By T. Berek. Southern Adventist University.

Kalenderer O generic calcium carbonate 500 mg with visa, Agus H buy calcium carbonate 500mg mastercard, Ozcalabi IT, Ozluk S (2005) The importance of Femoris und ihre Beziehung zur Hüftkopfnekrose (Morbus Perthes). Kealey W, Mayne E, McDonald W, Murray P, Cosgrove A (2000) The femoral valgus osteotomy in Legg-Calve-Perthes disease. Orthope- role of coagulation abnormalities in the development of Perthes’ dics 25: p513–7 disease. Kealey W, Lappin K, Leslie H, Sheridan B, Cosgrove A (2004) Endo- lateral pillar classification and Catterall classification of Legg-Calvé- crine Profile and Physical Stature of Children With Perthes Disease. J Pediatr Orthop 22: prognostic significance of the subchondral fracture and a two- 464–70 group classification of the femoral head involvement. Kumasaka Y, Harada K, Watanabe H, Higashihara T, Kishimoto H, Surg (Am) 66: 479–89 Sakurai K, Kozuka T (1991) Modified epiphyseal index for MRI in 65. Shang-li L, Ho TC (1991) The role of venous hypertension in the Legg-Calve-Perthes disease (LCPD). Lappin K, Kealey D, Cosgrove A (2002) Herring classification: how 194–200 useful is the initial radiograph? Boston Med ease in Greater Glasgow: is there an association with deprivation? Sponseller PD, Desai SS, Millis MB (1988) Comparison of femoral and Legg-Calve-Perthes disease and the consequences of surgical treat- innominate osteotomies for the treatment of Legg-Calvé-Perthes ment. Livesey J, Hay S, Bell M (1998) Perthes disease affecting three female 68. Stevens D, Tao S, Glueck C (2001) Recurrent Legg-Calve-Perthes dis- first-degree relatives. Stulberg SD, Cooperman DR, Wallenstein R (1981) The natural his- diolucent changes following ischemic necrosis of the capital femoral tory of Legg-Calve-Perthes disease. Margetts B, Perry C, Taylor J, Dangerfield P (2001) The incidence and 70. Van Campenhout A, Moens P, Fabry G (2006) Serial bone scintig- distribution of Legg-Calve-Perthes’ disease in Liverpool, 1982–95. Vasseur PB, Foley P, Stevenson S, Heitter D (1989) Mode of inheri- abduction brace for the treatment of Legg-Perthes diasease.

Clinical features Since the tumor grows very slowly it causes few symptoms generic 500 mg calcium carbonate mastercard, although diffuse pain can occasionally occur order 500mg calcium carbonate otc. AP and lateral x-rays of an adamantinoma of the tibia in a may notice a nodular, bumpy surface on the anterior as- 17-year old female patient 621 4 4. Occasionally, Diagnostic value of the molecular genetic detection of the t(11,22) translocation in Ewing’s tumors. Virchows Arch 425: however, spindle cell epithelial formations occur that 107–12 are almost impossible to differentiate from the stroma 12. Fagioli F, Aglietta M, Tienghi A, Ferrari S, Brach del Prever A, Vas- Cytokeratin-positive individual cells in an osteofibrous sallo E, Palmero A, Biasin E, Bacci G, Picci P, Madon E (2002) High- dose chemotherapy in the treatment of relapsed osteosarcoma: dysplasia-like stroma constitute a special variant (osteo- an Italian sarcoma group study. J Clin Oncol 20: 2150–6 fibrous dysplasia-like adamantinoma) that is rarely able 14. Fellinger EJ, Garin-Chesa P, Glasser DB, Huvos AG, Retting WJ to metastazise. Am J Surg Pathol 16: 746–55 The tumor must be resected widely, otherwise it will re- 15. If left untreated, or usually after several recurrences, Mangham D, Davies A (2002) Risk factors for survival and local it can also metastasize. J Bone Joint Surg Br 84: is very important, therefore, to differentiate it unequivo- 93–9 cally from osteofibrous dysplasia, which is generally not 16. Gedikoglu G, Aksoy M, Ruacan S (2001) Fibrocartilaginous mes- enchymoma of the distal femur: case report and literature review. An intralesional resection Pathol Int 51: 638–42 of the adamantinoma is not sufficient. Grimer R, Taminiau A, Cannon S (2002) Surgical outcomes in os- bridging procedures are required after wide resections teosarcoma. Grimer RJ, Bielack S, Flege S, Cannon SR, Foleras G, Andreeff I, rarely involved, functionally effective bridging is usually Sokolov T, Taminiau A, Dominkus M, San-Julian M, Kollender Y, Gosheger G (2005) Periosteal osteosarcoma–a European review of possible. Guo W, Wang X, Feng C (1996) P53 gene abnormalities in osteosar- References coma. Hefti FL, Gächter A, Remagen W, Nidecker A (1992) Recur- Bertoni F, Versari M, Pignotti E (2002) Osteosarcoma of the limb.

