[Tuberculosis in the cervical spine of a young woman].
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
P Myllynen
Publications and source records attributed to P Myllynen.
Prophylaxis of thromboembolism in orthopaedics and traumatology.
In a retrospective study we collected patient data relating to clinically detected postoperative thromboembolic complications before (n = 1710) and after (n = 2212) adopting a protocol for prophylaxis of deep vein thrombosis (DVT). A relatively low incidence of clinically diagnosed DVT, four per thousand, before systematic instructions for prophylaxis in 1981 could be explained by the frequent use of dextran as a volume expander in critically ill patients. However, following systematic prophylaxis the frequency of DVT decreased further (one per thousand).
Adolescent↗
Survival after massive transfusions exceeding four blood volumes in patients with blunt injuries.
The authors' experience with 29 patients with blunt injuries who sustained massive transfusions exceeding four blood volumes in the initial posttraumatic 12 hours was reviewed. The overall mortality was 62 per cent. Only one patient survived when the amount of transfusions exceeded 50 units. The most common bleeding sites were abdominal and pelvic. Half of the dead succumbed within the first 24 hours. Of those who died, seven died from brain injury, six from multiple organ failure (MOF), and five from uncontrollable bleeding. Initial shock was observed in 55 per cent of patients. The high mortality of patients with massive transfusions and MOF related to the duration of shock strongly promote the importance of initial volume resuscitation.
Adolescent↗
Chronic unilateral low-back pain. Predictors of outcome of facet joint injections.
One hundred nine patients with chronic (3-36 months; mean, 13.4 months) unilateral low-back pain and no signs of sciatica were subjected to facet joint injection, randomized in three therapy groups: cortisone and local anesthetic injected intra-articularly, the same mixture injected pericapsularly, and physiologic sodium hydrochloride injected intra-articularly into two facet joints. To evaluate the results, three outcome variables were formed: work, subjective, and disability outcome. The inappropriate signs (IAS) recorded before injections had the best predictability for a good outcome. The mode of injection or duration of symptoms had no significance as a predictor. It was concluded that the outcome after facet joint injection depends on the patient's biopsychosocial chances of self-facilitated improvement. If abnormal illness behavior and distress are found, it helps to estimate the response for treatment and to choose a realistic method of treatment.
Adult↗
Cervical spinal cord injury: the correlations of initial clinical features and blood gas analyses with early prognosis.
The predictive values of some early post-traumatic clinical symptoms and signs and laboratory tests on the problems, complications and prognosis of the initial treatment of tetraplegic patients were studied. The study was carried out by scrutinizing the files of 54 patients with a cervical spinal cord injury (40 of them complete and 14 incomplete). Most of the patients (n = 43) needed ventilatory support, the duration of which depended on the level and completeness of the spinal cord injury. Bradycardia, hypotonia and tachypnoea at admission occurred most frequently in those patients who later developed complications or died. In addition, the frequency of complications correlated with a patient's age, previous diseases and with the height and degree of the spinal cord injury. Tachypnoea on admission forecast the later development of respiratory complications. All 8 patients who died, 5 of them from pneumonia and 3 from pulmonary embolism, had their spinal cord injury at the level C4 to C5 and they were significantly older than those who survived.
Adult↗
Colloid osmotic and hydrostatic pressures and energy metabolism in high-protein joint swelling. A preliminary study of traumatic effusions of the knee.
In 10 patients referred to arthroscopy with traumatic effusions of the knee, the protein concentration of the synovial fluid (SF) correlated to its colloid osmotic pressure (pi SF). The pi SF did not correlate to the poorly determined hydrostatic pressure (PSF) in extended or slightly flexed joints or to the SF volume (VSF). SF hypoxia correlated to pi SF and to the number of intra-articular erythrocytes, but not to the determined PSF or VSF. SF hypoxia correlated to increase in lactate and decrease in pH, fitting enhanced anaerobic glycolysis. In addition, SF erythrocyte counts correlated to lactate increase. During a 5-min period of high PSF induced by flexion, the PSF decreased, and even more markedly so after the joints had been rinsed with saline. The results suggest that rinsing of joints in order to lower the pi SF and to remove erythrocytes is of benefit in cases of traumatic effusion.
