Andrew E Price, M.D.

Positron emission tomography (PET) response to initial chemotherapy and radiation therapy (RT) predicts local control in rhabdomyosarcoma
Dharmarajan K.V.; Wexler L.H.; Tom A.; Price A.; Fox J.J.; Schoder H.; Gavane S.; Meyers P.A.; Wolden S.L.
2011 ;81(2 SUPPL 1):S116-S116, International journal of radiation oncology biology physics
Purpose/Objective(s): The ¹⁸-F-fluorodeoxyglucose (FDG) PET is highly sensitive and specific in rhabdomyosarcoma (RMS) staging. The objective was to explore whether PET response to treatment correlates with local control. Materials/Methods: From 1/01 to 5/10, 94 patients received definitive radiotherapy for RMS in our department and had PET scans at one or more of the following time points: baseline pre-chemotherapy (82%), within one month before starting RT (85%), and within 131 days after completing RT (87%). Chemotherapy was delivered on or according to one of two institutional protocols using some or all of the following agents: vincristine, doxorubicin, cyclophosphamide, ifosfamide, etoposide, irinotecan, and carboplatin in 63%, or was delivered on or according to COG protocols in 37%. Generally due to very young age, 19% of patients underwent delayed planned resection of the primary tumor prior to RT (but after the pre-RT PET scan). Of these, 50% underwent intra-operative radiation therapy. The standardized uptake values (SUV_max for body weight) of the primary sites before chemotherapy, before RT, and after RT were compared. Results: Patient/disease characteristics: 50% male; median age 11 (range, 0.2-43) years; 47% alveolar, 52% embryonal, 1% pleomorphic. Breakdown by stage/group: 11% Stage 1, 4% Stage 2, 51% Stage 3, 34% Stage 4; 10% Group II, 56% Group III and 34% Group IV. Primary sites: 36% parameningeal, 22% extremity, 20% trunk, 10% bladder/prostate, 5% orbit, 3% GU, 3% head/neck. Median follow-up was 3 (range, 0.5-8.5) years. Nine patients had local failure, defined as radiographic progression at the primary site after RT. Most (64%) received an RT dose of 50.4 Gy, 2% received 54 Gy, and the remainder 25.2-49.6 Gy. RTwas delivered at a median of 15 weeks after initiation of chemotherapy. At diagnosis, median SUVof the primary tumor was 7. Initial SUV<= 7 vs. >7 showed a possible trend toward local control: 94% vs. 78% (p = 0.10). 40% of patients had no primary site uptake on PET scan prior to RTand had a trend improved local control: 96% vs. 82% (p = 0.07). 71% of patients had complete resolution of FDG uptake at their primary site on post-radiation PET scan and were more likely to have locally controlled disease as compared with those who had residual FDG uptake: 94% vs. 75% (p = 0.02). Other factors such as histology, primary site, stage, group, and surgical resection did not show a statistically significant impact on local control. Conclusions: A negative post-RT PET scan predicted local control with statistical significance. A negative PET scan after 15 weeks (median) of chemotherapy and prior to RT +/- surgery correlated with local control with a trend toward significance. Initial SUVof the primary tumor may predict local control but further study is warranted
— id: 150896, year: 2011, vol: 81, page: S116, stat: Journal Article,

Hypoplasia of the trapezius and history of ipsilateral transient neonatal brachial plexus palsy
Min, William; Price, Andrew E; Alfonso, Israel; Ramos, Lorna; Grossman, John A I
2011 Mar;44(3):225-228, Pediatric neurology
We present two children with hypoplasia of the left trapezius muscle and a history of ipsilateral transient neonatal brachial plexus palsy without documented trapezius weakness. Magnetic resonance imaging in these patients with unilateral left hypoplasia of the trapezius revealed decreased muscles in the left side of the neck and left supraclavicular region on coronal views, decreased muscle mass between the left splenius capitis muscle and the subcutaneous tissue at the level of the neck on axial views, and decreased size of the left paraspinal region on sagittal views. Three possibilities can explain the association of hypoplasia of the trapezius and obstetric brachial plexus palsy: increased vulnerability of the brachial plexus to stretch injury during delivery because of intrauterine trapezius weakness, a casual association of these two conditions, or an erroneous diagnosis of brachial plexus palsy in patients with trapezial weakness. Careful documentation of neck and shoulder movements can distinguish among shoulder weakness because of trapezius hypoplasia, brachial plexus palsy, or brachial plexus palsy with trapezius hypoplasia. Hence, we recommend precise documentation of neck movements in the initial description of patients with suspected neonatal brachial plexus palsy
— id: 123210, year: 2011, vol: 44, page: 225, stat: Journal Article,

