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At least 1,261 records · Page 70Linked to original sources
PubMed1983

Computerized tomography for ascertaining osteocartilagenous intraarticular (slice) fractures of the femoral head.

Posterior dislocation of the hip joint is the result of severe trauma and leaves those affected with a significant degree of morbidity. Avascular necrosis of the femoral head is its most feared, and yet difficult to diagnose, complication, mainly in the immediate postinjury period. Intraarticular (slice) fractures of the posteroinferior and inferomedial aspects of the femoral head associated with such dislocations may cause the same clinical symptomatology as the sequelae of avascular necrosis, yet need a different approach and have a different prognosis. Since these slice fractures occur in a blind spot area for routine radiographic examinations of the hip, they are often missed and consequently underdiagnosed. Computerized tomography of the hip following posterior dislocation has become a most useful tool in ascertaining the diagnosis in these patients because it very clearly delineates such "slice" fractures, thus enhancing the correct assessment of this severe and often crippling injury.

Adult↗
PubMed1983

[Arthrodesis of the hip].

The author has analysed the results in 14 patients who had a hip arthrodesis carried out 18 years ago. It may be concluded that the vast majority of these patients have generally been satisfied with their condition during this period and that they are capable of performing their physical activities. Most of these patients showed certain changes in the surrounding bonejoint structures, while no lesions of the opposite hip were found. Therefore, the hip arthrodesis merits to be a choice for a correct treatment as long as the other hip is healthy, and the lumbar spine and knee, of the same side, are with no changes. Otherwise, there is no safe surgical method which can provide satisfactory conditions to the patients, implying, no pain in the crippled hip, the ability to be upright for a long period of the day, and the viability for their everyday physical activities.

Adolescent↗
PubMed1983

Muscular torticollis. A modified surgical approach.

Since 1967 twelve children with muscular torticollis were treated at the Los Angeles Shriners Hospital for Crippled Children with a modified bipolar release of the sternocleidomastoid muscle. The results of the procedure were compared with the results in twenty-two other patients who had had either conservative treatment or other types of operations and who were seen between 1952 and 1981. The average follow-up was nine years (range, one to thirty-three years). Fourteen patients, most of them less than one year old, were treated non-operatively and had 86 per cent good or excellent results. The bipolar release and z-plasty was performed either when conservative treatment had failed or in older children who had had other operations, and it yielded 92 per cent good or excellent results. Only 15 per cent good and 77 per cent fair results were obtained when surgical procedures other than bipolar release were performed.

Child↗
PubMed1980

Fistulas of the penile urethra.

Urethral fistula, the most common complication of urethroplasty, is discussed. There has been no classification for these disorders, and the plethora of reconstruction procedures available often leads to confusion. The classification presented here for acquired fistulas attempts to give direction in the selection of appropriate management in individual cases. Early, acute fistulas are managed conservatively. In the case of mature single fistulas, local tissue may be used for surgical repair. These are subdivided, depending on the size of the opening. Chronic, multiple, large lesions draining the urethra require tissue from a distance for repair. In severe surgical cripples, a total new urethral reconstruction will be required. A new technique to expose the urethra, allowing correction of urethral fistulas with stricture and diverticulum, is described.

Humans↗
PubMed1980

Do hospital staff interfere with computer system implementation?

Sabotage of MCBIS by hospital staff endangers and disrupts the delivery of inpatient health care. Wide-spread interference, along with other implementation problems, cripples the ability of MCBIS to function properly and affects health care costs and quality of services.

Adjustment Disorders↗
PubMed1982

Giant-cell tumor of bone: analysis of two hundred and eight cases in Chinese patients.

Giant-cell tumor of bone seems to occur more frequently in Chinese people than in those residing in Western countries. The estimated incidence is about 20 per cent of all primary tumors of bone. Of 208 surgically treated and pathologically proved giant-cell tumors, 194 were benign. We excluded patients with primary or secondary amputation unrelated to recurrence and those followed for less than two years or lost to follow-up. Of the remaining 111 patients who were followed for more than two years, twenty-nine had a recurrence, giving a recurrence rate of 26.1 per cent. The rate of recurrence was highest following curettage and bone-grafting (41.2 per cent) and was much lower in patients who were treated by resection and fusion (7.1 per cent). Since resection of this tumor with reconstructive procedures, either by massive homogenous bone-grafting or artificial joint replacement, is complicated and might cripple the patient if it fails, we propose excision and curettage with bone-grafting as the most suitable method of treatment in the majority of patients with giant-cell tumor of bone.

Adolescent↗
PubMed1982

The mechanism of cyclic monoterpene inhibition of hepatic 3-hydroxy-3-methylglutaryl coenzyme A reductase in vivo in the rat.

