Shriners Hospitals for Children - Shreveport

CONTEXT: Information on the use of oral bisphosphonate agents to treat pediatric osteogenesis imperfecta (OI) is limited. OBJECTIVE: The objective of the investigation was to study the efficacy and safety of daily oral alendronate (ALN) in children with OI. DESIGN AND PARTICIPANTS: We conducted a multicenter, double-blind, randomized, placebo-controlled study. One hundred thirty-nine children (aged 4-19 yr) with type I, III, or IV OI were randomized to either placebo (n = 30) or ALN (n = 109) for 2 yr. ALN doses were 5 mg/d in children less than 40 kg and 10 mg/d for those 40 kg and greater. MAIN OUTCOME MEASURES: Spine areal bone mineral density (BMD) z-score, urinary N-telopeptide of collagen type I, extremity fracture incidence, vertebral area, iliac cortical width, bone pain, physical activity, and safety parameters were measured. RESULTS: ALN increased spine areal BMD by 51% vs. a 12% increase with placebo (P < 0.001); the mean spine areal BMD z-score increased significantly from -4.6 to -3.3 (P < 0.001) with ALN, whereas the change in the placebo group (from -4.6 to -4.5) was insignificant. Urinary N-telopeptide of collagen type I decreased by 62% in the ALN-treated group, compared with 32% with placebo (P < 0.001). Long-bone fracture incidence, average midline vertebral height, iliac cortical width, bone pain, and physical activity were similar between groups. The incidences of clinical and laboratory adverse experiences were also similar between the treatment and placebo groups. CONCLUSIONS: Oral ALN for 2 yr in pediatric patients with OI significantly decreased bone turnover and increased spine areal BMD but was not associated with improved fracture outcomes.

OBJECTIVE: We investigate the cost-effectiveness of adding robotic technology in spine surgery to an active neurosurgical practice. METHODS: The time of operative procedures, infection rates, revision rates, length of stay, and possible conversion of open to minimally invasive spine surgery (MIS) secondary to robotic image guidance technology were calculated using a combination of institution-specific and national data points. This cost matrix was subsequently applied to 1 year of elective clinical case volume at an academic practice with regard to payor mix, procedural mix, and procedural revenue. RESULTS: A total of 1,985 elective cases were analyzed over a 1-year period; of these, 557 thoracolumbar cases (28%) were analyzed. Fifty-eight (10.4%) were MIS fusions. Independent review determined an additional ~10% cases (50) to be candidates for MIS fusion. Furthermore, 41.4% patients had governmental insurance, while 58.6% had commercial insurance. The weighted average diagnosis-related group reimbursement for thoracolumbar procedures for the hospital system was calculated to be $25,057 for Medicare and $42,096 for commercial insurance. Time savings averaged 3.4 minutes per 1-level MIS procedure with robotic technology, resulting in annual savings of $5,713. Improved pedicle screw accuracy secondary to robotic technology would have resulted in 9.47 revisions being avoided, with cost savings of $314,661. Under appropriate payor mix components, robotic technology would have converted 31 Medicare and 18 commercial patients from open to MIS. This would have resulted in 140 fewer total hospital admission days ($251,860) and avoided 2.3 infections ($36,312). Robotic surgery resulted in immediate conservative savings estimate of $608,546 during a 1-year period at an academic center performing 557 elective thoracolumbar instrumentation cases. CONCLUSION: Application of robotic spine surgery is cost-effective, resulting in lesser revision surgery, lower infection rates, reduced length of stay, and shorter operative time. Further research is warranted, evaluating the financial impact of robotic spine surgery.

The purpose of this study was to determine whether there is a significant association between function and well-being in children with cerebral palsy. To determine this, the authors used validated measures of function (Gillette Functional Assessment Questionnaire, Gross Motor Function Classification System, Gross Motor Function Measure, and walking speed) and correlated them to health-related quality of life (HRQOL) measures (Pediatric Outcomes Data Collection Instrument, Pediatric Quality of Life instrument). In a cross-sectional study of ambulatory children with mild to moderate cerebral palsy aged 10.2 +/- 3.2 years, mild to moderate decreases in function were found when compared with normative data. As the assessment of HRQOL comprises both functional well-being and psychosocial well-being, the authors decided to specify the aspect of well-being to which they were referring. It was found that the child's function was not correlated to psychosocial well-being. The children with mild cerebral palsy had greater effects on their psychosocial well-being than would be predicted by their functional disability. Functional measures were good at predicting the functional well-being but were weak at predicting the psychosocial arm of well-being.

