Children and Medicine

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History of Scoliosis February 9, 2011

Filed under: Anna — Anna @ 5:17 am

Scoliosis is a curvature in the spine that can cause backaches, uneven hips and shoulders, and respiratory fatigue when the curve becomes severe. It can be caused by malformed ribs or vertebrae during pregnancy, muscular conditions, or can be of an unknown cause (idiopathic). Most minor cases require no treatment because the curve is not great enough to effect the child’s development but the child should receive regular checkups. When treatment is required a brace is used to straighten the spine but braces do not correct the curve, they simply stop the progression. Surgery is used to actually correct the curve and use rods and fusion to stabilize the spine (Zieve et al, 1). These treatments are effective but they have not always been around. Below is video which describes scoliosis symptoms and typical treatments.

Scoliosis treatment has an extensive history.  The word was first used by Hippocrates in the 4th century BCE but the condition he described was not what would today be termed scoliosis. Hippocrates thought that the curve was due to dislocations of the vertebrae not an actual curvature. Hippocrates also described a treatment for the condition that essentially consisted of stretching the body and forcing the spine to straighten although little was done to keep the spine straight. Little was done after this until the 1500s when the ideas were still much the same as what Hippocrates had written 2000 years before. The cause was attributed to tight corsets and children being yanked and picked up by only one arm. Corsets and pressure were used to treat the condition. These ideas preserved throughout the 17th century. In the mid 1700s, treatment methods were again changed when Andre, a doctor who attributed poor posture and high heels to causing scoliosis, prescribed gymnastics as a treatment. These ideas persisted even as ideas about scoliosis and orthopedics as a discipline were changing. Scoliosis began to describe a very specific type of curve while other words were used to describe different curves. More braces began to be invented around this time and they were found in every hospital and doctor’s office around that time. Gymnastics and braces began to evolve into the current treatments we see (Lovett 54-61).

Hippocrates examining a child

 

Effects of Untreated Deformites

Filed under: Anna — Anna @ 3:26 am

Children who grow up with untreated physical deformities often find themselves faced with social discrimination, an inability to keep up physically, and little access to education. One study  treated adults who had been born with cleft lip or palate in developing countries.  Little access to medical care was possible which limited the treatments available as children and now as adults.  Dr. Murthy and his team looked not only at the treatment of the condition but at the psychological effects of the treatment.  These adults had speech that was severely affected by their condition.  This, combined with their looks meant that the patients had often dropped out of school as children and spent their lives being teased for their looks. Most had felt these effects so long that they had begun to tolerate the teasing (Murthy 1). These effects are not unusual when it comes to untreated deformities.

Adult with Untreated Cleft Lip

Clubfoot, also common, is often left untreated in developing countries because families are unable or afraid to seek treatment for the conditions that affect the children. Even when they can afford the treatments they may be time or labor intensive for the families which can hinder treatment in poor families that must work many hours. A condition may also require months or years of continued treatment and money which can be difficult to acquire in distant towns or villages or in areas where therapies are very expensive and largely unavailable to people who cannot afford to pay steep private costs.

Before treatments were known, children who were born with these issues lived with them for their entire lives. In cases such as cleft lip and palate, which effects the abilities of children to breastfeed, children with this condition were left with no food source as bottles and formula were not yet available.  Others who were born with conditions such as clubfoot were unable to work normally. Some were able to walk with a limp because they only had one effected foot but children born with two effected feet either walked on the tops and sides of their feet or crawled on their knees.  The well known British Poet Lord George Byron was born with one clubfoot and was known to rather sensitive about it as a result of his unusual gait (“Lord George Gordon Byron” 1).

Child with Untreated Club Foot

 

Cleft Lip and Palate Repair History February 7, 2011

Filed under: Anna — Anna @ 5:33 am

Cleft lip and cleft palate are two very different conditions and while they often coexist, children can be born with only a cleft lip or only a cleft palate. These conditions are caused by an issue with development during pregnancy. Essentially, a hole is created where there should normally be bone and muscles. In cleft lip, a hole is created between the nose and the lip through the gums and teeth but the roof of the mouth is not effected. This can happen on one or both sides of the mouth. Cleft palate is a hole in the roof of the mouth that can extend into the nasal cavity although it certainly does not have to (“Cleft Lip and Palate” 1). Below are visual examples of these conditions.

