Topical timolol treatment for periocular infantile haemangioma in the developing world.

Infantile haemangioma is a relatively common benign tumour which often does not require treatment. We present a case of a segmental infantile haemangioma with periocular involvement impacting on early visual development which was successfully treated with topical timolol maleate 0.5% drops in the developing world.

Mycoplasma pneumoniae infection, meningoencephalitis, and hemophagocytosis.

Central nervous system manifestations are a common extrapulmonary complication of Mycoplasma pneumoniae infection, of which encephalitis is a well-recognized abnormality in children. In this report the first description of M. pneumoniae infection simultaneously complicated by meningoencephalitis and hemophagocytosis is presented.

Quantifying the cosmetic defect of adolescent idiopathic scoliosis.

Cosmesis is important in the treatment of adolescent idiopathic scoliosis patients. The aim of this study was to quantify the cosmetic defect using parameters of the ISIS (Oxford Metrics Ltd., Oxford, England) scan. Ten nonmedical judges scored photographs of 100 adolescent idiopathic scoliosis patients based on cosmetic criteria. This Cosmetic Spinal Score proved to be a reliable figure. The Cosmetic Spinal Score was then compared with ISIS parameters and the Cobb angle. An equation based on ISIS parameters was developed, which could predict Cosmetic Spinal Score with sufficient reproducibility to have a useful clinical application. Bracing reduced the rib hump but not enough to improve the cosmetic appearance. Spinal fusion and Harrington instrumentation improved all measured parameters influencing physical appearance.

Family stature in idiopathic scoliosis.

The standing heights of 40 children with scoliosis and 110 persons from their immediate families were compared with those of a group of 349 contemporary control subjects. Skeletal bone ages and puberty ratings did not differ from normal, but the children with scoliosis were found to be significantly taller than the controls. They were also taller than their unaffected relatives, suggesting that the increased stature is not due to genetic factors alone. Scoliotic children with an affected immediate-family member were of normal height, which suggests that growth is of less etiological importance in children with a strong genetic susceptibility.

Joint laxity and hip rotation in normal children and in those with congenital dislocation of the hip.

We measured the range of rotation in both hips of 397 normal children and in the unaffected hip of 135 children with unilateral congenital dislocation of the hip. Both groups were assessed for generalised joint laxity. Joint laxity was more common in normal children with an internally centred arc of hip rotation than in normal children with a neutral or an externally rotated arc. The children with congenitally dislocated hips had significantly more joint laxity than did the control group and significantly more of them had an internally centred arc of hip rotation. We suggest that the lax joint capsule fails to mould away the neonatal anteversion of the femoral neck during the first few months of life.

An analysis of normal back shape measured by ISIS scanning.

Two hundred seventy-one school children aged 10-16 years and 72 normal adults aged 21-59 years were scanned by ISIS. Subjects with any evidence of scoliosis were excluded from the study. Characteristic ISIS parameters of back shape showed no statistically significant differences related to age or sex for the children. Back shape in both men and women was not significantly different from that of the children, except for kyphosis angles which were greater.

Familial back shape in adolescent scoliosis. A photogrammetric population study.

A stereophotogrammetric technique (ISIS scanning) was used to assess the back shape of children with adolescent idiopathic scoliosis (index cases), their unaffected relatives, normal adults and children, and children with small idiopathic scoliotic curves (Cobb's angle less than 30 degrees) to detect any familial trends that may predispose to scoliosis. The analysis revealed a characteristic three-dimensional scoliotic back shape; no differences in unaffected relatives as regards sex or a positive family history of scoliosis; similar back shapes in unaffected parents and normal adults, both of whom differ from index cases and children with small curves. Unaffected siblings had a sagittal profile between those of normal children and children with small curves. This may represent an inherited tendency to scoliosis.

A comparative trial of two walking systems for paralysed people.

