Slipped capital femoral epiphysis: ultrasonographic findings

The diaphragmatic eventration will be congenital or acquired; the damage to the phrenic nerve its for elongenest, cruch, gun ball or iatrogenic; this last one could be during cardiac surgery, birth trauma, venodissection and colocation of one thorax drill. We presented the case of one premature newborn of 32 weeks with 1374g of weight, with respiratory distress syndrome which evolutioned to bilateral pneumothorax and posteriorly left diaphragmatic eventration secondary to a phrenic nerve damage by the thorax drill which one reach to mediastinum. The diagnosis of these entity will suspect by abnormal elevation of the affected hemidiaphragm and confirmed by fluoroscopy. The treatment its a early diaphragmatic pleat.     

Slipped femoral capital epiphysis as a sequela to childhood irradiation for malignant tumors

Five cases of slipped femoral capital epiphysis were noted in children with prior irradiation for malignancy whose femoral head and neck had been included in the radiation portal. Three of the 5 were patients who had lymphoma. As a result of increasing survival rates for these types of patients, this previously unrecognized radiation-related growth disturbance may be more likely to be seen in the future.     

The contralateral hip in slipped capital femoral epiphysis

Although orthognathic surgery has now become a routine part of oral and maxillofacial surgery practice, concern and apprehension about major jaw surgery continues to plague the minds of many orthodontists faced with the prospect of referring their patients for surgery. Like all surgery, complications also occur with orthognathic procedures, most of which can be prevented by thorough planning and careful surgery. In this article a brief overview of the potential complications associated with orthognathic surgery is presented for the benefit of orthodontists involved in the management of patients undergoing combined orthodontic-surgical treatment.     

Familial slipped capital femoral epiphysis: a report and considerations in management

BACKGROUND: Familial inheritance of slipped capital femoral epiphysis (SCFE) is known. It has not been described in non-identical twins. A family where the mother and three of five siblings developed SCFE were investigated and managed. METHODS: Anthropometric measurement consisted of height-weight ratios. Serum sex hormone levels and bone Gla Protein was measured. Bone mineral densities were evaluated. RESULTS: The affected siblings had higher bodyweight percentiles. Other investigations were within normal limits. CONCLUSION: The unfavourable height-to-weight ratio was one of the mainstays in developing a management protocol for all siblings. The management protocol developed for the family is discussed.     

Total avascular necrosis of the capital femoral epiphysis in congenital dislocated hips

Ninety-four hips involved with total avascular necrosis in the treatment of congenital dislocation of the hips were reviewed in a search for etiological factors and effective salvage procedures. Pre-reduction traction and adductor tenotomy did not prevent avascular necrosis. Abduction of the hip in the "frog" position was the incriminating common denominator. This position may cause (1) interference of the blood supply to the femoral head by compression of the medial branch of the deep profundus artery; and (2) pressure on the intraepiphyseal grooves by the glenoid labrum. The containment of the femoral head by acetabuloplasty (preferably) below age 8, followed at a later date (over age 10) by transfer distally of the greater trochanter, with the abductor muscles, offers a satisfactory salvage procedure.     

Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip

We examined the femora of 2665 adult human skeletons from an osteological collection to determine the prevalence of post-slip morphology termed femoral head-tilt deformity by Murray and pistol-grip deformity by Stulberg et al. The hypothesis was that primary osteoarthrosis of the hip is a secondary manifestation of a subclinical developmental disorder of the hip. The prevalence of post-slip morphology was 8 per cent (215 of 2665 skeletons). Severe osteoarthrosis was more prevalent in association with post-slip morphology (116 [38 per cent] of 306 hips) than in the matched controls (seventy-nine [26 per cent] of 306 hips) (p < 0.005). In the skeletons that had unilateral post-slip morphology, severe osteoarthrosis was more prevalent in the involved hips (thirty-one [37 per cent] of eighty-three) than in the contralateral, normal hips (eighteen [22 per cent] of eighty-three) (p < 0.05). Post-slip morphology, which was unrelated to age, was found to be a major risk factor for the development of high-grade osteoarthrosis. We noted evidence of high-grade osteoarthrosis in sixty-three (68 percent) of the ninety-three hips with minimum post-slip morphology in skeletons from individuals who had been fifty-six years old or more at the time of death compared with forty-five (48 percent) of the ninety-three control hips. This difference was significant (p < 0.025) [corrected]. The osteoarthrosis in the hips with post-slip morphology was distinctly characterized by anterior flattening of the acetabulum, cystic degeneration in the anterior metaphyseal-epiphyseal region, and progression to global osteoarthrosis of the hip.     

