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Biomedical subjects

C H Shih

Publications and source records attributed to C H Shih.

At least 55 records · Page 3Linked to original sources
PubMed1998

Treatment of cutout of a lag screw of a dynamic hip screw in an intertrochanteric fracture.

Sixteen consecutive patients with cutout of a lag screw of a dynamic hip screw fixation in an intertrochanteric fracture were treated with reinsertion of a lag screw, bone cement supplementation in the neck-trochanter, and subtrochanteric valgus osteotomy. Postoperatively, patients were permitted to ambulate with protected weight-bearing. Fourteen patients were followed-up for at least 1 year (median 2 years; range 1-3 years), and all had a solid union. The union period took a median of 5 months, with a range of 3-7 months. Usually, union of an intertrochanteric fracture was faster than that of subtrochanteric osteotomy (P < 0.01). There were no complications of wound infection, loss of reduction, cutout of a lag screw, or osteonecrosis of the femoral head. From clinical and theoretical considerations, we conclude that despite cutout of a lag screw of a dynamic hip screw fixation being difficult to treat, out technique still can provide an excellent outcome. Therefore, we strongly recommend its wide use.

Aged↗
PubMed1998

Staple augmentation to treat a humeral nonunion after failed Seidel locked nailing.

Seidel locked nailing has been successfully used to treat a humeral shaft fracture or nonunion. However, if union fails despite this treatment, the next approach to try has not been well defined. We, therefore, developed a technique using a staple to enforce the local stability without removing the failed nail. The technique was very simple, and the outcome was always satisfactory.

Adult↗
PubMed1998

Cementless Roy-Camille femoral component.

From 1984 to 1987, a complete, single-layered, porous-coated femoral component (Roy-Camille type) was used for primary cementless total hip replacement in 80 patients. Seventy-two patients (77 hips) with a minimal follow-up of 5 years (mean 7.2 years) were assessed clinically and radiographically. Thigh pain occurred in 4 hips. Osteolysis appeared in 5 hips. Cortical thinning around the femoral component was significant at the proximal and middle levels. In total, 6 femoral components failed, which led to reoperation due to aseptic loosening (4 hips) and septic loosening (2 hips). The hip rating score (modified d'Aubigne and Postel rating system) in the surviving hips progressed from 9.0 (range 6-10) preoperatively to 16.3 (range 12-18) points at the latest follow-up. From this study, we found that the complete, single-layered, porous-coated stem had a low loosening rate after 5 years. Bone ingrowth into the porous coating was found in most of the cases. A lower stress shielding effect in comparison with the complete, multi-layered, porous-coated prosthesis was also noted.

Adult↗
PubMed1998

Limb-threatening necrotizing alternariosis salvaged by adjunctive hyperbaric oxygen therapy.

We describe, to our knowledge, the first case of limb-threatening necrotizing alternariosis whose limbs were successfully salvaged by adjunctive hyperbaric oxygen therapy (HBO2). This 58-y-old patient was immunocompromised with both diabetes and Cushing's syndrome. She suffered from necrotizing soft tissue infection of both legs caused by Alternaria. It was impossible to halt the progression of the invasive infection with standard anti-fungal treatment and aggressive surgical debridement. After the use of HBO2, the wound was stabilized and eventually healed. Adjunctive HBO2 in this case has demonstrated its role in the treatment of complicating necrotizing soft tissue infection caused by invasive fungal infection. The possible mechanisms may be the potentiation of immune responses and the enhancement of fibroblast proliferation.

Alternaria↗
PubMed1998

Bone healing of tibial lengthening is enhanced by hyperbaric oxygen therapy: a study of bone mineral density and torsional strength on rabbits.

