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Biomedical subjects

P D Sponseller

Publications and source records attributed to P D Sponseller.

At least 55 records · Page 3Linked to original sources
PubMed1996

A combined vertical and horizontal pelvic osteotomy approach for primary and secondary repair of bladder exstrophy.

PURPOSE: We describe a new combined horizontal and vertical pelvic osteotomy procedure for bladder exstrophy. MATERIALS AND METHODS: A total of 36 patients with the bladder exstrophy complex underwent this procedure during a 3-year period (8 primary and 18 secondary bladder closures, and 6 at bladder neck reconstruction). RESULTS: There were no instances of dehiscence and only a minor bladder prolapse in 1 patient with cloacal exstrophy. Two patients had a transient femoral nerve palsy and there was 1 superficial pin infection. Urological complications included symptomatic urinary tract infections in 5 patients, acute epididymitis in 1 and bladder calculi in 2. CONCLUSIONS: This new osteotomy procedure is of great benefit in initial or repeat closure of bladder exstrophy and may help in eventually achieving continence.

Bladder Exstrophy↗
PubMed1995

Efficacy of multimodality spinal cord monitoring during surgery for neuromuscular scoliosis.

STUDY DESIGN: This study determined the relative efficacy of somatosensory-evoked potentials and motor-evoked potentials in monitoring spinal cord function during surgery for patients with idiopathic versus neuromuscular scoliosis. OBJECTIVES: To determine whether patients with idiopathic versus neuromuscular scoliosis demonstrate significantly different somatosensory-evoked potentials and motor-evoked potentials recorded during surgery. SUMMARY OF BACKGROUND DATA: Ashkenaze et al (1993) and others have reported that cortical somatosensory-evoked potentials are unreliable when used to monitor spinal cord function in patients with neuromuscular scoliosis. It was recommended that other neurophysiologic tests be used. METHODS: Somatosensory-evoked potentials and motor-evoked potentials were recorded from two groups of patients: those with idiopathic scoliosis and those with neuromuscular scoliosis. Somatosensory-evoked potentials were obtained before and during surgery. Motor-evoked potentials were obtained during surgery. Normal variability, as indicated from idiopathic scoliotic results, was compared with data obtained from patients with neuromuscular scoliosis. Motor-evoked potentials and somatosensory-evoked potentials were obtained sequentially during the duration of surgery. RESULTS: Single-channel cortical somatosensory-evoked potentials demonstrated a 27% positive rate, which was consistent with results (28%) from Ashkenaze et al. The use of multiple recording sites for the somatosensory-evoked potentials and the addition of motor-evoked potential procedures indicated that a reliable response could be obtained in more than 96% of the patients. It also was found that cortical somatosensory-evoked potentials were more affected by anesthetic agents when recorded from patients with neuromuscular scoliosis compared with patients with idiopathic scoliosis. CONCLUSIONS: Single-channel cortical somatosensory-evoked potentials demonstrated a high level of unreliability, which reduced their clinical effectiveness. However, by using multiple recording sites with the somatosensory-evoked potentials and by administering motor-evoked potential procedures, it was possible to monitor spinal cord function in neuromuscular patients and avoid postoperative neurologic deficits.

Adolescent↗
PubMed1995

Cell proliferation of human fibroblasts and osteoblasts in osteogenesis imperfecta: influence of age.

Clinical studies indicate that as a group, osteogenesis imperfecta (OI) subjects are shorter than age- and sex-matched controls. Not only somatic growth, but also cellular growth appears to be impaired, and these may be related to defects in extracellular matrix common to this disorder. We have investigated the growth characteristics of dermal fibroblasts and trabecular osteoblasts isolated from patients with OI and control subjects of various ages. Cell growth curves and cell doubling times were determined by measuring cell number using crystal violet dye binding. Growth curves were modeled by a modified logistic function, the three parameters of which are markers for biologically relevant growth parameters: the plateau value or upper asymptote, which reflects the maximum cell density upon confluence; the maximal growth rate (microM); and the lag time. Both normal human fibroblasts and osteoblasts showed an age-dependent decrease in microM. Normal fibroblasts exhibited no age-dependence to their upper asymptote or lag time. Fibroblasts derived from patients with OI did not have significantly different upper asymptote values microM, or lag times when compared with normal fibroblasts. Normal osteoblasts had a decrease in upper asymptote, decrease in microM, but a relatively constant lag time with increasing age. In contrast, OI osteoblast microM was decreased relative to that of normal subjects. For osteoblasts from OI patients, decreased microM appeared unrelated to the age of the subject, whereas OI fibroblasts did exhibit an age-dependent decrease in microM. The percentage of collagenase-digestible protein (a measure of collagen synthesis) produced by normal human fibroblasts correlated well with microM. Treating normal human osteoblasts with the proline analogue 3,4-dehydroproline, which destabilizes collagen triple helix formation and alters collagen synthesis, secretion, and turnover, also decreased microM. A dose response to varying concentrations of 3,4-dehydroproline was observed for normal human bone cell microM. These data suggest a link between type I collagen synthesis and cellular proliferation.

