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Hemiepiphyseodesis, hemiepihyseal stapling, and guided growth pin systems all in- volve insertion of hardware across the epiphysis in order to halt growth across a portion of the 146 AMSRJ 2015 Volume 1, Number 2OSTEOCHONDRITIS DISSECANS knee and is thought to possibly arise from repeti- BRIEF REPORTS tive trauma. Direct repair of the nerve is un- resolution using splinting and therapy alone. Most importantly,typing called back typing, also known as reverse cord blood collection should never compromisetyping. His history wassynkinesis of the medial rectus following ab- complicated by multiple neurogenic tumors in-ducens nerve palsy.

This micro trauma can be a result of normal activity, but adolescents with sports in- juries or lack of coordination may be at an in- creased risk. common; one group’s experience showed only Pharmacological treatment can be used to treat 44 surgical radial nerve repairs in 22 years at a neuropathic pain from a lesion but cannot repair large tertiary care center.4 Because most radial functional loss. In this step, only the plasma from the the well-being of the mother or the neonate. The previous cases were cluding a stable left optic nerve glioma and amanaged with muscle recession surgery to pro- pilocytic astrocytoma of his brainstem develop-duce orthotropia without a decrease in the synki- ing several years after his strabismus surgery.netic behavior.

The excessive pressure of four.5 Late-onset Blount’s was further dividedin the medial compartment of the knee in pa- into adolescent type, occurring after 10 years oftients with Blount’s disease often leads to knee age, and juvenile type, occurring between thepain and early arthritic changes.4 Generally, ages of 4 and 10.6 While the exact etiology ofthere are two distinct forms of Blount’s disease: Blount’s is unknown, early walking, obesity,early-onset/infantile Blount’s, and late-onset and bone mineral content are thought to con AMSRJ 2015 Volume 1, Number 2 145OSTEOCHONDRITIS DISSECANSBRIEF REPORTS physis and subsequently correct the weight- bearing axis. Studies have shown recurrence rates ex- graph of both lower extremities is used to diag- ceeding 50%.9 Excessive obesity, Langenskiöld nose Blount’s disease and to determine the pri- stage III, and age greater than 4.5 years have all mary sources of medial axis deviation. The anatomical course of the The medical literature sparsely covers surgical nerve makes it susceptible to lesions. Many of these publications focus ing from the posterior cord of the brachial on abdominal surgery.10 Popular media outlets, plexus, it travels snugly along the humerus in the such as healthcare and news websites, cover this spiral groove before continuing distally. Documentation of her husband’s DISCUSSION blood type was never provided or verified. To comprehend how contamination affects the Due to the increased risk of fetal demise due to agglutination reaction when determining blood maternal hypothyroidism, she was induced at 40 type, the basic ABO antigen-antibody reactions weeks gestation. To determine blood type, a vaginally for cervical ripening and the following blood sample is mixed with anti-A antibodies morning was given intravenous oxytocin for la- and anti-B antibodies. Twenty hours after the first checked to see whether or not agglutination has misoprostol dose, she was fully dilated and ef- occurred. She began to push, but with each contrac- and B antigens on their surface, therefore there tion, a prolonged fetal bradycardic episode are no antibodies in the plasma. The labor failed to progress, and blood cells have no antigens on their surface, the patient underwent an urgent cesarean deliv- therefore there are both anti-A and anti-B anti- ery which resulted in a viable female newborn. Type A red blood cells During the cesarean delivery, the umbilical cord have A antigens on their surface and have anti- 158 AMSRJ 2015 Volume 1, Number 2FALSE NEONATAL BLOOD TYPINGB antibodies in the plasma. AMSRJ 2015 Volume 1, Number 2 193PYODERMA GANGRENOSUMBRIEF REPORTS 29.

