Proximal hamstring lengthening in the sitting cerebral palsy patient.

We retrospectively studied 62 nonambulatory children with spastic quadriplegic cerebral palsy who underwent proximal hamstring lengthening to improve hip and spine positioning. Preoperatively, all had hamstring contracture, with difficulty sitting due to hip extensor thrust and increased kyphosis. Thirty-five patients with follow-up greater than or equal to 2 years were studied using a modified Reimer scale to assess sitting ability. Sitting ability improved significantly (p less than 0.01) postoperatively, along with popliteal angle (p less than 0.001) and straight leg raising (p less than 0.001). Proximal hamstring lengthening is effective in treating severe hamstring contractures in the wheelchair-bound child with cerebral palsy.

Chondrodiatasis in rabbits: a study of the effect of transphyseal bone lengthening on cell division, synthetic function, and microcirculation in the growth plate.

The effects of chondrodiatasis on chondrocyte division, matrix synthesis, and microcirculation in rabbit growth plate were studied. The procedure did not produce any significant change in the percentage of cells labeled with tritiated thymidine, the intensity of radioactive sulfate labeling of the matrix, or the blood supply of the physis. These findings suggest that the procedure does not work by stimulating cell division, synthetic function, or vascularity of the plate, but rather by stretching the matrix passively.

Leiomyoma of spermatic cord with unusual features.

We describe a case of a patient with osseous metaplasia and chronic inflammatory changes in a leiomyoma of the spermatic cord, as well as a lipoma of the cord with similar changes. The differential diagnosis and possible etiology of these findings are presented.

Effect of route of administration on the selectivity of hematoporphyrin derivative for tumor tissue.

Hematoporphyrin derivative (HPD) has the ability to localize with moderate selectivity to tumor tissue, where it can be activated by visible light and produce singlet oxygen-mediated damage to cellular biomolecules. However, HPD is less than ideal as an agent for tumor photoradiation therapy because it produces a period of photosensitivity that can last 30 days or more, and it can be toxic to surrounding tissues such as skin when used in the treatment of subcutaneous metastases. The usefulness of intraarterial injection for refining the selectivity of HPD was investigated in this work. Intraarterial administration of HPD was not found to provide higher tumor levels of HPD, nor was it able to increase significantly the concentration of HPD relative to surrounding tissues, such as skin and muscle. However, fluorescence microscopy findings suggested that some fluorescent HPD component is rapidly accumulated in tumor macrophages following intraarterial injection.

Metastases to the adrenal glands and the development of Addison's disease.

Metastases to the adrenal glands are common in patients with cancer but symptomatic Addison's disease is rarely noted in this population. The development of body computerized tomography (CT) allows the diagnosis of adrenal metastases to be made more readily antemortem. From 1980 to 1981, 19% (4/21) of patients at the Massachusetts General Hospital who had metastatic cancer and who were noted to have enlarged adrenal glands on CT also had or developed symptomatic adrenal insufficiency. The case histories of 8 patients with Addison's disease and one patient with adrenal hemorrhage on the basis of metastatic infiltration are reviewed. Since adrenal insufficiency may develop abruptly in this group of patients, it is suggested that prophylactic maintenance glucocorticoid therapy be initiated as soon as the diagnosis of adrenal metastases is made.

Comparison of the effects of left ventricular distention during cardioplegic-induced ischemic arrest and ventricular fibrillation.

To evaluate the role of left ventricular distention in the pathophysiology of myocardial injury during cardiac surgery, 40 isolated, perfused feline hearts were subjected to 1 hour of either hypothermic potassium arrest (groups 1, 2 and 3) or 1 hour of hypothermic ventricular fibrilation (groups 4 and 5). During this period, intracavitary left ventricular pressure was maintained at 0 mm Hg in groups 1 and 4, at 30 mm Hg in groups 2 and 5 and 45 mm Hg in group 3. After either reperfusion of defibrillation, myocardial gas tensions, left ventricular function, coronary blood flow, the ration of endocardial to epicardial blood flow, and myocardial water content were measured to evaluate the degree of myocardial injury incurred. In addition, structural changes in the myocardium were assessed using light and electron microscopy. No differences in these parameters were seen in hearts that underwent ischemic arrest, regardless of the presence or absence of significant left ventricular distention. In fibrillating hearts, however, dilatation decreased ventricular performance, impaired subendocaridal blood flow and elevated myocardial CO2 tensions. These results suggest that left ventricular distention per se is not harmful during periods of ischemia. During periods of ventricular fibrillation, howevr, distention produces impaired subendocardial blood flow, resulting increased ischemia and decreased recovery of ventricular performance.

Effect of multiple-dose potassium cardioplegia on myocardial ischemia, return of ventricular function, and ultrastructural preservation.

To evaluate the myocardial protection afforded by multiple-dose versus single-dose administration of potassium cardioplegic solution, we studied 24 isolated feline hearts before, during, and after 1 hour of ischemic arrest. Intramyocardial gas tensions, ventricular function, histologic preservation, and postischemic myocardial edema were compared in hearts maintained at 27 degrees C during the ischemic period. Equal groups of hearts received no infusion of cardioplegic solution, a single dose of potassium solution at the onset of ischemia, or multiple infusions of the cardioplegic solution throughout the arrest period. During ischemia, single-dose cardioplegic administration resulted in less accumulation of myocardial carbon dioxide (Pmco2) than did hypothermia alone, reflecting a reduction in metabolic activity during ischemia. The fact that multiple-dose cardioplegia further reduced Pmco2 accumulation suggests an intermittent washout of metabolic end products. During reperfusion, hearts protected by multidose cardioplegia demonstrated superior preservation of ventricular performance compared to hearts protected by single-dose cardioplegia or hypothermia alone. In addition, multiple infusions of the cardioplegic solution resulted in optimal structural preservation in both light and electron microscope studies.