Aging↗
PubMed1995

Applications of osteotomy in the cloacal exstrophy patient.

During the last 18 years we treated 22 patients with cloacal exstrophy of whom 13 were referred for further treatment after initial treatment elsewhere. One patient underwent cystectomy with ileal conduit urinary diversion soon after birth and 9 of the remaining 21 underwent initial closure without osteotomy. Of these 9 patients significant complications developed in 8 (89%) after bladder closure, including dehiscence in 6 (1 underwent 2 unsuccessful closures), a vesicocutaneous fistula and postoperative ventral hernia in 1, and bladder prolapse in 1. In contrast, complications developed in only 2 of the 12 patients (17%) who underwent osteotomy at the time of initial closure, including bladder dehiscence in 1 and significant prolapse in 1. Patients who underwent osteotomy and those who did not were similar in terms of the size of omphalocele, presence of myelomeningocele and time of primary closure. We also found that osteotomy or failed closure has no effect on the eventual continence of cloacal exstrophy patients. While osteotomy is not the only variable involved in successful cloacal exstrophy closure, our results indicate the need for osteotomy in these patients to increase the success rate at the time of initial bladder closure.

Child↗
PubMed1995

The anatomy of the pelvis in the exstrophy complex.

We compared computerized tomography scans of the pelvis of twenty-four patients who had exstrophy of the bladder with scans of age-matched controls in order to analyze the pelvic deformity that accompanies the variably severe manifestations of this condition. The patients who had classic exstrophy of the bladder were found to have a mean of 12 degrees of external rotation of the posterior aspect of the pelvis on each side, retroversion of the acetabula, a mean additional 18 degrees of external rotation and 30 per cent shortening of the pubic rami, and progressive diastasis of the symphysis pubis. The foot-progression angle demonstrated 20 to 30 degrees of external rotation beyond the normal limits seen in early childhood, but this improved with age. The patients who had exstrophy of the cloaca and the bladder not only had all of these pelvic deformities to a greater degree but also had asymmetry of measured parameters between the right and left sides of the pelvis, malformation of the sacro-iliac joints, and occasional dislocation of the hip. An understanding of the pelvic anatomy that accompanies exstrophy is essential when corrective approaches are planned. Such an understanding will improve the rate of success of both closure of the bladder and control of urinary continence postoperatively.

Adolescent↗
PubMed1995

Compartment syndrome of the foot in children.

Compartment syndrome of the foot following trauma is well known in adults but has not been discussed frequently in texts on pediatric trauma. In the current study, seven children and teenagers were identified as having had compartment syndrome of the foot during a five-year period. The average age at the time of the diagnosis was ten years (range, four to sixteen years). The cause of the compartment syndrome was a crush injury in six patients and a motor-vehicle accident in one. All patients had swelling and pain with passive motion, but none had neurovascular deficits. Only the two oldest children had an osseous injury that necessitated open reduction and internal fixation, but all had elevated compartment pressures ranging from thirty-eight to fifty-five millimeters of mercury (5.07 to 7.33 kilopascals). All seven patients had fasciotomies of the nine compartments of the foot, and the skin was closed primarily within five days after the operation. No patient had complications or needed a skin graft. All patients had a good or excellent result after an average duration of follow-up of forty-one months (range, twenty-three to fifty-three months). Orthopaedists managing children who have a traumatic injury of the foot, especially a crush injury, should have a high index of suspicion for compartment syndrome, even in the absence of severe fracture.

Adolescent↗
PubMed1995

The thoracolumbar spine in Marfan syndrome.

We analyzed the prevalence, inheritance, progression, and functional implications of spinal deformity in Marfan syndrome using four different groups of patients. We studied 113 patients who had Marfan syndrome, eighty-two of whom were skeletally immature, in order to characterize the alignment and function of the spine. The patients were selected from a clinic that provides total care with no bias toward the presence of orthopaedic conditions. Scoliosis was identified in fifty-two of the eighty-two patients, and the prevalences for the sexes were equal. The thoracic portion of the curve was convex to the right in all but two patients. The mean kyphosis was greater than that in the general population. Five distinct sagittal profiles were identified on the basis of whether the thoracic kyphosis was within, greater than, or less than normal limits and whether the transition between the kyphosis and lordosis occurred at or caudad to the normal level or whether the curves were reversed. Spondylolisthesis was present in five patients (6 per cent), with a mean slip of 30 per cent. Fourteen pedigrees were studied in depth. There was no familial pattern of the scoliosis. A separate group of fifty-six patients with scoliosis, for whom serial follow-up radiographs were available, was studied for progression. Patients who had a curve of more than 30 degrees had mild progression, and those who had a curve of more than 50 degrees had marked progression (mean, 3 +/- 4 degrees per year). Pain and function of the back were studied in thirty patients who were thirty-five to forty-five years old; these patients were found to be more impaired than matched controls. The presence of scoliosis was associated with pain in the region of the curve in these patients.