Glenohumeral deformity in children with brachial plexus birth injuries
Ruchelsman, David E; Grossman, John A I; Price, Andrew E
2011 ;69(1):36-43, Bulletin of the NYU Hospital for Joint Diseases
Shoulder deformity remains the most common musculo-skeletal sequela following a brachial plexus birth injury. The natural history of untreated glenohumeral deformity is one of progression in this unique patient population. In infants and young children with persistent neurological deficits, shoulder dysfunction becomes a major source of morbidity, as these children have extreme difficulty placing the hand in space. The functional limitations due to muscle denervation and the resultant periarticular soft tissue contractures and progressive osseous deformities have been well-characterized. Increasing attention is being given to the glenohumeral dysplasia (GHD) and the associated prevalence of early posterior dislocation of the shoulder in infants with brachial plexus birth injuries. GHD represents a spectrum of findings, including glenoid and humeral head articular incongruities and dysplasia, subluxation, and frank dislocation. This article presents our comprehensive, temporally-based management strategies for the glenohumeral joint deformities in these children utilizing soft tissue and bony reconstructive procedures
— id: 128794, year: 2011, vol: 69, page: 36, stat: Journal Article,

Outcome after tendon transfers to restore wrist extension in children with brachial plexus birth injuries
Ruchelsman, David E; Ramos, Lorna E; Price, Andrew E; Grossman, Leslie Agatha; Valencia, Herbert; Grossman, John A I
2011 Jun;31(4):455-457, Journal of pediatric orthopedics
Children with brachial plexus birth injuries often require tendon transfer to restore active wrist extension and maximize hand function. The purpose of this study is to assess the clinical results in children with brachial plexus birth injuries after tendon transfer to reconstruct active wrist extension. Over a 10-year period, 21 children (11 male, 10 female) underwent tendon transfer to reconstruct active wrist extension by a single surgeon. Eight patients had C5/C6/C7 injury and 13 patients had global palsy (C5-T1). The average age at surgery was 5.5 years (range, 3 to 8 y). Restoration of wrist extension was measured according to the functional scale of Duclos and Gilbert. The mean duration of follow-up was 36 months (minimum follow-up of 1 y). At latest follow-up, 14 (66%) children (C5/C6/C7, n=8; global, n=6) demonstrated active wrist extension >/=30 degrees. Within the global injury subcohort, 3 patients demonstrated static extension of the wrist. Four failures occurred in the global palsy group. Children with absent active wrist extension after a brachial plexus birth injury can benefit from a tendon transfer. The more severe global palsy cases have a worse outcome
— id: 132591, year: 2011, vol: 31, page: 455, stat: Journal Article,

Persistent Posterior Interosseous Nerve Palsy Associated with a Chronic Type I Monteggia Fracture-Dislocation in a Child: A Case Report and Review of the Literature
Ruchelsman, David E; Pasqualetto, Michele; Price, Andrew E; Grossman, John A I
2009 Jun;4(2):167-172, Hand (New York, N.Y.)
We present a rare case of persistent complete posterior interosseous nerve palsy associated with a chronic type I Monteggia elbow fracture-dislocation consisting of anterior dislocation of the radial head and malunion of the ulna in an 8-year-old child requiring surgical treatment. Posterior interosseous nerve neuropraxia following acute Monteggia injury patterns about the elbow has been described and is thought to be secondary to traction or direct trauma. The condition typically resolves following successful closed reduction of the radial head. This report describes combined treatment of the nerve and skeletal injury for the chronic type I Monteggia injury. The literature is reviewed, and diagnostic challenges with and treatment options for chronic Monteggia fracture-dislocations in children are discussed
— id: 91483, year: 2009, vol: 4, page: 167, stat: Journal Article,

