Erkki Heikkinen

Ultrasonic features of the Osgood-Schlatter lesion.

Summary: Ultrasound was used to compare the knees of 10 boys and four girls with typical clinical Osgood–Schlatter lesions with 27 symptomless knees. The normal sonographic changes of the tibial tubercle with advancing age are described. In all children with Osgood–Schlatter lesions, the distal patellar tendon thickened and became more echogenic than normal tendons, and an anechoic zone of edema was seen anterior to the tibial tuberosity. Four knees disclosed a thin shell-like elevated fragment of the tibial tuberosity seen as an echogenic surface. In 12 knees, single or multiple fragments of the tibial tuberosity were easily shown. Ultrasound is proposed as a simple, fast, and reliable method for the diagnosis of the Osgood–Schlatter lesion.

Microvascular Flaps from the Lateral Arm and Radial Forearm for the Repair of Defects of the Achilles Tendon Region

Two patients presented with loss of skin in the Achilles tendon region, which is difficult to repair satisfactorily. They were both treated with microvascular flaps, one of which was taken from the lateral arm, and the other from the radial forearm. Both methods gave good functional results.

DISTURBED PATTERNS OF VENOUS DRAINAGE OF THE FEMORAL NECK IN PERTHES' DISEASE

1. Intra-osseous venographs have been obtained in twenty-eight hips affected by Perthes disease and in twenty normal hips after the injection of opaque medium into the femoral neck. 2. In the normal hips the contrast medium drained rapidly into the local veins; none flowed distally into the diaphysis. 3. In the initial and in the fragmentation stages of Perthes9 disease some contrast medium always flowed into the diaphysis and the flow into the local veins was greatly reduced. 4. In the restitution stage the venographs approached normal. 5. The implications of these findings are discussed.

Imipenem-cilastatin vs. tobramycin and metronidazole for appendicitis-related infections.

The efficacy of imipenem-cilastatin was compared with that of tobramycin and metronidazole for the treatment of appendicitis-associated abdominal infections in children in an open, randomized trial. Two hundred eighteen patients between 2.5 and 16.8 years of age hospitalized for appendectomy because of suspected acute appendicitis were allocated to 5 treatment groups. The appendix was perforated in 54 (33.8%) of the 160 cases with appendicitis. All patients responded favorably to treatment. Infection in the wound coccurred in 15 of 125 (12.0%) of those without preoperative antibiotic

Preoperative Russell traction in Legg-Calvé-Perthes disease.

Divergent opinions about the pathophysiology and the optimal time and methods for the treatment of Legg-Calvé-Perthes (LCP) disease exist. Synovitis causing restriction of hip motions may be hazardous to the circulation to the femoral head. We studied 23 children (24 hips) in the initial phase of LCP disease. Seven to 14 days of Russell traction decreased the intraosseous pressure significantly (p < 0.001) and increased the hip motion a mean of 33.6°. As assessed by osteovenography, the venous congestion decreased in almost every hip during Russell traction.

Cardiac Tamponade Caused by a Mediastinal Teratoma

Mediastinal masses in children younger than 2 years often cause symptoms from tracheal compression, but clinical indications later in childhood are less frequent. Mediastinal teratomata arise in the anterior region, and when they produce symptoms these are usually manifestations of tracheal compression, pain, pleural perforation or secondary infection of the tumour. Pericardial perforation is a rare and life-threatening complication. A case of sudden pericardial perforation and cardiac tamponade caused by a mediastinal teratoma is described.

INFANTILE ANEURYSM OF THE DUCTUS ARTERIOSUS: Diagnosis, Incidence, Pathogenesis, and Prognosis

Abstract. Heikkinen, E. S., Similä, S., Laitinen, J. and Larmi, T. (Departments of Surgery, Paediatrics and Roentgenology, University of Oulu, Oulu, Finland). Infantile aneurysm of the ductus arteriosus. Acta Paediat Scand, 63:241, 1974.–A neoplastic‐like density on X‐ray is not a rare diagnostic problem in infancy. Nevertheless, knowledge about the infantile ductal aneurysm (IDA) producing a characteristic tumour‐like mediastinal shadow on plain chest film is very limited.

Thymus simulating left upper lobe atelectasis.

Aberrant locations and configurations of the thymus may occur. This is illustrated in a seven month old boy. He had a finding radiologically interpreted as a left upper lobe atelectasis, but proved at thoracotomy to be the left lobe of the thymus which was normal except for the unusual location.

Experimental aortic coarctation in puppies

Coarctation was produced in nine puppies at the age of 2 months with a simple silk ligature on the thoracic aorta. The constriction was standardized by measuring the blood pressure below the coarctation. Two of the operated puppies died. Five puppies were sham operated and they served as a control group. The blood pressure was followed by an indirect ultrasound method. At the end of 7 months of follow-up, when the dogs were 9 months old, the mean blood pressures were 11276 mm Hg in the control group and 193121 mm Hg in the coarctation group. The difference between the groups was highly significant (P < 0.001). A good collateral circulation could be demonstrated in the coarctation group by aortic angiography and it was also demonstrated in the measurements of renal perfusion with an isotope technique. It is suggested that experimental work involving coarctation should be performed in young animals which will develop good collateral circulation during their growth.

Pulmonary Degradation and Cardiovascular Effects of Intracavally Infused 5-Hydroxytryptamine in Man

5-Hydroxytryptamine (5-HT) was infused intra-cavally in 7 patients at a rate of 800 µg/min during thoracotomy. Samples were aspirated prior to resection of the lung through cannulas introduced into the main common pulmonary artery and vein, both before the infusion and 10 min and 15 min after its start. Brachial and pulmonary artery pressures, pulse rate and electrocardiogram were recorded at the same time. Degradation of 5-HT was found to occur throughout the circulation; thrombocytes were apparently able to inactivate almost all the infused 5-HT by means of their absorption mechanism. The proportion inactivated by the lungs was, at the most, one-third. The majority of the infused 5-HT which passed through the pulmonary barrier, was probably in an inactive form in the thrombocytes, since its influence on systemic blood pressure was slight.