Spiral CT angiography is highly sensitive in the detection of arterial anatomy in the circle of Willis and is a reliable alternative to MR angiography.

Twenty-six patients with medically refractory complex partial seizures had temporal lobectomy after evaluation, which included prolonged scalp EEG recordings, positron emission tomography (PET), MRI, and x-ray CT. PET showed a region of focal interictal temporal hypometabolism corresponding to electrographic localization of seizure onset in 21. Five patients had a region of increased MRI signal intensity on the spin echo image in the region of the EEG focus, 2 had an abnormality ipsilateral to but distinct from the EEG focus, and 1 had bilateral findings. CT was abnormal in 3 cases; 2 had tumors. Three patients had low grade tumors (1 with a normal PET). PET can detect metabolic dysfunction associated with mild pathologic changes in epileptic foci, but increased signal intensity on MRI does not necessarily correlate with the degree of pathologic abnormality. Tumors may be less likely when both CT and MRI are normal.

Objective: To determine the age-specific incidence, prevalence, and characteristics of fractures in persons with spina bifida.Design: Year-long historical cross-sectional study.Subjects: Two hundred twenty-one consecutive patients aged 2-58 years evaluated in 2003 at a regional referral center. Twenty percent (n ¼ 44) were children age 2-10 years; 30% (n ¼ 68) were adolescents age 11-18 years; and 50% (n ¼ 109) were adults age 19-58 years. Fifty-five percent (n ¼ 121) were female; 64% (n ¼ 141) had shunted hydrocephalus. Fifty-eight percent (n ¼ 129) were community ambulators. Defect levels included 14% (n ¼ 31) thoracic; 37% (n ¼ 81) mid-lumbar; 35% (n ¼ 79) low-lumbar; and 14% (n ¼ 30) sacral.Methods: Chart review of 221 consecutive children, adolescents, and adults enrolled in a spina bifida program in Syracuse, New York, was used to determine incidence and prevalence rates. Chi-square was used for subgroup analyses, and linear regression was used to examine independent association of motor level, functional independence (Functional Independence Measures score), body mass index (BMI), shunted hydrocephalus, epilepsy, and/or other congenital anomalies with fractures, controlling for insurance status, race/ethnicity, age, and sex.Results: Annual incidence of fractures among children, adolescents, and adults was 23/1000; 29/1000; and 18/1000, respectively. Overall prevalence was 200/1000. One in 4 patients with fractures reported multiple fractures. Median age at first fracture was 11 years. Most fractures involved the femur or tibia. Comparisons between adult-and childhood-onset fractures were not significant for difference in sex, BMI, defect level, functional independence, shunted hydrocephalus, epilepsy, or other congenital anomalies. In regression models only defect level RR ¼ 1.646 (P ¼ 0.019; 95% CI 1.085-2.498) and age RR ¼ 1.033 (P ¼ 0.036; 95% CI 1.002-1.065) were independently associated with fractures.Conclusions: Fractures in persons with spina bifida are most common during early adolescence. Environmental modifications may be more effective than pharmacological treatment in reducing the prevalence of fractures in this population. Spinal Cord Med. 2007;30:S5-S9 J

No abstract

No abstract

We treated eight dysplastic acetabula in six skeletally mature patients with Down's syndrome by a modified Bernese periacetabular osteotomy. The mean age at the time of surgery was 16.5 years (12.8 to 28.5). Mean length of follow-up was five years (2 to 10.4).Pre-operatively the mean (Tonnis) acetabular angle was 28 degrees, the centre-edge angle was -9 degrees, and the extrusion index was 60%; post-operatively they were 3 degrees, 37 degrees, and 17%, respectively. Two patients with post-operative (Tonnis) acetabular angles > 10 degrees developed subluxation post-operatively and required secondary varus derotation femoral osteotomies. Another patient developed a late labral tear which was treated arthroscopically. All eight hips remain clinically stable, and are either asymptomatic or symptomatically improved. These results suggest that the modified Bernese periacetabular osteotomy can be used successfully in the treatment of acetabular dysplasia in patients with Down's syndrome.

No abstract

Bracing for adolescent scoliosis has been postulated to cause permanent loss of bone mass and to predispose to adult osteoporosis. To determine whether brace use affects the rate of bone accretion with growth, the authors conducted a prospective study of 52 girls with adolescent idiopathic scoliosis. Dual-energy x-ray absorptiometry (DEXA) showed a significant increase in spinal bone mineral density (BMD) over a 1-year period of brace wear. BMD correlated with measures of growth and pubertal status, but not average daily brace wear or severity of scoliosis. The annual rate of bone density accumulation was similar to reported normal values. The annual rate of change of volumetric bone density increased only slightly during the study period, suggesting that most of the change in BMD with time reflects growth in the dimensions of the spine. Brace treatment does not appear to inhibit bone density accumulation in girls with adolescent idiopathic scoliosis.