Slipped capital femoral epiphysis: an analysis of treatment outcome according to physeal stability.

INTRODUCTION: Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents. Treatment can be associated with serious complications, mainly avascular necrosis (AVN). The objective of this study was to evaluate treatment outcomes and complications based on physeal stability at presentation. METHODS: We reviewed retrospectively all children treated for SCFE from 1990 through 2000 at the Children's Hospital of Eastern Ontario, Ottawa. RESULTS: Of a total of 87 patients (56 male) identified, 73 had slips classed as stable and 14, unstable; 42 involved the left side, 34 the right, and 19 were bilateral. Avascular necrosis (AVN) developed in 1 patient with a stable slip (morbidity 1.4%) and in 3 with unstable slips (21.4%; p = 0.001). Manipulative anatomical reduction was done in 11 cases (78.5%), all unstable slips. All slips complicated by AVN had been classified according to the traditional system as acute-on-chronic. Complication rates differed significantly between unstable slips (36%) and stable (20%). No statistically significant association was found between AVN and slip severity, time to fixation or use of reduction. CONCLUSIONS: The treatment of stable slips exhibits a lower incidence of AVN. These results nevertheless suggest that gentle reduction of unstable slips is safe and unaccompanied by an increase in complications.     

Inhibition of allergen-induced bronchoconstriction in hyperreactive rats as a model for testing 5-lipoxygenase inhibitors and leukotriene D4 receptor antagonists

Sensitized inbred hyperreactive rats showed reproducible episodes of dyspnea when exposed to aerosols of antigen. Following inhibition of the serotonin component of the response by pretreatment with methysergide, the model was shown to be useful for studying the oral activity of compounds that affect the production or action of leukotrienes. This was shown through inhibition of the duration of dyspnea by two selective 5-lipoxygenase inhibitors, L-651,392 and L-615,919, and two selective leukotriene D₄ receptor antagonists, L-647,438 and L-649,923. Selectivity of the compounds could be demonstrated by reducing inhibition of the antigen response in the absence of methysergide and failure to inhibit serotonin-induced dyspnea. It is concluded that the model provides a reproducible method for screening large numbers of leukotriene inhibitors and antagonists and gives a measurement of their duration of biological activity.     

Degloving injuries in children

Degloving injuries are uncommon but serious and are being encountered with increasing frequency in children. A 5-year review of experience with degloving injuries on the Orthopaedic Service at the Winnipeg (Manitoba, Canada) Children's Hospital revealed 16 patients who had sustained this trauma in association with fractures. Twelve of these children had typical anatomical degloving. However, six patients had an associated concealed degloving or so-called "physiological degloving," with disruption of the underlying skin vasculature but no actual disruption of the skin surface. The most common causes of degloving injuries were being run over by a motor vehicle and farm machinery accidents. The diagnosis and proper management of the degloved extremity, especially when accompanied by underlying fracture, are essential in children if morbidity and limb loss are to be minimized.     

Symphalangism in children. Case report and review of the literature

Symphalangism is an uncommon syndrome characterized by fusion of the interphalangeal joints of the hands and feet. The fusion can involve the proximal or the distal joints; however, involvement of the proximal interphalangeal joints is more common. Symphalangism often is associated with several other skeletal and nonskeletal abnormalities. Analysis of the pedigrees of affected families reveals this trait to be autosomal dominant. The authors present the case of a 9-year-old boy with bilateral symphalangism of the proximal interphalangeal joints in the fingers and toes. His father is affected similarly. A comparison of these cases with those published in the literature indicates that although the radiologic appearance of symphalangism appears disabling, the fused phalanges seldom cause disability or loss of function of the hand. Surgical intervention is not required in most patients. The father and son reported also had capitellar hypoplasia and subluxation of the radial head associated with limitation of elbow flexion and extension.     

Atrial and venous thrombosis secondary to septic arthritis of the sacroiliac joint in a child with hereditary protein C deficiency

Septic arthritis and osteomyelitis in children is seldom accompanied by calf vein thrombosis and rarely by atrial thrombosis. We report the case of an 11-year, 5-month-old boy with septic arthritis and osteomyelitis of the sacroiliac region who developed deep venous thrombosis, in addition to life-threatening right atrial thrombosis. After an intensive hematologic investigation, a hereditary protein C deficiency was revealed. The association of venous thrombosis with septic arthritis or osteomyelitis should raise the possibility of the presence of protein C deficiency.     