Different types of Cleft Lip and Palate

Surgeries to repair these conditions range from very simple to very complicated depending on the type and extent of the deformity. These surgeries now depend on modern techiniques but they are not new.  Cleft lip repairs were first recorded in China in the fourth century B.C.E. The next recorded surgeries happened in the 13th century  by a Flemish surgeron. He also pioneered the use of metal plates or cotton to close the holes in the palate that cause the speech of patients to be very nasally or soft due to the flow of air into the nose. This method was used to solve the problems until anesthesia advanced in the 19th century.  Surgeries were rare because of the pain and difficulty.  In the 1800s, this began to change and surgeries that closed the palate and lip began to be much more advanced,  As more was learned about anatomy. These changes led to modern techniques which try to improve speech development and facial growth(Leow et al 335-6). Today, a child born with cleft lip and palate often only have a small scar on their lip and maybe slightly crooked teeth as the only visible signs of the condition. Orthodontia and plastic surgery make these things hardly noticeable. Speech therapy means that the children speak much like their peers although there is often a slightly nasal quality to their voices that is due to air escaping through the palate.

 

Surgery or Casting? February 6, 2011

Filed under: Anna — Anna @ 3:55 am

There are two common methods for treating clubfoot. The first modern method designed is a surgical treatment that combines surgery and casting in order to place the foot in its proper position. The second modern method is the Ponseti Methods developed by Ignacio Ponseti of Iowa that is essentially placing the foot in a series of cast where each cast forces the foot in a slightly different position until the final cast places the foot in the expected position. This method usually means that children require no surgery although some children may have an issue that simply casting won’t fix. In these cases, the repair is often done in a simple procedure that does require general anesthetics (Adegbehingbe, et al 1). This method was not new had in fact been practiced since the time of Hippocrates and even before, according to Dr. Ponseti and his colleagues (Dobbs, et. al 1)

The typical cuts made during surgery to repair clubfoot.

 

Dr. Ponseti Demonstrating his technique.

Manystudies have been done comparing these two methods, many in countries such as Nigeria where controversy often surrounds physcians who attempt to change the status quo. Children were split into two groups and each group was treated for their clubfoot. One group’s treatment consisted mostly of surgery with occasional minor casting while the other group’s treatment consisted of casting with minor surgery only done where absolutely necessary. According to Dr. Adegbehingbe and his colleagues, the Ponseti method produced more efficient results, with fewer problems for the children and their families and lower costs for the hospital and families (Adegbehingbe 1). This is just one study but many have been done and the results seem to agree that the method that subjects children to less anesthesia and does not mean cutting the tendons produces better results. Below is a method that explains about the spreading of the Ponseti method and Ponseti’s goals in spreading his methodology.

I believe that the Ponseti method is a better way of treating clubfoot. It does not subject children to the risks of general anesthesia such as breathing problems. It also means that the tendons are not cut and there is no risk of scar tissue forming around the tendons. With the Ponseti method, there is a risk of the clubfoot reoccurring although it is usually slight and nightly brace wearing cuts down on the risk.

 

Overview of Orthopedic Deformities and their treatments February 2, 2011

Filed under: Anna — Anna @ 12:53 am

Many orthopedic deformities are common in children. The most well-known are deformites that impact life for children such as cleft lip, cleft palate, clubfoot, and hand deformities such as clubhand and syndactly. These disease while easily treated through surgery, casting, and therapy in the modern world were not always so simple and easy to treat. All have been studied by many doctors and therapists in order to find therapies that provided the most competent care possible for children. According the Iowa Orthopaedic Journal, Clubfoot was treated by the Indians around 1000 BC and Hippocrates in the 400s CE using methods similar to the non-surgical methods used today although the treatments were not used later(Dobbs, Morcuende, Gurnett,Ponseti).

Accoding Orthopeadics, Clubhand was identified in the 1700s although the first effective treatments were not until the 1950s(Fitzgerald, Kaufer, Malkani 935).

Accoridng to Perko M., Cleft lip was frist treated by surgery in  China in the 300s BC but the surgery was not more successful until anesthatics were more successful allowing the painful surgery to be performed easily(par, 1). Other deformities had treatment progressions in similar patterns.