BACKGROUND: Studies evaluating multilevel surgery to treat spastic deformity and functional deficits in cerebral palsy (CP) usually focus on data from instrumented gait analysis and clinical examination without examining functional and health-related quality of life (HRQOL) outcomes. Recently, outcome measures for well-being in children with a variety of musculoskeletal disorders have also been validated specifically for CP. Therefore, this study aimed to investigate the impact of multilevel surgery on the function and HRQOL in a group of ambulatory children with CP. METHODS: In a multicenter prospective trial, 57 ambulatory children with CP, mean age 9.5 years, underwent multilevel soft tissue surgery to correct sagittal imbalance. Validated clinical outcome measures for HRQOL were administered preoperatively and postoperatively with an average follow-up time of 15.2 months. The functional and psychosocial components of the Pediatric Outcomes Data Collection Instrument (PODCI), Pediatric Quality of Life Questionnaire (PedsQL), and the Functional Assessment Questionnaire Walking Score were used. RESULTS: Significant improvements in outcome scores occurred postoperatively in the following: PedsQL parent-total (17.6%; P < 0.001) and parent-physical sections (25.0%; P < 0.001), the Functional Assessment Questionnaire Walking Score (15.3%; P < 0.001), and the PODCI sections for transfers and basic mobility (15.8%; P < 0.001), sports and physical function (23.9%; P = 0.012), and global (12.9%; P < 0.001). Improvements also occurred in the PedsQL child-total (8.4%; P = 0.104) and child-physical sections (8.6%; P = 0.189), but these were not statistically significant. There were no significant changes in the PODCI parent-derived pain (-3.2%; P = 0.504) and happiness sections (1.9%; P = 0.645). CONCLUSIONS: Multilevel surgery in ambulatory patients with CP improves function and HRQOL. However, improved functional well-being does not imply improved psychosocial well-being, and patients and their families should be counseled accordingly.

Spinal decompensation after Cotrel-Dubousset (C-D) instrumentation in the King type II curve pattern has become a recognized complication secondary to progression of the unfused lumbar curve. Twenty-three patients with type II curves who underwent selective thoracic fusion according to the guidelines established by King et al. were reviewed. Mean follow-up was 19.5 months. Lumbar curves greater than 45 degrees associated with a low flexibility index were significantly more likely to develop postoperative progression of the uninstrumented lumbar curve with resultant spinal decompensation, suggesting that in these curves the King criteria for selective thoracic fusion may not be appropriate.

We reviewed 19 children who had undergone a new modification of the L'Episcopo procedure for obstetric brachial plexus palsy. Through an axillary approach the latissimus dorsi tendon was re-routed anteriorly to the humerus and then anastomosed to the teres major tendon routed posteriorly. At an average follow-up of four years two months, the mean increase in shoulder abduction was 26 degrees and the mean increase in external rotation was 29 degrees. No neurovascular injury or postoperative infection occurred. Two patients had complications, and five did not gain from the procedure. The modified operation was relatively easier to perform and provided excellent cosmesis.

In Brief Study Design. Outcomes are retrospectively compared for patients with neuromuscular scoliosis after instrumented surgery and fusion to the pelvis versus lumbar 5 fusion alone. Objectives. To compare outcomes for patients with neuromuscular scoliosis for correction of scoliosis, lumbar 5 tilt, and pelvic obliquity after instrumented surgery and pelvic fusion, and by fusion only to lumbar 5. Summary of Background Data. Correction of scoliosis and pelvic obliquity in neuromuscular disease using spinal instrumentation is an accepted surgical procedure. Controversy remains concerning the caudal extent of fusion and instrumentation to lumbar 5 or to the sacrum. Methods. Patients with progressive neuromuscular scoliosis underwent spinal fusion with segmental instrumentation using a U-rod terminating in pedicle screw fixation at L5. Similar patients underwent spinal fusion with a unit rod and sacral fusion. Results. From 1998 to 2002, 55 patients with neuromuscular scoliosis underwent instrumentation and L5 fusion with the U-rod or to the sacrum with the unit rod. Initial and long-term corrections of scoliosis and pelvic obliquity were similar in both groups. Conclusions. Instrumentation and fusion to L5 is a less technically difficult procedure, requires less surgical time, has decreased blood loss, and less risk of infection compared to instrumented pelvic fusion. Postoperative and long-term follow-up indicates that L5 fusion can correct scoliosis and pelvic obliquity, comparable to results of sacrum fusion. Instrumentation at L5 shows correction of scoliosis and pelvic obliquity comparable to that accomplished with pelvic instrumentation for patients with neuromuscular scoliosis. Correction of scoliosis and pelvic obliquity compares favorably with instrumentation to the sacrum, yet is less technically difficult, requires less surgical time, and yields decreased blood loss and risk of infection.