A treat- been identified as correlated to recurrence.10 The ment plan should be devised based on severity knee joint of overweight or obese patients is un- and origination of the deformity in each case. Influence of varus and valgus deviation without and with ligament dissection. The topic narrowly, predominantly discussing breast likelihood of nerve injury is elevated in this re- and prostate surgeries.11,12 Overtreatment via gion due to high nerve tension and the spiraling surgery leads to increased spending and could course of the nerve.2 Lesions can include rup- lead to increased morbidities associated with po- ture, neurapraxia, axonotmesis, and neu- tentially unnecessary procedures. Most radial nerve damage suffered in- have even suggested that overuse of medical traoperatively turns out to be neurapraxic.3 By treatment can lead to overuse of surgical treat- definition, these patients experience complete ment in a given patient, which may compound recovery in three months. Evaluation and management of peripheral nerve in- Street Journal [Web page]. Type B red blood false agglutination reaction of cold agglu- BRIEF REPORTScells have B antigens on their surface and anti-A tinins.3,4 Reverse blood typing would resolveantibodies in the plasma. Pyoderma gangrenosum after silicone prosthesis implant in the breasts and facial plastic surgery.

When there is an un- stable fracture or loose body, then open reduc- tion with internal fixation and occasionally bone grafting is undertaken. She was immediately given 300 µg whenfrequency of cis-AB was 1.1 x 10-5. Black arrows are normal pathways while red arrows er pathologic mechanisms are at play in con- indicate hypothesized pathology. Costa J, Monteiro D, Valenca-Filipe R, Reis J, Silva A.

Post-operative images of the bilateral hemi-epiphysiodesis are shown in 148 AMSRJ 2015 Volume 1, Number 2OSTEOCHONDRITIS DISSECANS BRIEF REPORTSFigure 7. the neonate was suspected to be Rh(D) because the earlier that Rho(D) is given, the lower the This case highlights the risks of cord blood con- risk of isoimmunization. 300 µg of Rho(D) immunoglobulin should cord blood collection for transplantation: a comparison of three meth- be administered at 28 weeks gestation to all Rh ods. A: (left) illustrates the possible junction to the proposed central reorganization. AMSRJ 2015 Volume 1, Number 2 179PRIMARY EPITHELIOID ANGIOSARCOMABRIEF REPORTS shaft.

der excessively high compressive forces relative Treatment of Blount’s disease includes both sur- to patients of normal weight, which can exacer- gical and nonsurgical interventions that attempt bate the deformity. In cases of more se- the deleterious effects of surgical overtreat- vere, unresolved nerve palsy, other modes of in- ment.15 jury are present with or without concomitant neurapraxia. When testing a blood this inconsistency, but it is never performed onsample, if agglutination occurs with anti-A neonates.serum, the blood sample is type A.

Adolescent obesity may be to redistribute weight-bearing forces and pro- particularly detrimental to lower limb health. In less severe Early life obesity has been linked to osteoarthri- cases, orthoses or gradual correction using ex- tis (OA) of the knee and hip, as well as rapid ternal fixation may suffice. Spontaneous recovery is very un- For cases similar to the one presented here, con- usual; our case demonstrates an exceptional in- servative treatment could begin with rehabilita- stance of late recovery. This is be-cause the anti-A antibodies in the serum will Contamination of the cord blood sample is a rarecause agglutination in the presence of A anti- occurrence, but nevertheless it is tremendouslygens on the surface of red blood cells. There are various tech-blood sample agglutinates with both anti-A and niques for the collection of cord blood that cananti-B serum, the blood is type AB.

