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Biomedical subjects

R L LaMont

Publications and source records attributed to R L LaMont.

16 recordsLinked to original sources
PubMed1991

Spinal cord monitoring in patients with nonidiopathic spinal deformities using somatosensory evoked potentials.

Seventy-nine somatosensory evoked potentials were intraoperatively recorded in 52 patients undergoing spinal surgery for nonidiopathic spinal deformities. There were 37 true-negative, 28 true-positive (a significant change in the somatosensory evoked potential related to the surgical process), and 14 false-positive (a significant change in the somatosensory evoked potential not related to a surgical event) readings. There were, however, no postoperative neurologic deficits with any of the true-positive readings and no false negatives. Spinal and subcortical somatosensory evoked potentials gave few false-positive readings. True-positive somatosensory evoked potentials occurred in 44% of the patients with neuromuscular deformities, 17% with congenital deformities, 45% with Luque instrumentation, 22% with Harrington instrumentation, and none with fusion in situ. Fifty percent of the true positives occurred while the sublaminar wires were tightened. The predictive accuracy of intraoperative spinal cord monitoring in this patient population is not high, but the sensitivity to potentially harmful surgical events is high.

Child↗
PubMed1990

Posterior spinal fusion: allograft versus autograft bone.

The effectiveness of allograft bone for posterior spinal fusion in neuromuscular scoliosis is controversial. Thirty patients with cerebral palsy, treated with posterior spinal fusion, were divided into two groups. Group 1 consisted of 18 patients treated by posterior spinal fusion using autogenous bone graft. Group 2 consisted of 12 patients treated by posterior spinal fusion using freeze-dried allograft bone. The average preoperative curve of 70 degrees in Group 1 was corrected to 35 degrees (50% correction). At 3.2 years average follow-up, the curves averaged 51 degrees (46% loss of correction). The average preoperative curve of 80 degrees in Group 2 was corrected to 39 degrees (51% correction). At 3.5 years average follow-up, the curves averaged 54 degrees (38% loss of correction). Anesthesia time decreased from 344 to 281 minutes (p less than 0.05), and intraoperative blood loss decreased from 2730 to 1740 ml (p less than 0.025) when allograft bone was used as a substitute for autograft bone. Freeze-dried allograft bone is a readily available, safe, and effective substitute for autogenous bone graft in patients with cerebral palsy undergoing posterior spinal fusion.

Adolescent↗
PubMed1989

Resolving solitary osteochondromas. A report of two cases and literature review.

Resolving osteochondromas were previously thought to be uncommon. Two cases are presented, including the first report of a resolving solitary osteochondroma of the proximal tibia. These cases, along with previous reports, suggest resolution may occur, especially in boys under age 12 years. Surgical excision should be delayed in this group of patients provided malignant transformation or neurovascular compromise is not a concern.

Bone Neoplasms↗
PubMed1983

Spinal cord monitoring during spinal surgery using somatosensory spinal evoked potentials.

Intraoperative monitoring of spinal cord function has been carried out in 59 patients during spinal instrumentation for scoliosis. Posterior tibial nerve stimulation in the popliteal space was performed and spinal evoked potentials from electrodes in the spinous processes observed. A rod artifact problem causing partial obliteration of the wave form can be minimized or eliminated by careful selection of the insertion of the fixation device. A drop in amplitude of the signal occurred in many of the tracings from control to distraction observations but did not result in neurologic deficit. One patient had a loss of the signal after maximum distraction with a Harrington rod and a return with release of distraction. This patient awoke with paralytic urinary bladder retention which resolved spontaneously but no other neurologic deficit. This method has been used for monitoring of spinal cord function during Harrington rod instrumentation, using both compression and distraction systems as well as Luque rod instrumentation. This method is safe, simple, and provides consistent and predictable wave forms; it appears to be reliable in indicating continuation of spinal cord function during the procedure.

Adolescent↗
PubMed1983

Osteomyelitis of the pelvis in children.

We reviewed the records of sixteen patients with osteomyelitis of the pelvis, all of whom were fifteen years old or younger. Eleven of the patients were followed for an average of 3.5 years (range, two to nine years). Pelvic osteomyelitis in children is an uncommon lesion. Review of the literature gives the impression that this lesion is usually diagnosed late in its course and requires surgical drainage for adequate treatment. The role of the technetium bone scan in making an early diagnosis is important. All of the patients in this series were treated with antibiotic therapy alone, and surgical drainage was not found to be necessary. All of the patients who were followed for at least two years had no recurrence and no permanent sequelae.

Adolescent↗
PubMed1982

Skeletal changes associated with copper deficiency.