Brachial plexus birth palsy: an overview of early treatment considerations
Ruchelsman, David E; Pettrone, Sarah; Price, Andrew E; Grossman, John A I
2009 ;67(1):83-89, Bulletin of the NYU Hospital for Joint Diseases
Since the description by Smellie in 1764, in a French midwifery text, that first suggested an obstetric origin for upper limb birth palsy, great strides have been made in both diagnosis and early and late treatment. This report presents an overview of selected aspects of this complex and extensive subject. Early treatment options are reviewed in the context of the present controversies regarding the natural history and the indications for and timing of microsurgical intervention in infants with brachial plexus birth injuries
— id: 99290, year: 2009, vol: 67, page: 83, stat: Journal Article,

Cortical dysplasia and obstetrical brachial plexus palsy
Alfonso, Israel; Alfonso, Daniel T; Price, Andrew E; Grossman, John A I
2008 Dec;23(12):1477-1480, Journal of child neurology
We report 2 patients with obstetrical brachial plexus palsy, ipsilateral leg weakness, and contralateral motor cortical dysplasia. To our knowledge, this is the first description of such an association. In both cases, the diagnosis of obstetrical brachial plexus palsy was established clinically shortly after birth and later confirmed neurophysiologically. Motor cortex dysplasia was diagnosed by magnetic resonance imaging (MRI). The association of obstetrical brachial plexus palsy and contralateral motor cortex dysplasia, a condition known to produce congenital hemiparesis, raises the possibility that the cortical dysplasia was a predisposing factor for obstetrical brachial plexus palsy in these cases
— id: 91482, year: 2008, vol: 23, page: 1477, stat: Journal Article,

Botulinum toxin type A as an adjunct to the surgical treatment of the medial rotation deformity of the shoulder in birth injuries of the brachial plexus
Price, A E; Ditaranto, P; Yaylali, I; Tidwell, M A; Grossman, J A I
2007 Mar;89(3):327-329, Journal of bone & joint surgery (British volume)
We retrospectively reviewed 26 patients who underwent reconstruction of the shoulder for a medial rotation contracture after birth injury of the brachial plexus. Of these, 13 patients with a mean age of 5.8 years (2.8 to 12.9) received an injection of botulinum toxin type A into the pectoralis major as a surgical adjunct. They were matched with 13 patients with a mean age of 4.0 years (1.9 to 7.2) who underwent an identical operation before the introduction of botulinum toxin therapy to our unit. Pre-operatively, there was no significant difference (p = 0.093) in the modified Gilbert shoulder scores for the two groups. Post-operatively, the patients who received the botulinum toxin had significantly better Gilbert shoulder scores (p = 0.012) at a mean follow-up of three years (1.5 to 9.8). It appears that botulinum toxin type A produces benefits which are sustained beyond the period for which the toxin is recognised to be active. We suggest that by temporarily weakening some of the power of medial rotation, afferent signals to the brain are reduced and cortical recruitment for the injured nerves is improved
— id: 71310, year: 2007, vol: 89, page: 327, stat: Journal Article,

Entrapment neuropathy contributing to dysfunction after brachial plexus birth injuries
Price, Andrew E; Beric, Aleksandar; Yaylali, Ilker; Grossman, John A I
2007 Sep;27(6):717-717, Journal of pediatric orthopedics
— id: 95128, year: 2007, vol: 27, page: 717, stat: Journal Article,

Is arthroscopic release indicated?
Price, Andrew E; Tidwell, Michael A; Grossman, John A I
2007 Feb;89(2):452-452, Journal of bone & joint surgery (American volume)
— id: 71307, year: 2007, vol: 89, page: 452, stat: Journal Article,

