Biomedical subjects

T F Kling

Publications and source records attributed to T F Kling.

At least 19 recordsLinked to original sources

PubMed1996

Cuneiform osteotomy of the femoral neck in severe slipped capital femoral epiphysis.

From 1978 through 1988, 27 severe slipped epiphyses (Grade III) in 23 adolescent patients were treated with a cuneiform osteotomy of the proximal neck of the femur. Average time of followup was 8 years 5 months. The results were graded by the criteria of Southwick, with emphasis on pain, function, range of motion, and radiographic appearance. Arbitrarily, no hips were rated excellent, because the authors thought that this rating should be reserved for normal hips that have not had any disease process nor surgical procedure. There were 19 good, 4 fair, and 4 poor results. The 4 poor results were in patients with avascular necrosis. The avascular necrosis rate was 15%. Eight hips had some joint space narrowing during the postoperative followup period. All joint space narrowing was resolved by 20 months postoperatively. All patients, including those with avascular necrosis, improved in joint flexion and joint internal rotation. Although the avascular necrosis rate of 15% is significant, the authors believe that the potential for restoring hip anatomy and providing a normally functioning hip in the adolescent patient makes this procedure a viable treatment option.

Adolescent↗

PubMed1994

The radiographic anatomy of the thoracic pedicle.

A cadaveric study of the radiographic characteristics of the thoracic pedicle was performed. Dried vertebrae at T6 and T7 were mounted and x-rayed at varying angles. The relationship of the pedicles to wire markers, methyl methacrylate cores, and Cotrel Dubousset hooks was analyzed. The oval image of the pedicle on radiographs is its waist. This image narrows with axial rotation of the x-ray beam. The relationship of a correctly placed pedicle hook to its pedicle is radiographically unchanged by rotation. Conversely, an incorrectly placed hook cannot be made to appear in position by rotating the x-ray beam.

Adult↗

PubMed1994

Developmental dysplasia of the hip.

OBJECTIVE: The definition and early treatment of congenital dysplasia of the hip are controversial. The purpose of this study was to discuss the reasons for changing the acronym to developmental dysplasia of the hip (DDH) and to address its early detection and treatment. DESIGN: This multicenter study was designed to provide an updated assessment of the definition, pathologic anatomy, prevalence, etiology, natural history, early detection, and treatment of DDH. RESULTS: DDH more accurately describes the condition previously termed congenital dysplasia of the hip. The disorder is not always present at birth (congenital) and an infant may have a normal neonatal hip screening examination and subsequently develop a dysplastic or dislocated hip. Developmental dysplasia encompasses the wide spectrum of hip problems seen in infants and children. Physicians should understand that a normal neonatal screening examination does not assure normal hip development. The diagnosis of developmental dysplasia is made by physical examination. The Ortolani and Barlow maneuvers were designed to detect a subluxatable, dislocatable, or dislocated hip in the neonatal period. In the older child, limited abduction becomes a more reliable sign. The examination is variable depending on the type of dysplasia and changes with growth. The ultrasound is proving to be a sensitive tool in confirming the diagnosis in newborns and infants from birth to 4 months of age. The ultrasound is also valuable in older infants in terms of documenting that the dysplasia is responding to treatment. However, the ultrasound depends on an experienced sonographer and, in some cases, may be too sensitive, resulting in overtreatment. After 3 to 4 months of age, an anteroposterior pelvis radiograph can confirm the diagnosis. CONCLUSIONS: All newborns should have a neonatal hip screening physical examination. After screening, the hips should be re-examined during health examination visits at 2 weeks, 2 months, 4 months, 6 months, 9 months, and 1 year of age. If any question arises during these visits or if there are associated risk factors, we recommend an ultrasound if the infant is < 4 months of age or an anteroposterior pelvis radiograph if > 4 months of age.

Follow-Up Studies↗

PubMed1990

Digital radiography can reduce scoliosis x-ray exposure.

Digital radiology is a new computerized system of acquiring x-rays in a digital (electronic) format. It possesses a greatly expanded dose response curve that allows a very broad range of x-ray dose to produce a diagnostic image. Potential advantages include significantly reduced radiation exposure without loss of image quality, acquisition of images of constant density irrespective of under or over exposure, and reduced repeat rates for unsatisfactory films. The authors prospectively studied 30 adolescents with scoliosis who had both conventional (full dose) and digital (full, one-half, or one-third dose) x-rays. They found digital made AP and lateral image with all anatomic areas clearly depicted at full and one-half dose. Digital laterals were better at full dose and equal to conventional at one-half dose. Cobb angles were easily measured on all one-third dose AP and on 8 of 10 one-third dose digital laterals. Digital clearly depicted the Risser sign at one-half and one-third dose and the repeat rate was nil in this study, indicating digital compensates well for exposure errors. The study indicates that digital does allow radiation dose to be reduced by at least one-half in scoliosis patients and that it does have improved image quality with good contrast over a wide range of x-ray exposure.