One hundred forty-nine Grice procedures performed between 1955 and 1982 were reviewed. The valgus deformities were secondary to poliomyelitis, cerebral palsy, myelodysplasia, flexible flatfoot, clubfoot, congenital vertical talus, and other neuromuscular diseases. Review consisted of radiographic and clinical follow-up. Overall evaluation revealed 46% unsatisfactory results because of both graft failure and residual clinical deformity. Previous unrecognized ankle valgus and instability prejudiced the results in the myelodysplasia and flexible flatfoot. Recommendations include consideration of the Grice procedure in poliomyelitis and cerebral palsy coupled with appropriate tendon balancing, but not in myelodysplasia or flexible flatfoot in the presence of often unrecognized ankle valgus.

OBJECTIVE Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. Limited literature exists defining risk factors associated with outcomes during initial hospitalization in these patients. In this study, the authors investigated patient demographics, clinical and hospital characteristics impacting short-term outcomes, and costs in adolescent patients undergoing surgical deformity correction for idiopathic scoliosis. Additionally, the authors elucidate the impact of hospital surgical volume on outcomes for these patients. METHODS Using the National Inpatient Sample database and appropriate International Classification of Diseases, 9th Revision codes, the authors identified adolescent patients (10-19 years of age) undergoing surgical deformity correction for idiopathic scoliosis during 2001-2014. For national estimates, appropriate weights provided by the Agency of Healthcare Research and Quality were used. Multivariable regression techniques were employed to assess the association of risk factors with discharge disposition, postsurgical neurological complications, length of hospital stay, and hospitalization costs. RESULTS Overall, 75,106 adolescent patients underwent surgical deformity correction. The rates of postsurgical complications were estimated at 0.9% for neurological issues, 2.8% for respiratory complications, 0.8% for cardiac complications, 0.4% for infections, 2.7% for gastrointestinal complications, 0.1% for venous thromboembolic events, and 0.1% for acute renal failure. Overall, patients stayed at the hospital for an average of 5.72 days (median 5 days) and on average incurred hospitalization costs estimated at $54,997 (median $47,909). As compared with patients at low-volume centers (≤ 50 operations/year), those undergoing surgical deformity correction at high-volume centers (> 50/year) had a significantly lower likelihood of an unfavorable discharge (discharge to rehabilitation) (OR 1.16, 95% CI 1.03-1.30, p = 0.016) and incurred lower costs (mean $33,462 vs $56,436, p < 0.001) but had a longer duration of stay (mean 6 vs 5.65 days, p = 0.002). In terms of neurological complications, no significant differences in the odds ratios were noted between high- and low-volume centers (OR 1.23, 95% CI 0.97-1.55, p = 0.091). CONCLUSIONS This study provides insight into the clinical characteristics of AIS patients and their postoperative outcomes following deformity correction as they relate to hospital volume. It provides information regarding independent risk factors for unfavorable discharge and neurological complications following surgery for AIS. The proposed estimates could be used as an adjunct to clinical judgment in presurgical planning, risk stratification, and cost containment.

The Bridle procedure is a tritendon anastomosis between the posterior tibialis, anterior tibialis, and peroneus longus, combined with an Achilles tendon lengthening for treating equinus and equinovarus deformities. The technique avoids problems of tendon attachment to bone and tendon placement for balance. One hundred seven procedures were performed on patients with cerebral palsy with 74% excellent and good results overall. The average follow-up was 5 years 9 months. The procedure was also performed with mixed results, on smaller groups of patients with other neuromuscular diseases.