We investigated the effect of intermittent hyperbaric oxygen (HBO) therapy on the bone healing of tibial lengthening in rabbits. Twelve male rabbits were divided into two groups of six animals each. The first group went through 2.5 atmospheres absolute of hyperbaric oxygenation for 2 hours daily, and the second group did not go through hyperbaric oxygenation. Each animal's right tibia was lengthened 5 mm using an uniplanar lengthening device. Bone mineral density (BMD) study was performed for all of the animals at 1 day before operation and at 3, 4, 5, and 6 weeks after operation. All of the animals were killed at 6 weeks postoperatively for biomechanical testing. Using the preoperative BMD as an internal control, we found that the BMD of the HBO group was increased significantly compared with the non HBO group. The mean %BMD at 3, 4, 5, and 6 weeks were 69.5%, 80.1%, 87.8%, and 96.9%, respectively, in HBO group, whereas the mean %BMD were 51.6%, 67.7%, 70.5%, and 79.2%, respectively, in non-HBO group (two tailed t test, p < 0.01, p < 0.01, p < 0.01, and p < 0.01 at 3, 4, 5, and 6 weeks, respectively). Using the contralateral nonoperated tibia as an internal control, we found that torsional strength of lengthened tibia of the HBO group was increased significantly compared with the non-HBO group. The mean percent of maximal torque was 88.6% in HBO group at 6 weeks, whereas the mean percent of maximal torque was 76.0% in non-HBO group (two-tailed t test, p < 0.01). The results of this study suggest that the bone healing of tibial lengthening is enhanced by intermittent hyperbaric oxygen therapy.

Absorptiometry, Photon↗
PubMed1998

Treatment of clavicular aseptic nonunion: comparison of plating and intramedullary nailing techniques.

OBJECTIVE: The aim of this retrospective study was to investigate and compare the effects of plating and intramedullary nailing in the treatment of clavicular aseptic nonunion. METHODS: Thirty-three consecutive patients with middle-third clavicular aseptic nonunions with previous nonoperative treatment were treated by plating (13 patients) and intramedullary nailing (20 patients) with supplementary cancellous bone grafting. The indications for such treatment were middle-third aseptic nonunions without previous operative treatment and with local pain or tenderness, deformity, or neurologic complaint. The choice of plating or intramedullary nailing was according to the surgeon's individual preference. RESULTS: Twenty-nine patients were followed for at least 1 year (range, 1-7 years; median, 3 years; plating, 11; intramedullary nailing, 18). The union rate was 81.8% (9 of 11) for plating and 88.9% (16 of 18) for intramedullary nailing (p = 0.35, Fisher's exact test). The union period was 4.0 +/- 1.3 months for plating and 4.1 +/- 1.1 months for intramedullary nailing (p = 0.80, unpaired Student's t test). The complication rate was 27.3% (3 of 11) for plating and 11.1% (2 of 18) for intramedullary nailing (p = 0.21, Fisher's exact test). There were no significant differences in other parameters. CONCLUSION: Intramedullary nailing may have a higher union rate with a lower complication rate than plating (p > 0.05). At least in common situations, it is not inferior to plating. Whenever possible, therefore, intramedullary nailing should be used preferentially to treat clavicular aseptic nonunion without previous operative treatment. Nevertheless, both techniques have relatively higher nonunion rates in the treatment of clavicular nonunion than in the treatment of other long-bone nonunions. Gentle handling of surrounding soft tissues to reduce bony fragments should be strictly executed.

Adult↗
PubMed1998

Augmentative plate fixation for the management of femoral nonunion with broken interlocking nail.

Five patients with femoral nonunion and a broken interlocking nail were treated with the augmentative plating procedure. This group included two male and three female patients whose average age was 25 years (range, 21-35 years). All of the injuries resulted from traffic accidents and were closed fractures. Four of the injuries were initially managed with a Grosse-Kempf interlocking nailing system, and one case was managed with an AO interlocking nailing system. The broken interlocking nail was left in place in situ, and an augmentative plate fixation was applied to the fracture site to provide a rigid fixation. Simultaneous bone grafting was performed in three of the patients to repair the bony defect. All of these patients walked bearing full weight on the extremity without aching at the fracture site within 3 months, and all of these five fractures obtained a bony union within an average of 5.4 months after this treatment. From our experience, we have found this method to be a useful treatment for the nonunion of femoral shaft fracture with a broken interlocking nail.

