Scoliosis surgery: a risk factor for cholelithiasis?

Scoliosis surgery has been associated with pancreatitis and acalculous cholecystitis, and also has been implicated as a risk factor for cholelithiasis. A prospective study of 36 children and adolescents undergoing scoliosis surgery was performed using ultrasound to determine the incidence of cholelithiasis following spine surgery. The patients underwent abdominal ultrasound exams preoperatively, immediately postoperatively, and then at intervals following surgery with 2-5-year follow-up. Four of 36 patients (11.1%) (one male, three female) developed gallstones, although all had been free of gallstones after surgery. The gallstones appeared between 2 + 5 and 5 years after surgery. Those with gallstones were not different from those without with respect to 14 factors. It is concluded that scoliosis surgery is not a risk factor for gallstones, because of the delay in onset of cholelithiasis after surgery. Furthermore, the prevalence of gallstones in this study sample is not greater than that reported in historical control studies of European young adults.

Clinical determination of femoral anteversion. A comparison with established techniques.

We evaluated femoral anteversion preoperatively in fifty-nine patients (ninety-one hips), using a clinical method that we developed, Magilligan radiographs, and computed tomographic scans. These measurements were then compared with values for anteversion that were obtained intraoperatively. To determine femoral anteversion clinically, the patient was placed in the prone position and the maximum lateral trochanteric prominence was related to the degree of internal rotation of the hip. Compared with computed tomographic scanning and Magilligan radiographic determination, the clinically determined anteversion correlated most closely (to within 4 degrees) with the amount measured at the time of the operation. The clinical method was found to be superior to radiographic techniques for determination of the degree of femoral anteversion in children who have not had a previous operation about the hip.

Spondylometaphyseal dysplasia, corner fracture type: a heritable condition associated with coxa vara.

The authors present the radiographic features of a previously incompletely delineated bone dysplasia, which they call spondylometaphyseal dysplasia, corner fracture type. This is a dominant heritable condition associated with short stature and developmental coxa vara. The progressive hip deformity usually causes significant disability requiring surgical correction. Developmental coxa vara, simulated corner fractures of long tubular bones, and vertebral body abnormalities result in a diagnostic constellation. Knowledge of these distinctive radiologic features allows accurate diagnosis, which in turn should lead to appropriate genetic counseling and possibly to earlier, more efficacious surgical treatment of the coxa vara.

Epiphyseal dysplasia with coxa vara, microcephaly, and normal intelligence in sibs: expanded spectrum of Lowry-Wood syndrome?

We report on a brother and sister with epiphyseal dysplasia and coxa vara, microcephaly, and short stature. This constellation of findings similar to that found in the Lowry-Wood syndrome (Epiphyseal dysplasia, microcephaly, short stature, and mental retardation). In the sibs we describe, mental retardation is not apparent, and they have the additional finding of developmental coxa vara. Despite these 2 exceptions, this family probably represents the same disorder described by Lowry and Wood (Clinical Genetics 8:269-274, 1975), and serves to expand the spectrum of the syndrome to include coxa vara. It is also possible that these sibs represent a previously undescribed syndrome, most likely with autosomal recessive inheritance.

The femoral head notch.

A notch-like defect at the vertex of the proximal femoral ossification center is a normal variant in children. This has often been mistaken for Legg-Perthes disease. This sharply defined defect is distinct from the irregular epiphyseal ossification patterns common in other areas.

Ball-and-socket ankle joint.

The ball-and-socket ankle joint is a malformation of the ankle in which the articular surface of the talus is hemispherical in both the anteroposterior and lateral projections and has a congruent, concave tibial articular surface. Fourteen patients with this condition were identified retrospectively. Thirteen patients were thought to have the congenital type of ball-and-socket ankle joint which in many was associated with tarsal coalition, short limb, and ray fusion and deletion anomalies. One case of the acquired type, demonstrating less geometric rounding of the talar margins, was seen in a patient with myelomeningocele, probably resulting from sensory and motor deficits. Although the exact etiology of the congenital type is unknown, its association with other malformations suggests that the ball-and-socket ankle joint results from an overall maldevelopment of the ankle and foot.

Relationship of somatomedin-C concentration to bone age in boys with constitutional delay of growth.