Cell Count↗
Lumbar facet joint syndrome. A randomised clinical trial.
A group of 109 patients with unilateral low back pain for over three months were randomised to receive one of three types of injection treatment: cortisone and local anaesthetic injected into two facet joints (28), the same mixture around two facet joints (39), or physiological saline into two facet joints (42). The effect of the treatment was evaluated in relation to work attendance, pain, disability and movements of the lumbar spine. Patients were examined one hour and two and six weeks after treatment and also completed a questionnaire after three months. A significant improvement was observed in work attendance, pain and disability scores, but this was independent of the treatment given and movements of the lumbar spine were not improved. Of the 70 patients with initial pain relief after injection, 36% reported persisting benefit at the three month follow-up, independent of the mode of treatment given. We conclude that facet joint injection is a non-specific method of treatment and the good results depend on a tendency to spontaneous regression and to the psychosocial aspects of back pain.
Adult↗
[Lumbar facet joint syndrome. Significance of non-organic signs. A randomized placebo-controlled clinical study].
One hundred and nine patients with chronic (greater than 3 months) unilateral low back pain had less than or equal to 2/5 or greater than or equal to 3/5 inappropriate signs (IAS) in 65 and 44 cases, respectively. The patients were randomized in three therapy groups: cortison and local anaesthetic injected intra-articularly into two facet joints (28 patients), the same mixture injected pericapsularly around two facet joints as well (39 patients) and injection of physiologic sodium hydrochloride intra-articularly into two facet joints (42 patients). The effect of the treatment was evaluated within an hour, two and six weeks after the treatment with work status, pain scale, disability score and movements of the lumbar spine. In addition, the patients returned a questionnaire three months after the treatment. Although similar improvement was observed during the follow-up the pain scales and disability scores were, however, in the beginning and at the end of the study more pathological in the group scoring greater than or equal to 3/5 IAS. It is suggested that persistent high levels of IAS depend more on psychosocial factors than on anatomical disorders and therefore explain why the somatic treatment does not work. Identification of these patients may also prevent the doctor from a burn-out syndrome after many failed treatments. This study also shows that if a biological effect of a treatment is to be studied the patients with multiple IAS should be excluded from the material. There was no difference in the results when either intra-articular or pericapsular cortisone and local anaesthetic or saline intra-articularly was used.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The significance of arthroscopy and examination under anaesthesia in the diagnosis of fresh injury haemarthrosis of the knee joint.
Arthroscopy and examination under anaesthesia were performed for 328 consecutive knee injuries with haemarthrosis. These examinations were grouped according to a modified classification (Jackson and Abe, 1972) into very useful (117/328, 36 per cent), useful (98/328, 30 per cent) and useless (113/328, 34 per cent) categories. The probability of arthroscopy being useful was estimated mathematically. The factors which made this procedure useful were knee pain on exertion before the injury (P = 0.0561), the mechanism of the injury (P less than 0.0001) and the clinical stability of the patella (P = 0.0007). On arrival in the emergency department it was first decided whether the leg should be mobilized, immobilized in a plaster cast, operated on or, if a definitive diagnosis could not be reached, arthroscopy was deemed necessary. This resulted in the treatment following arthroscopy, and examination under anaesthesia, being altered from conservative to operative (P less than 0.0001). Results suggest that arthroscopy and examination under anaesthesia should always be considered to help in the diagnosis of acute injury haemarthrosis of the knee especially after a valgus or varus strain.
Adolescent↗
Recurrence of deformity after removal of Harrington's fixation of spine fracture. Seventy-six cases followed for 2 years.
