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Biomedical subjects

R N Hensinger

Publications and source records attributed to R N Hensinger.

At least 55 records · Page 3Linked to original sources
PubMed1986

Limp.

Limping is never normal, and few parents tolerate the problem long before seeking medical consultation. However, the conditions that may produce a limp are legion and run the gamut from a stone in the shoe to the first manifestation of malignant neoplasm or chronic renal disease. As a consequence, one must have an orderly approach to diagnosis. Many of the problems that cause the child to limp are presented, but this article is concerned with an overview of the problem, differential diagnosis, and suggested steps in evaluating the child who limps.

Child↗
PubMed1986

Orthopedic problems of the shoulder and neck.

If one excludes trauma, problems of the neck and shoulder in children are relatively uncommon. Still, the pediatrician or family practitioner should have sufficient familiarity to provide the family with appropriate counseling and referral. This article emphasizes the common problems, but also notes less common conditions that, if unrecognized, may have serious impact on the health and well-being of the child.

Axis, Cervical Vertebra↗
PubMed1986

The influence of trimethaphan (Arfonad)-induced hypotension with and without spine distraction on canine spinal cord blood flow.

Controlled hypotension is used in scoliosis surgery to reduce the need for transfusion and to improve operating conditions, but there is concern that deliberate hypotension may decrease spinal cord blood flow (SCBF) and predispose the spinal cord to injury, particularly when it is distracted during Harrington instrumentation. To study the effect of deliberate hypotension on SCBF, the mean arterial pressure (MAP) was reduced to 50% of its normotensive value with trimethaphan (Arfonad) in dogs and the SCBF measured using the hydrogen washout technique with and without spine distraction. The SCBF was significantly reduced to half its normotensive value of 23.2 ml/min/100 gm to 11.4 ml/min/100 gm after hypotension was established. The SCBF remained significantly decreased compared with controls when measured at 30, 45, and 60 minutes following the induction of hypotension and also when hypotension was terminated. SCBF was not further reduced when 2 cm of spine distraction was added. These results show that induction of hypotension with trimethaphan is associated with a similar decrease in SCBF, which is maintained as long as the drug is used and that this effect continues after the drug is terminated and the MAP increases. Cautiously extrapolating these findings clinically would suggest that trimethaphan may not be the drug of choice for controlled hypotension during scoliosis surgery, despite its apparently favorable hemodynamic and hormonal responses.

Animals↗
PubMed1986

Intervertebral disc impingement syndrome in a child. Report of a case and suggested pathology.

Nerve root impingement syndrome is rare in children and adolescents. The symptomatology of the pediatric group sometimes differs from that of the adult. An accurate diagnosis is often delayed because of concerns for neoplasm, infection, and spondylolisthesis. A case report of an 11-year-old boy with symptoms and myelographic findings consistent with a herniated disc is presented. A review of the literature disclosed only four cases of herniated disc in children under the age of 12 years. Our case represents one of the youngest patients with documented intervertebral disc impingement syndrome. Rather than a herniation due to degenerative changes in the annulus, a slipping of the entire disc, and vertebral end-plate (a "slipped vertebral apophysis") may precipitate a central disc impingement in children and adolescents. This has been reported in cases of trauma previously. However, the authors think that this slipped vertebral apophysis may, in fact, represent a large number of the so-called herniated discs in adolescents. It is also suggested that this may be an identifiable syndrome with a susceptible age range, activity level and body habitus.

Child↗
PubMed1986

Changes in the cervical spine in juvenile rheumatoid arthritis.

One hundred and twenty-one patients with juvenile rheumatoid arthritis were studied clinically and roentgenographically for evidence of disease of the cervical spine. None of the fifty-seven patients with pauciarticular-onset juvenile rheumatoid arthritis had cervical symptoms or signs, and only one had minor roentgenographic changes of disease in the cervical spine. In contrast, clinical stiffness and roentgenographic changes in the cervical spine occurred commonly in the fifty-one patients with polyarticular-onset disease and in the thirteen patients with systemic-onset disease. Despite extensive roentgenographic involvement of the cervical spine, however, pain in the neck was not a common complaint. Neither severe pain in the neck nor torticollis, occurring either separately or concomitantly, is frequently found in patients with juvenile rheumatoid arthritis, and its presence may suggest an intercurrent problem such as a fracture or infection. As patients with juvenile rheumatoid arthritis rarely have disease in the cervical spine alone, the patient should be carefully examined for involvement of multiple joints.

