PubMed Health⌕ Search

Biomedical subjects

Vernon T Tolo

Publications and source records attributed to Vernon T Tolo.

13 recordsLinked to original sources
PubMed2005

The effect of scoliosis surgery on lung function in the immediate postoperative period.

STUDY DESIGN: Prospective, single-cohort study. OBJECTIVES: To determine the immediate change in pulmonary function test (PFT) in children following scoliosis surgery. SUMMARY OF BACKGROUND DATA: The number of pediatric scoliosis surgeries is increasing each year because of recent advances in spinal instrumentation, surgical techniques, and improved perioperative monitoring. Pulmonary function decreases immediately following scoliosis surgery, but the extent of this decrease is not well documented in pediatric patients. To use preoperative PFTs to assess the risk of postoperative complications, knowledge of the postoperative decline in PFT is necessary. METHODS: We measured preoperative and daily postoperative PFT in 24 children who had scoliosis surgery (age 12.7 +/- 2.7 [SD] years) from January 2002 to June 2003. There were 10 male and 14 female patients. Two (8%) patients had congenital scoliosis, 11 (46%) had idiopathic scoliosis, 9 (38%) had scoliosis due to a neuromuscular disease, and 2 (8%) had kyphoscoliosis. Fifteen (62%) patients had posterior spinal fusion (PSF), 5 (21%) had anterior spinal fusion (ASF), and 4 (17%) had both ASF and PSF performed. PFT parameters (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], FEV1/FVC, and forced expiratory rate between 25% and 75% of FVC [FEF25%-75%]) were measured before surgery and daily after surgery by bedside spirometry until hospital discharge. RESULTS: PFT declined up to 60% after surgery. The PFT nadir is at 3 days. PFT values remained significantly decreased at 1 week, with values at about half of preoperative baseline. No patient required postoperative mechanical ventilation > or =3 days. There was no statistical significance between the degree of decline in PFT with etiology of either the scoliosis or the type of surgery performed. CONCLUSIONS: Our study found that patients are still at risk for postoperative complications as long as 1 week postoperatively and that PFTs do not return to near baseline until 1 to 2 months after surgery. The postoperative decrease in PFT should be considered during preoperative prediction of postoperative risk.

Adolescent↗
PubMed2003

Lymphangiomatosis of the spine: two cases requiring surgical intervention.

STUDY DESIGN: Two cases of lymphangiomatosis of the spine are presented. OBJECTIVES: To report two cases of lymphangiomatosis of the spine requiring surgical intervention and to review the literature. SUMMARY OF BACKGROUND INFORMATION: Lymphangiomatosis is a rare childhood disease characterized by abnormal lymph tissue at multiple sites. Skeletal and visceral involvement are both common. Prognosis depends on the extent of extraskeletal disease. METHODS: Two cases of lymphangiomatosis causing neural compression and instability at the cervicothoracic junction are presented. Both patients underwent surgical decompression and stabilization. RESULTS: One patient died, whereas the other regained full function and activity. CONCLUSIONS: Surgery is indicated when lymphangiomatosis causes neural compression and instability of the spine. Surgical outcome is strongly influenced by extraskeletal involvement.

Adolescent↗
PubMed2002

Thoracoscopic anterior spinal release and fusion: evolution of a faster, improved approach.

PURPOSE: The aim of this study was to compare the perioperative parameters and outcomes of video-assisted thoracoscopic surgery (VATS) with open thoracotomy for anterior release and fusion in the treatment of pediatric spinal deformities. METHODS: Twenty-six patients treated with VATS anterior spinal release and posterior spinal fusion by the authors were reviewed retrospectively. Fourteen age- and disease-matched patients who underwent open thoracotomy for anterior spinal release and posterior spinal fusion by the same group of surgeons during the same time period were evaluated for comparison. Patients whose anterior level of exposure extended below the diaphragm were excluded. RESULTS: Blood loss, operative transfusion, and length of postoperative chest tube use all were decreased in the VATS patients compared with thoracotomy patients (P < or =.05). The average operating time for VATS was less than that for thoracotomy but did not reach statistical significance. However, operating time was significantly shorter in the second 13 VATS patients compared with the first 13 patients. No complications specifically related to the VATS approach were identified. CONCLUSIONS: The VATS technique is a safe and comparable alternative to open thoracotomy. Although there is a learning curve for VATS, greater experience could show an advantage in this approach to the anterior spine for the treatment of pediatric spinal deformity.