A trial has been performed to compare two designs of reciprocal walking orthosis for paralysed people--the hip guidance orthosis (HGO) from Oswestry, England, and the reciprocating gait orthosis (RGO) from New Orleans, USA. Eighteen male and 4 female paraplegic subjects used each orthosis for 4 months, in a crossover study. All aspects of the provision and use of the devices were monitored, and a variety of assessments were made. Fifteen subjects were able to use both orthoses, 5 were unable to use either and 2 succeeded with the HGO but not the RGO. At the end of the trial 12 subjects chose to keep the RGO, 4 the HGO, and 6 kept neither. Those choosing the RGO liked its appearance; those choosing the HGO liked the speed of donning and doffing. The RGO was about 50% more expensive to supply than the HGO.

Performance of three walking orthoses for the paralysed: a case study using gait analysis.

Three types of walking orthosis are currently available to enable paralysed people to achieve reciprocal gait. This case study assesses the performance in walking of one patient who was proficient in the use of all three devices. The results of a biomechanical analysis are presented in which comparisons are made between the orthoses in terms of general gait parameters and movement of the lower limbs and pelvis.

The modified Schollner costoplasty.

The modified Schollner costoplasty is a cosmetic procedure for the correction of rib prominence deformity in scoliosis. We present the results of the procedure in 21 patients who had previously undergone spinal fusion for scoliosis. We found the procedure to be well tolerated without major complications. Objective cosmetic improvement was achieved in all but one case. All but one patient considered the procedure to have been of cosmetic benefit.

The role of the quadriceps in controlling impulsive forces around heel strike.

The damaging effect of transient loads on joints has been observed in vitro and in vivo, and may be an aetiological factor in osteoarthrosis. The events around heel strike, when the velocity of the foot is brought rapidly to zero, may be a source of such loads in normal activity. By modifying the rate at which the limb descends to the ground, quadriceps action influences the magnitude of the heel strike transient. Experiments were carried out to analyse the occurrence of these transients, and a two-dimensional mathematical model of the knee joint and lower leg was used to calculate the forces developed at the knee in response to them. Paralysis of the quadriceps resulted in a large increase in the heel strike transient.

Functional biomechanical assessment of the Oxford Meniscal Knee.

The Oxford Meniscal Knee is an unconstrained surface arthroplasty that has given good clinical results. The biomechanics of knee function during walking in patients with this arthroplasty were examined using a three-dimensional television/force platform/computer system. Two groups of patients were studied: a retrospective group of 13 patients with single joint disease and a prospective group of 13 knee arthroplasties in 10 patients with mixed joint pathology. General gait parameters (cadence, velocity, and stride length) were near normal in the retrospective group and showed a useful improvement in the prospective group. In the sagittal plane the knee showed some limitation of extension and a tendency toward an abnormal flexion-extension moment pattern. In the coronal plane, the knee arthroplasty generally corrected errors of alignment, but about one-third of the patients had adduction/abduction moments outside the normal range. The clinical results of the arthroplasty are thus better than the biomechanical results, an observation common to all of the knee arthroplasties that have been studied using comparable methods.

Surface stereophotogrammetry of thoracic kyphosis.

The thoracic kyphosis angles of 16 normal individuals, 10 patients with Scheuermann's disease and 11 with adolescent idiopathic scoliosis were measured both radiographically and from Integrated Shape Imaging System (ISIS) scans obtained by surface stereophotogrammetry. There was a high correlation between the two measures. The method of kyphosis measurement from ISIS scans was then used for 30 patients with adolescent idiopathic scoliosis who underwent corrective surgery. A significant reduction in thoracic kyphosis was observed postoperatively. In another group of 28 patients managed conservatively by bracing, some hypokyphosis developed after treatment. However, we found no association between hypokyphosis and curve progression.

Back shape in brace treatment of idiopathic scoliosis.