Adolescent↗
PubMed1994

Back pain in children.

This article describes a quick, straightforward examination for back pain in children. The differential diagnosis is given, along with warning signs of serious causes of back pain. Guidelines are given for handling the more common problem of nonspecific back pain and minimizing unnecessary radiographs and other tests.

Back Pain↗
PubMed1994

Hip dysplasia in spastic cerebral palsy.

Previous reports have noted a relationship between pelvic obliquity and hip dysplasia in spastic cerebral palsy but did not confirm its existence by scientific study. A study is reported that confirms the association of pelvic obliquity with hip dysplasia in spastic cerebral palsy. At presentation of subluxation or dislocation prior to surgery, 80 patients were indexed into five body alignment types. Reclassifications were performed with passage of time in order to study the natural history and effects of surgery. In all cases, hip dysplasia was found to be consistent with the forces related to pelvic obliquity.

Adolescent↗
PubMed1994

Thoracic and lumbar spine injuries in children: different than in adults.

A study of 38 patients, ages birth through 17 years, is reported that was performed to identify patterns of thoracic and lumbar spine injuries and healing in children in order to make appropriate treatment recommendations and avoid unnecessary surgery. This retrospective/prospective study, which is the largest review of children's thoracic and lumbar spine injuries in the orthopaedic literature, supports several accepted concepts regarding children's spine fractures. In addition, the periosteal sleeve fracture mimicking lumbar dislocations in small children, which has not been reported previously in the clinical setting, is described. Thoracic and lumbar spine injuries in children have distinct differences from these injuries in adults, and the treatment should take these differences into consideration.

Adolescent↗
PubMed1994

Problem elbow fractures in children.

In this article guidelines are given for the treatment of pediatric elbow fractures, including supracondylar, medial epicondylar, lateral condylar, proximal radial, and olecranon fractures. Treatment techniques are described in detail and suggestions are provided to minimize complications.

Adolescent↗
PubMed1993

Outcome of Wisconsin instrumentation in idiopathic scoliosis. Minimum 5-year follow-up.

Wisconsin segmental spinal instrumentation was developed by Drummond et al to provide rigid fixation for correction of spinal deformities without the risk of neurologic injury associated with the passage of sublaminar wires. Up to this point, there have been no outcome studies with follow-up of longer than 2 years. Thirty-five patients with adolescent idiopathic scoliosis treated by the Wisconsin procedure between 1984 and 1987 were reviewed by radiographs, physical examination, and an outcome scale. Minimum length of follow-up was 5 years with an average of 6.3 years. Curves were corrected from a mean of 59 degrees preoperatively to 32 degrees postoperatively (46%), and 36 degrees at final follow-up (39%). Wisconsin segmental spinal instrumentation did not increase thoracic kyphosis. There was evidence of slight lumbar flattening in long fusions. According to the criteria described, 92% had a successful outcome. Complications of the procedure included two wound infections (one superficial, one deep), one rod displacement, and two wire breakages. No pseudarthroses or neurologic complications were identified in this series. Wisconsin segmental spinal instrumentation safely achieves the objectives of partial correction, arthrodesis, and early return to function. The technique may still have a role, particularly in the thoracic region, in selective thoracic fusion of King type II curves, rigid curves, and double thoracic curves.

Adolescent↗
PubMed1992

Roberts/pseudothalidomide syndrome and normal intelligence: approaches to diagnosis and management.

Roberts/pseudothalidomide syndrome is a rare autosomal recessive disorder, involving growth and mental retardation, midline craniofacial abnormalities and tetraphocomelia. Cytogenetic studies have confirmed reproducible chromosomal abnormalities throughout the syndrome's wide range of clinical presentations. A family with two affected siblings is presented. One child was stillborn; the other, though severely affected by all of the physical characteristics of this disorder, has developed normally both at school and in his social-personal skills. This report supports the idea that Roberts syndrome and pseudothalidomide syndrome are the same condition, and emphasizes that normal intelligence and positive social-personal adjustment are possible, even with all of the stigmata of Roberts syndrome. Aggressive medical intervention is suggested, as well as forthright parental counselling when discussing the possible outcome for these patients.

Abnormalities, Multiple↗
PubMed1992

Peroneal nerve palsy after early cast application for femoral fractures in children.

The incidence and contributing factors associated with post-casting peroneal nerve palsy were examined in a series of 110 consecutive pediatric femoral shaft fractures treated with early hip spica cast application. Four patients with peroneal nerve palsy were identified. All four had 90 degrees/90 degrees casts placed and underwent cast wedging for alignment. All palsies resolved with immediate cast removal. Other treatment options for certain femur fractures with significant initial shortening should be considered. We advise pre- and post-cast neurologic examination and avoidance of forceful distraction. Fracture manipulation, through wedging, should be delayed.

Casts, Surgical↗