Adolescent↗
PubMed1985

The influence of induced hypotension and spine distraction on canine spinal cord blood flow.

Deliberate hypotension is used in scoliosis surgery to reduce the need for blood transfusion and to improve operating conditions. There are concerns, however, that hypotension may decrease spinal cord blood flow (SCBF) and thereby predispose the spinal cord to ischemic injury, particularly when it is distracted during Harrington instrumentation. In a canine model, the mean arterial pressure (MAP) was reduced to 50% of the normotensive value with sodium nitroprusside and halothane to study its effects, with and without spinal distraction, on spinal cord blood flow measured by the hydrogen clearance technique. The induction of systemic hypotension resulted in a significant decrease in spinal cord blood flow from 15.7 +/- 1.1 ml/min/100 g (control) to 10.7 +/- 4.7 ml/min/100 g. This initial decrease in spinal cord blood flow returned to normotensive values by 35 minutes following the induction of hypotension, suggesting an autoregulatory effect. This indicates that the induction of deliberate hypotension to half its normotensive mean arterial pressure is associated with a significant decrease in spinal cord blood flow that returns to normotensive levels by 35 minutes. One and two centimeters of longitudinal distraction applied during systemic hypotension did not reduce spinal cord blood flow when it was applied at least 45 minutes after the hypotension was induced. Thus, when longitudinal stretch of a magnitude approximating that used clinically during Harrington instrumentation is applied in the presence of systemic hypotension, the normal SCBF is not reduced when the autoregulating system is functioning.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Split posterior tibial-tendon transfers in children with cerebral spastic paralysis and equinovarus deformity.

In the treatment of equinovarus deformity of the foot in children with cerebral spastic paralysis, to supplement heel-cord lengthening, we split the posterior tibial tendon and transferred its posterior half laterally into the peroneus brevis tendon. Thirty-seven operations were performed on thirty-one hemiplegic, quadriplegic, and diplegic children who were followed for a mean of eight years postoperatively (range, four to fourteen years), at which time twenty-six of the thirty-one children were skeletally mature. There were thirty excellent, four good, and three poor results. The results did not deteriorate with time. Thirty-two of thirty-four children with good or excellent results had functioning dorsiflexors of the foot and were brace-free postoperatively. The children who had a poor result had recurrent deformity, but none had development of a calcaneal or calcaneovalgus deformity.

Adolescent↗
PubMed1984

Arthrography in the posttraumatic elbow in children.

Radiographic interpretation of children's elbows after trauma can be perplexing because of the large proportion of unossified cartilage relative to bone. The numbers of ossification centers appearing at different ages also complicate the interpretation. This study summarizes arthrographic experience in 10 children who sustained elbow trauma. Nine children had arthrography performed 5-24 months after injury. Seven patients had supracondylar or condylar fractures, one patient had a proximal radial fracture, and two patients had suspected osteochondritis dissecans. Arthrography was useful in delineating the integrity of the joint surfaces and in identifying healed rotated fracture components, cartilaginous spurs, nonunion of unossified fragments, and the normal physis. A small scarred joint and intraarticular loose bodies also were demonstrated. Elbow arthrography, though clearly not indicated for all pediatric elbow trauma, can contribute valuable information in the complex elbow fracture.

Adolescent↗
PubMed1984

Distal tibial physeal fractures in children that may require open reduction.

Fractures of the distal end of the tibia in children often involve the physis. They are of particular importance because partial growth arrest can occur and result in angular deformity, limb-length discrepancy, or incongruity of the joint surface (or a combination of these). We evaluated the cases of thirty-two children who had a fracture leading to established partial growth arrest of the distal end of the tibia. Most of this group had had a Salter-Harris Type-III or Type-IV fracture. Twenty-eight of the fractures had been treated by gentle closed reduction and immobilization in a plaster cast. We also evaluated the cases of thirty-three children who were seen by us for treatment of an acute fracture; most of these were Salter-Harris Type-III or Type-IV fractures of the distal end of the tibia. Nineteen of the twenty acute Type-III or Type-IV fractures that were treated with accurate open reduction of the physis and internal fixation healed without growth disturbance, while five of the nine fractures that were treated by closed means formed a bone bridge, presaging a disturbance in growth. This study suggests that Salter-Harris Type-III and Type-IV, and perhaps Type-II, fractures of the distal end of the tibia commonly cause disturbance of growth in the tibia, and that anatomical reduction of the physis by closed or open means may decrease the incidence of these disturbances of growth, including shortening and varus angulation of the ankle.