No AccessJournal of Urology1 Jul 1953Ureteral Injuries in Gynecologic Surgery Eugene C. St. Martin, Burdette E. Trichel, James H. Campbell, and C.M. Locke Eugene C. St. MartinEugene C. St. Martin More articles by this author , Burdette E. TrichelBurdette E. Trichel More articles by this author , James H. CampbellJames H. Campbell More articles by this author , and C.M. LockeC.M. Locke More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)67869-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1953 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited by Wu H, Yang P, Yeh G, Chou P, Hsu J and Lin K (2006) The detection of ureteral injuries after hysterectomyJournal of Minimally Invasive Gynecology, 10.1016/j.jmig.2006.04.018, VOL. 13, NO. 5, (403-408), Online publication date: 1-Sep-2006. VISCO A, TABER K, WEIDNER A, BARBER M and MYERS E (2001) Cost-Effectiveness of Universal Cystoscopy to Identify Ureteral Injury at HysterectomyObstetrics & Gynecology, 10.1097/00006250-200105000-00008, VOL. 97, NO. 5, (685-692), Online publication date: 1-May-2001. Tulikangas P, Gill I and Falcone T (2001) Laparoscopic Repair of Ureteral InjuriesThe Journal of the American Association of Gynecologic Laparoscopists, 10.1016/S1074-3804(05)60587-7, VOL. 8, NO. 2, (259-262), Online publication date: 1-May-2001. Hasson H and Parker W (1998) Prevention and management of Urnary tract injury in laparoscopic surgeryThe Journal of the American Association of Gynecologic Laparoscopists, 10.1016/S1074-3804(98)80073-X, VOL. 5, NO. 2, (97-112), Online publication date: 1-May-1998. Wood C and Maher P (1997) 7 Laparoscopic hysterectomyBaillière's Clinical Obstetrics and Gynaecology, 10.1016/S0950-3552(97)80053-3, VOL. 11, NO. 1, (111-136), Online publication date: 1-Mar-1997. Kovac S (1997) 6 Vaginal hysterectomyBaillière's Clinical Obstetrics and Gynaecology, 10.1016/S0950-3552(97)80052-1, VOL. 11, NO. 1, (95-110), Online publication date: 1-Mar-1997. Masterson B (1997) Ureteral Injury Manual of Gynecologic Surgery, 10.1007/978-1-4684-0073-1_22, (239-248), . Carl Wood E, Maher P and Pelosi M (1996) Routine use of ureteric catheters at laparoscopic hysterectomy may cause unnecessary complicationsThe Journal of the American Association of Gynecologic Laparoscopists, 10.1016/S1074-3804(96)80070-3, VOL. 3, NO. 3, (393-397), Online publication date: 1-May-1996. Lang E (1994) Traumatic Lesions of the Ureter Radiology of the Lower Urinary Tract, 10.1007/978-3-642-84431-7_2, (13-32), . Mann W and Koonings P (1993) Ureteral injuries in gynecologic surgeryInternational Urogynecology Journal, 10.1007/BF00387388, VOL. 4, NO. 6, (361-365), Online publication date: 1-Dec-1993. Cruikshank S and Kovac S (2004) Role of the uterosacral-cardinal ligament complex in protecting the ureter during vaginal hysterectomyInternational Journal of Gynecology & Obstetrics, 10.1016/0020-7292(93)90374-6, VOL. 40, NO. 2, (141-144), Online publication date: 1-Feb-1993. Stanhope C, Wilson T, Utz W, Smith L and O’Brien P (1991) Suture entrapment and secondary ureteral obstructionAmerican Journal of Obstetrics and Gynecology, 10.1016/0002-9378(91)91430-5, VOL. 164, NO. 6, (1513-1519), Online publication date: 1-Jun-1991. Spirnak J, Hampel N and Resnick M (2018) Ureteral Injuries Complicating Vascular Surgery: Is Repair Indicated?Journal of Urology, VOL. 141, NO. 1, (13-14), Online publication date: 1-Jan-1989.Dowling R, Corriere J and Sandler C (2018) Iatrogenic Ureteral InjuryJournal of Urology, VOL. 135, NO. 5, (912-915), Online publication date: 1-May-1986. Masterson B (1986) Ureteral Injury Manual of Gynecologic Surgery, 10.1007/978-1-4612-4860-6_26, (339-349), . Ansong K, Khashu B, Lee W and Smith A (1985) Prophylactic use of ureteral stent in iatrogenic injuries to ureterUrology, 10.1016/0090-4295(85)90253-5, VOL. 26, NO. 1, (45-49), Online publication date: 1-Jul-1985. Peters P, Bright T and Kibbey R (1981) Ureteral Trauma Due to Penetrating Missiles Traumatologie des Urogenitaltraktes, 10.1007/978-3-642-80573-8_7, (319-331), . Peters P, Bright T and Kibbey R (1981) Ureteral Injuries Secondary to Operative Procedures Traumatologie des Urogenitaltraktes, 10.1007/978-3-642-80573-8_6, (309-317), . Williams T (1981) The Ureter in Obstetrics and Gynecology The Ureter, 10.1007/978-1-4612-5907-7_28, (583-624), . Zinman L, Libertino J and Roth R (1978) Management of operative ureteral injuryUrology, 10.1016/0090-4295(78)90394-1, VOL. 12, NO. 3, (290-303), Online publication date: 1-Sep-1978. Whitehouse G (1977) The radiology of urinary tract abnormalities associated with hysterectomyClinical Radiology, 10.1016/S0009-9260(77)80104-9, VOL. 28, NO. 2, (201-210), Online publication date: 1-Jan-1977. Bright T and Peters P (1977) Ureteral injuries secondary to operative proceduresUrology, 10.1016/0090-4295(77)90277-1, VOL. 9, NO. 1, (22-26), Online publication date: 1-Jan-1977. Hoch W, Kursh E and Persky L (2018) Early, Aggressive Management of Intraoperative Ureteral InjuriesJournal of Urology, VOL. 114, NO. 4, (530-532), Online publication date: 1-Oct-1975. Fernandes M, Lavengood R, Ward J and Draper J (1973) Reconstruction of lower ureter and urethra, and closure of vesicovaginal fistula and other bladder defects Various uses of bladder flapUrology, 10.1016/0090-4295(73)90376-2, VOL. 1, NO. 5, (444-452), Online publication date: 1-May-1973. McAninch M and Moore C (1970) Diagnosis and treatment of urologic complications of gynecologic surgeryThe American Journal of Surgery, 10.1016/S0002-9610(70)80027-7, VOL. 120, NO. 4, (542-545), Online publication date: 1-Oct-1970. WILLIAMS J and PORTER R (1966) THE BOARI BLADDER FLAP IN LOWER URETERIC INJURIESBritish Journal of Urology, 10.1111/j.1464-410X.1966.tb09748.x, VOL. 38, NO. 5, (528-533), Online publication date: 1-Oct-1966. Tsuji I and Tabata S (2018) Experimental Study on the Permeability of the Deligated UreterJournal of Urology, VOL. 91, NO. 5, (505-508), Online publication date: 1-May-1964. Gerbie A and O'conor V (2016) Gynecologic Ureteral InjuryPostgraduate Medicine, 10.1080/00325481.1962.11692697, VOL. 32, NO. 4, (335-338), Online publication date: 1-Oct-1962. Marvin Harvard B (1959) Ureteral Injuries in Routine Pelvic SurgeryMedical Clinics of North America, 10.1016/S0025-7125(16)34086-X, VOL. 43, NO. 6, (1713-1729), Online publication date: 1-Nov-1959. Remington J (1959) Prevention of ureteral injury in surgery of the pelvic colonDiseases of the Colon & Rectum, 10.1007/BF02616876, VOL. 2, NO. 4, (340-349), Online publication date: 1-Jul-1959. Forsythe W and Persky L (1959) Comparison of ureteral and renal injuriesThe American Journal of Surgery, 10.1016/0002-9610(59)90246-6, VOL. 97, NO. 5, (558-562), Online publication date: 1-May-1959. Brown W and Sutherland C (1959) The Repair of Ureteral Injuries**Presented at the Sixty-ninth Annual Meeting of The American Association of Obstetricians and Gynecologists, Hot Springs, Va., Sept. 4-6, 1958.American Journal of Obstetrics and Gynecology, 10.1016/S0002-9378(16)36799-0, VOL. 77, NO. 4, (862-879), Online publication date: 1-Apr-1959. Reisman D, Kamholz J and Kantor H (2018) Early Deligation of the UreterJournal of Urology, VOL. 78, NO. 4, (363-375), Online publication date: 1-Oct-1957. Dick V (1957) Surgical Injuries to the UreterSurgical Clinics of North America, 10.1016/S0039-6109(16)35200-8, VOL. 37, NO. 3, (775-782), Online publication date: 1-Jun-1957. Burns R (2018) Reconstruction of the Lower Ureters by a Tube Made from Bladder Flaps: a Case ReportJournal of Urology, VOL. 74, NO. 3, (348-353), Online publication date: 1-Sep-1955.Wishard W (2018) Surgical Injuries of the Ureter and BladderJournal of Urology, VOL. 73, NO. 6, (1009-1014), Online publication date: 1-Jun-1955. Harrow B (1954) Renal function after complete bilateral ureteral obstruction following colporrhaphyThe American Journal of Surgery, 10.1016/0002-9610(54)90229-9, VOL. 87, NO. 6, (842-850), Online publication date: 1-Jun-1954. Volume 70Issue 1July 1953Page: 51-57 Advertisement Copyright & Permissions© 1953 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Eugene C. St. Martin More articles by this author Burdette E. Trichel More articles by this author James H. Campbell More articles by this author C.M. Locke More articles by this author Expand All Advertisement PDF downloadLoading ...

