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Randall T Loder

Publications and source records attributed to Randall T Loder.

5 recordsLinked to original sources
PubMed2002

Low-dose ketorolac improves analgesia and reduces morphine requirements following posterior spinal fusion in adolescents.

PURPOSE: To determine if low-dose ketorolac would improve analgesia while minimizing unwanted side effects in adolescents following posterior spinal fusion (PSF). METHODS: A prospective randomized double-blind placebo-controlled trial assessed the analgesic effects of low-dose ketorolac following PSF. Thirty-five adolescents aged 11-17 yr were randomly assigned to receive placebo or 0.5 mg x kg(-1) ketorolac (maximum of 15 mg) six hourly postoperatively for 36 hr in conjunction with standard morphine patient controlled analgesia (PCA). Pain and sedation were assessed twice daily for the first three postoperative days (POD). The incidence of side effects related to both non-steroidal anti-inflammatory agents and opioids were recorded. RESULTS: Adolescents in the ketorolac group received an average dose of 0.2 mg x kg(-1) (average exposure 1.2 mg x kg(-1)), had lower pain scores on POD one and two (P < 0.05) and consumed less morphine in the postanesthesia care unit and on POD two. There was no difference in the incidence of pruritus, nausea, vomiting or constipation, but patients in the ketorolac group tolerated activity better on POD one (P < 0.05). There were no differences between groups with regard to postoperative blood loss or transfusion requirements. Fourteen patients were followed for two years and the incidence of curve progression, hardware failure or back pain at final follow-up was not different. CONCLUSION: Low-dose ketorolac in conjunction with morphine PCA improved the quality of analgesia and reduced morphine requirements following PSF compared to placebo without increasing the incidence of non-steroidal anti-inflammatory side effects.

Adolescent↗
PubMed2002

The long-term effect of pelvic osteotomy on birth canal size.

The effect of pelvic osteotomy on birth canal size at skeletal maturity is unknown. This information would be useful to counsel women of reproductive age who have undergone pelvic osteotomy. It was the purpose of this study to answer that question. A retrospective review of girls who had undergone pelvic osteotomy in the period 1980-1999 was performed. Transverse plane birth canal dimensions (inlet, mid-pelvis, and outlet) were measured from radiographs before and after osteotomy and at final follow-up. Final follow-up diameters were compared to threshold values (obstetric pelvimetry and clinical guidelines). There were 37 patients (40 osteotomies: 31 Salter, 5 Steel, 2 Chiari, and 2 Ganz). The average age at osteotomy was 7.5 +/- 5.3 years (range 2.0-21.3 years), and at final follow-up was 16.0 +/- 4.7 years (range 2.9-25.7 years); the average follow-up was 8.5 +/- 5.2 years (range 0.5-17.6 years). The effect of osteotomy at skeletal maturity was investigated by analyzing the 30 children > or = 14 years of age at the final follow-up. The pelvic inlet was above the threshold for all 30 children. The mid-pelvis was below the low normal threshold (9.5 cm) in 3 of 21 Salter, 2 of 5 Steel, and 1 of 2 Chiari osteotomies. The pelvic outlet was below the threshold in 2 of 21 Salter and 2 of 5 Steel osteotomies. The mid-pelvis dimensions were narrower in those who underwent osteotomy when older: 7.1 +/- 4.9 years (n = 24) and 11.9 +/- 7.9 years (n = 6) (p = 0.06) for those above and below the 9.5 cm mid-pelvis threshold, respectively. In conclusion, 6 of the 30 cases had a mid-pelvis which was below threshold at skeletal maturity. If the transverse mid-pelvis diameter at skeletal maturity is < 9.5 cm, then the likelihood of Cesarean section is increased, and this information should be given to the patient.

Adolescent↗
PubMedDate not supplied

Sagittal profiles of the spine in scoliosis associated with an Arnold-Chiari malformation with or without syringomyelia.

The sagittal spine of children with Arnold-Chiari I malformation with or without syringomyelia and associated scoliosis (ACS) has been poorly studied. A retrospective review of scoliosis secondary to ACS from three centers was undertaken. Sagittal and coronal plane variables were measured from standing radiographs. There were 30 ACS children (19 girls, 11 boys) with an average curve of 50 +/- 20 degrees and age of 11.2 +/- 3.2 years. Syringomyelia was present in 26 (87%). The scoliosis was thoracic in 25, thoracolumbar in 3 and lumbar in 2; 18 curves were right and 12 were left. A positive correlation was noted between cervical lordosis (CL) and thoracic kyphosis (TK). The 30 children with ACS scoliosis were compared with 26 children with adolescent idiopathic scoliosis (AID). The ACS group had more left curves (40% vs. 0%, P = 0.0002), more boys (37% vs. 8%, P = 0.01), and was younger (11.3 +/- 3.7 years vs. 14.2 +/- 1.8 years, P = 0.004). TK and CL were increased in ACS (TK: 40 +/- 13 degrees vs. 30 +/- 13 degrees, P = 0.005; CL: 16 +/- 21 degrees vs. -5 +/- 12 degrees, P < 0.0001). The ACS and AID groups were subdivided by CL >0 degrees and <0 degrees. In the ACS group, 19% (5 of 21) had CL <0 degrees, in the AID group 77% (20 of 26) had CL <0 degrees (P = 0.0001). When cervical lordosis is >0 degrees or thoracic kyphosis is >40 degrees (Cobb method), the clinician should strongly suspect the presence of an Arnold-Chiari I malformation with or without syringomyelia.

Adolescent↗
PubMedDate not supplied

Leg-length discrepancy and bone age in unilateral idiopathic talipes equinovarus.

The goals of this retrospective review were to evaluate leg-length discrepancy in patients with a unilateral clubfoot and to determine the relationship between bone age and chronologic age in the same population. Thirty-two of 47 patients referred for scanograms had a discrepancy more than 0.5 cm. Shortening was predominantly in the tibia, and four patients had radiographic evidence of growth disturbance. Five had been treated surgically at the time of review. If clinically indicated, a scanogram and standing radiographs of the ankle are necessary to determine the location and magnitude of discrepancy. Although the literature supports a neurologic etiology in some patients, and bone age may be delayed in certain neuromuscular conditions associated with limb shortening (hemiplegia), the authors' results suggest that bone age is statistically equivalent to chronologic age in the unilateral clubfoot population. These findings do not provide indirect support for a neurologic etiology.

Age Factors↗