The radiographic result was assessed in 76 patients with acute unstable fractures of the thoracic or lumbar spine admitted during the years 1977-1984, and who were managed by early reduction and stabilization using Harrington distraction rods and a three-segmental posterolateral fusion. The radiographs were analyzed for anterior and posterior heights plus sagittal and frontal widths of the fractured vertebral body and the angles of kyphosis and scoliosis of the spine. All the measurements were made at admission, immediately postoperatively, and at the latest follow-up at least 3 months after removal of the rods, which was done as a routine procedure 6-12 months after the accident. The mean follow-up was 29 months. The posterior height and sagittal width of the vertebral bodies were best restored, whereas the initially well-reduced anterior height and the angle of kyphosis often had returned to values close to those seen on admission. The best anatomic restoration was obtained in rotation-dislocation injuries of the thoracic and thoracolumbar spine, and was poorest in burst fractures of the lumbar spine.
Adolescent↗
[Venous thrombosis in spinal and spinal cord injuries].
Explore the source record for details and available documents.
Adolescent↗
Aseptic necrosis of the femoral head during pregnancy.
Two patients are presented with rare aseptic osteonecrosis of the femoral head appearing during the last trimester of pregnancy. Both patients suffered from increasing pain in one hip joint, beginning about one month before parturition. Radiographs demonstrated local osteoporotic changes of the femoral head on the painful side. Needle aspiration of the hip joint yielded a scant amount of clear, sterile synovial fluid and gave prompt relief of pain in both cases. The patients' history did not demonstrate any predisposing factors to osteonecrosis other than pregnancy. Treatment comprised omission of weight-bearing on the affected lower extremity for a month or two. The patients had completely recovered one year postpartum, and radiographs were normal.
Adult↗
Treatment of fresh tears of the anterior cruciate ligament. A comparison of primary suture and augmentation with carbon fibre.
Early results after a follow-up of 1 year of primary suture and carbon fibre augmentation in the treatment of fresh anterior cruciate ligament tears in 57 consecutive and randomized patients are presented. There was no statistical difference between the two groups in the postoperative course. At an average of 13 months follow-up, complete stability was achieved regarding the pivot shift sign in 16 (55 per cent) and 18 (75 per cent) of the sutured and augmented groups respectively. There were 3/29 obvious pivot shifts in the sutured and 1/24 in the augmented knees. Seventeen carbon fibre reinforced knees were postoperatively arthroscoped at the 1-year follow-up. A structure resembling a 'neoligament' was observed in 8/16 knees. In 11 knees there were no signs of carbon material, in 4 knees subsynovial microparticles were scattered around the anterior compartment and in 3 knees the carbon fibre tow was bare in the joint despite careful covering within the ligament remnants at the time of the operation. Although no statistical difference was obtained between the two groups the augmentation procedure seemed to improve stability at the 1-year follow-up.
Adolescent↗
Beta-adrenergic receptors of human lymphocytes in physically active and immobilized subjects: characterization by a polyethylene glycol precipitation assay.
To investigate the role of physical conditioning in the regulation of cellular beta-adrenergic responsiveness in man, a simple and accurate method for the determination of lymphocytic beta-adrenergic receptors was developed and subsequently utilized for the characterization of these receptors in subjects with varying degrees of physical fitness. This method combines the advantages of the use of [125I]iodocyanopindolol as the radioligand and polyethylene glycol (PEG) precipitation for the separation of bound and unbound radioligand. The assay is quick and easy to perform and allows several samples to be processed simultaneously. The concentration of beta-adrenergic receptors in lymphocytic membrane particulates in 16 healthy subjects was 58 +/- 4 fmol/mg protein (mean +/- SEM) and the Kd of the interaction between [125I]iodocyanopindolol and the receptor was 4 X 10(-11) mol/l. The receptor level was similar in both sexes. As compared with the controls, the cellular concentration of beta-adrenergic receptors was higher in eight regularly competing long-distance runners (73 +/- 4 fmol/mg protein; p less than 0.025), whereas the corresponding receptor level in six sprinters (62 +/- 9 fmol/mg protein) did not differ from that of controls. The concentration of lymphocyte beta-adrenergic receptors in seven patients undergoing supine immobilization for weeks because of neck fracture or dislocation showed a wide range from 44 to 155 fmol/mg protein.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Glucose intolerance and insulin resistance accompany immobilization.