Cast wedging is unsuitable for: Conservative treatment humeral fractures generic calcium carbonate 500 mg otc, Cast immobilization joint fractures buy 500mg calcium carbonate with amex, During the first few days, the purpose of cast immobi- after the application of plastic casts as these are too lization is to rest the affected area and reduce swelling. The longuette technique with white plaster satisfies these requirements and is easy to apply, and thus convenient for Cast removal the patient. Proven stress-reducing any unpleasant and time-consuming change of plaster. In measures include a calm explanation of the procedure, small children with stable fractures that do not require comfortable positioning, quieter cast saws, slow, safe op- correction, e. Percutaneous fixation methods are preferable as involves daily cleaning of the pin entry sites with cotton they allow closed reduction and thus respect the buds/hydrogen peroxide, daily showers or baths. Introduce Closed reduction under anesthesia, percutaneous one (radius and ulna) or two oppositely curving, flexible wire fixation and cast immobilization titanium nails, ascending from one side (radius, humerus), This method is recommended for metaphyseal fractures descending (ulna) or ascending from the medial and lateral which prove to be unstable after reduction and which, in sides (femur) or descending (tibia). Ascending = nails are view of the patient’s age, do not allow any remodeling of inserted at the distal end and advanced in a proximal direc- secondary deformities. Descending= nails are inserted at the proximal end The diameter of the wire is selected on the basis of and advanced in a distal direction. Biomechanical princi- the patient’s age and the fracture site and ranges from ap- ples for optimal stability: sum of the nail diameters approx. The wires are bent at 90° above skin level 70–80% of the medullary cavity. Bend the nails so as to and trimmed, leaving space for postoperative swelling. Double nails should have identi- Wire-cast contact is avoided by means of circular cut-outs cal diameters.

Pseudofacilitation may occur in normal subjects with repetitive nerve stimulation at high (20–50 Hz) rates or after strong volitional contraction generic 500 mg calcium carbonate otc, and probably reflects a reduction in the temporal dispersion of the summa- tion of a constant number of muscle fiber action potentials due to increases in the propagation velocity of action potentials of muscle cells with repeated activation order calcium carbonate 500mg otc. The recording shows an incrementing response characterized by an increase in the amplitude of the successive M waves with a corresponding decrease in the dura- tion of the M wave resulting in no change in the area of the negative phase of the successive M waves. ELECTRODIAGNOSTIC MEDICINE/NEUROMUSCULAR PHYSIOLOGY 401 TABLE 5–51 Disorder Polymyositis/Dermatomyositis Inclusion Body Myositis Etiology Clinical Presentation Labs EDX NCS NCS Findings EMG EMG Treatment TABLE 5–52 Characteristics McArdle’s Disease (Type V) Pompe’s Disease (Type II) Etiology Onset Clinical Presentation EDX NCS NCS Findings EMG EMG Labs Treatment UMN signs Cerebrum, Tumor, brain stem, syrinx, spinal cord multiple sclerosis (+) Sensory changes LMN signs Peripheral nerve Neuropathy Weakness UMN signs Anterior horn cell, Amyotrophic lateral cortical spinal tract sclerosis (–) Sensory changes Anterior horn cell Poliomyelitis Neuromuscular Myasthenia gravis, junction Lambert-Eaton syndrome LMN signs Pain Polymyositis Muscle Painless Myopathy GAIT PATHOLOGY AND PROBABLE CAUSES (TABLE 6–4. The shoulder on the opposite side acts as a stabilizer Once the patient has learned the mechanics of the prosthesis and how to use it efficiently, he/she is ready for training in purposeful activity. The therapist should present different activities to help solve new problems that inevitably arise in the patient’s life. Before attempting any activity, prepositioning of the terminal device is essential. Drills in the approach, grasp, and release of various sizes of objects and different types of materials are used. The amputee is taught to grasp objects with adequate pressure control on the terminal device. The amputee should gain confidence in using the prosthesis in a wide range of activities that are meaningful and important. Initially the activities of most importance for the amputee are feeding and dressing. Because a pros- thesis is not needed to achieve basic independence, activities chosen for him should require the use of two hands. As the patient attempts, performs, and succeeds in these activities, he becomes more willing to accept the use of the prosthesis and can rely on it. After training in feeding, dressing, and grooming is completed, progression to specialized activities such as communication skills, which involve use of the telephone or key- board, can be made. Homemaking, vocational, and recreational interests should be encouraged, and the activities associated with these interests should be emphasized in the training process. This should be repeated by the amputee until the speed of the movement and the angle of flexion are smooth and controlled. Loss of reflexes may result from a sensory, motor, or mixed radiculopathy.