Adolescent↗

PubMed1990

Operative treatment of ankle fractures in children.

Fractures of the ankle (distal tibia) that involve the physis or the articular surface are one of the more common injuries for which operative treatment is indicated in children. It should be considered if accurate reduction of the articular surface, the physis, or both cannot be achieved by closed means. Operative treatment often will be required in Salter-Harris type III and IV fractures, juvenile Tillaux, and triplane fractures.

Adolescent↗

PubMed1988

Undetected posttraumatic instability of "stable" thoracolumbar fractures.

A review of 106 consecutive patients who had operative stabilization of thoracolumbar fractures revealed that 16 patients had surgery 4 months to 13 years after injury, for chronic instability. In these 16 patients, there were 8 wedge-compression fractures, 6 flexion-distraction injuries, 1 burst fracture, and 1 fracture-dislocation. All six patients with flexion-distraction injuries and the two patients with either a burst fracture or a fracture-dislocation had good results. Only two of the eight patients with wedge-compression fractures had good results. We concluded from this study that: (a) instability that presents without a progressive spinal deformity may go unrecognized; (b) all types of spine fractures can produce chronic, painful instability; and (c) poor results predominate in wedge-compression fractures operated more than 13 months after injury, regardless of the type of surgical treatment rendered.

Adolescent↗

PubMed1988

The effect of trimethaphan-induced hypotension on canine spinal cord blood flow. Measurement at different cord levels using radiolabelled microspheres.

Controlled hypotension which is used during scoliosis surgery to improve operating conditions and minimize transfusion requirements may decrease spinal cord blood flow (SCBF). Previous studies using hydrogen washout, an invasive technique, have shown that trimethaphan-induced hypotension is associated with a decrease in SCBF, whereas hypotension induced with sodium nitroprusside or nitroglycerin is not. To determine whether the decrease seen with trimethaphan represented a generalized rather than regional spinal cord phenomenon, SCBF was measured at three separate cord levels (T2-3, 7-8, L2-3) using a noninvasive radionuclide-labelled microsphere technique. When the mean arterial pressure was reduced by 50%, SCBF decreased 35 to 45% at all levels of the cord examined, and remained at this reduced level during the period of hypotension. The results confirm that trimethaphan-induced hypotension is associated with a significant reduction in SCBF and that this occurs throughout the spinal cord during the period of hypotension.

Animals↗

PubMed1987

Effect of nitroglycerine-induced hypotension on canine spinal cord blood flow.

Twenty-four mongrel dogs were anaesthetized with pentobarbitone and morphine sulphate. Neuromuscular blockade was achieved using pancuronium. Spinal cord blood flow was measured using the radionuclide microsphere and hydrogen washout methods before, during, and following nitroglycerine-induced hypotension. Heart rate, mean arterial pressure, cardiac output, pulmonary capillary wedge pressure, and acid-base balance were determined with each measurement. Mean arterial pressure was reduced by 50%. Spinal cord blood flow, as measured by the microsphere method, increased during the period of hypotension, whereas values obtained using the hydrogen washout method were not significantly different from those at normotension. No significant change in spinal cord blood flow was detected by either method after the application of spinal distraction. Nitroglycerine acts predominantly on venous capacitance vessels and it is postulated that perfusion pressure, and therefore flow, is maintained despite a reduction in arterial pressure.

Anesthesia, General↗

PubMed1987

Heel reconstruction with the deep circumflex iliac artery osteocutaneous flap.

A patient with extensive loss of bone and soft tissue from the right heel is presented. The defect was reconstructed using an osteocutaneous flap based on the deep circumflex iliac vessels. Indications for this procedure include extensive loss of bone and soft tissue precluding the use of local flaps. A 30-month period has elapsed since her reconstruction. A single ulcer developed 13 months postoperatively that healed after flap revision. We feel that tailoring the flap to minimize redundancy at the initial operation, subsequent tissue excision if necessary, and reinnervation augment durability of the flap.

Child↗

PubMed1987

Arthrography in evaluation of birth injuries of the shoulder.