Fetal deformations: a risk factor for obstetrical brachial plexus palsy?
Alfonso, Israel; Diaz-Arca, Gemma; Alfonso, Daniel T; Shuhaiber, Hans H; Papazian, Oscar; Price, Andrew E; Grossman, John A I
2006 Oct;35(4):246-249, Pediatric neurology
The purpose of this report is to discuss the association of brachial plexus palsy and congenital deformations. We reviewed all charts of patients less than 1 year of age with obstetrical brachial plexus palsy evaluated by one of the authors (IA) between January 1998 and October 2005 at Miami Children's Hospital Brachial Plexus Center. Of 158 patients with obstetrical brachial plexus palsy, 7 had deformations (4.4%). Deformations were present in 32% of patients delivered by cesarean section, but in only 2% of patients delivered vaginally. The deformations were ipsilateral, involving the chest in two patients, distal arms in two patients, proximal arm in one patient, ear in one patient, and the leg in one patient. All patients with deformations had unilateral Erb's palsies. None had a history of maternal uterine malformation. Two presumptive mechanisms of injury, one causing the deformation (compressive forces) and one causing brachial plexus palsy at the time of delivery (traction forces), were present in all cases. The higher incidence of deformation in patients with obstetrical brachial plexus palsy born by cesarean sections and the presence of two presumptive mechanisms in all of the cases presented here raises the possibility that fetal deformations are a risk factor for obstetrical brachial plexus palsy
— id: 72449, year: 2006, vol: 35, page: 246, stat: Journal Article,

Shoulder function following partial spinal accessory nerve transfer for brachial plexus birth injury
Grossman, John A I; Di Taranto, Patricia; Alfonso, Daniel; Ramos, Lorna E; Price, Andrew E
2006 ;59(4):373-375, Journal of plastic, reconstructive & aesthetic surgery : JPRAS
Over a 5-year-period, 26 infants underwent a partial transfer of the spinal accessory nerve into the suprascapular nerve using a nerve graft, as part of the repair of a brachial plexus birth injury. At a minimum follow-up of 2.5 years, all children had shoulder function of Grade 4 or better using a modified Gilbert Scale. Average lateral rotation was measured at 53 degrees
— id: 72451, year: 2006, vol: 59, page: 373, stat: Journal Article,

Outcome following nonoperative treatment of brachial plexus birth injuries
DiTaranto, Patricia; Campagna, Liliana; Price, Andrew E; Grossman, John A I
2004 Feb;19(2):87-90, Journal of child neurology
Ninety-one infants who sustained a brachial plexus birth injury were treated with only physical and occupational therapy. The children were evaluated at 3-month intervals and followed for a minimum of 2 years. Sixty-three children with an upper or upper-middle plexus injury recovered good to excellent shoulder and hand function. In all of these children, critical marker muscles recovered M4 by 6 months of age. Twelve infants sustained a global palsy, with critical marker muscles remaining at M0-M1 at 6 months, resulting in a useless extremity. Sixteen infants with upper and upper-middle plexus injuries failed to recover greater than M1-M2 deltoid and biceps by 6 months, resulting in a very poor final outcome. These data provide useful guidelines for selection of infants for surgical reconstruction to improve ultimate outcome
— id: 72453, year: 2004, vol: 19, page: 87, stat: Journal Article,

Potential for remodeling of the glenoid in children with brachial plexus palsy and shoulder subluxation/dislocation
Price, Andrew E; Grossman, John A I; Tidwell, Michael
2004 May-Jun;24(3):346-346, Journal of pediatric orthopedics
— id: 71309, year: 2004, vol: 24, page: 346, stat: Journal Article,

Perioperative complications associated with brachial plexus repair in infants
Grossman, J A I; Price, A E; Sadeghi, P
2003 Jun;28(3):274-275, Journal of hand surgery (British volume)
This report details the complications experienced during 100 consecutive cases of brachial plexus surgery in infants. There were eight perioperative complications. There was no mortality or permanent sequelae from any complication
— id: 71312, year: 2003, vol: 28, page: 274, stat: Journal Article,