Adolescent↗
PubMed2002

Rib fixation for humeral lengthening following interscapulothoracic resection for malignant tumor.

We report a case of humeral lengthening in an adolescent, 6.5 years after interscapulothoracic resection for an osteosarcoma of the scapula. The lengthening external fixator was augmented by ipsilateral rib fixation in order to prevent cephalad migration of the proximal fragment. At a 3-year follow-up, the patient was satisfied, with an improved cosmesis and function of his limb.

Adolescent↗
PubMedDate not supplied

Effect of surgical delay on perioperative complications and need for open reduction in supracondylar humerus fractures in children.

This retrospective study examined whether a delay of greater than 12 hours is associated with an increased risk of perioperative complications in the operative treatment of supracondylar humerus fractures in children. Of 150 consecutive children with supracondylar fractures, 50 underwent surgery in less than 12 hours and 100 underwent surgery greater than 12 hours after injury. There was no significant difference between groups in rate of open reduction (P = 0.55), pin tract infection (P = 1.0), iatrogenic nerve injury (P = 1.0), vascular complication (P = 0.33), or compartment syndrome (P = 1.0), including when Gartland type III fractures were analyzed independently. There was no iatrogenic nerve injury, no compartment syndrome, and one pin tract infection in 150 patients. The study confirms previous retrospective studies finding no significant difference in perioperative complications or rate of open reduction in children undergoing early versus delayed surgical treatment of supracondylar humerus fractures.

Child↗
PubMedDate not supplied

Pelvic fractures in children: an exploration of practice patterns and patient outcomes.

Pelvic fractures in children represent a unique set of patients for several reasons. Pediatric pelvic fractures are relatively uncommon and the long-term consequences of these fractures and their associated injuries often have a substantial impact on these patients for the rest of their lives. There is significant controversy regarding the appropriate approach toward the management of these injuries. Nevertheless, there is substantial variability in the orthopaedic management of pediatric pelvic fractures, which warrants a closer investigation. A good starting point for addressing some of these issues is to explore the relationship between practice patterns and patient outcomes. More specifically, a study exploring the relationship between the type of centers that treat these unique fractures and patient outcomes can yield some insightful information. In an effort to address these issues, the authors used the National Pediatric Trauma Registry to conduct a retrospective analysis of this unique pediatric population. The main outcome of interest focused on mortality. With respect to patient information, the independent variables involved demographics (gender, age, race), type of injury (penetrating, blunt, crush), presence of head injury, injury severity indices (Injury Severity Score [ISS], Glasgow Coma Scale), and the Functional Independence Measure. After adjusting for confounding and interaction effects between these variables, only ISS and the type of hospital were determined to be significant in predicting survival.

Adolescent↗
PubMedDate not supplied

Back pain and backpacks in school children.

OBJECTIVE: Back pain in adults is common and well studied. In contrast, back pain in children has received comparatively little scientific study, despite recent media attention. The purpose of this study is to see what factors influence the prevalence of back pain in middle school children, with particular attention to the weight of children's backpacks and the availability of school lockers. METHODS: A population-based sample of 1540 children ages 11-14 years in a large metropolitan area was studied. A questionnaire was used to determine presence and severity of back pain, availability of lockers, backpack use, use of 1 or 2 straps to carry backpack, activity limitations due to back pain, and use of pain medication for back pain. Gender, age, weight of the child, and weight of his or her backpack were recorded. Results of scoliosis screening were evaluated with regard to the above information. Data were analyzed using the chi test and univariate or multivariate logistic regression analysis as appropriate. RESULTS: Overall, 37% of the children reported back pain. Backpacks were used by 97% of children, hence there were too few students not using backpacks to treat backpack use as an independent variable. Multivariate analysis found back pain associated with use of a heavier backpack (P=0.001), younger age (P<0.001), female sex (P<0.001), and a positive screening examination for scoliosis (P=0.009). Children with lockers available reported less back pain (P=0.016). The use of 1 or 2 straps to carry the backpack did not have a significant association with back pain (P=0.588). Of the children who reported back pain, 34% limited their activity due to the pain, 14% use medication for pain relief, and 82% believed their backpack either caused or worsened their pain. CONCLUSIONS: The incidence of back pain in early adolescence approaches that seen in adults. Recommendations for an "acceptable" weight of backpacks cannot be made from this study, as the weights of students' backpacks seem directly proportional to the likelihood of back pain. This study identifies 2 factors associated with self-reported back pain in early adolescents that are amenable to change: availability of school lockers and lighter backpacks. These findings may be useful in advising families and influencing school policies.

