Pyogenic granuloma in a renal transplant patient: case report.

This case report describes a 14-year-old female referred to Pediatric Dentistry for evaluation and treatment of cyclosporine-induced gingival hyperplasia. Examination of the anterior maxillary area showed a red, vascular, exophytic, soft-tissue mass which had been excised a few months earlier without a histopathologic examination being done. The mass did not appear consistent with gingival overgrowth induced by long-term use of medication, and thus an excisional biopsy was performed, which diagnosed the lesion as a pyogenic granuloma. A review of the literature and management recommendations are discussed.

Long-term results after physiological genu varum.

All reports agree that the physiological genu varum is a normal condition in early childhood which does not require any treatment, but there is no documentation to correlate between the clinical and radiographic severity of the varus deformity in early childhood and the prognosis in later life. Seventy three cases (135 knees) were followed up from the onset of genu varum at age 11.5 months (range, 8-24 months) until the last follow-up, at age 36.5 years (range, 28-65 years). The angles, femorotibial and metaphyseal-diaphyseal of tibia at first examination were analysed on 107 radiographs (57 cases). The femorotibial angle measured 17 degrees (range, 0-40 degrees), and the metaphyseal-diaphyseal angle of the tibia was 8 degrees (range, 0-21 degrees). None of these knees developed Blount's disease. About two-thirds of the cases (50 cases, 89 knees) showed no symptoms at all and were satisfactory, whereas about one-third of the cases (17 cases, 34 knees) reported that sometimes, they have mild pain, stiffness or both, especially on exertion. One can not be sure whether these cases should be interpreted as a beginning of arthrosis or not. More research is needed to study the long-term results after physiological genu varum as unfortunately there appear to be no reports of work on this topic in the world literature.

Long-term results after infantile Blount's disease.

A long-term follow-up of 49 patients with an average age of 38 years (range: 25-67 years) who had experienced infantile Blount's disease was done. Thirty-seven patients had bilateral disease, giving a total of 86 affected knees. Thirty-eight knees had conservative or no treatment during childhood; 13 were treated by epiphysiodesis, and 35 by osteotomy. At follow-up, 11 knees showed arthrosis, and 9 were graded as mild. Ten knees had been surgically treated by medial meniscectomy at an average age of 29 years (range: 19-45 years), after the diagnosis of Blount's disease. Four of the knees showed arthrosis. Most of the patients had a straight leg and mild or no pain from their knee. It is concluded that most children with infantile Blount's disease will, at the age of 40 years, have a straight leg without arthrosis and that one third can reach this result without any treatment.

Relevancy of radiographic features in elbow fractures.

PURPOSE: To correlate radiographic and clinical findings of elbow fractures. MATERIAL AND METHODS: A retrospective study was made of 110 consecutive adult elbow fractures of various types involving the humerus, the ulna, and the radius. RESULTS: Twenty-seven fractures with radiographically conspicuous distortions healed. Of these only 15 had clinical sequelae. Five had clinical sequelae without showing conspicuous radiographic distortions after healing. CONCLUSION: For radiographic evaluation and classification purposes, it would seem to be important to note the status of the capitellum, the capitellum-trochlear plane, and the combination of a distal humerus and a proximal ulna fracture. The outcome of common olecranon fractures and injuries to the radial head would seem to depend less on a detailed radiographic description.

Long-term results after adolescent Blount's disease.

A long-term follow-up study was made of 23 patients with an average age of 47 years (range 38-68 years) who had adolescent Blount's disease. Four patients had bilateral disease (27 affected knees). Nine knees had no treatment during childhood, 11 were treated by physiodesis, and seven were treated by osteotomy of the proximal tibia. At follow-up, most of the patients had no pain or mild pain from their knee. Nine knees showed arthrosis. We conclude that most children with adolescent Blount's disease will have a straight leg at middle age without arthrosis and that this result can be obtained in one of four patients without treatment.

Metaphyseal-diaphyseal angle in Blount's disease. A 30-year follow-up of 13 unoperated children.

We analyzed the metaphyseal-diaphyseal angle in 13 patients with infantile Blount's disease, who had been followed without treatment during the entire growth period and without any form of realignment procedure in adulthood. On diagnosis at 23 (17-35) months of age, the metaphyseal-diaphyseal angle varied between 7 degrees and 25 degrees. At follow-up, most of the legs were almost straight. We found that the diagnosis of Blount's disease cannot be based solely on the metaphyseal-diaphyseal angle and that a bowed knee must be followed with repeated examinations before it can be decided whether treatment is needed.

Coccygodynia.

Ten coccygectomies were performed. Patients were all females (aged 26-74, average 46). All patients expressed satisfaction after the operation (one was deceased at the time of follow up). The material is too small for definitive conclusions, but it shows clearly that carefully selected cases with traumatic or idiopathic coccygodynia could benefit from coccygectomy.

Hemicondylar tibial osteotomy in Blount's disease. A report of 2 cases.

Two neglected cases of Blount's disease with severe sloping of the medial tibial condyle and excessive ligamentous laxity are presented. Elevation of the medial tibial condyle gave good results.

A prognostic algorithm for assessment of subcapital femoral neck fractures.

A new method for prognostication of non-union in subcapital femoral neck fractures is presented. From routine pre- and post-operative films from 112 patients with Garden stage 2, 3, and 4 fractures 4 parameters were obtained: Cranial displacement, orientation of the nail in the femoral head, depth of nail inserted, and attainment of perfect reduction. These 4 variables were combined into a simple algorithm capable of non-union prediction at various levels of certainty (74-100%).

Osteoarthritis following Blount's disease.

Investigation of 133 knees with Blount's disease in 86 patients showed that no patient below the age of 30 had evidence of degenerative change in the affected knees. Seventeen patients over 30 years of age had a total of 27 affected knees, of which 11 were osteoarthritic. Although increasing varus deformity predisposed to degenerative change the relationship was not constant and no firm relationship could be drawn between the amount of wear, the compartment of the knee involved and the degree of deformity.

Physiological genu varum.

Physiological genu varum is a condition which, during the first years of life, usually does not require any treatment, but it can present differential diagnostic difficulties. The condition can be distinguished from Mb Blount, prenatal genu varum, hypophosphataemia, rachitis, and post-traumatic genu varum in its course, roentgenological picture, and laboratory examination. It is highly probable that physiological genu varum is the reversible initial stage at Mb Blount, because both physiological genu and Mb Blount can occur at the same time in the same patient.