Outcome after later combined brachial plexus and shoulder surgery after birth trauma
Grossman, J A I; Price, A E; Tidwell, M A; Ramos, L E; Alfonso, I; Yaylali, I
2003 Nov;85(8):1166-1168, Journal of bone & joint surgery (British volume)
Of 22 infants aged between 11 and 29 months who underwent a combined reconstruction of the upper brachial plexus and shoulder for the sequelae of a birth injury, 19 were followed up for two or more years. The results were evaluated using a modified Gilbert scale. Three patients required a secondary procedure before follow-up. Three patients had a persistent minor internal rotation contracture. All improved by at least two grades on a modified Gilbert scale
— id: 71311, year: 2003, vol: 85, page: 1166, stat: Journal Article,

Outcome of surgical treatment for forearm pronation deformities in children with obstetric brachial plexus injuries
Liggio, F J; Tham, S; Price, A; Ramos, L E; Mulloy, E; Grossman, J A
1999 Feb;24(1):43-45, Journal of hand surgery (British volume)
Seven children were operated on for pronation contractures of the forearm due to obstetric brachial plexus injuries. All underwent extensive preoperative evaluations to determine the extent of injury, secondary deformities, and capacity to perform a few basic tasks. Sequential video studies were used to document these findings. Operative procedures performed included various combinations of tendon/muscle lengthenings and/or transfers. Postoperative evaluations focused on function rather than gains in active range of motion and the patient/parental assessment of the benefit of the procedure by response to a questionnaire. All patients were followed for a minimum of I year following surgery. The average gain in active supination was 45 degrees. Each patient showed significant functional gains with a high degree of satisfaction
— id: 71316, year: 1999, vol: 24, page: 43, stat: Journal Article,

Mental health of preschool children and their mothers in a mixed urban/rural population. I. Prevalence and ecological factors
Thompson, M J; Stevenson, J; Sonuga-Barke, E; Nott, P; Bhatti, Z; Price, A; Hudswell, M
1996 Jan;168(1):16-20, British journal of psychiatry
BACKGROUND: The prevalence rate of behaviour problems and maternal mental disturbance was estimated using a sample of 1047 families with a 3-year-old child from a mixed urban/rural area. METHOD: Parents completed the Child Behaviour Checklist, EAS Temperament Questionnaire, Weiss-Werry-Peters Activity Scale and the GHQ-30. RESULTS: The rate of behaviour problems (13.2%) was similar to that obtained in studies of urban children. The rate of maternal disturbance (27.6%) was lower than in other population samples. Few differences were found in the prevalence rates in the urban and rural areas. CONCLUSIONS: Preschool children and their parents living in non-urban areas had the same rates of problems as those in conurbations. The service needs of such families are similar regardless of locality
— id: 145980, year: 1996, vol: 168, page: 16, stat: Journal Article,

A management approach for secondary shoulder and forearm deformities following obstetrical brachial plexus injury
Price AE; Grossman JA
1995 Nov;11(4):607-617, Hand clinics
This article provides an overview of the historical perspectives of shoulder deformity. Biomechanical considerations are discussed, as well as the authors' personal approach to these types of injuries
— id: 6860, year: 1995, vol: 11, page: 607, stat: Journal Article,

Computed tomographic analysis of pes cavus
Price AE; Maisel R; Drennan JC
1993 Sep-Oct;13(5):646-653, Journal of pediatric orthopedics
Patterns of muscle degeneration in patients with peripheral neuropathies exhibiting pes cavus deformity were studied by computed tomography (CT). Twenty-six patients attending the muscle disease clinic at Newington Children's Hospital with hereditary sensory motor neuropathies (HSMN) I, II, or III had clinical and radiographic assessment in addition to CT scans of the feet and legs at designated levels. The pattern of muscle degeneration was analyzed with other variables, including age, sex, tibial torsion, cavus, heel varus, and claw toes. Multiple regression/correlation analysis clearly demonstrated earlier and more severe involvement of the intrinsic muscles of the foot as compared with the extrinsic muscles. The most consistent early degeneration occurred in the pedal lumbricals and interossei, which have the most distal innervation. The order of muscle degeneration is a centripetal pattern, with two types of degeneration occurring in the leg muscles: type P patients had earlier degeneration of the leg muscles innervated by the peroneal nerve, and type T patients showed earlier degeneration of those extrinsics innervated by the posterior tibial nerve
— id: 13076, year: 1993, vol: 13, page: 646, stat: Journal Article,