An analysis of an air-ambulance program for children

Air-ambulance services are extremely expensive to operate and maintain. The value of their existence has been questioned in this era of rationalization and downsizing. We examined the cost, safety, flight crew composition, types of trauma, and effectiveness of our air-ambulance program at the Children's Hospital of Eastern Ontario (CHEO) over a 3-year period, 1994-1997. During this time, 392 children were aeroevacuated to CHEO, 113 surgical (29%), 136 medical (35%), and 143 neonates (36%). Of the surgical cases, 43% were transferred for orthopaedic trauma, the commonest being fractured femur, 23% for general surgical cases, most common being thoracoabdominal trauma, and 22% for neurosurgical reasons, most commonly basilar skull fractures. The average response time (time from which the call was received to the time when the helicopter reached the patient site) for all of the cases was 46 min. The average travel time (time from departure of patient site to arrival at CHEO) for these same cases was 25.59 min. The air-ambulance program for children in the Ottawa-Carleton Eastern Ontario areas, was found to be safe, effective, and allowed earlier specialized medical care to be provided.     

Human eosinophil major basic protein augments bronchoconstriction induced by intravenous agonists in guinea pigs

The direct effect of intratracheal (IT) administration of human major basic protein (MBP) on pulmonary inspiratory pressure (PIP), and the effect on agonist-induced change in PIP, were determined in anesthetized, ventilated guinea pigs. 500 g MBP increased PIP from 24.1±4.3 to 49.8±7.4 cm H₂O (p<>n=10). Maximum PIP was achieved within 30 min after 500 g MBP. The direct PIP response to 250 g MBP was not different from vehicle. The PIP responses to intravenous (IV) acetylcholine (Ach) and 5-hydroxytryptamine (5-HT) were measured before and after administration of 250 g MBP (n=12). MBP caused a modest, but significant potentiation of the increase in PIP induced by 1, 3 and 10 g/kg Ach (24, 32 and 28%, respectively,p<0.02) and=" to=" 1=">g/kg 5-HT (43%p<0.02). we=" conclude=" that=" mbp=" at=" a=" dose=" that=" does=" not=" directly=" affect=" inspiratory=" pressure=" is=" capable=" of=" augmenting=" the=" pip=" response=" to=" iv=" ach=" and=">in vivo.     

Parental resilience: A neglected construct in resilience research

The substantial focus of resilience research on childhood well‐being has resulted in limited knowledge regarding other aspects of resilience in families, such as that of parents. Informed by literature in childhood and family resilience, in this review, we progress conceptual understanding by focusing on parental resilience. The definition of parental resilience, as the capacity of parents to deliver a competent and quality level of parenting to children despite the presence of risk factors, is offered here as a worthwhile framework through which to explore variables thought to contribute to resilience among parents. A conceptual model is proposed whereby parental psychological well‐being and self‐efficacy, family functioning, and social connectedness are specifically addressed, with each posited as playing an important role in parents’ ability to deliver high‐quality parenting. In addition to these factors, how parents accommodate adversity and find meaning in their everyday lives within their families is hypothesised to be an important process in understanding parental resilience.     

Exercise Dependence in Amateur Competitors and Non-Competitor Recreational Exercisers

Research has demonstrated that exercising has health promoting effects. However, if habitual sporting activities become uncontrollable, detrimental health consequences can occur among a minority of individuals. Furthermore, such obligatory exercise can cause serious decline in school/work productivity, as well as financial problems, relationship problems, and poor psychological and physical wellbeing. The aim of the present study was to compare characteristics related to exercise dependence (ED) between recreational exercisers and amateur competitors. A total of 1439 participants (41.4 % male; mean age = 32 years) completed a battery of measures including the Exercise Dependence Scale (EDS), SCOFF, Well-Being Questionnaire, and Rosenberg’s Self-Esteem Scale. Results showed that 6.5 % of participants identified themselves as amateur competitive exercisers. Amateur competitors exercised significantly more (6.4 h) than non-competitor recreational exercisers (4.6 h). Amateur competitors also scored significantly higher on the EDS. Significant effects were found between competing and self-esteem concerning ED. Results showed that both features had a strong effect on ED. The study highlights the connection between ED symptoms and lower self-esteem and/or lower levels of subjective wellbeing. These influential factors are worth considering when planning preventive interventions addressing ED for both amateur competitors and non-competitive recreational athletes as well as when promoting sport as a healthy activity.