Serum somatomedin-C (Sm-C) levels increase sharply during puberty, leading to difficulty in the interpretation of Sm-C values obtained from children who exhibit a discrepancy between chronological age (CA) and pubertal development. To evaluate the utility of assessing Sm-C levels on the basis of bone age (BA), we measured serum Sm-C levels in 44 boys with constitutional delay of growth (CDG). Levels of Sm-C were compared with the normative data of the Nichols Institute Reference Laboratories (NIRL), Los Angeles, by age category, substituting BA for CA. We found the mean Sm-C level in boys with CDG to be lower than that for NIRL normal subjects in each age category for both CA and BA, but the regression curve for Sm-C levels based on BA more closely approximated the NIRL regression curve than did the curve based on CA. The rise in Sm-C levels observed in NIRL normal subjects between CA 13 to 14 years is delayed in boys with CDG until CA 15 to 17 years only when a correction for BA is not made. We conclude that in boys with CDG, Sm-C levels should be interpreted on the basis of BA rather than CA, especially during the peripubertal period. The observation of blunted Sm-C levels in all age categories, even when BA was used, suggests that short children with presumed CDG may be at high risk for a "nonclassic" form of growth hormone deficiency.

Infiltrating angiolipoma with phlebolith formation.

Angiolipomas are uncommon benign soft tissue tumors with both fatty and vascular components; they may be encapsulated or locally invasive. Three cases are reported in which phleboliths were present within infiltrating angiolipomas. The demonstration of phleboliths in a lipoma suggests the diagnosis of infiltrating angiolipoma rather than the usual encapsulated lipoma.

Emergency radiology in childhood.

Radiologic aspects of childhood illness and injury differ from those of adults, and specific investigational plans and techniques are necessary. In this article, common illnesses and complaints referred to the respiratory, gastrointestinal, and skeletal systems are discussed. For each, the initial radiologic examination is indicated, and follow-up consultation and investigation are described.

The upper femoral notch.

A notch-like defect in the cortex of the medial side of the femoral neck is described in asymptomatic children. Its appearance is similar to the metaphyseal cortical defects seen in other locations as normal variants.

Congenital bone anomalies associated with lipomas.

Congenital bone anomalies are occasionally located adjacent to deep lipomas. These bone dysplasias may take the form of localized overgrowth or osseous malformation. Two patients with iliac anomalies and spinal dysraphism and one with a hypertrophied rib and vertebra associated with lipomas are described. As both the lipomas and osseous anomalies tend to lie in the same sensory nerve distribution, there may be a common embryonic neural dysfunction affecting formation and subsequent growth of these structures.

The relationship of isotopic bone imaging findings to prognosis in Legg-Perthes disease.

A significant association was observed between the size of the radioactive uptake defect on bone image and the end-result (Mose) in 34 hips of children with early Legg-Perthes disease. A correlation between the size of the bone-image defect and radiographic prognostic criteria, Catterall classification and extent of subchondral fissure was also observed in 27 early Legg-Perthes cases. Bone imaging is recommended for suspected Legg-Perthes patients, not only to establish the diagnosis but to assess the stage of disease and to determine prognosis.

Arthrographic findings in septic arthritis of the hip in infants.

Both standard radiography and arthrography are essential in the diagnosis of septic arthritis in infancy. Plain films demonstrate lateral subluxation, marked delay in appearance of the femoral ossification center, deformity of the femoral neck, and acetabular dysplasia. Arthrography shows cartilaginous deformity, subluxation, and contracture of capsular structures. These observations may distinguish the late sequelae of bacterial infection from other entities such as noninfectious avascular necrosis.

Proximal femoral focal deficiency (PFFD).

Proximal femoral focal deficiency (PFFD) is a spectrum of congenital osseous anomalies characterized by a deficiency in the structure of the proximal femur. Thirteen patients with PFFD were classified based on a system describing acetabular shape and femoral position. Radiological evaluation includes identification and description of the PFFD and evaluation of the associated limb anomalies, of which ipsilateral fibular hemimelia is the most common. Contrast arthrography is indicated to disclose the presence and location of the femoral head.

Multiple symmetrical fractures of bone of unresolved etiology.

The clinical, laboratory, and radiologic picture of a unique patient with symmetrical fractures of the anterior tibial midshafts, dorsal ulnar cortices, and lateral metatarsals is presented. The findings are not compatible with a diagnosis of osteogenesis imperfecta or osteomalacia despite osseous fragility. The elevated serum pyrophosphate and low urine phosphate content suggest that abnormalities in phosphate metabolism may have contributed to the formation of bone which is biochemically and structurally deficient.