[Fractures of the neck of the talus].
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Biomedical subjects
Publications and source records attributed to L B Skogland.
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In a prospective study, 62 girls who consulted the paediatric department because of tall stature were examined for spinal deformities. Thirteen cases of scoliosis measuring 10 degrees or more were found. Eighteen girls had a thoracic kyphosis of more than 40 degrees and 11 had additional vertebral abnormalities indicating Scheuermann's disease. The incidence of scoliosis and Scheuermann's disease was much higher in our material than normal.
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The length of the thoracolumbar spine was measured on standardized X-ray films from 274 children (6 1/2--18 1/2 years) with idiopathic scoliosis and 212 controls. Where possible, the height and width (traverse diameter) of two vertebral bodies (T-6 and L-4) were also measured. Although a tendency towards longer spines in the scoliotics could be found, there was no significant difference between children with idiopathic scoliosis and controls in this respect. In girls the pubertal growth-spurt of the spine was found to start about 1 year earlier than in the controls and the growth of the spine seemed to cease later in the scoliotics. The height and width of T-6 was significantly greater in the scoliotics than in the controls for girls under 13 years of age. In the older girls and in the boys no significant difference could be demonstrated. The height of L-4 tended to be greater in the scoliotic boys and younger girls, though the differences were not statistically significant. The index height/width was calculated for T-6 and L-4 in all groups of patients and higher values could be demonstrated in the scoliotics for all test groups. The greatest height of T-6 in scoliotics might indicate a longer thoracic spine in these children. The higher values of the height/width indices suggest that the thoracolumbar spine in children with idiopathic scoliosis has an increased slenderness compared with the spine in non-scoliotic children.
Serum somatomedin A was determined by radioreceptor assay in 31 girls with idiopathic scoliosis and 30 controls, with ages ranging from 9.7-16.2 years. In the material as a whole no significant difference could be found between scoliotics and controls. Similarly no differences were found in the girls under 13 years of age. However, in girls older than 13 years the controls had significantly higher somatomedin A levels than the scoliotics. In the second part of the study 26 girls with idiopathic scoliosis and 22 controls were examined with regard to the urinary excretion of non-dialyzable hydroxyproline,. which has been suggested to be correlated with collagen synthesis. The percentage non-dialyzable fraction of the total hydroxyproline was found to be significantly higher in the control girls. The mean age was 12.8 years for both groups. The results suggest a higher growth rate in the controls than in the scoliotics for girls over 12 years. There is, however, no definite evidence as to the function of the somatomedins or of the relationship between non-dialyzable hydroxyproline and growth.
In a total of 95 children with idiopathic scoliosis and 60 controls between the ages of 7 and 17 years, a prospective study of hormones related to growth and maturation was carried out. The pituitary release mechanism for growth hormone was evaluated using the propanolol/L-dopa stimulation test. In addition the blood levels of testosterone, sex hormone binding globulin, oestradiol, thyroxin, prolactin, cortisol, follicle stimulating hormone and luteinizing hormone were determined. The girls were divided into age groups and all results were evaluated according to chronological and skeletal age. The number of boys was too small (25) to allow subdivision into age groups. The girls with idiopathic scoliosis had a significantly higher response to the growth hormone stimulation test than had the controls between the ages of 7 and 12 years whereas no significant difference could be found for the older girls. In girls with a skeletal age between 9 and 12 years a significantly higher mean serum level of testosterone was found (P less than 0.05). No significant differences could be demonstrated for the remaining hormones. Growth hormone and testosterone are the most important growth factors in prepubertal and pubertal children. Thus, the present findings suggest a hormonal basis for the increased stature in children with idiopathic scoliosis which has previously been reported.
Five cases of congenital contractural arachnodactyly (CCA) are reported. Three belong to the one family. CCA has often been mistaken for Marfan's disease and arthrogrypois multiplex. Because CCA has a more favourable prognosis, it is very important to be able to recognize this syndrome.
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