms persist after spinal surgery.
Acute Disease↗
Pigmented villonodular synovitis arising from the sheath of the extensor hallucis longus in an eight-month-old infant.
Pigmented villonodular synovitis (PVS) is a disease of unknown origin that most commonly affects the synovial joints and synovial sheaths of the skeletally mature. In an eight-month-old infant, a leg swelling thought likely to be a sarcoma proved to be PVS on biopsy.
Diagnosis, Differential↗
Idiopathic scoliosis and asymmetry of form and function.
This report investigates dimensions of hand and foot preference in 159 girls with idiopathic scoliosis diagnosed after the age of 8 years, 1,522 girls with clinically straight spines, and 132 with minor truncal asymmetry. It was found that, although there was no significant difference in hand or foot preference for individual items between scoliotic groups and controls, there was a statistically significant tendency for children with any degree of asymmetry to show uniform lateralization in the sense of consistency of side preference. Another, smaller group showed a tendency for scoliosis to be associated with clearly visible facial asymmetry, which itself correlated with handedness. It was concluded that theories of scoliosis need to include the frequently ignored minor observations, such as the well-known fact of lateralization of the curve, if they are to describe the condition completely. Because the asymmetry of cerebral lateralization is known to be genetically determined and because it is thought to result in other skeletal asymmetries, such as skull and limb inequality, it seemed reasonable to investigate the primary cause of that gross asymmetry, idiopathic scoliosis.
Adolescent↗
Handedness and scoliosis convexity: a reappraisal.
The handedness of 254 girls with idiopathic scoliosis, minimum age eight years at diagnosis, attending Our Lady's Hospital was related to their scoliosis convexity. Curve patterns were assigned to right or left on the basis of the convexity of the low thoracic component only, regardless of primary curve. The curve pattern matched handedness in 82%. Of 228 right-handed children, 197 had a right convex curve pattern; of 26 left-handed children, 12 had a left convex pattern. The correlation between scoliosis configuration and handedness was statistically significant. This is in contrast to the findings of previous studies, which have considered convexity only, without reference to the configuration of the whole spine. The implication of this finding is that scoliosis is associated with cortical functions.
Child↗
Equilibrial dysfunction in scoliosis--cause or effect?
To determine whether equilibrial dysfunction is the cause or effect of idiopathic scoliosis, patients with idiopathic scoliosis, congenital scoliosis, and comparable controls were tested, using clinical postural tests and electronystagmographic recording of spontaneous and positional nystagmus, smooth visual pursuit, and rotation-induced nystagmus. The scoliosis patients were stratified as progressive or nonprogressive. Dysfunctional responses occurred in the idiopathic progressive and congenital progressive groups, and in two idiopathic non-progressive patients whose curves subsequently deteriorated. These results suggest that equilibrial dysfunction is characteristic of patients with progressive curves, regardless of etiology, implying that it is secondary to the curve rather than a primary event. Seven patients with progressive curves undergoing surgical correction and stabilization were tested preoperatively and 6 months postoperatively. No change in the responses occurred, suggesting the dysfunction persists at least 6 months following arrest of progression.
Adolescent↗