Biomedical subjects

S J Kumar

Publications and source records attributed to S J Kumar.

62 records · Page 4Linked to original sources

PubMedDate not supplied

In situ posterolateral spine arthrodesis for grades III, IV, and V spondylolisthesis in children and adolescents.

The purpose of the study was to analyze the results after in situ posterolateral arthrodesis without reduction in children and adolescents with Meyerding grades III and IV spondylolisthesis and in patients with spondyloptosis who had an average follow-up of 12.8 years. The study population consisted of 21 patients who underwent an in situ posterolateral spinal fusion from L4 to S1 with autogenous iliac bone graft and were immobilized in a pantaloon cast for 4 months. All patients reported improvement after the operation and had no limitation in daily activities. Only four of 21 patients complained of occasional mild pain after physical activity, which resolved with rest and did not disturb their work. After surgery there were no motor deficits, incontinence of bowel or bladder, or sexual dysfunction. Roentgenographic findings showed progression of the slip in five patients and increase of the slip angle and the displacement index in two patients. These changes happened during the first year after the operation. Progression of the slip was not associated with symptoms. There was no pseudarthrosis. In situ posterolateral arthrodesis with a large amount of autogenous bone graft followed by immobilization in a pantaloon cast yields a solid arthrodesis and provides satisfactory results.

Adolescent↗

PubMedDate not supplied

Factors leading to hip subluxation and dislocation in femoral lengthening of unilateral congenital short femur.

Congenital short femur is a rare and complex deformity. For it to be treated in the most accurate way, we must know of every possible complication. The purpose of this study was to determine the factors leading to hip subluxation or dislocation in patients with an unilateral congenital short femur who underwent a femoral lengthening procedure. Forty-four patients with congenital unilateral short femora types I, II, and IIIA were seen between 1981 and 1993 at Alfred I. duPont Hospital for Children. Seventeen patients had type I, 9 patients had type II, and 18 patients had type IIIA. Twenty patients underwent simultaneous lengthening of the femur and tibia, and 24 patients had primary lengthening of the femur. Eleven patients had an epiphysiodesis of the contralateral femur for residual leg length discrepancies of <6 cm. We observed that in patients with type IIIA, the acetabular dysplasia is severe, as well as the coxa vara deformity, and is associated with progressive subluxation and dislocation of the hip with lengthening. We believe that the combined abnormality of coxa vara and bow of the femoral shaft contributes to hip subluxation and dislocation in congenital short femur in association with an acetabular dysplasia prior to the lengthening. We recommend correction of the varus bow of the femur and the neck-shaft angle to 120 degrees and the acetabular index to <25 degrees prior to lengthening of type IIIA femora.

Acetabulum↗

PubMedDate not supplied

Intraspinal epidermoid tumors in children: problems in recognition and imaging techniques for diagnosis.

Iatrogenic intraspinal epidermoid tumors are very rare. The similarity of the clinical manifestations of the tumor with other childhood problems can pose a problem in diagnosis. In addition, because of the lag in time between the lumbar puncture and the development of a symptomatic tumor, this relationship is overlooked and can cause a delay in diagnosis, as in the present report of four children. Magnetic resonance imaging was found to be superior to myelography in defining the tumor and its relationship to other structures inside the dural sac. All patients underwent surgical excision, with subsequent resolution of symptoms.

Child↗

PubMedDate not supplied

Corrective cosmetic supramalleolar osteotomy for valgus deformity of the ankle joint: a report of two cases.

Valgus deformity of the ankle joint can cause pain in walking and a significant gait disturbance because of the altered ankle mechanics and the secondary planovalgus deformity of the foot. A technique of supramalleolar osteotomy that is cosmetically better than a closing wedge osteotomy for correction of this condition is described in two patients with hereditary multiple exostoses. The osteotomy is inherently stable, and minimal or no internal fixation is needed.

Ankle↗

PubMedDate not supplied

Unicameral bone cysts in the humerus and femur in the same child.

Although simple bone cysts in children have been described by many authors, there has been only one previous report of more than one lesion in a single patient. We describe an 11-year-old boy with symptoms caused by a cyst in the proximal femur. Following steroid injection of the cyst, a pathological fracture occurred and was treated by immobilization in a cast. A year later, a pathological fracture occurred through a cyst in the proximal humerus. This was treated in a sling. Steroid injection of both lesions was performed when the cystic areas persisted, and both cysts subsequently healed. This case demonstrates that simple bone cysts are not always solitary lesions and that patients with these cysts should be carefully monitored for recurrence following treatment.

Anti-Inflammatory Agents↗

PubMedDate not supplied

Hip dysplasia associated with Charcot-Marie-Tooth disease in the older child and adolescent.

Severe hip dysplasia in children with Charcot-Marie-Tooth disease is asymptomatic or minimally symptomatic and usually goes undetected until early adolescence. We report five patients between the ages of 8 and 15 years who presented with hip dysplasia; all five required surgery. The dysplasia in two of these patients was detected only on routine screening because of their older sisters' problems. A multicenter study will be needed to determine the exact incidence of hip dysplasia associated with Charcot-Marie-Tooth disease.

Adolescent↗

PubMedDate not supplied

Oesophageal manometry in noncardiac chest pain.

Chest pain of oesophageal origin is an important differential diagnosis in patients with cardiac chest pain. A preliminary survey of 40 patients with noncardiac chest pain (NCCP) revealed oesophageal motility disorder in 47.5%; achalasia cardia being the most frequent disease (47.3%). 15.8% of these patients with motility disorder had features of progressive systemic sclerosis and another 15.8% had non specific oesophageal motility disorder (variants). Compared to barium swallow, oesophageal manometry was found to be superior in the diagnosis of oesophageal motility disorder.

Adult↗

PubMedDate not supplied

Split tibialis posterior tendon transfer and tendo-Achillis lengthening for spastic equinovarus feet.

Twenty-one patients with a minimum follow-up of 2 years who underwent combined split tibialis posterior tendon transfer and tendo-Achilles lengthening for equinovarus foot deformities were evaluated. The results in 15 of 18 ambulatory patients were graded as excellent or good; patients had marked improvement of their equinovarus foot deformity in both stance and swing phases of gait and became brace-free postoperatively. All non-ambulatory patients had a plantigrade foot. The complication rate was low, and patient satisfaction with the procedure was very high. In three patients, however, the procedure failed because of technical errors. We address the causes of failure and methods to avoid these errors. Preoperative computerized gait analysis does not appear to be essential in achieving a good result.

Achilles Tendon↗