Two cases of giant cell tumor and aneurysmal bone cyst of the talus were analyzed with a review of eight cases from the literature. This anatomic setting represents a distinct clinical and roentgenographic entity with a less aggressive natural history than the more common sites. All lesions presented a characteristic radiographic involvement of the head and neck of the talus. Eight of ten lesions were treated by curettage, with or without bone grafting, and healed. Two underwent partial en bloc resection. None developed late fracture, recurrence, avascular necrosis, or metastases. We concluded that a giant cell tumor or aneurysmal bone cyst when located in the talus may be difficult to differentiate but tends to exhibit a less aggressive biological behavior and a more favorable prognosis than the more classical proximal lesion. Talectomy is not indicated in the primary treatment. Curettage with or without bone graft has a high success rate. Cryosurgery should be reserved for a recurrent lesion.

Adolescent↗

PubMed1981

Pitfalls in the use of the Pavlik harness for treatment of congenital dysplasia, subluxation, and dislocation of the hip.

We reviewed the records of treatment of eighteen infants with congenital dysplasia, subluxation, or dislocation of the hip who had problems with the involved hip following treatment with the Pavlik harness. The most common problem (seen in twelve patients with a dislocated hip) was failure to obtain reduction. This failure was attributed primarily to improper use of the harness by the physician. In some patients, three to five months elapsed before the physician recognized the lack of reduction. In nine patients, a Pavlik harness of poor quality and construction added to both the physician's and the patient's problems, and in six patients, poor patient compliance with the use of the harness was partially responsible for the failure. In three patients who were initially treated in the Pavlik harness, avascular necrosis of the hip subsequently developed, in two following open reduction and in one after closed reduction and cast application. The physician's indications for use and application of the harness must be appropriate. The child must be examined frequently out of the harness both clinically and roentgenographically. Failure to achieve reduction or adductor relaxation must be recognized promptly and dealt with immediately.

Hip↗

PubMed1979

Response of hypertensive adolescents to dynamic and isometric exercise stress.

Isometric handgrip and dynamic exercise stress tests were performed on 109 hypertensive and 74 normotensive subjects 14 to 17 years old. The hypertensive subjects had resting systolic or diastolic pressures persistently above the 95th percentile on four consecutive examinations. Blood pressures and ECGs were recorded during isometric handgrip (25% maximum effort for four minutes) and bicycle ergometry until the subject was exhausted. The hypertensive subjects increased systolic pressure by an average 16 mm Hg with isometric exercise and 53 mm Hg with dynamic exercise. Control subjects had similar pressure changes, averaging 18 and 54 mm Hg, respectively. During isometric handgrip stress, diastolic pressures increased 12 mm Hg in hypertensive subjects and 18 mm Hg in control subjects. Only two hypertensive adolescents developed systolic pressures exceeding 200 mm Hg during dynamic exercise stress, and none developed systolic pressures above 200 mm Hg during isometric exercise stress. None of the normotensive or hypertensive subjects developed cardiac arrhythmias and the prevalence of ST segment depression during maximal stress was less than 2% in both groups. Therefore, in adolescents with mild to moderate hypertension the risk of developing significant ECG or hemodynamic abnormalities during mild isometric or heavy dynamic exercise is small. We believe the decision to restrict physical activity of an adolescent with elevated pressures should be based on the development of abnormal ST segment depression, cardiac arrhythmias, or excessive blood pressures at the time of exercise stress testing.

Adolescent↗

PubMedDate not supplied

High-dose chemotherapy for breast cancer?

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Age Factors↗