Birth injuries of the shoulder and proximal humerus of infants can be difficult to evaluate on plain radiographs because of lack of ossification in the proximal humeral epiphysis. We here describe arthrography of the infant shoulder and advocate it as a useful diagnostic procedure in the evaluation of humeral fractures and brachial palsies. Two infants with birth injuries of the shoulder are described. The value of dynamic fluoroscopic evaluation of the injured joint in conjunction with arthrography is illustrated in evaluation of a brachial plexus palsy.

Arthrography↗

PubMed1987

Foot deformity in hereditary onycho-osteodysplasia.

A 30-year-old woman with hereditary onycho-osteodysplasia was examined. In addition to the classic tetrad of fingernail and toenail dysplasia, patellar aplasia, iliac horns, and radial head hypoplasia and dislocation, she also had scoliosis, proteinuria, and distinctive bilateral foot anomalies. The foot deformity consisted of a ball-and-socket ankle joint, valgus ankle, forefoot supination, and lateral subluxation at the tarsal-metatarsal joints. The literature showed that the radiographic findings of foot deformity in this dysplasia have never been reported in detail before. Evidence suggests that this distinctive pattern of deformity may be more common than previously appreciated.

Adult↗

PubMed1987

Angular deformities of the lower limbs in children.

Bowlegs and knock-knees are common concerns in the early years of life. For the majority of children, these problems represent normal physiologic development and they correct spontaneously. A few children will have pathologic malalignment, which may lead to functional or cosmetic problems that may require treatment, usually bracing and occasionally surgery. Physiologic varus and valgus and the common causes of pathologic malalignment, including Blount's disease, rickets, hereditary conditions, infection, and trauma are discussed.

Adolescent↗

PubMed1986

The role of arthrography in the management of dysplasia epiphysealis hemimelica.

Dysplasia epiphysealis hemimelica can be diagnosed on plain radiographs of the affected areas. However, double contrast arthrography in three new cases provided additional information. The cartilaginous portions of the lesion at the articular surface of the bone were precisely demonstrated, aiding the orthopedic surgeon in deciding which patients should have surgery and planning the extent of operation necessary.

Adolescent↗

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

MRI and CT evaluation of primary bone and soft-tissue tumors.

Twenty-six patients with primary tumors of bone or somatic soft tissues underwent both magnetic resonance imaging (MRI) and computed tomography (CT); 15 of the patients had radionuclide bone scans as well. Only in a minority of cases did these tomographic methods provide information needed for diagnosis that could not be derived from the plain radiographs alone; however, for assessing the extent of the disease, both CT and MRI proved very valuable, particularly MRI. Specifically, MRI was superior to CT in delineating the extent of the neoplasms and their relation to surrounding structures in 21 of the patients, equal in four, and inferior in only one. Furthermore, in the 13 patients with tumors of long bone, MRI was judged superior to CT in visualizing marrow abnormality in 12 cases, and equal in only one case. Radionuclide scans demonstrated the lesions in 14 of the 15 cases; its primary utility was in excluding additional lesions. It is concluded that for these patients, MRI was the imaging method of choice in assessing the extent of bone and soft-tissue tumors.

Adolescent↗

PubMed1986

Autoimmunity to articular collagen in patients with osteoarticular syndromes.

We studied the occurrence of autoimmunity to articular antigens in 39 patients with noninflammatory osteoarticular syndromes and 60 controls. Cell mediated immunity (CMI) was measured by assaying for leukocyte inhibitory factor (LIF) in supernates of mononuclear leukocytes cultured with native human collagen (types I, II, or III) or proteoglycan monomer. After stimulation with type II collagen, but not other antigens, 27/39 patients and 13/60 controls had positive LIF assays (p less than 0.001). In controls, but not in patients, CMI was associated with positivity for the HLA antigen DR4. No patient had antibodies to native type II collagen. These findings may reflect normal responses to articular injury or suggest that CMI contributes to the pathogenesis of osteoarticular syndromes. But they also emphasize that peripheral blood reactivity is not a certain reflection of synovial immunopathology.

Adolescent↗

PubMed1986

Bilateral fracture of the pedicle of the second cervical vertebra in the young child.

We report the cases of five children, six to eighteen months old, who had bilateral fracture of the pedicles of the second cervical vertebra. The children were treated with gentle cervical traction in mild extension or were maintained in near-anatomical reduction in a Minerva jacket or halo cast. The fractures united in four patients. One patient underwent fusion to stabilize the spine.

Braces↗

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↗