The family declined sur- presentation can be seen in Figure 2. AMSRJ 2015 Volume 1, Number 2 155MODIFICATION OF TENDON TRANSFERBRIEF REPORTS 3. The A and B alleles are dominant technically easier and used more commonly in as compared to the recessive O alleles. Best-corrected vision was20/25 in his right eye and 20/50 in his left eye. This can be done in a transchondral or antegrade fashion. A structural mutation in the type A the maternal circulation.14 The incidence of fe-or B glycosyl transferase produces a single en- tal-maternal hemorrhage greater than 30 m L atzyme with bifunctional activity.11 The cis-AB delivery is about 1 in 200-300 deliveries.13 In thephenotype has only been researched in certain patient case that was presented, Rho(D) im-populations. Other In our patient, it appeared that his paradoxicalmechanisms including ephaptic transmission, adduction of the left eye on attempted left lateral gaze was consistent with abducens to oculomo- tor synkinesis. If the OCD has fractured then surgical treatment with stabi- lization is indicated and generally performed with arthroscopic fixation. Based on a study11 done on blood munoglobulin was not administered at 28samples from the Japanese population, the gene weeks. (D) newborn, an additional 300 µg of Rho(D) should be administered within 72 hours. His history of intracranial and brainstem manipulation is suggestive of synki AMSRJ 2015 Volume 1, Number 2 165BOTULINUM TOXIN INJECTIONSBRIEF REPORTS ducing left medial rectus activation (Figure 3).6 Nevertheless, it is still entirely possible that oth- Figure 3. Successful treatment of postoperative pyoderma gangrenosum after breast reduction: a rare complication. We present a case of bilateral medial femoral condyle OCD in an adolescent, obese African-American boy with early onset Blount’s disease. gested that 72% of patients treated by nerve grafting experienced some return of function.7 The most important aspect of caring for patients Despite this, nerve repair requires exact local- with these injuries is to conduct a thorough phys- ization of a nerve lesion, which is often impracti- ical examination.5 Establishing a new baseline cal, as in this case. Million: Cost of Overtreatment of Prostate Cancer. Antoniadis G, Kretschmer T, Pedro MT, König RW, Heinen CP, Medscape [Web page]. Iatrogenic nerve injuries: prevalence, diagnosis and treat- cle/779223. If ag- There are two main techniques for cord bloodglutination occurs with both A and B blood, the collection: the syringe method and the gravityblood sample is type O due to the presence of and glass tube method. This is due to the fact that newborns with antiseptic and a 16 gauge needle is insertedhave not synthesized antibodies to A or B anti- into the umbilical vein and the cord blood is al-gens yet, so there is no built-in quality assurance lowed to drain into the collection bag by gravity.check when typing their blood.2 To avoid clotting of the cord blood during the collection process, the collection bag contains Once the process of blood typing is understood, an anticoagulant solution. Biopsy indicated ator synkinesis following an abducens nerve pal- recurrence of pilocytic astrocytoma, which wassy. We are unaware of any reports of this finding in the literature. Arthroscopic probing of OCD lesions B) OCD lesions posttranschondral microfractureseverity of meniscal tears and cartilage defects, CASE PRESENTATIONillustrating the effects of increased weight on the CASE PRESENTATIONknee joint. Recurrence of varus deformity after proximal tibial osteotomy in Blount disease: long-5. Tendon transfer surgery clinical functionality, after the onset of nerve should also be considered. The syringe method in-anti-A and anti-B antibodies in the plasma of volves clamping the cord prior to delivery of thetype O blood. By using the syringeit becomes clear that certain substances could method, the exposure to air is minimized andcatalyze the false agglutination reaction, thus sterility is maintained.5distorting the blood type result. The patient was managed with botulinum managed by sub-occipital craniotomy in 2012toxin injections into the left medial rectus mus- due to sudden neurologic compromise (Figurecle with promising results. Corresponding Author: Ryan Shields, BS, Northeast Ohio After his surgical resection, he developed left Medical University, 4209 Ohio 44, Rootstown, OH 44272. He had se- vere left esotropia of 50 prism diopters (PD) Email: [email protected] complete paralysis on abduction. Grillo MA, Cavalheiro TT, da Silva Mulazani M, Rocha JL, gangrenosum on the breast: a case presentation and review of the Semchechen D, da Cunha CA.

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