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This retrospective study analyzed the clinical, bacteriological, and radiological features of pediatric patients with acute hematogenous osteomyelitis and septic arthritis. Eighty-four patients with septic arthritis and 39 with acute hematogenous osteomyelitis were enrolled. Their age ranged from 13 days to 17 years. In patients with septic arthritis, the hip joint was the most often infected site. The tibia was the most often involved site in acute hematogenous osteomyelitis. A bacteriological diagnosis was established in 78 (63%) patients. Overall, methicillin-susceptible Staphylococcus aureus (36 cases) was the most common causative organism identified, followed by methicillin-resistant S. aureus (10 cases). The median duration of antibiotic therapy was 33 days. Serum bactericidal titers were obtained for 19 (15%) of the 123 patients. The median duration of hospitalization and antibiotic treatment was not significantly different between patients with and without serum bactericidal titer testing. More patients without serum bactericidal titer testing had symptom relapse which required re-admission for further treatment. In conclusion, the incidence of methicillin-resistant S. aureus as a cause of bone and joint infections has been increasing. Serum bactericidal titer is valuable for the management of patients receiving sequential therapy for acute hematogenous osteomyelitis and septic arthritis.

Acute primary infection of the epiphysis is uncommon. We present 2 cases of acute osteomyelitis of the distal femoral epiphysis. They were not diagnosed until 10 days and 3 weeks, respectively, after the onset of symptoms. The epiphyseal infection spread into the knee joint, and surgical debridement was performed. The majority of reported cases in the medical literature are of bacterial etiology, and the most common pathogen is Staphylococcus aureus. We report a rare case which was infected by Salmonella enteritidis. Prompt diagnosis and early treatment are required to prevent further destruction and growth disturbance.

Background: Periacetabular osteotomies are technically demanding surgical procedures. We developed a modified technique that uses a transtrochanteric approach. Our goal was to facilitate surgical exposure without compromising the results of surgery. The purpose of the present study was to review the early results in our initial group of patients who had this procedure., Methods: We retrospectively reviewed the results of a modified periacetabular osteotomy in thirty-eight consecutive patients (forty-six hips) at an average duration of follow-up of 4.2 years. The average age of the patients was thirty-one years (range, eighteen to fifty-eight years) at the time of surgery. We evaluated the results with use of serial radiographs and the Merle d'Aubigné and Postel hip-scoring system., Results: All osteotomies healed. Preoperatively, the average lateral center-edge angle was 3 degrees (range, -15 degrees to 12 degrees ), the anterior center-edge angle was 0 degrees (range, -20 degrees to 5 degrees ), the acetabular angle of Sharp was 57 degrees (range, 50 degrees to 68 degrees ), and the femoral head coverage was 53% (range, 40% to 66%). Postoperatively, the average lateral center-edge angle was 35 degrees (range, 23 degrees to 45 degrees ), the anterior center-edge angle was 32 degrees (range, 20 degrees to 55 degrees ), the acetabular angle of Sharp was 40 degrees (range, 37 degrees to 45 degrees ), and the femoral head coverage was 92% (range, 85% to 100%). The average amount of medialization of the femoral head was 6 mm. At the latest follow-up examination, improvement in the grade of osteoarthritis was noted in eight hips, while progression of osteoarthritis was seen in five hips. Functionally, the average Merle d'Aubigné and Postel hip score improved from 13.2 points preoperatively to 17.0 points postoperatively. No patient had a neurovascular complication., Conclusion: Our early experience with a modified periacetabular osteotomy showed encouraging results in terms of the technical ease of the technique and the outcome in our patients.

Obstructive sleep apnea is rarely caused by laryngomalacia in adult patients. To our knowledge, laryngomalacia secondary to osteogenesis imperfecta inducing obstructive sleep apnea has not been reported. We present an adult osteogenesis imperfecta patient with obstructive sleep apnea. Oral examination demonstrated an extremely long epiglottis in the oral cavity. Fiberoptic nasopharyngoscopy revealed that the epiglottis and redundant mucosa of the arytenoids were drawn into the laryngeal inlet during inspiration. Supraglottoplasty with intraoral and laryngoscopic approach was carried out and resulted in marked decreases in snoring, sleep apnea, and daytime sleepiness. In this report, we describe a unique laryngeal manifestation inducing obstructive sleep apnea in an adult with brittle bone disease. The anomaly of laryngeal structure can be corrected by surgical intervention with good response in the sleep-disordered breathing., (Copyright 2002, Elsevier Science (USA). All rights reserved.))