Adult↗
PubMed1998

Closed management and percutaneous fixation of unstable proximal humerus fractures.

BACKGROUND: In dealing with displaced proximal humerus fractures, there is still much controversy in treatment modalities. The latest investigations emphasize the concept of minimal exposure and rigid fixation. METHODS: The technique of closed reduction and percutaneous fixation with cannulated screws and k-pins was performed on 19 patients with two- and three-part proximal humerus fractures. The outcomes were evaluated with a mean follow-up of 21 months. RESULTS: All except one case had a solid union of the fracture. Sixteen of 19 patients (84%) acquired good or excellent results according to Neer's classification. No further collapse or avascular necrosis was found. CONCLUSION: The method of closed reduction and percutaneous fixation, although technically demanding, yields satisfactory results in displaced proximal humerus fracture. Cannulated screws provided rigid fixation that was the underlying tenet for early functional retrieval.

Adolescent↗
PubMed1998

Case report: Metachronous early gastric carcinoma in a reconstructed gastric tube after radical operation for oesophageal carcinoma.

The incidence of double cancer has increased as a result of the significant advances in both diagnostic procedures and anti-cancer therapy, and as the outcome of oesophageal squamous cell carcinoma (ESCC) has improved, the number of cases of double cancer of the oesophagus and stomach has also increased. Two patients with metachronous early gastric carcinoma in a reconstructed gastric tube were successfully treated after subtotal oesophagectomy for ESCC. These cases have shown that early diagnosis of second cancer is very important for curative therapy.

Adenocarcinoma↗
PubMed1998

Porous coated anatomic total hip arthroplasty: 5- to 10-year follow up.

BACKGROUND: We report the medium term results of a study of patients with noncemented total hip arthroplasty (THA) using a first generation porous coated anatomic (PCA) prosthesis. MATERIALS AND METHODS: We reviewed 161 primary uncemented PCA THAs performed in 141 patients from November 1985 through March 1989 in our hospital. Subjects were followed up for a minimum of 5 years or until revision. Most common indicators for THA were osteoarthritis in 81 hips (50.3%) and avascular necrosis in 64 hips (39.8%). The average age at operation was 48.2 years. The average follow-up period was 6.9 years in patients without revision. RESULTS: The average modified d'Aubigne and Postel hip scores improved from 10.9 points preoperatively to 17.4 points at the final postoperative evaluation. Results were rated as good to excellent in 146 hips (90.7%). Twelve (7.4%) hips received revision arthroplasty, 8 because of cup loosening, one because of polyethylene wear, and 3 hips because of stem loosening. Prostheses were removed in 2 hips, one due to tuberculosis and the other due to infection. Other complications included focal osteolysis in 54 hips (33.5%), posterior dislocation in 3 hips (1.9%), and lesser trochanter fracture in one hip. Thigh pain occurred in 30 hips (18.6%). In 114 hips, the roentgenograms were used to assess polyethylene wear. The average wear rate was 0.11 +/- 0.15 mm/year. Excessive wear rate (> 0.2 mm/year) occurred in 28 hips (24.6%). Factors contributing to higher wear rate included young age, cup inclination angle beyond the range of 35-55 degrees, and thin polyethylene liner. CONCLUSION: The high rate of osteolysis and thigh pain in these patients should alert surgeons to be cautious in using this type of prosthesis.

Adult↗
PubMed1998

Tuberculosis of the ankle: report of four cases.