 

Annotated Bibliography-Anna January 31, 2011

Filed under: Anna,Resources — Anna @ 9:05 pm

Works Cited
Adegbehingbe, OO, LM Oginni, OJ Ogundele, AL Ariyibi, PO Abiola, and OD Ojo. “PONSETI CLUBFOOT MANAGEMENT: CHANGING SURGICAL TRENDS IN NIGERIA.” The Iowa Orthopaedic Journal. 2010. Web. 02 Feb. 2011. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958264/>.
In this experiment, researchers attempted to treat clubfoot in Nigerian children whose condition had been left untreated longer than usual in American children. These patients had never been exposed to the Ponseti Method which was the new treatment being tested by the researchers. In order to insure the experiment was accurate, a computer was used to randomize the subjects without looking at their age, the severity of their clubfoot, or treatment history. All affected feet were then scored based on severity by a team of experts that had no relation to the experiment or the patients. These results would be compared to the end results to see if the treatments had worked. The criteria of a expected results are explained in the article. The two groups were then treated by one of two methods: The surgical method that had been used previously in Nigeria(where the study was taking place) or the Ponseti method. The surgical method combines surgery and positioning of the foot in order to place the foot in the typical position. The ponseti method means placing a series of casts on the affected foot that each places the foot in a slightly different postion. The end result was that the Ponseti method produced good results for less money and decreased the amount of surgery these children needed.
“Children’s Clubfoot: Treatment with Casting or Operation? – Your Orthopaedic Connection – AAOS.” AAOS – Your Orthopaedic Connection. Ed. AAOS. Web. 09 Feb. 2011. <http://orthoinfo.aaos.org/topic.cfm?topic=a00296>.
“Cleft Lip and Palate.” Cleft Lip and Palate. Ed. Kidshealth. Web. 07 Feb. 2011. <http://kidshealth.org/parent/medical/ears/cleft_lip_palate.html>.
“Cleft Lip and Palate Pre and Post Repair.” Web. 1 Feb. 2011. <http://qvh.nhs.uk/assets/Cleft_lip_and_palate>.
An accurate picture of what a child’s face would like before and after an operation to prepare cleft lip and palate.
Dobbs MD, Matthew B., Jose A. Moecunde MD,PhD, Christina A. Gurnett MD, PhD, and Igancio V. Ponseti. “Treatment of Idiopathic Clubfoot.” The Iowa Orthopaedic Journal. 2000. Web. 01 Feb. 2011. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888755/>.
An article that details the history of clubfoot treament and the way the treatments built upon each other to come to the modern treatments. This article is very accurate and is written by some of the foremost experts in the field.
Fitzgerald, Robert Hannon. “Orthopaedics.” Google Books. Web. 01 Feb. 2011. <http://books.google.com/books?id=2Xd_l0gOF-UC&lpg=PP1&dq=orthopaedics&pg=PP1#v=onepage&q&f=false>.
A textbook that features information about all types of orthopaedics.
Guevara, Jose. “YouTube – What Is Scoliosis? – Doctor Chiropractor Atlanta Ga- Gainesville Ga.” YouTube – Broadcast Yourself. 23 Feb. 2010. Web. 09 Feb. 2011. <http://www.youtube.com/watch?v=vFkjS8GCzvs&feature=related>.
Hadish, Cindy. “Ponseti Races Set for Oct. 9 in Iowa City | Eastern Iowa Health.” Eastern Iowa Health | Health News All The Time. 4 Oct. 2009. Web. 05 Feb. 2011. <http://easterniowahealth.com/2010/10/04/ponseti-races-set-for-oct-9-in-iowa-city/>.
Leow MD, Aik-Ming, and Lun-Jou Lo MD. “Palatoplasty: Evolution and Controversie.” July-Aug. 2008. Web. 7 Feb. 2011. <http://memo.cgu.edu.tw/cgmj/3104/310402.pdf>.
Leow MD, Aik-Ming, and Lun-Jou Lo MD. “Palatoplasty: Evolution and Controversie.” July-Aug. 2008. Web. 7 Feb. 2011. <http://memo.cgu.edu.tw/cgmj/3104/310402.pdf>.
“Lord George Gordon Byron – Biography and Works. Search Texts, Read Online. Discuss.” The Literature Network: Online Classic Literature, Poems, and Quotes. Essays & Summaries. Ed. The Literature Network. Web. 09 Feb. 2011. <http://www.online-literature.com/byron/>.
Lovett MD, Robert W. “The History of Scoliosis.” The Journal of Bone and Surgery, 8 Feb. 2011. Web. 9 Feb. 2011. <http://www.ejbjs.org/cgi/reprint/s2-11/1/54.pdf>.