Seventeen hours after a single oral dose of the cyclic monoterpenes cineole or menthol, rat liver 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase activity was inhibited by up to 70%. The transient nature of this effect (no inhibition 41 h after dosing) was compatible with the rapid metabolism and excretion of these terpenes. Neither menthol, and its major metabolite, menthylglucuronide, nor cineole acted as direct inhibitors of HMG-CoA reductase activity in vitro, although menthol was found to bind to liver microsomes Ks approximately 0.1 mM). Unlike the short term effects of dietary cholesterol, terpene administration did not affect HMG-CoA reductase activity by modulation of the lipid microenvironment of the enzyme. Thus, following menthol or cineole treatment, we found no deviations from the normal kinetic responses to changes in temperature or in concentration of HMG-CoA. Furthermore, the inhibitory effect was still seen after solubilization of the enzyme from microsomes. The loss of HMG-CoA reductase activity was not associated with increased phosphorylation of the enzyme. Immunotitration of HMG-CoA reductase from terpene-treated rats showed that activity loss was due to less enzyme molecules (together with some possibly "cripple" enzyme), indicating that rates of enzyme synthesis or degradation had been altered. Since menthol inhibition of reductase was still observed in rats deprived of foods, we conclude that the effect is not mediated by those hormones whose concentration is changed during fasting (insulin, glucagon, and adrenaline).

Animals↗
PubMed1982

Orthopaedic management of lumbosacral agenesis. Long-term follow-up.

Twenty-two patients with lumbosacral agenesis were treated at the Shriners Hospital for Crippled Children, Chicago Unit, from 1953 to 1979. At the time of this study, ten of the patients were skeletally mature after an average follow-up of 24.1 years. Two patients had died, twelve could be examined, and eight who were unable to return for examination responded to a questionnaire. Eleven of the patients had diabetic mothers. Of the orthopaedic problems in these patients, knee-flexion contractures with popliteal webbing were the most difficult to correct. These deformities varied in severity with the level of the agenesis and the resulting loss of motor power. Other problems were dislocations and flexions contractures of the hips, scoliosis, equinovarus deformities of the foot, and instability at the spinal-pelvic junction. When there was inadequate quadriceps function it was difficult to correct knee-flexion contractures and to prevent them from recurring. For severe knee deformity, knee disarticulation and prosthetic fitting were the most effective treatment. Spinal-pelvic instability was not a problem in eighteen of the twenty surviving patients. Unreduced dislocated hips also did not cause any problems.

Abnormalities, Multiple↗
PubMed1981

Determination of the Catterall classification in Legg-Calvé-Perthes disease.

Fifty hips in forty-four children with Legg-Calvé-Perthes disease, treated at the Shriners Hospital for Crippled Children, San Francisco, were evaluated with a simplified method of Catterall's classification. Our data indicate that the Catterall rating changed in 40 per cent of the hips when they were classified before they had reached the fragmentation stage of Waldenström compared with only 6 per cent when they were classified after fragmentation had occurred.

Child↗
PubMedDate not supplied

Combined wrist arthrodesis and metacarpophalangeal joint arthroplasty in rheumatoid arthritis.

This paper describes a surgical procedure which combines wrist arthrodesis and metacarpophalangeal joint arthroplasty into one operation. Its basic indication is the severely crippled rheumatoid patient who is faced with multiple reconstructive surgical procedures. In addition to the combined wrist fusion and metacarpophalangeal joint arthroplasty, other surgical procedures can sometimes be performed into same hand, thereby completing the entire reconstruction in one operation. Of the 19 patients who have undergone the combined procedure, only one failed to obtain a solid clinical arthrodesis. There were no infections, skin sluffs or other complications. Combining the two procedures did not jeopardize either wrist fusion or metacarpophalangeal joint arthroplasty. Specific contraindications for the procedure are fixed wrist flexion contracture or a complete dislocation requiring extensive exposure in order to align or reduce the radiocarpal joint.

Adult↗
PubMed1981

[Treatment of upper limb lymphedema after mastectomy with escine and levo-thyroxine].

Lymphoedema of the upper limb is the most serious and most crippling complication of mastectomy. An account is given of the factors possibly responsible, and a classification of the different forms is proposed. When fibrosis has set in, treatment is followed by very disappointing results, being at best able to bring about a partial, but transitory reduction in limb volume and consistency. Reference is also made to results obtained in 70 cases with two substances, 1-thyroxine and escine (somatoline), applied by massotherapy in postural drainage, ionophoresis, and pressotherapy, according to the requirements of each case. The results were distinctly satisfactory, though the outstanding fact was the maintenance of the response throughout many follow-up controls. It is felt, therefore, that somatoline can be usefully given in cyclic form, both in cases treated in an early stage, and also in all patients were lymphoedema is a likely risk after mastectomy.

Arm↗
PubMed1981

[Long-term study of 34 cases of subarachnoid hemorrhage not subjected to surgical intervention].

The prognosis of subarachnoid haemorrhage is still a matter of debate. Reference is made to a long-term study of 34 patients not subjected to surgical management. Four recurrences (11.8%), with 3 deaths (8.8%), were noted over a 1-5 yr observation period. A crippling neurological deficiency was noted in 11 subjects (32.2%). The influence of the neurological state in the acute stage on prognosis is discussed.

