Cases reported "Cerebral Palsy"

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11/44. Gluteus minimus-induced femoral head deformation in dysplasia of the hip.

    Lateral notching of the femoral head is considered pathognomonic for spastic subluxation of the hip. Less frequently, flattening is seen with extrusion of the femoral head in nonspastic hip dysplasia. The aim of this study was to throw light on its underlying pathomechanism. On the radiographs of 297 hips with developmental dysplasia, lateral flattening of the femoral head was seen in 18 hips (6%), but notching was present in only 1. Of 7 dysplasias due to cerebral palsy, 6 showed lateral notching. The gluteus minimus was felt to be responsible for the lateral femoral head changes as the muscle counteracts lateral migration of the femoral head. Intraoperative dissection of 3 hips supported this view. 1 hip with developmental dysplasia and lateral notching was subjected to a periacetabular osteotomy. At surgery, the tendon of the gluteus minimus was found to fit tightly into the notch. Of 2 hips with spastic dysplasia, 1 presented with and the other without lateral notching. In the hip with lateral notching, the gluteus minimus had a normal appearance and it lay in the defect of the femoral head. In the hip without notching, the gluteus minimus was atrophied with signs of fatty degeneration. We therefore believe that lateral notching is a sign of hypertonicity of the gluteus minimus muscle.
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12/44. scoliosis and severe pelvic obliquity in a patient with cerebral palsy: surgical treatment utilizing halo-femoral traction.

    STUDY DESIGN: Case report of severe scoliosis and associated pelvic obliquity in a 14-year-old patient with cerebral palsy. OBJECTIVES: To report the presentation of the case, the operative considerations, and the management of this spinal deformity. SUMMARY OF BACKGROUND DATA: Spinal deformity in cerebral palsy may include scoliosis, kyphosis, and hyperlordosis. Pelvic obliquity is a frequent feature associated with neuromuscular scoliosis. The severity of the pelvic obliquity deformity presented here is unusual, and this case study delineates an effective surgical treatment plan for these patients using intraoperative halo-femoral traction. methods: A same-day, two-stage surgical reconstruction was performed to effectively correct this spinal deformity. The patient underwent an anterior spinal fusion from T10 to S1 and a posterior spinal fusion from T2 to the pelvis; the posterior procedure was performed with the patient in intraoperative halo-femoral traction. Sacral fixation was obtained using the Galveston technique bilaterally. RESULTS: The patient responded well to surgical intervention, had no complications, and continues to have stable correction of his pelvic obliquity deformity 2 years after surgery. CONCLUSION: It is concluded that scoliosis with associated severe pelvic obliquity deformities can be treated with anterior and posterior spinal fusion and instrumentation with intraoperative halo-femoral traction in the properly selected and prepared patient with cerebral palsy.
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ranking = 4
keywords = operative
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13/44. Reversible coma in children after improper baclofen pump insertion.

    We report the occurrence of delayed postoperative coma in five of nine consecutive children following surgery for insertion of baclofen infusion pumps. We suspect that improper technique resulted in an inadvertent administration of an intrathecal baclofen bolus. We suggest ways to minimize this risk.
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keywords = operative
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14/44. Gastric volvulus after laparoscopic Nissen fundoplication with gastrostomy.

    The authors present the case report of a 13-year-old boy in whom organoaxial gastric volvulus developed four months after a laparoscopic Nissen fundoplication and placement of gastrostomy. Intraoperative findings were significant for volvulus about an axis defined by 2 fixation points, one at the fundoplication site and the other in the area of the gastrostomy tube, positioned close to the pylorus. Of the 142 pediatric cases of gastric volvulus reported to date, only 7 describe it as a complication subsequent to gastric surgery, and just one case has been reported after laparoscopic Nissen fundoplication. This case shows that fundoplication and gastrostomy, a recommended treatment for gastric volvulus, does not always preclude its development. Increasing numbers of pediatric surgeons are performing laparoscopic Nissen fundoplication procedures. The authors advise surgeons to consider this potentially fatal complication, both intraoperatively when selecting a location for gastrostomy and postoperatively when evaluating complaints.
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ranking = 3
keywords = operative
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15/44. Transient Foix-Chavany-Marie syndrome after surgical resection of a right insulo-opercular low-grade glioma: case report.

    OBJECTIVE AND IMPORTANCE: We describe an atypical case of transient Foix-Chavany-Marie syndrome, or faciopharyngoglossomasticatory diplegia with automatic voluntary dissociation, occurring after surgical resection of a right insulo-opercular glioma. CLINICAL PRESENTATION: A 26-year-old right-handed man experienced partial seizures that were poorly controlled by antiepileptic drugs during a 2-year period as a result of a right insulo-opercular low-grade glioma, leading to the proposal of surgical resection. In addition, 1 year before the operation, the patient experienced a severe brain injury that resulted in a coma. A computed tomographic scan revealed left opercular contusion. The patient recovered completely within 6 months. INTERVENTION: Intraoperative corticosubcortical electrical functional mapping was performed along the resection, allowing the identification and preservation of the facial and upper limb motor structures. A subtotal removal of the glioma was achieved. The patient had postoperative anarthria, with loss of voluntary muscular functions of the face and tongue, and he had trouble chewing and swallowing. All of these symptoms resolved within 3 months. CONCLUSION: These findings provide insight into the use of surgery to treat a right insulo-opercular tumor. First, surgeons must be particularly cautious in cases with a potential contralateral lesion (e.g., history of head injury), even if such a lesion is not visible on magnetic resonance imaging scans; preoperative metabolic imaging and electrophysiological investigations should be considered before an operative decision is made. Second, surgeons must perform intraoperative functional mapping to identify and to attempt to preserve the corticosubcortical facial motor structures. A procedure performed while the patient is awake should be discussed to detect the structures involved in chewing and swallowing in cases of suspected bilateral lesions. Third, the patient must be informed of this particular risk before surgery is performed.
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ranking = 5
keywords = operative
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16/44. Sectorial posterior rhizotomy, a new technique of surgical treatment for spasticity.