Vascular cell adhesion molecule-1 (VCAM-1) has been implicated as being important in the pathophysiology of acute pain episodes (APE) and acute chest syndrome (ACS) of sickle cell disease (SCD). The frequency of these episodes is reduced by chronic transfusion therapy. The impact of chronic transfusion therapy on VCAM-1 expression is unknown. Soluble VCAM-1 (sVCAM-1) levels were measured in plasma using an ELISA assay (R&D Systems) in 61 patients with SCD (age range 1.5-20 years) and 12 normal controls (2.5-14 years). SCD patients included 20 with ACS, 14 with APE, 12 at well-child visits, and 15 receiving chronic transfusion therapy. Asymptomatic SCD patients had higher sVCAM-1 levels compared to normal subjects (P < 0.001). Levels of sVCAM-1 were further elevated during ACS (P < 0.001) and APE (P = 0.072) and returned to the asymptomatic range on resolution. Levels were significantly lower in transfused patients (P = 0.003) compared to asymptomatic SCD patients. Our findings of increased VCAM-1 expression during ACS and perhaps APE offer a rationale for therapeutic use of cytokine and other VCAM-1 modulators. The reduction of sVCAM-1 levels observed in our transfused SCD patients offers insight into the mechanism of the protective effect of transfusion against ACS and APE and possibly stroke.