This article details the history of the treatment of scolosis extending from Hippocrates to the present day and the way these theories evolved. The article attempts to explain how present day treatments evolved and came to be the accepted form of treatment and very accurately does that. This article appears to be well-researched and was published by The Journal of Bone and Surgery.
M., Perko. “The History of Treatment of Cleft Lip and Palate.” Pubmed.gov. National Instituites of Health. Web. 01 Feb. 2011. <http://www.ncbi.nlm.nih.gov/pubmed/3095876>.
An abstract of an article that details the treatment history of cleft lip and palate extending back to ancient times. This article appears to have good information although only the abstract is avalible.
Murthy, Jyotsna. “Management of Cleft Lip and Palate in Adults.” PubMed. Indian Journal of Plastic Surgery, Oct. 2009. Web. 9 Feb. 2011. <Jyotsna>.
This article is a detailed account of a study that treated adult patients with cleft lip and palate. These people have lived a life of difficulty and find their lives greatly changed after the surgeries. The surgeries and the challenges of the region where the surgeries were performed provided unique challenges compared to the typical challenges that happen when the surgery is performed on a infant with a more malleable skull. This very reputable article was published in the Indian Journal of Plastic Surgery.
New York-Presbytarian. “Hand Deformities, Congenital – New York Presbyterian Hospital.” New York Presbyterian Hospital – Top NYC Doctors, Comprehensive Medical Care. Web. 01 Feb. 2011. <http://nyp.org/health/congenital-hand-deformities.html>.
A website that accurately explains the symptoms and treatments of common orthopadic hand deformities. Explains how a deformity could happen in the known cases.
Orthopediatrics. “A Patient’s Guide to Clubfoot.” Welcome to Orthopediatrics.com. Web. 05 Feb. 2011. <http://www.orthopediatrics.com/docs/Guides/clubfoot.html>.
“PubMed Health – Scoliosis.” PubMed. Ed. David Zieve MD and C. Benjamin Ma, MD. 17 Sept. 2009. Web. 09 Feb. 2011. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002221>.
ReSurge International. “35-Year Old Ghanaian With Cleft Lip | Flickr – Photo Sharing!” Welcome to Flickr – Photo Sharing. 3 Feb. 2006. Web. 09 Feb. 2011. <http://www.flickr.com/photos/interplast/96405973/>.
Saunders. “Full Size Picture Clubhand Radial.jpg.” Medical Dictionary. 2007. Web. 01 Feb. 2011. <http://medical-dictionary.thefreedictionary.com/_/viewer.aspx?path=dorland&name=clubhand_radial.jpg>.
“SpringerImages – Hippocrates Examining a Child, a Painting by Robert Thom, 1950’s.” SpringerImages. Web. 09 Feb. 2011. <http://www.springerimages.com/Images/MedicineAndPublicHealth/5-10.1186_1748-7161-4-6-11>.
Univerisity of Iowa-Healthcare. “YouTube – Tom Brokaw and The Ponseti Method.” YouTube – Broadcast Yourself. Web. 05 Feb. 2011. <http://www.youtube.com/watch?v=Wum4K15PtBg>.
We Care Health Care Services. “Clubfoot Surgery,Clubfoot Surgery India,Clubfoot Surgery Cost India.” Medical Tourism India,Medical Surgery Tourism India,India Health Tour. 2010. Web. 01 Feb. 2011. <http://indiahealthtour.com/treatments/orthopedics/foot/clubfoot-surgery.html>.
An article that explains the features and symptoms of clubfoot along with pictures of the condition before and after an operation to repair the condition. Featured on a health care services website.
Wheeless III MD, Clifford R. “Calcaneovalgus Foot – Wheeless’ Textbook of Orthopaedics.” Duke Orthopaedics Presents Wheeless’ Encyclopedia of Orthopaedics. Web. 31 Jan. 2011. <http://www.wheelessonline.com/ortho/calcaneovalgus_foot>.
An encyclopedia entry of the causes, symptoms, and treatments of calcneovalgus foot which is also known as clubfoot. Most cases are mild and very few children require treatment but there are treatments available. These include casting to use the foot’s natural flexibility to correct the problem and surgical treatment which is more common as children age and the foot loses it’s flexibility(Wheeless 1).