Adolescent↗
PubMed1983

Spondylolysis and spondylolisthesis in children.

Spondylolysis is a common problem found in 5% of the general population. The etiology is a combination of two factors: (1) hereditary predisposition resulting from a congenital deficiency of the sacrum and posterior structures and (2) developmental factors, such as trauma, posture, or certain repetitive activities, that may precipitate a stress fracture of the pars interarticularis in susceptible individuals. Although the lesion occurs during the growth years, few individuals develop symptoms during childhood and adolescence. For the occasional child who develops symptoms, the onset usually coincides with the adolescent growth spurt, and similarly progression of spondylolisthesis occurs between the ages of 10 and 15. When symptoms develop, the child may complain of low back pain and to a lesser extent pain in the posterior buttock and thighs, usually without a neurologic deficit. A few seek medical attention because of the postural deformity or abnormal gait, secondary to hamstring tightness. Symptoms are usually initiated by strenuous activity and relieved by limitation of activity or rest. Children with spondylolisthesis appear to have more flexibility or looseness at the L5-S1 junction than their adult counterparts (Fig. 7-11). This increased mobility is reflected in the radiologic appearance of the vertebrae. There is gradual erosion of the anterior as well as the posterior aspect of the sacrum, which becomes domed or peaked in the middle. This inhibition of growth is mirrored in the trapezoid shape of the body of L5 and directly related to the degree of slip. The wear pattern suggests a teeter-totter type of instability of the fifth lumbar vertebra on the sacrum (Fig. 7-15). The sclerotic buttress appearance or reactive changes common in adults are uncommon in children (Fig. 7-17). As the slip advances to the higher grades, the sacrum and posterior aspect of the pelvis become more vertical (anterior inclination), again reflecting instability in combination with tight hamstrings and backward pulling of the pelvis (angle of tilt), giving rise to the marked physical changes and localized kyphosis of the lumbosacral spine. There is considerable evidence to suggest that when the spondylolisthesis exceeds 50%, there are many dynamic and anatomic factors at work to potentiate continued deformity and symptoms in the growing adolescent. This is reflected clinically by the frequent failure of conservative measures in controlling symptoms and the need for surgical intervention in a significant percentage of patients once the slip exceeds grade II.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1983

Anti-inhibitor coagulant complex (Autoplex) in hemophilia inhibitor patients undergoing synovectomy.

Surgical synovectomy employed in the management of hemophilic arthropathy has been contraindicated in patients with inhibitors because of potential difficulties in achieving hemostasis. However, the development of activated prothrombin-complex concentrates has improved the management of hemophiliacs with inhibitors, particularly those with high levels of inhibitor for whom other treatment modalities are of minimal benefit. With the use of one of these activated products, Autoplex, surgical procedures have been successfully accomplished in hemophiliacs with inhibitors. Two inhibitor patients who each had severe arthropathy of one knee underwent elective surgical synovectomy while being treated with Autoplex. Hemostasis was achieved during the perioperative period in both patients. Neither patient exhibited clinical signs of suggestive of consumptive coagulopathy or thrombosis, side effects potentially associated with the use of activated prothrombin-complex concentrates.

Adolescent↗
PubMed1983

Angular and torsional deformities of the lower limbs in children.

Angular and torsional malalignments of the lower extremity in children are common problems for which parents seek orthopedic advice. Calcaneal valgus of the foot, internal tibial torsion, genu varus, genu valgus, and femoral anteversion are normally observed in infants and usually are corrected with growth. The majority of angular deformities are physiologic; however, it is important to distinguish those requiring further evaluation and treatment. Accurate examination and knowledge of the natural history of rotational and angular deformities allow accurate assessment of the child and sound advice to the parents. There is a trend away from the use of shoe modifications, Denis-Browne-type bars, and twister cables in treating these deformities. Surgical treatment is occasionally required, but the prerequisites in each case should be carefully observed.

Adolescent↗