Informed consent.
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Diagnostic Tests, Routine↗
Biomedical subjects
H R Cowell
Publications and source records attributed to H R Cowell.
A sense of history.
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Education, Medical, Graduate↗
Charcot-Marie-Tooth disease and schizophrenia in identical twins.
Charcot-Marie-Tooth disease and schizophrenia occurred in monozygotic twins. Dermatoglyphics and blood grouping determined monozygocity. Charcot-Marie-Tooth disease appeared to be an autosomal dominant trait transmitted from the mother. No definite evidence of inheritance was seen for schizophrenia.
Adult↗
Lower extremity fractures simulating infection in myelomeningocele.
Thirteen patients with myelomeningocele sustained 33 fractures of the lower extremity. Fourteen fractures were accompanied by increased local heat, swelling, redness and a systemic response, including an elevated temperature and leukocyte count. Diagnosis of these fractures, which occur without a significant history of trauma, requires special roentgenographic studies. If routine films fail to reveal a fracture in a swollen red extremity in patients with myelomeningocele, stress films should be obtained in the area of the major swelling or where clinical pseudo-motion is suspected. The proper treatment of these fractures and the associated elevated temperature is immobilization. When these injuries are immobilized, the leukocyte count and temperature quickly return to normal.
Adolescent↗
A survey of Down Syndrome at the Hospital for the Mentally Retarded, Georgetown, Delaware.
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Delaware↗
Cytogenetic abnormalities in orthopedic patients.
Patients with orthopedic problems may also have chromosomal abnormalities. Individuals who present with subtle clinical findings suggestive of a known syndrome resulting from a chromosomal abnormality, such as Klinefelter syndrome, Turner syndrome, or any of the known trisomiers, should be investigated further in order to confirm the diagnosis. In addition, those patients who have multiple congenital abnormalities in several systems should also have chromosome analysis. This should be done not only to gain new information in regard to chromosome abnormalities, but also to establish a diagnosis for the individual and thus provide proper genetic counseling for the family. If the clinical picture strongly suggests a chromosomal abnormality, and routine karyotyping does not demonstrate one, it is imperative that one or more banding techniques be utilized before a chromosomal abnormality can be ruled out.
Abnormalities, Multiple↗
Shoes and shoe corrections.
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Bone Diseases↗
Minibike and motorcycle accidents in adolescents. A new epidemic.
Twenty-one adolescents, ranging in age from 9 to 16 years, sustained accidental injuries while operating a minibike, motorcycle, or go-cart. Their injuries ranged from lacerations and contusions to paraplegia and amputation. This study suggests that this new pattern of injury is reaching epidemic levels in this age group.
Accidents, Traffic↗
Genetic aspects of orthopedic conditions.
Genetic conditions seen by orthopedists may be divided into Mendelian disorders, chromosome abnormalities and multifactorial conditions. Mendelian disorders involve the abnormality of a single gene and obey the rules of Mendelian inheritance. Chromosome abnormalities are caused by the absence or duplication of a sufficient number of genes to allow this abnormality to be detected by chromosome studies. Chromosome studies are used to confirm the diagnosis of well described syndromes of deletion or trisomy. These studies are also necessary to determine whether mongolism has been caused by non-disjunction or translocation, so that proper genetic counseling can be carried out in these conditions. Multifactorial conditions are determined by several genes or more commonly, by a combination of genetic and environmental factors. These conditions recur in families in a greater incidence than one would expect in the general population but do not obey the rules of Mendelian inheritance. Genetic counseling cannot be performed without an absolute diagnosis, an absolute knowledge of the patterns of inheritance and a well documented family pedigree. The basic principles of genetics covered in this article should allow the orthopedist to understand when genetic counseling is indicated for his patients.
Bone Diseases↗
Polyurethane foam in postoperative casts.
One-half inch thick polyurethane foam is recommended for use in postoperative casts to avoid complications seen with postoperative swelling. The polyurethane is placed over the operative area, over the dorsum of the foot, and the anterior surface of the leg. The use of polyurethane foam in the postoperative cast not only avoids the necessity of having to split the cast in many instances but the foam also constitutes a compression dressing. If splitting of the postoperative cast should become necessary, the foam protects the skin.
Casts, Surgical↗
The incidence of spina bifida occulta in idiopathic scoliosis.
A review of the roentgenograms of the spine of 100 patients with idiopathic scoliosis and 371 parents and siblings used as controls, showed an incidence of spina bifida occulta of 34 per cent and 41 per cent in their siblings. There was no increase in the incidence of spina bifida occulta in the patients with idiopathic scoliosis as compared with the control group. A review of the parents of these patients showed an incidence of spina bifida occulta of the lumbosacral area of 9 per cent in the mothers, and 13 per cent in the fathers, thus showing a decrease in the incidence of spina bifida occulta in the adult as compared with the teenager. The studies in the adult confirm the finding in the teenagers. There is no increased incidence of spina bifida occulta in idiopathic scoliosis.
Adolescent↗
Rigid flatfoot.
The proper management of the rigid flat-foot requires an accurate diagnosis since the condition is treated on causal or rational basis. Calcaneonavicular coalition best seen on an oblique view of the foot may be treated by resection of the coalition with extensor digitorum brevis interposition. If the diagnosis is made sufficiently early, the resection can lead to an essentially normal foot. Coalition between the talus and the calcaneus may occur in the posterior, middle or anterior facet. The most common coalitions are seen in the middle facet area followed by those in the anterior facet with the posterior facet coalition rarely being seen. Coalitions in the area of the middle facet are usually managed nonoperatively; triple arthrodesis is used only if symptoms are not relieved by nonoperative measures. Resection of a talocalcaneal coalition in the middle facet is rarely indicated but occasionally will give relief when the coalition either presses on the medial plantar nerve or causes a mechanical disturbance of the ankle. Anterior facet coalitions should receive a trial of cast immobilization but frequently require triple arthrodesis. Other conditions such as rheumatoid and post-traumatic arthritis will frequently respond to a period of immobilization in a plaster cast. Triple arthrodesis has not been required in rheumatoid arthritis in the author's series but occasionally is necessary in the post-traumatic rigid flatfoot. Other rare causes of the rigid flatfoot should be kept in mind for a complete diagnostic evaluation since even a neoplasm (fibrosarcoma) has been reported to cause this symptom complex.
Arthrodesis↗