Copper deficiency has been described in premature infants on hyperalimentation. The bony abnormalities are generalized and are usually associated with anemia and neutropenia. These changes present with normal serum levels of iron, ascorbic acid, calcium, phosphorus, and magnesium, as well as with depressed levels of copper and ceruloplasmin. They appear at about three to nine months of age in infants with a low birth weight who are receiving total parenteral nutrition, but can be prevented by greater than normal maintenance levels of copper supplements. Established bone changes improve rapidly after the administration of therapeutic supplements.

Copper↗
PubMed1981

Quantitative assessment of femoral head involvement in Legg-Calvé-Perthes disease.

We have developed a method for determining the extent of avascularity of the capital femoral epiphysis in suspected Legg-Calvé-Perthes disease. The avascularity is expressed quantitatively as a percentage of the normal uptake of a radionuclide in the vicinity of the involved hip. In twenty-seven patients who had radionuclide scintigraphy this method was reliable in establishing an early diagnosis of Legg-Calvé-Perthes disease as well as in assessing the amount of involvement of the femoral head. In some patients the diagnosis can be established by radionuclide scintigraphy before the changes of Legg-Calvé-Perthes disease are apparent on standard radiographs.

Child↗
PubMedDate not supplied

Deep, late infections associated with internal fixation in children.

Deep, late infection associated with internal fixation is well known in adults, but has not been previously reported in children. We report here six cases of deep, late infection in children associated with internal fixation of the proximal femur. All patients had cerebral palsy and had undergone a proximal femoral osteotomy for hip subluxation or dislocation. The patients presented with infection between 7 and 24 months after a period of total recovery. The clinical presentation was variable, although many patients had increasing hip pain. Radiographs showed radiolucency around the lag screw. The bacteriologic finding was usually Staphylococcus aureus, and patients responded to wound debridement, hardware removal, and intravenous antibiotics. In light of these cases of deep, late infection, we strongly urge routine removal of metallic implants as soon as bony healing will allow.

Bone Plates↗
PubMedDate not supplied

Acute hematogenous osteomyelitis in children.

Sixty-nine children with acute hematogenous osteomyelitis were studied retrospectively. All were treated with antibiotics, and eight underwent fenestration osteotomies. In the operatively treated group, three poor results occurred. In a more recent prospective study of 44 patients, drainage was undertaken only when pus was aspirated. All results were good or excellent. We recommend operative drainage only when a demonstrated abscess is found by aspiration.

Anti-Bacterial Agents↗
PubMedDate not supplied

Spondylolisthesis in myelomeningocele.

Radiographic spinal evaluations were done on 305 patients with myelodysplasia. Asymptomatic spondylolisthesis, which averaged 37.1% translation, was seen in 5.9% of the patients. The prevalence of spondylolisthesis increased to 15.6% of patients with L5-S1 motor levels. Patients with myelodysplasia do develop spondylolisthesis. Increased lumbar lordosis and concomitant diminished thoracic kyphosis were commonly seen in the patients with spondylolisthesis.

Adolescent↗
PubMedDate not supplied

Acute hemarthrosis of the knee in children.

The purpose of this study was to determine the cause of acute hemarthrosis of the knee in a prospective pediatric patient population. Between December 1988 and August 1991, 21 consecutive children who were seen with an acute traumatic hemarthrosis of the knee had an arthroscopic evaluation. The average age of the children at the time of injury was 14 years, 3 months (range, 10 to 17 years). The mechanism of injury was a torsional strain to the knee in 12 (71%) of the 17 patients who could accurately remember the injury. The initial evaluation included a history, physical examination, and anteroposterior, lateral, sunrise, and comparison radiographs. The arthroscopic procedure was performed under general anesthesia, and the arthroscopic findings were compared with preoperative findings. During arthroscopic examination, an osteochondral fracture of the lateral femoral condyle or patella was identified in 14 (67%) of the 21 patients. Preoperative radiographs failed to identify the fracture in 5 (36%) of the 14 patients who had an osteochondral fracture. The anterior cruciate ligament was visualized and probed; an injury was found in only two cases (10%). We concluded that in children an acute traumatic hemarthrosis reflects a major injury to the knee. The children in this study had a high frequency of osteochondral fractures; ACL injuries were found in only two patients. Because of the unreliable nature of radiographic evaluation, arthroscopic evaluation is a valuable tool in differential diagnosis and treatment of acute hemarthrosis of the knee.

Acute Disease↗
PubMedDate not supplied

Comparison of disk excision and combined disk excision and spinal fusion for lumbar disk ruptures.

In a series of private patients 77 per cent over-all satisfactory results were obtained from surgical disk excision performed without spinal fusion. Patients in whom spinal fusion combined with discectomy has been recommended by other authors are not much more satisfied than patients with discectomy alone without fusion (81% versus 74% satisfactory). Patients in whom the third party influence prevails were significantly more dissatisfied (only 59% satisfactory). Findings of a definite disk rupture at the time of surgery result in a higher incidence of satisfactory rating than those with degenerative changes or with normal findings.

Adolescent↗