Tuberculosis of the ankle joint is relatively uncommon, and the treatment usually includes chemotherapy, immobilization and non-weight bearing protection. It is easily confused with pyogenic arthritis, which often leads to delayed diagnosis. We reviewed the records of 4 patients with ankle tuberculosis with advanced articular lesions without evidence of pulmonary tuberculosis. They took antituberculous agents for 5 to 6 months. Two of them had positive bacterial cultures, and all four had initially received surgical management under the impression of pyogenic osteomyelitis. Two patients underwent arthrodesis and the other two synovectomy with debridement. The clinical and radiologic results were better in the patients who underwent arthrodesis. We consider surgery with open biopsy of a painful swelling ankle to be helpful in the differential diagnosis of tuberculous and pyogenic arthritis. Arthrodesis in patients with severe osteoarticular destruction of the ankle provides a better prognosis and more stable joint than other treatment methods.

Adult↗
PubMed1998

Total hip arthroplasty in Salmonella coxitis: four cases report.

Suppurative coxitis induced by salmonella is rarely reported in the literature. Furthermore, reconstruction with a total hip arthroplasty (THA) in such patients has never been reported. However, in this study, we present 4 cases; 2 normal male patients and 2 female patients with underlying systemic lupus erythematosus (SLE). The ages range from 26 to 61 years. All 4 cases revealed growth of group B salmonella from the cultures of synovial fluid. They all received THA after the infections were eradicated. The functional assessment of pain, range of motion, walking ability together with the radiographic assessment were used according to the new hip score system. After a minimum follow-up of 2 years, all of the reconstructed hips showed good to excellent results since no infections recurred during this period. Although the long-term results are uncertain, the short-term clinical advantage of THA in the treatment of quiescent salmonella coxitis is encouraging.

Adult↗
PubMed1998

Cementless ceramic total hip arthroplasty: a 5 to 16 year follow-up.

BACKGROUND: Cementless total hip arthroplasty (THA) was invented to replace cemented THA and thus avoided cement disease, which shortened the longevity of implants. Ceramic THA was an early type of cementless THA which was used at our institution for several years. In the literature, reports about ceramic THA are very rare, moreover, the results of THA are controversial. This retrospective study was to report our experience. MATERIALS AND METHODS: Seventy-two cementless ceramic THAs were performed and followed for at least 5 years (range, 5 to 16 years; average, 9.8 years) at our institution. Patients ranged in age from 23 to 68 years (average, 45 years) with a male to female ratio of 3 to 1. A modified d'Aubigne and Postels' method was used to evaluate the functional and radiographic outcomes. RESULTS: Only 51.4% of the cases achieved a satisfactory result. Furthermore, the complication rate was very high, especially for aseptic loosening (34.7%). For ankylosing spondylitis cases, the satisfactory result rate was only 30% (2/7) and the unsatisfactory cases even had a loosening rate of 80% (4/5). CONCLUSION: Compared to other types of cementless THA, the satisfactory result rate with ceramic THA was markedly lower and the complication rate was relatively higher. Therefore, we conclude that cementless ceramic THA is not an ideal implant and its usage should be strictly restricted.

Adult↗
PubMed1997

Mechanical properties of acrylic bone cement containing PMMA-SiO2 hybrid sol-gel material.

An organic-inorganic hybrid material, poly(methyl methacrylate) (PMMA)-SiO2 (SiO2 content of 72 wt%), was prepared by incorporating PMMA structure units covalently into an SiO2 glass network via the sol-gel approach. The hybrid sol-gel material PMMA-SiO2 was subsequently used as the solid powder component of bone cement and its mechanical properties were evaluated. The effects of the addition of tricalcium phosphate (TCP), hydroxyethyl methacrylate (HEMA), and ethylene glycol dimethacrylate (EGDMA) on the properties of the sol-gel hybrid bone cement were also investigated. The influence of these components on the temperature rise during polymerization was discussed. It was found that the new bone cement containing PMMA-SiO2 hybrid sol-gel material had higher modulus than that of Simplex-P bone cement. The addition of TCP in the new bone cement increased the Young's modulus and the polymerization time; the inverse was observed for the tensile, bending, and compressive strengths, and the polymerization temperature. The addition of HEMA and EGDMA in the new bone cement had the opposite effect of TCP. The comparison between the new sol-gel bone cement and the commercial Simplex P bone cement was discussed.