Pin removal in slipped capital femoral epiphysis: the unsuitability of titanium devices

Whole-cell recordings were made from dissociated bullfrog sympathetic neurons. Tetraethylammonium (30 mM) and apamin (100 nM) were added to the superfusate to eliminate the known calcium-activated potassium currents termed Ic and IAHP. Under these conditions, the action potential carried by calcium ions was followed by a prolonged (10-60 s) after-hyperpolarization. A current component (IAC) underlying the after-hyperpolarization was eliminated by barium (2 mM) and showed voltage-dependence identical to that of a M-type potassium current. I concluded that the after-hyperpolarization is caused not only by IAHP but also by the calcium-dependent potentiation of M-current.     

Biomechanical analysis of single- versus double-screw fixation in slipped capital femoral epiphysis at physiological load levels

Slipped capital femoral epiphyses in 12 pairs of bovine femora were pinned with a single screw on one side and two screws on the other. The specimens were subjected to physiological shear loads across the epiphysis (100 cycles at 1.1 Hz; 400 N for slow walking, and 900 N for fast walking). The rates of creep were decreased 23% with double screws compared to single screws at slow walking, and 30% at fast walking; this was not statistically significant. Single-screw fixation in slipped epiphyses is thus recommended, because the small gains in resistance to cyclic creep at physiological loading were not statistically different, and did not offset the increased risks of complications with multiple screws.     

Osteochondroma of the femoral neck secondary to a slipped upper femoral epiphysis

Traumatic osteochondromas may develop following damage to the growth plate, but these lesions are rare. Osteochondromas developing secondary to a slipped upper femoral epiphysis (SUFE) have not been previously described. We report such a case and discuss its pathogenesis in relation to the possible aetiologies of primary osteochondromas and SUFE.     

Traumatic separation of the upper femoral epiphysis in a child aged two

Traumatic separation of the proximal femoral epiphysis in children is a serious and as yet unresolved problem. Should treatment be conservative or surgical? Because of the rarity of the lesion, the literature offers no definite answer. In the case presented, conservative treatment gave a good result.     

Rhabdomyolysis associated with simvastatin-gemfibrozil therapy

Simvastatin is a potent inhibitor of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase intended for use as a hypocholesterolemic agent. The long-term clinical experience with simvastatin indicates that it is a safe, effective, and well-tolerated hypolipidemic agent. Laboratory adverse events involving elevations of serum transaminase levels and serum creatine kinase (CK) levels to more than three times the upper limit of normal range have been seen in 1.5% and 3.4% of cases, respectively. We describe a case of severe myopathy and rhabdomyolysis associated with concomitant use of simvastatin and gemfibrozil. Seven days after discontinuing administration of gemfibrozil and simvastatin, the patient's condition improved and she was discharged home. Although this is the first report to indicate an association between myopathy and concomitant use of simvastatin and gemfibrozil, we strongly recommend caution and careful monitoring if simvastatin is given to patients receiving gemfibrozil.     

Stevens-Johnson syndrome associated with carvedilol therapy

Stevens-Johnson syndrome, related to carvedilol use, has not been previously reported as a serious adverse experience requiring hospitalization. We report this reaction in a 71-year-old man with stable ischemic cardiomyopathy.