One hundred and sixty-six cementless primary total hip arthroplasties were performed in 133 patients with porous coated Omnifit prosthesis. The average age was 49.7 years. The mean follow-up period was 8.2 years with a minimum of 5 years. Good to excellent clinical results were achieved in 93% of patients. The overall revision rate was 5.4%. Radiographically, bone ingrowth occurred in all unrevised cups, and in 95% of unrevised stems. Osteolytic lesions appeared at an average of 3.8 years postoperatively. Femoral and pelvic osteolysis were seen in 21% and 4% of the surviving hips respectively. All femoral osteolytic lesions were found in the proximal Gruen zones 1 and 7. The mean annual polyethylene wear rate was 0.15 mm. Approximately one-third of the hips were observed to have excessive wear. Our experience with cementless Omnifit total hip prosthesis is encouraging. Of significant concern is the high incidence of excessive polyethylene wear and osteolysis.

Acute osteomyelitis in childhood is uncommon. Early diagnosis is often difficult. We present a 7-year-old boy with clinical manifestation of fever and progressive left thigh swelling for one week. Sonography of the left thigh showed periosteal thickening with subperiosteal abscess around the metaphysis of the left distal femur. Tc-99m bone scintigraphy showed increased uptakes at the left distal femur. Osteomyelitis was suspected from the examination of ultrasound and bone scan examinations. His symptoms were not relieved following systemic antibiotic therapy and a follow-up color Doppler sonography showed vascular flows within and around the periosteum indicating active inflammation. He finally received surgical drainage and the operative findings confirmed the diagnosis of osteomyelitis. In conclusion, ultrasound may be a helpful and convenient tool for establishing the early diagnosis of pediatric osteomyelitis. Ultrasound and color Doppler sonography can be used as clinical parameters to evaluate the disease severity and the progression of osteomyelitis in children.

A retrospective review revealed localized femoral osteolysis occurred in 8 out of 134 cementless ceramic total hip arthroplasties (6.0%) performed during an average 9-year period. The average latent period was 8 years. The lesion was usually located in the deeper periprosthetic area. Localized osteolysis usually occurred after loosening of the femoral stem, suggesting the pathogenesis may be a foreign-body reaction to the ceramic debris.

This is a retrospective study of 31 cases of acute septic arthritis of the hip in children treated at Chang Gung Memorial Hospital from 1983 to 1989. The average follow-up period was 35 months. Among them, there were 18 males (58%) and 13 females (42%). None were involved bilaterally. Fifteen cases (48%) were below 5 years of age. All cases met the diagnostic criteria including bacteriological results, clinical and radiographic changes. Limited range of motion, fever, and tenderness were the most common symptoms and signs. More than half of the patients (52%) had a leukocyte count of over 15,000/cmm. The erythrocyte sedimentation rate was elevated in 30 cases (97%). Pathogens had been isolated from blood, arthrocentesis fluid, or surgical specimens in 26 cases (84%). Staphylococcus aureus was the most common causative organism (58%). Twenty-seven cases (87%) underwent emergency arthrotomy and debridement. Five (19%) of them received unsatisfactory results. A delay in definite treatment, very young infants, and the association with osteomyelitis of the adjacent bone were the important factors associated with poor prognosis. Four cases (13%) who received only medical treatment showed satisfactory results. Early diagnosis and significant response to antibiotics contributed to this favorable outcome.

In a prospective study from December 1986 to August 1989, 17 consecutive patients with femoral shortening due to aseptic nonunion of femoral shaft fractures were treated with limitedly open Gross-Kempf locking nailing with a lengthening procedure. Patients were followed up for at least 1 year (average 25 months). There was a 88.2% union rate with an average union period of 5.2 months. Average lengthening was 2.4 cm (1.0 approximately 3.0 cm), and average operation time 90 min (70 approximately 130 min). The blood loss was slight (average 200 ml). Complications (11.8%) were 5.9% implant failure and 5.9% nonunion which were not difficult to manage. No neurovascular complications were noted. We conclude that for 5 cm shortening or less in femoral aseptic nonunion, this treatment constitutes the simplest technique and can achieve a very satisfactory result.

Twenty New Zealand rabbits were chosen for this study (5 for controls and 15 for the alcohol group). In the alcohol group, each rabbit was fed with rice wine (2 g/kg/day alcohol) for 1 year. Bone marrow pressure of the femoral basal neck, erythrocyte sedimentation rate (ESR), liver functions, uric acid, triglyceride, cholesterol, amylase, and blood alcohol level were measured at 0 day, 6 months and 1 year. Finally, the rabbits were sacrificed at the end of the study. The livers and femoral heads were examined for pathology. The bone volume and fat cell size of the femoral head were measured with a computerized "Bone Scanner". The results (1 year comparison) were a significantly higher level of cholesterol in the alcohol group (72 +/- 40 mg% vs 26 +/- 8 mg%, p less than 0.05) and greater bone marrow pressure (27.71 +/- 8.97 mmHg vs 18.20 +/- 4.09 mmHg, p less than 0.05), and no significant difference in triglyceride, uric acid and liver function, ESR, etc., when using Student's 2-tailed t-test. Liver changes (fatty liver) occurred in 3 animals in the alcohol group. The effect of alcohol on the trabecular bone volume was not significant (51.5 +/- 4.6 vol.% vs 50.0 +/- 5.2 vol.%), but the average fat cell size of the femoral head was significantly larger than that for normal controls (2,745 +/- 605 mu2 vs 2,185 +/- 458 mu2, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