Biocompatible Materials↗
PubMed1997

Effect of emergency physician-performed pelvic sonography on length of stay in the emergency department.

STUDY OBJECTIVE: To evaluate the sensitivity and specificity of emergency physician-performed pelvic sonography (EPPPS) and its effect on length of stay (LOS) in the emergency department. METHODS: The study involved a prospective observational convenience sample of women in early pregnancy requiring ED pelvic ultrasound evaluation. Differences in LOS were analyzed with the use of the Mann-Whitney test, with EPPPS and consultation status as classification variables. Results were stratified by diagnosis to identify patient subsets in which EPPPS had the greatest impact. A multivariate model was used to determine the independent associations of EPPPS and consultation status with LOS. RESULTS: Among 115 pregnant patients, those who underwent EPPPS had a decreased median LOS compared with those who received pelvic sonography administered by radiologists or obstetrics-gynecology consultants (60 versus 180 minutes; P < .001). Obstetrics-gynecology consultation was associated with an increase in LOS from 60 to 170 minutes (P < .001). Stratification revealed that the decreased LOS was most significant in patients with viable intrauterine pregnancies (IUPs) and was not seen in those with abnormal pregnancies. This result was attributed primarily to the need for consultation in the latter group. Multivariate analysis demonstrated that EPPPS remained significantly associated with decreased LOS overall, after adjustment for the potentially confounding effect of consultation status (P < 001). The sensitivity of EPPPS for IUP was 94% (95% confidence interval [CI], 82% to 98%), and the specificity was 100% (95% CI, 83% to 100%). All 10 ectopic pregnancies, six of which were detected by EPPS and are included in the aforementioned sensitivity and specificity analysis, plus four detected by NEPPPS, were correctly identified; none was missed. No patient had an adverse outcome as a result of EPPPS. CONCLUSION: Pelvic ultrasound performed by emergency physicians after a brief period of training shortens ED LOS in women in early pregnancy, particularly in those with viable IUPs. This practice appears to be sensitive, specific, and safe.

Education, Medical, Continuing↗
PubMed1997

A Morse-code recognition system with LMS and matching algorithms for persons with disabilities.

Single-switch communication is an effective auxiliary method for persons with disabilities. However, it is not easy to recognize the Morse codes typed by them. In our earlier proposed Morse code auto-recognition method, using the Least-Mean-Square (LMS) adaptive algorithm, it was demonstrated that the system could successfully recognize the Morse-coded messages at unstable typing speeds. However, the speed variation had to be limited to a range between 0.67 and two times the present speed. In the case of beginners or those with heavy disabilities, this rule can not always be complied with, producing a low recognition rate of 20%. To address this limitation, this paper offers an advanced recognition method which combines the Least-Mean-Square algorithm with a character-by-character matching technique. The recognition rate for this method from simulated and real data from various sources is as high as 75% or more on average. This practical application of the single-switch method means a step forward toward alternative communication for disabled persons.

Algorithms↗
PubMed1997

Survivorship analysis of DKS instrumentation in the treatment of spondylolisthesis.

This retrospective study analyzed the survivorship of DKS instrumentation and the clinical outcomes in 185 patients with spondylolisthesis. These patients were treated with Zielke DKS instrumentation for a mean followup period of 3.5 years. Eight (4.3%) patients had late removal of implants, 25 (14%) had rod breakage, three (1.7%) had screw breakage, and 16 (8.7%) had nut loosening. The survivor rate of DKS instrumentation was 96% within 3 months after operation, 80% at 2 years, and 61% at 5 years after surgery. One hundred sixty-three (88%) patients had solid posterolateral fusion, and 167 (90%) patients had good to excellent results. Adjacent instability developed in 18 (9.7%) patients. Although Zielke DKS instrumentation has a smaller rod and relatively insecure locking system between the rod and screw, it is an effective implant for the treatment of spondylolisthesis.

Adult↗