    After their experience of Foerster's operation and its technical modifications in 80 cases the authors report a new concept of analysis and treatment of spasticity in lower limbs. Spasticity of the different muscle groups is classified either as "useful spasticity" or "handicapping spasticity". The first has to be preserved, the second must be reduced. In order to achieve this purpose a new technique is presented, based on operative sectorial identification of the posterior rootlets subserving the "handicapping spasticity" by electrophysiological stimulation, muscle testing, and E.M.G. studies. The conus medullaris and cauda equina are exposed by T 11-L 1 laminectomy, performed in the lateral position. The clinical and E.M.G. evaluation of responses to stimulation enables the surgeon to establish a map of rootlet groups which are marked with coloured threads. Selective resection of "handicapping posterior rootlets" is then performed after several tests of the mapping. The rootlets subserving useful spasticity are carefully preserved. Ten cases are reported, comprising five cases of cerebral palsy operated upon since 1974 and five cases of posttraumatic spastic paraplegia from the same period. Pre and postoperative findings are summarized. The technical features of this procedure are discussed and compared with other surgical procedures. The problem of the rootlet reflex arch is considered in the light of the effects of stimulation of anterior and posterior rootlets at the same level.
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ranking = 2
keywords = operative
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17/44. The Americans With Disabilities Act of 1990 expands employment opportunities for persons with developmental disabilities.

    The primary purpose of the ADA is the full inclusion of persons with disabilities within their communities. The ADA prohibits discrimination on the basis of disability in the areas of employment, transportation, public accommodations, telecommunications, and state and local government agencies. The person described in this report encountered some of this discrimination. He successfully obtained paid community-integrated employment only after overcoming major obstacles and barriers, the greatest being transportation. In our highly mobile society, reliable transportation is essential for the acquisition and maintenance of community-integrated employment. The participant was repeatedly denied access to public transportation on the basis of his disability. To help overcome this barrier, Transition Services had to provide needed transportation at great expense, which delayed opportunities for the participant to gain control of this aspect of his life. Enactment of the ADA makes it more difficult for public transportation agencies to deny services to persons with disabilities by claiming inconvenience or lack of accessible vehicles. When publicly funded transportation programs assume their full responsibility for transportation to the public, agencies like Transition Services can focus on individualized employment and training issues rather than on providing transportation. In the workplace, the employer's willingness to work cooperatively with the participant and the staff of Transition Services resulted in several low-cost and reasonable accommodations based on the participant's needs and abilities. A simple rearrangement of work space allowed the participant to perform his job while benefiting the other workers in the crowded restaurant kitchen.(ABSTRACT TRUNCATED AT 250 WORDS)
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ranking = 1
keywords = operative
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18/44. Postoperative heterotopic ossification in the child with cerebral palsy: three case reports.

    Three children with cerebral palsy and mental retardation showed irritability after surgical procedures. They were subsequently diagnosed as having heterotopic ossification. Heterotopic ossification developed around the hip in all cases--two after bilateral adductor releases at the operative site and the third after spinal fusion at a site unrelated to the surgery.
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ranking = 5
keywords = operative
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19/44. hand somatosensory cortex activity following selective dorsal rhizotomy: report of three cases with fMRI.

    INTRODUCTION: Selective dorsal rhizotomy (SDR) is an effective treatment for lower extremity spasticity in cerebral palsy. Cortical organization in sensory cortex may be abnormal in cerebral palsy, and deafferentation is known to lead to cortical reorganization in many situations. methods: We used functional magnetic resonance imaging (fMRI) of hand sensory stimulation to determine if the partial deafferentation of the lower extremity sensory system, associated with SDR, led to any alterations in the cortical somatosensory representation for the upper limbs. Three patients with spastic diplegia were studied with blood oxygen level-dependent (BOLD)-fMRI before and after SDR. fMRI during tactile stimulation of the digits of the right hand was used to map hand somatosensory cortex. Comparison of the cortical maps devoted to the hand before and after SDR assessed for cortical reorganization following partial deafferentation of the lower extremity. RESULTS: In the one patient with upper extremity involvement, the hand sensory representation was markedly enhanced following SDR. In the other two patients, a normal pattern, but with diminished activity, was seen compared with preoperative findings. SDR for lower limb spastic diplegia does not lead to extensive reorganization of cortex dedicated to the representation of the upper limb. An essentially normal pattern of activation was seen both before and after SDR. CONCLUSION: The relief of attention demands associated with spasticity may explain the modulation in intensity seen after SDR in the patients who exhibited no upper extremity involvement despite lower limb spasticity.
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ranking = 1
keywords = operative
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20/44. Neuropathic pain following multilevel surgery in children with cerebral palsy: a case series and review.

    Six children with cerebral palsy are presented who developed neuropathic pain following multilevel orthopedic surgery. This significant complication is previously unreported. The diagnosis and treatment options are reviewed. Treatment should be kept as simple and noninvasive as possible, and aim to enable physiotherapy to continue. Early recognition and interdisciplinary treatment is important to prevent a downward spiral of increasing pain and decreased function. A good outcome in respect of improved pain and functioning was achieved in five of these six children. It is our opinion that this complication should form part of informed consent for multilevel surgery and that anesthetists should be aware of this complication when managing postoperative pain control.
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keywords = operative
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