Adolescent↗
PubMedDate not supplied

Childhood diskitis.

Childhood diskitis may occur in the thoracic, lumbar, or sacral spine and can affect children of all ages, but it is most common in the lumbar region in children younger than 5 years. Physical examination, laboratory tests, and radiologic studies all aid in the diagnosis of this clinical syndrome, and proper use can prevent unnecessary invasive intervention. Presentation varies with age; the child may refuse to bear weight on the lower extremities or may present with back pain, abdominal pain, a limp, or, if an infant or toddler, with irritability. The etiology appears to be a bacterial infection, usually caused by Staphylococcus aureus. Most children improve rapidly with a 4- to 6-week course of antibiotics. Although not routinely necessary, immobilization decreases symptoms and, in the case of osseous destruction, prevents progression of spinal deformity. Biopsy of the infected disk space is reserved for children refractory to intravenous antibiotics. Follow-up should include plain radiographs at regular intervals for 12 to 18 months to ensure resolution of the destructive process.

Anti-Bacterial Agents↗
PubMedDate not supplied

Langerhans cell histiocytosis of bone in children and adolescents.

The purpose of this paper was to analyze the orthopaedic aspects of Langerhans cell histiocytosis and to assess the outcome after treatment. Fifty-six patients with Langerhans cell histiocytosis involving the bone were retrospectively studied. Three groups were identified with regard to the type of bone involvement. Group I patients (n = 26) had a solitary bone lesion, with no systemic involvement. No treatment was given in 22 patients and curettage was done in 4 patients. At last follow-up, complete or partial healing was observed in 25 patients. Group II patients (n = 13) had multiple bone lesions, with no systemic involvement. Clinical and radiographic pictures as well as the outcome after treatment were similar to those in group I. Group III patients (n = 17) had bone and systemic involvement. Chemotherapy was used in all group III patients, with adjuvant radiotherapy in seven patients. Recurrence or new lesions were observed in 11 patients. Complications of treatment were observed in 14 patients. Lesions in group I and II patients had a considerable potential for spontaneous healing. Group III patients had the worst prognosis. Current chemotherapy protocols have a high morbidity and produce a variable response.

Adolescent↗
PubMedDate not supplied

Comparison of proximal and distal rotational femoral osteotomy in children with cerebral palsy.

This study compares the complication rates and results of 27 proximal (intertrochanteric) and 51 distal femoral rotational osteotomies in 48 patients with static encephalopathy. There was no significant difference between the 14% rate of orthopaedic complications in the intertrochanteric osteotomy (ITO) group and the 10% rate in the distal osteotomy (DO) group. Loss of fixation occurred in three of 51 limbs (6%) in the DO group and in none of 27 limbs in the ITO group. If the results of one surgeon are excluded, fixation loss occurred in one of the 49 remaining DO cases (2%). There was one delayed union in the study population (1/27 limbs [4%] in the ITO group). Of the 33 limbs studied with postoperative gait analysis, overcorrection was present in two limbs (6%): one of 10 limbs (10%) in the ITO group and one of 23 (4%) in the DO group. Static and dynamic measures of femoral rotation improved in both groups, and no statistically significant differences were present between the two groups. Though variable, the mean change in dynamic and static measurements postoperatively was approximately 40% less than the amount of derotation reported at surgery.

Adolescent↗
PubMedDate not supplied

"Perthes-like" changes in a free riding untreated congenital dislocated hip.

The development of avascular necrosis of the femoral head (AVN) after the treatment of congenital dislocation of the hip (CDH) is a well-known complication, but the coexistence in an old child of untreated CDH and ischemic changes of the femoral head has not been reported. Many authors and several years of clinical observation have shown that Perthes-like changes do not occur unless the two sides of the joint are in contact. The purpose of this paper was to report a case of Perthes-like disease that occurred in an untreated CDH, and to discuss the possible pathogenesis. The patient is an 8-year-old African American girl, who presented with a leg length discrepancy, and very mild complaints at the left hip. Physical examination revealed left hip stiffness with a positive Galeazzi sign. Pelvic radiographs showed a complete high riding dislocation of the left hip, with a small and dense femoral head. MRI showed a decreased signal of the entire femoral head. Hematologic and metabolic work-up was normal. Although the vascular theory seems to be well accepted in the pathogenesis of Perthes disease, it does not seem that the contact between the femoral head and the acetabulum is necessary to produce ischemic changes of the femoral epiphysis.

Child↗