Mohab Foad

the episodes of hypothermia decreased in frequency. Over the next month her average body temperature increased approximately 1.0 degree with maximum lowest temperature up 2.2 degrees. Discussion: The etiology of the patient’s intermittent hypothermia remains unknown. Several case studies have been published using clomipramine for spontaneous recurrent hypothermia. The mechanism of action of clomipramine on body temperature is unknown. In this patient with brain injury secondary to cavernous hemangioma bleed clomipramine appeared to have an effect on body temperature. Conclusions: The patient had an average body temperature that was increased with the initiation of clomipramine. Clomipramine has an effect on body temperature and may be used to treat recurrent hypothermia.

CASE PRESENTATION A 43–year-old man was referred to the senior author (M.T.A.) with a chronic draining ulcer over the left midshaft tibia for approximately 2 months. The patient was a nonsmoker with no significant comorbidities. He had a 37-year history of chronic osteomyelitis of unknown etiology. He was managed nonoperatively for approximately 17 years and subsequently underwent multiple surgical procedures without resolution of his symptoms. On examination, he was afebrile with an obvious 2.0 3 3.5-cm draining ulcer over the anteromedial aspect of the midshaft tibia with discolored and atrophic skin adjacent to the ulcer. He had a history of a gastrocnemius rotational muscle flap several years before the current presentation but maintained a viable soleus and gastrocnemius with adequate ankle dorsiflexion and plantar flexion. Multiple previous surgical scars were present (Fig. 1). He had 4/5 motor strength in ankle dorsiflexion and plantar flexion. There was no evidence of neurologic injury or vascular compromise. Radiographs demonstrated a large area of increased bone sclerosis and cortical hypertrophy in the midshaft tibia with an incomplete fracture of the anterior cortex consistent with chronic osteomyelitis (Fig. 2). Radiographic alignment was anatomic.

Background: The aim of the study is to determine the accuracy of hand injections with and without the aid of ultrasound (U/S) into the carpal tunnel, thumb carpometacarpal (CMC) joint, first dorsal compartment (DC) and the radiocarpal (RC) joint. Methods: Four participants of various level of experience injected the carpal tunnel, thumb CMC, first DC, and RC joint into 40 fresh frozen cadaver specimens with blue dye and radiographic contrast. Participants 1 and 2 were injected without U/S guidance, and participants 3 and 4 were injected with U/S guidance. A successful injection was determined by both fluoroscopy and dissection/direct observation. Additional information was recorded for each injection such as median nerve infiltration and evidence of thumb CMC arthrosis. Results: The overall accuracy for carpal tunnel, thumb CMC, first DC, and RC injections were 95%, 63%, 90%, and 90%, respectively. Success was compared with and without U/S guidance. Success rates were similar for ea...

the episodes of hypothermia decreased in frequency. Over the next month her average body temperature increased approximately 1.0 degree with maximum lowest temperature up 2.2 degrees. Discussion: The etiology of the patient’s intermittent hypothermia remains unknown. Several case studies have been published using clomipramine for spontaneous recurrent hypothermia. The mechanism of action of clomipramine on body temperature is unknown. In this patient with brain injury secondary to cavernous hemangioma bleed clomipramine appeared to have an effect on body temperature. Conclusions: The patient had an average body temperature that was increased with the initiation of clomipramine. Clomipramine has an effect on body temperature and may be used to treat recurrent hypothermia.

outcomes following early pediatric traumatic brain injury (TBI). Design: Correlation study of FA with neuropsychological testing in a TBI group and comparison group of children with orthopedic injuries (OI). Setting: Children’s hospital outpatient radiology and outpatient facilities where neuropsychological testing was performed. Participants: 9 children with a history of TBI (age 7.89 1.00 years; Glasgow Coma Scale [GCS] 10.11 4.68) were compared to 12 children with OI (age 7.51 0.95). All children were at least 12 months post injury at time of evaluation. Interventions: Not applicable. Main Outcome Measures: DTI measured FA and neuropsychological testing. Results: In the TBI group, FA values in multiple brain areas correlated significantly (P .05) with neuropsychological testing. Spatial IQ scores correlated significantly with FA in the inferior frontal-occipital fasciculus (IFO) and splenium of the corpus callosum (sCC). Global IQ scores correlated significantly with FA in the sCC only. Measures of attention correlated significantly with FA in the superior longitudinal fasciculus (SLF). Measures of executive functioning (EF) correlated significantly with FA in the sCC, body of the corpus callosum (bCC), and the SLF. In the OI group, FA values did not correlate significantly with any of the neuropsychological tests used in this study, except in the SLF when subjects were tested on visual memory. Conclusions: Associations between FA values and neuropsychological findings following early pediatric TBI suggest that persistent white matter changes may provide an index of neuropsychological impairment and EF deficits. Limitations to this study include its small sample size and heterogeneity of injury severity. Future studies should be considered with larger sample sizes, acute and sub-acute TBI, and with differentiation of TBI severity.

CASE PRESENTATION A 45-year-old woman presented with a fractured right sacral ala (Zone 1) and contralateral superior and inferior rami fractures. The fracture pattern was classified as lateral compression Type I (Orthopaedic Trauma Association 61-A2.2) and determined to be stable (Fig. 1). Conservative management with partial weightbearing and assistive devices on the injured side as well as physical therapy for gait training and strengthening was initiated. Six months after the initial incident, the patient continued to have significant groin pain and was referred to the senior author (MTA). At evaluation, the patient demonstrated a trace antalgic gait with a coxalgic component, pubic and ischial pain with palpation, and sitting discomfort limiting her ability to work. Plain radiographs, pelvic computed tomography scan, and bone scan revealed a healed sacral fracture in addition to an oligotrophic nonunion of the ischial (inferior) ramus and a hypertrophic nonunion of the pubic (superior) ramus but no pelvic ring deformity (Fig. 2A–D).

Purpose The spontaneous recovery rate of neonatal brachial plexus palsy (NBPP) is often cited as 75–95%. However, recent reports have found the recovery rate to be much lower. The purpose of this study was to perform an evidence-based review aimed at summarizing the available English language information regarding prognosis following NBPP based on the Narakas classification. Methods A Medline database search was performed to identify articles that focused on the natural history, outcome, prognosis, or conservative treatment of neonatal brachial plexus birth injury from 1966 to 2006. Twenty-four articles were identified. The articles were graded according to the Oxford Evidence Based Grading Scale and data regarding sample size, follow up, study purpose, Narakas grouping, Mallet scale, and recovery of function at 3 and 6 months were extracted. Of the 24 articles, 11 were included for review. Data analysis included odds ratios and percent recovery. Results Of the 11 studies, only one ...