OBJECTIVE: A multi-site Randomized-Controlled Trial compared a home-based Supported Speed Treadmill Training Exercise Program (SSTTEP) with a strengthening exercise program in children with cerebral palsy (CP) on the following categories; Participation, quality of life (QOL), self-concept, goal attainment, and satisfaction. DESIGN: Twenty-six children with spastic cerebral palsy were assigned by site-based block randomization to the SSTTEP (n=14) or strengthening exercise (n=12) group. Both groups participated in a two week clinic-based induction period and continued the intervention at home for ten weeks. Data were collected at baseline, post-intervention (12 weeks), and follow-up (16 weeks). Assessments included the Canadian Occupational Performance Measure, Children's Assessment of Participation and Enjoyment Scale, Pediatric Quality of Life Cerebral Palsy Module, and Piers-Harris Children's Self-Concept Scale. Evaluators were blinded to group assignment at two sites. RESULTS: Satisfaction and performance on individual goals, participation, and parent-reported QOL improved in both groups with improvement maintained for four weeks post intervention. CONCLUSION: The hypothesis that the SSTTEP group would have better outcomes than the exercise group was not supported. However, both groups showed that children with CP can make gains in participation, individual goals, and satisfaction following a 12-week intensive exercise intervention, and these findings persisted for four weeks post intervention.

AIM: To determine whether there is a difference between perspectives of functioning and health-related quality of life (HRQL) of parents and ambulatory adolescents with spastic cerebral palsy (CP). METHOD: A total of 139 parent patient pairs (73 females, 66 males; median age 14 y 6 mo, age range 11-18 y, Gross Motor Function Classification System [GMFCS] levels I-III, with hemiplegia [n=23], diplegia [n=103], triplegia [n=9], and quadriplegia [n=4]) were recruited from outpatient CP clinics at three pediatric orthopaedic hospitals, between 2000 and 2006, from whom Pediatric Outcomes Data Collection Instrument (PODCI) responses were collected. RESULTS: Cross-sectional data, calculated with intraclass correlation coefficients [ICC], showed parents and adolescents agreed more on functioning (ICC=0.488-0.748) than HRQL (ICC=0.242-0.568; PODCI). Parents and adolescents both recognized significant comorbidities (ICC=0.502-0.713), but adolescents saw themselves as less limited (ICC=0.330) than parents. The greatest differences between parents and adolescents were in HRQL scales for male adolescents, with only a small part explained by GMFCS level difference between sexes (effect size 0.002-0.143). Age, parent well-being, and parent sex had little effect and comorbidities had no effect. GMFCS level was the most common predictor. INTERPRETATION: Most scales on health conditions, function, and HRQL agreed between parents and adolescents aged 11 to 18 years. Parent proxy is reasonable when necessary, but assessing both parents and adolescents gives additional insight. Adolescents do not consider themselves as limited by health conditions as parents do; parents have greater satisfaction with current level of symptoms than adolescents, and findings vary on expectations for treatment.

