SPMLs & EtOH

fresh platelet donors] – took all day. Surgery was late evening once the platelet count was satisfactory. Platelet protein load brought out rising ammonia. Got it done, though under ‘controlled coma’. Similar, but not as difficult, are sickle cell related cases and hemophilia contracture cases. All this is frightening if incisions are needed. Our first cases were CP as a result of Tetralogy of Fallot (& a few TF variations). Blue babies. The CP effort level was killing them before final staged cardiac repairs could be completed. Straight ‘local’ + ‘FFP’ and these kids looked far better than any CP kid post surgery treated the usual way. We were doing a ‘make do’. Open surgery was out of the question. Outcomes were jaw dropping. But, why??? <===

This boy was said to need tibial osteotomies (break shin bones and rotate lower half outward and metal plate or internally rod to hold the ‘corrections’ until they heal. Long time off legs etc. Risks, not minor. A different diagnosis, not tibial torsion (= a twist in and of the tibia bone), but rather tibial rotation (which is still not in the books). The tibia is fine. We can manually unwind it but springs back inwardly through the knee joint by spastic forces that were also thwarting his walking. The tibia malrotation was gone before he got to recovery room. He walked

on his own a few days later. There is always a wow case that compels rethinking what you think you know. That follows...