Physical activity is known to increase glucose tolerance and insulin sensitivity. To examine the influence of physical inactivity on insulin sensitivity, we measured oral glucose tolerance (OGTT) and insulin response to glucose in 18 patients immobilized to bed for six weeks after acute spine fracture. The results were compared to those of nine chronically immobilized spinal cord injury patients and to eight healthy mobile controls. During the first week after trauma both glucose and insulin responses in the OGTT were two- to three-fold above normal (p less than 0.01). The index of insulin resistance (glucose area X insulin area) was seven-fold greater than in healthy controls (p less than 0.001). After three weeks' immobilization insulin resistance had declined by 30-35% (p less than 0.05) being then at the level observed in chronically immobilized subjects. After remobilization the insulin resistance was further decreased but remained still 2.3 times higher than in controls. Thus, trauma causes a manifold increase in insulin resistance, which is reduced but not normalized during the subsequent immobilization and remobilization.
Adolescent↗
Anterolateral decompression for neural involvement in thoracolumbar fractures. A review of 78 cases.
Of a total of 905 patients with fracture or fracture-dislocation of the thoracolumbar spine admitted from 1969 to 1982, a neurological deficit was present in 334 (37%). All unstable injuries were initially treated by reduction and posterior fusion. In 79 of these patients, an anterolateral decompression was undertaken later because of persistent neurological deficit and radiographic demonstration of encroachment on the spinal canal. One patient died of pulmonary embolism; 78 were reviewed after a mean period of four years. Of these 78 patients 18 made a complete neurological recovery while 53 appeared to have benefited from the procedure; 25 remained unchanged. The best results were obtained in burst fractures at thoracolumbar and lumbar levels when a solitary detached fragment of a vertebral body had been displaced into the spinal canal. These results indicate that anterolateral decompression of the spinal canal should be considered, after careful evaluation, for certain injuries of the spine in which there is severe neural involvement.
Adolescent↗
The blood F VIII:Ag/F VIII:C ratio as an early indicator of deep venous thrombosis during post-traumatic immobilization.
Twenty-two consecutive patients with spinal fractures (eight with spinal cord injuries) were studied. All patients were immobilized in bed for 6 weeks after trauma. The occurrence of deep venous thrombosis (DVT) was detected by the 125I-labeled fibrinogen test and confirmed by venography. F VIII:C, F VIII:Ag, and AT III activities were determined 2, 6, and 10 to 12 days after trauma. All paralyzed patients (n = 8) developed DVT and two of them had pulmonary embolism within 5 days after trauma. F VIII:Ag and F VIII:C disproportionally increased and the values of F VIII:Ag/F VIII:C ratio above 2 predicted DVT. AT III remained normal during the whole immobilization time and the values of DVT(+) and DVT(-) groups were comparable.
Adult↗
Outcome of clavicular fracture in 89 patients.
During 1982, 118 patients with clavicular fracture were treated in the Department of Orthopaedics and Traumatology, Helsinki University Central Hospital. Eighty-nine patients appeared for the follow-up examination in 1984. Eighty-three fractures were treated with immobilization in a sling. Four fractures were treated with plate fixation primarily and two patients were operated on for delayed union. The immobilization averaged 21 days, range 10-42 days. The follow-up was 2 years in all cases. The result was good in 65 cases, satisfactory in 20, and poor in 4 cases. Patients with primary dislocation of more than 15 mm or with shortening observed at the follow-up examination had statistically significantly more pain than patients without these findings.
Adolescent↗