A 19-month-old nonambulatory child with knee flexion contractures was found to have dislocated patellae. Only three previous cases of bilateral congenital dislocated patellea have been reported. Surgical treatment rationale and technique are reviewed.

No AccessJournal of Urology1 Nov 1951Priapism in sickle Cell Anemia* J.H. Campbell, and Sam D. Cummins J.H. CampbellJ.H. Campbell , and Sam D. CumminsSam D. Cummins View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)74401-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1951 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByHamre M, Harmon E, Kirkpatrick D, Stern M and Humbert J (2018) Priapism as a Complication of Sickle Cell DiseaseJournal of Urology, VOL. 145, NO. 1, (1-5), Online publication date: 1-Jan-1991.Mykulak D and Glassberg K (2018) Impotence Following Childhood PriapismJournal of Urology, VOL. 144, NO. 1, (134-135), Online publication date: 1-Jul-1990.Noe H (2018) Editorial CommentJournal of Urology, VOL. 144, NO. 1, (135-135), Online publication date: 1-Jul-1990.Seeler R (2018) Intensive Transfusion Therapy for Priapism in Boys with Sickle Cell AnemiaJournal of Urology, VOL. 110, NO. 3, (360-361), Online publication date: 1-Sep-1973.Duback R and Ramey J (2018) Priapism In Sickle Cell Trait: Case Report Utilizing Hemovac Suction as an Adjunct to TherapyJournal of Urology, VOL. 100, NO. 2, (175-178), Online publication date: 1-Aug-1968.Hasen H and Raines S (2018) Priapism Associated with Sickle Cell DiseaseJournal of Urology, VOL. 88, NO. 1, (71-76), Online publication date: 1-Jul-1962.Erman S and Bloomberg H (2018) Priapism in Sickle Cell Anemia: Treatment by Estrogenic HormoneJournal of Urology, VOL. 84, NO. 2, (345-346), Online publication date: 1-Aug-1960.Hinman F (2018) Priapism; Reasons for Failure of TherapyJournal of Urology, VOL. 83, NO. 4, (420-428), Online publication date: 1-Apr-1960.Dahlen C, Kaplan L and Goodwin W (2018) Priapism Occurring as a Complication of TularemiaJournal of Urology, VOL. 72, NO. 6, (1192-1195), Online publication date: 1-Dec-1954. Volume 66Issue 5November 1951Page: 697-703 Advertisement Copyright & Permissions© 1951 by The American Urological Association Education and Research, Inc.MetricsAuthor Information J.H. Campbell More articles by this author Sam D. Cummins More articles by this author Expand All Advertisement Loading ...

Located in a community mental health center, the first decision support center in psychiatry used peer support and an Internet-based software program, CommonGround, to assist consumers in decisional uncertainty about psychiatric medication use and to foster shared decision making between the consumer and prescriber. This study examined the impact of the decision support center on the consumer-doctor interaction in the medication consultation. A pretest/posttest design assigned consumers to either an experimental or control group for 4 months. The Measure of Patient-Centered Communication (MPCC) (Brown, Stewart, McCracken, McWhinney, & Levenstein, 1986) was used to evaluate the medication consultation. The Patient Perception of Patient-Centeredness Questionnaire (PPPC) (Stewart, Meredith, Ryan, & Brown, 2004 Stewart , M. , Meredith , L. , Ryan , B. L. , & Brown , J. B. ( 2004 ). The patient perception of patient centeredness questionnaire . London , Ontario : University of Western Ontario . [Google Scholar]) was used to evaluate the consumer's and prescriber's perceptions of the consultation. A one-way multivariate analysis of covariance was not significant for the combined dependent variable of the measures at Time 2, while controlling for the measures at Time 1. When the CommonGround report was referenced in the experimental group, post hoc analyses revealed significant differences (t[41] = 4.14, p = .001) in the PPCC-consumer score. This study provides provisional evidence of the effectiveness of a shared decision-making intervention. The clinical potential of a program that assists mental health consumers in communicating decisional uncertainty and developing shared decisions concerning medication use is worthy of further study.