Adult↗
PubMed1980

Late genitourinary tract complications associated with severe pelvic injury.

The late urologic complications in certain patients with a severe pelvic injury is inevitable, regardless of the immediate form of therapy instituted to the traumatized lower part of the urinary tract. The three most common late genitourinary complications are deep urethral stricture, urinary incontinence and erectile impotency. The modified posterior urethroplasty for deep urethral stricture used in this series is simple and extremely successful. The genitourinary prosthesis was found quite useful in the surgical management of traumatic urinary incontinence and erectile impotency. These surgical techniques have made it possible to rehabilitate totally the crippling urologic sequelae of pelvic trauma.

Adult↗
PubMed1980

Comparison of reconstructive methods used following ablative head and neck operations.

To overcome the sometimes crippling effect of extensive ablative surgery for oral cancer, two reconstructive techniques, the forehead flap of McGregor and the deltopectoral flap described by Bakamjian, have been incorporated into the operative procedure making it nearly routine. The records of 77 patients in whom 55 deltopectoral flaps and 30 forehead flaps were used were reviewed retrospectively. The failure rate of deltopectoral flaps was 16.4% and for forehead flaps was 7%. Causes of failure included infection, pressure by bone, prosthesis or teeth, residual cancer, previous irradiation and flap crowding. Functional results were similar with both flaps. The forehead flap is preferred although it has cosmetic disadvantages. Both these flap procedures, which are staged and result in prolonged hospitalization for the patient, may in the future be replaced by myocutaneous and free-flap reconstructions.

Adult↗
PubMed1980

Congenital dislocation of the patella.

This is a report of 2 rare, neglected congenital irreducible complete lateral dislocations of the patella. The patients were boys, 10 and 13 years old. The dislocations were designated irreducible because closed manipulative effects were invariably failures and the dislocations are permanent because they persist from birth until openly reduced. The deformity was neglected for years (one patient through childhood, the other into adolescence) during which time the anomalous defects were exacerbated by adverse growth changes. The propitious time (late infancy or early childhood) for open reduction and patellar stabilization with an excellent prognosis had long since passed by the time the patients were first seen by an orthopedic surgeon. Neglect had not only caused them to grow up as cripples, but had also rendered their patellae more difficult to reduce surgically. Neglect also increased the challenge to their surgeon to stabilize their patellae and to cope with their needless and preventable secondary deformities by multiple surgical interventions with decreased prospects of emerging free of residual problems and disabilities. In the growing child with active proximal tibial epiphyseal cartilage, interference with growth was avoided by patellar stabilization using the W. T. Green technique for quadricepsplasty. In the adolescent boy, who was closer to skeletal maturity, patellar stabilization was effectually accomplished by transplanting the tibial tuberosity medially and distally with relative impunity and reinforcing it with a Campbell sling. Angular and linear limb deformities were treated by epiphysiodeses. Prolonged dislocations result in loss of normal articular contours, and nonuse of articular cartilages has a morbid effect; both predispose the joint to early degenerative arthritis. Early diagnosis and early referral for orthopedic care are imperative because delay vitiates the ultimate result.

Adolescent↗
PubMed1980

[Varicothrombophlebitis. Current clinco-statistical aspects. Surgical treatment and its socioeconomic importance].

A clinical and statistical comparison a is made of the surgical frequency of cases of varicothrombophlebitis in 1972-1976 (10.8%), as reported in 1977, and 1977-1978 (38,3%). An objective assessment is made of this increase and its current interest. The degree of understanding reached by the general practitioner and patients of their district is held to be responsible for the increase. Stress is laid on the advantages of early surgery and some of its techniques. Medical management, on the other hand, not only delays surgical resolution, but also encourages the onset of complications that may convert an apparently benign disease into a crippling, or even mortal form (extension of the thrombophlebitic process to the deep circulation, followed by post-thrombotic syndromes, pulmonary embolism, ecc.). Two benefits to society are confered by surgical management: 1) rapid and final cure with a short hospital stay, low cost of theraputic aids, ecc.; 2) early and completion re-insertion of the patient into his social and working surroundings, free of the sense of psychological frustration brought about by the mistaken and general conviction that an unattainable, final cure has in fact been achieved.

Adult↗
PubMed1995

Open surgical techniques for laryngotracheal stenosis.

Adult subglottic and proximal tracheal stenoses are some of the most crippling complications of endotracheal intubation or other laryngotracheal trauma. Subglottic stenoses are a part of the broader category of laryngotracheal stenoses that comprises any lesion from supraglottic larynx to trachea. Patients with laryngotracheal or tracheal stenosis may present with stridor, shortness of breath, or exercise intolerance and may be tracheotomy dependent. The surgeon must have several choices of procedures available to correctly treat the variety of lesions that may occur. This article briefly outlines the pathophysiology of subglottic and tracheal stenosis and discusses in detail the open procedures available.

Anastomosis, Surgical↗