Deficient Musculature Research Articles

Anesthesia in patients with arthrogryposis multiplex congenita: a report of 10 patients.

Anesthesia in patients with arthrogryposis multiplex congenita: a report of 10 patients.

Histology of the fetal prune belly syndrome with reference to the efficacy of prenatal decompression.

Deficient abdominal musculature, complex abnormalities of urinary tracts and bilateral abdominal cryptorchidism represent the basic characteristics of prune belly syndrome (PBS). Although prenatal diagnosis of PBS is rarely made, because of the wide variety of ultrasonographic images, reported cases have gradually increased. Once a fetus suspected of having PBS is found, it is sometimes difficult for the pediatric urologists to decide how to treat them. The histology of the kidney and urinary tracts in fetuses with PBS was reviewed in order to give suggestions on the management of prenatal cases. Autopsy records of nine fetuses (5 males, 2 females and 2 undetermined) with characteristically distended and deficient abdominal wall were reviewed. Gestational age (GA) at detection ranged from 12 to 25 weeks and at delivery from 13 to 32 weeks. Renal histology in two fetuses showed earlier than normal disappearance of cortical nephrogenic zone replaced by cortical cysts and dysplastic structures. The nephrogenic zone was retained in five fetuses which were younger than GA 20 weeks. While the number of glomeruli along the medullary ray was normal for the age in three fetuses younger than GA 20 weeks, it was decreased in all others. Bladder histology was variable showing both increased musculature and defective or dysplastic muscles. There was a tendency for connective tissues in the bladder wall to increase in proportion to GA, The ureter revealed scarcity of muscle bundles among dense connective tissue. The urethra was atretic in eight fetuses. The clinical implication from the renal histology is that decompression of the urinary tract should be done before GA 20 weeks. However, the early fetal treatment appears to have no effect on the urodynamics in this disorder with deficient musculature.

UCLA Anatomic Total Shoulder Arthroplasty

The UCLA total shoulder arthroplasty was designed to mobilize the shoulder joint in order to permit normal anthropometric range of motion and durable long-term fixation of the components. The prosthesis is fundamentally nonconstrained for the usual arthritic conditions, currently with four sizes of femoral and glenoid components. For patients with deficient and irreparable rotator cuffs, additional restraint may be effected by using a superior glenoid subacromial rim. The first 11 patients have been followed for 1 1/2 to 3 1/2-years; relief of pain has been complete in all but two patients. The function and range of motion results were related to the status of the rotator cuff; five patients achieved excellent results, including two with osteoarthritis who had near normal function. Patients with deficient rotator cuffs achieved functional use of the extremity but without full range of motion. Functionally, in addition to the five patients who were rated excellent, two were rated as being good, three fair, and one poor. In addition to five with excellent range of motion, there were three good and four fair ratings. Two patients, one with grossly deficient musculature caused by a gunshot wound and a second who was posttrauma required revision surgery with a subacromial glenoid prosthesis. This prosthesis is now frequently utilized if muscles and rotator cuff are deficient at the primary surgery, in order to provide additional restraint. Determination of the efficacy of hooded components will require further follow-up. The additional size ranges and components together with improved instrumentation have greatly facilitated recent surgery.

Soft-tissue placentography in diagnosis of bicornuate uterus.

Anomalies of fusion of the uterus are important as a source of complications during pregnancy. Malformations resulting from abnormal fusion of the müllerian ducts range from the rare uterus didelphys (two uteri, two cervices, and two vaginae) to the nearly normal uterus arcuatus, which in the non-pregnant state shows only a fundal concavity but during pregnancy exhibits marked abnormalities of contour. The most common anomaly, arcuate uterus, was found by Falls (2) in 3.8 per cent of deliveries. Some of these anomalies of uterine septation are relatively rare and do not concern us in this paper. Uterus bicornis unicollis, with a double uterus and a single cervix, uterus septus and subseptus, presenting variable degrees of septation arising from the uterine fundus, and uterus arcuatus are sometimes grouped together and termed bicornuate uterus. All of these are of interest here. The purpose of the present paper is to describe the roentgenographic findings which may lead to suspicion of bicornuate uterus. Obstetrical Significance Anomalous malformations of the uterus predispose to a variety of gynecological as well as obstetrical complications. The extra area of endometrium may result in menorrhagia; the poorer egress of menstrual products may lead to dysmenorrhea. During pregnancy the anomalous shape of the uterus results in faulty implantations with a high incidence of abortion (1), premature separation of the placenta, and placenta praevia (5). Labor may be prolonged or there may even be uterine rupture due to the weak or deficient musculature of the anomalous uterus (5). Premature rupture of the membranes (3) and premature labor are frequent. Dystocia may occur as a result of impaction of the non-pregnant horn of the uterus and may necessitate cesarean section. Prolapse may also complicate delivery. Retained placenta and postpartum hemorrhage are other possibilities (4). Abnormal presentations include the breech and transverse types. It is easy to understand that the fetus would take up an unusual position in a deformed cavity. Falls (2) has described a transverse oblique presentation in arcuate uterus and considers this position practically pathognomonic in a primiparous patient. Jarcho (4) reproduced a roentgenogram of an abnormal presentation associated with arcuate uterus but made no comment. Case Reports Case I: Mrs. F. F., 24 years old, para i, gravida ii, entered the hospital Feb. 19, 1954. She had passed a cupful of bright red blood per vagina one and one-half hours previously, after which low back pain developed. Her previous pregnancy had terminated, after difficult labor, in delivery of a 5-pound child. On physical examination, the fundus of the uterus was found to be 25 cm. above the symphysis pubis, and to have a transverse diameter of 27 cm. The perineum was smeared with blood.