PURPOSE: Although frequently used in pediatric rehabilitation settings, the WeeFIM has not been tested in surgical pediatric orthopaedic patients. METHODS: The WeeFIM was administered to patients with surgical cerebral palsy at defined intervals preoperatively and at both 6 and 12 months postoperatively. The age-adjusted change scores from baseline to follow-up were tested both parametrically and nonparametrically. RESULTS: Four hundred sixty-eight patients had baseline evaluations. There were 161 six-month follow-up assessments and 108 twelve-month follow-up assessments. The baseline WeeFIM was able to separate children with different patterns of cerebral palsy. Hemiplegic patients had higher scores than diplegic and tetraplegic patients. Overall age-adjusted scores were improved at both 6 (mean increase 2.0) and 12 months (mean increase 2.2). The instrument showed significant ceiling effects for diplegic and hemiplegic patients with lower or upper extremity surgery and limited responsiveness for lower extremity surgery in tetraplegic patients. Parametrically, it showed improvements in mobility for both rhizotomy and tetraplegic upper extremity surgery. Nonparametric tests were not significant for rhizotomy mobility improvement. CONCLUSIONS: Although the WeeFIM adequately reflects the severity of neurological involvement in pediatric orthopaedic patients with cerebral palsy, it has a significant ceiling effect in diplegic and hemiplegic patients limiting responsiveness and lacks content validity for tetraplegic patients. The instrument may have some use in tetraplegic patients with upper extremity surgery and in rhizotomy patients. We recommend against its general use for orthopaedic surgery in patients with cerebral palsy lower extremity or spine surgery and in hemiplegic patients with upper extremity surgery.

BACKGROUND: The Pediatric Outcomes Data Collection Instrument (PODCI) is an outcomes assessment tool developed to allow measurement of health-related quality of life in children with disorders having musculoskeletal impact. The instrument was tested by Hunsaker and colleagues on a large population-based sample of children (n=5300), and partial results of that survey were published in 2002. Further publication of the findings did not occur. The PODCI was designed to collect data on age, sex, comorbidities, race and ethnicity, makeup of the household, and other demographic data that could have an impact on function and psychosocial issues. This retrospective study evaluated the impact of age, sex, and health/comorbid conditions on the subscales of the PODCI. METHODS: Using the database that was developed by Hunsaker and colleagues for the American Academy of Orthopaedic Surgeons, a 1-way multivariate analysis of variance was conducted to determine effects of prior comorbid condition versus no prior comorbid condition on the dependent variables of the PODCI Upper Extremity Function, Transfers and Basic Mobility, Sports and Physical Function, Comfort, and Happiness scales by parent respondent. A follow-up analysis of the health/comorbid condition, age, and sex of the child on the PODCI subscales using independent samples t tests was performed. RESULTS: Significant differences in the PODCI subscales of Transfers and Basic Mobility, Sports and Physical Function, Comfort, and Happiness occurred between children with a prior comorbid condition versus no prior reported comorbid condition. The sex of the child with a comorbid condition versus without a comorbidity appears to affect the PODCI subscale scores except for the Upper Extremity Function subscale. PODCI scales show an initial increase with age. Age at plateau varies, as do patterns of scores after plateau, with gradual decreases in quality-of-life scales. CONCLUSIONS: With further exploration of the population-based database, it was possible to confirm that age, sex, and comorbidities do have an impact on the levels of functional and psychosocial assessments done with the PODCI. Assessments done with the PODCI should include the assessment of, and potential correction for, these variables. LEVEL OF EVIDENCE: Prognostic studies level II retrospective.

Summary Klippel-Trenaunay syndrome is a triad of cutaneous hemangiomas, varicose veins, and hypertrophy of soft tissue and bone; when combined with arteriovenous fistulas, the syndrome is known as Klippel-Trenaunay-Weber syndrome. Orthopaedic surgical management of localized limb-length discrepancy or hypertrophy in these conditions is frequently indicated, especially in the lower limb. Forty orthopaedic procedures in 21 patients were retrospectively reviewed. Nine (22.5%) wound complications were identified in this study group. All the complications were associated with transverse amputations. All required significant further treatment and extension of hospital stay. Wound complications should be anticipated in patients with Klippel-Trenaunay syndrome having orthopaedic surgical procedures, especially terminal amputations.