This preliminary study has shown that bracing may improve the cosmetic appearance of a scoliotic back although the underlying curve remains unchanged. Thirty-two patients treated with the Boston brace for adolescent idiopathic scoliosis were assessed both roentgenographically and by integrated shape imaging system scanning before and after treatment. The mean follow-up time was 16 months. Surface shape improved in 41% of the patients, whereas roentgenographic improvement occurred in only 9%. Roentgenographic measurements should, therefore, be considered in conjunction with corresponding surface shape measurements in the assessment of brace treatment of scoliosis.

Correction of body height in scoliotic patients using ISIS scanning.

Measurement of height in scoliotic patients is complicated by changes in spinal shape in both the coronal and sagittal planes. A method is described by which these changes can be measured and compared with the shape of the normal spine, using an automated stereophotogrammetric technique (ISIS). The resultant height change may be of use in the prediction of respiratory function.

ISIS scanning: a useful assessment technique in the management of scoliosis.

The value of surface topographical measurements in the assessment of curve progression in adolescent idiopathic scoliosis is demonstrated in a group of 51 patients. Cobb angles at the commencement of the study ranged from 10 degrees -55 degrees (mean 34.5 degrees), and the mean follow-up period was greater than 2 years. The surface shape method correctly identified curve evolution in 84% of the patient group. Of these, the eight patients who underwent spinal instrumentation were correctly predicted as candidates for surgery.

Scoliosis surgery and its effect on back shape.

Thirty-four patients with adolescent idiopathic scoliosis were assessed by radiography and the integrated shape imaging system (ISIS) both before and after spinal surgery. Twenty-seven patients underwent Harrington instrumentation, after which lateral indices of curvature were significantly improved, but changes in the transverse plane were less pronounced. Sublaminar wiring was carried out in two patients whose thoracic lordosis was corrected by the surgery. Five patients whose severe deformity had persisted after previous spinal surgery underwent costoplasty, which resulted in a significant improvement in back shape measurements. We conclude that the cosmetic deformity of the back in scoliosis is only partially corrected by operations on the spine itself, whilst costoplasty addresses the problem directly, and improves the surface shape.

A method for analysis of back shape in scoliosis.

The shape of the back is an important factor in the clinical assessment of various spinal disorders, in particular scoliosis. A method of analysis of back surface shape is described which was designed to present most of the numerical parameters needed to assess the progress of the disease as it affects body shape. Measurements of back surface shape and manually marked anatomical landmarks were taken from a television/computer surface measurement system in which a plane of light was scanned over the back and from moiré topographs. The anatomical landmarks were used to define reference planes from which successive analyses were matched. Asymmetry in the transverse plane was illustrated by horizontal cross-sections and skin surface angles. The lateral deformity was shown by an estimate of the line of the vertebral bodies beneath the skin, derived by adding an extra lateral displacement to the palpated positions of the spinous processes, proportional to the rotation of the skin in the transverse plane. This model was used to estimate vertebral end-plate angles and Cobb angles. Lateral sections showed kyphosis and lordosis. Correlations of Lateral Asymmetry from the surface shape analysis with Cobb angle from X-ray measurements in three groups of patients (totalling 119 subjects) were in the range r = 0.77 to r = 0.94, p less than 0.0001. The analysis has reduced follow-up X-ray examinations at the Nuffield Orthopaedic Centre because it indicates quantitatively and with complete safety both lateral asymmetry and deformity in the transverse plane.

Influence of walking speed on gait parameters.

Modern three-dimensional gait analysis systems give information on joint angles and moments in the sagittal and coronal planes, for which normal ranges may not be readily available in the literature. Since patients with joint disease tend to walk slowly and with a short stride, it is essential that normal ranges for gait parameters should be defined with reference to speed of walking. This we have done using a population of 10 normal male subjects aged from 18 to 63 years, walking at speeds which range from very slow to very fast. The ranges of knee angle and moment are given, together with the changes in these parameters with walking speed. Peak knee flexion moment is strongly related to walking speed, whereas coronal plane knee angle is virtually independent of it. The stride length is probably the best basis for deciding the normal range for a particular measurement.