In a prospective study of 31 subtrochanteric fractures treated with Grosse-Kempf interlocking nails with a followup period of at least 1 year, there was a 87.1% (27/31) union rate, and a union period of 4.2 +/- 1.8 months. Knee range of motion in 28 acute traumatic cases was on average 127.5 +/- 23.0 degrees. The significant complications included: nail breakage, 3.2% (1/31); nonunion without nail breakage, 9.7% (3/31); neglected femoral fracture with malunion, 3.2% (1/31). The interlocking nailing has the advantages of: a) closed method, b) weight-sharing principle, c) shortening prevention, d) non-rigid fixation. From the theoretical and clinical comparison among the various implants, we conclude that closed interlocking nailing is one of the better instruments for subtrochanteric fracture treatment, and moreover, the most reasonable of all. However, for the higher level subtrochanteric fractures, reconstruction-style locking nails should be chosen.

In rats anesthetized with urethane, the effects of distention of the stomach upon cecal motility and neural mechanisms which generate this effect were studied. Cecal motility was inhibited which generate this effect were studied. Cecal motility was inhibited when the pars glandularis of the stomach was distended by pressure ranging from 25 to 30 cm H2O. This inhibitory reflex was not affected by bilateral cervical vagotomy, but completely abolished following bilateral severance of the greater splanchnic nerves or after intravenous administration of guanethidine. After transection of the spinal cord at the level of the 5th thoracic segment the inhibitory reflex remained intact, but was abolished following pithing of the 6th thoracic segment and below. It may be concluded that the afferent and efferent path of the gastrocecal inhibitory reflex mainly pass through the greater splanchnic nerves and the reflex center is located in thoracic segments caudal to the 6th thoracic segment.

The effects of electrical stimulation of the satiety and feeding centers (SC, FC) on gastric, cecal and rectal motility were studied in rats anesthetized with urethane. Each center produced excitatory, inhibitory and biphasic responses in these organs. Cecal and rectal responses to stimulation of SC or FC were usually the opposite of the gastric response; for example, the gastric response was excitatory, whereas cecal and rectal responses were inhibitory. Gastric and cecal excitatory responses were abolished by vagotomy and the rectal response by severance of parasympathetic branches of the pudendal plexus (PSB). Gastric and ceca inhibitory responses were fairly depressed by vagotomy and abolished by successive splanchnicotomy, while the rectal inhibitory response was abolished by severance of inferior mesenteric nerves (IMN) and PSB. It was concluded that the satiety and feeding centers modulate not only gastric motility but also cecal and rectal motility, and that the excitatory response is conveyed through vagus nerves to the stomach and cecum and through PSB to the rectum. The inhibitory response is mediated mainly through vagus nerves, partially through splanchnic nerves to the stomach and cecum, and through IMN and PSB to the rectum. The characteristics of efferent terminal neurons eliciting excitatory and inhibitory responses were studied pharmacologically.

Twenty-two children with femoral shaft fractures, between the age of 10 and 14 years, were treated with the Hoffmann external fixation apparatus from 1980 to 1985. This method of treatment is very simple. It requires less surgical exposure and allows earlier ambulation and easy nursing care. In addition, it makes patients comfortable in multiple trauma conditions. The average time to union and removal of fixators was 72 days (range, 44 to 80 days). There were no deep wound infections, nonunions, or rotationary deformities. On followup, all patients regained the range of motion of knee joints in 3 months without significant leg length discrepancy or radiographic evidence of growth disturbance. The device may serve as an alternative method for femoral shaft fractures in prepuberty, especially in areas of tropical climate.

Intraosseous hypertension is noted both in osteoarthritis of the hip and ischemic necrosis of the femoral head. The mean intraosseous pressure in osteoarthritis cases was 30.0 +/- 4.2 mmHg. The incidence of abnormal intraosseous pressure and positive stress tests was 39% and 26.7%, respectively. In patients with ischemic necrosis of the femoral head, intraosseous pressure was 45.6 +/- 19.4 mmHg, 79% of patients had abnormal intraosseous pressure, and 56.1% had positive stress tests. Intraosseous pressure studies indicated a statistically significant difference between patients with osteoarthritis and those with ischemic necrosis of the femoral head.