Tips of the trade #30. Constructing a bracket for fixation of supracondylar fractures in children
Toledano B; Price AE
1990 Nov;19(11):1026-1029, Orthopaedic review
Displaced supracondylar fractures in children are best treated with anatomic reduction and percutaneous fixation. Flynn et al first described the pediatric application of a simple holding bracket to facilitate reduction and percutaneous pinning of supracondylar fractures. A similar bracket can be easily constructed with connecting rods and clamps from a Hoffman or an AO external fixator tray
— id: 14282, year: 1990, vol: 19, page: 1026, stat: Journal Article,

A posterior arthroscopic approach to bullet extraction from the hip
Goldman A; Minkoff J; Price A; Krinick R
1987 Nov;27(11):1294-1300, Journal of trauma
A 22-year-old male sustained a gunshot injury to the left hip region. The bullet lodged in the articular surface of the femoral head posterosuperomedially. The location of the bullet within the hip joint stimulated the performance of an arthroscopy of the hip through a posterior approach. The authors are unaware of any other report in the literature describing such an approach. To minimize the dangers, a limited posterior incision was made and deepened through the short rotators. The arthroscope was introduced through the incision to perforate the posteroinferior portion of the hip joint capsule. The bullet was easily visualized with a 70 degree arthroscope. Positioning at the joint and traction are vital components to visualization. The use of three-dimensional CT scanning is an aid to the graphic understanding of the bullet's pathway and relations to the surfaces of the hip joint
— id: 11323, year: 1987, vol: 27, page: 1294, stat: Journal Article,

Posterior fracture dislocation of the shoulder with biceps tendon interposition
Goldman A; Sherman O; Price A; Minkoff J
1987 Sep;27(9):1083-1086, Journal of trauma
Posterior dislocation of the shoulder, a rare injury, results from direct trauma, indirect trauma, or via a seizure or electrical shock. We present a case with a posterior fracture dislocation of the shoulder secondary to a seizure in which interposition of the biceps tendon precluded closed reduction. The fractured lesser tuberosity fragment included the bicipital groove, allowing the biceps tendon to sublux posteriorly preventing closed reduction, thus requiring a subsequent open reduction
— id: 11373, year: 1987, vol: 27, page: 1083, stat: Journal Article,

Surgical management of late post-traumatic and ischemic neuropathies involving the lower extremities: classification and results of therapy
Lusskin, R; Battista, A; Lenzo, S; Price, A
1986 Oct;7(2):95-104, Foot & ankle
Traumatic/ischemic events such as fractures, dislocations, lacerations, compression, vascular injuries, and embolus can result in several degrees of nerve injury with resultant sequelae of paralysis, sensory loss, and irritative phenomena (pain, hyperesthesia, and dysesthesia). Neuroma pain may prevent rehabilitation following amputation or nerve lacerations. Thirty-four patients with the late sequelae of traumatic/ischemic neuropathies underwent 36 neural operations using magnification techniques to define and repair neural lesions. Major bone and joint reconstruction could be performed at the same operation with protection of arterial and venous supply. A recovery score using defined criteria for motor, sensory, and irritative (pain) recovery has been developed to quantify the end results in compression/ischemia, contusion/stretch, laceration, idiopathic/irritative disorder, and painful neuroma. Excellent and good results were found in 39 of the 87 specific deficits analyzed (45%). Thus, there is the possibility of improved results in these late neuropathies with therapy before irrevocable muscle fibrosis occurs and intractable pain develops
— id: 74821, year: 1986, vol: 7, page: 95, stat: Journal Article,