M. Musan. Morris College.
Slipped capital femoral epiphysis levitra 10mg with mastercard erectile dysfunction treatment forums, Epiphysiodesis, Prophylaxis, In situ pinning, Osteotomy Introduction Slipped capital femoral epiphysis (SCFE) is a comparatively rare disorder; however, various new methods for its treatment have been reported. The various treatments offer methods for gentle reduction by traction, manual reduction, internal ﬁxation, and osteotomy. We have investi- gated clinical and radiographic evaluation of the patients suffering from SCFE who have undergone surgical therapy in our hospital. Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan 9 10 M. Materials and Methods There were 27 patients (23 males, 4 females) in the present study, with 29 hips treated surgically from 1971 to 2004 in the Kitasato University Hospital. Among the patients with unilateral SCFE, there were 7 acute, 6 acute on chronic, and 16 chronic SCFE. The underlying disease was Down syndrome; hypothyroidism was seen in 1 hip, eunuch- oidism and Frohlich’s syndrome were seen in 1 hip, and juvenile rheumatoid arthritis (JRA) with short-stature chronic renal failure was seen in 1 hip. Clinical evaluations of treatment methods, prophylactic ﬁxation of the unaffected side, rehabilitation, complications, and radiographic evaluation of the PTA were investigated. Results Of the surgically treated cases, pinning (cannulated screw ﬁxation) was performed on 11 hips, osteotomy on 9 hips, and in situ pinning on 9 hips. According to the classiﬁca- tion of severity, pinning was performed on 6 hips and osteotomy was performed on 1 hip of an acute slip. Pinning was performed on 1 hip, osteotomy on 6 hips, and in situ pinning on 9 hips of chronic slips. Pinning was performed on 4 hips and osteotomy was performed on 2 hips in acute on chronic slips (Table 1). Prophylactic ﬁxation of the unaffected side was performed on 13 hips (44. For rehabilitation, partial weight-bearing started after 6 weeks, and brace support for non-weight-bearing was applied in 6 cases. Postoperative complications of avascular necrosis of the femoral head were noted in 7 hips (24. Joint space narrowing and deformity of the femoral head were also noted in 3 hips (10. According to the classiﬁcation, the acute type of SCFE was seen in 4 of 7 hips (57. Clinical classiﬁcation and treatment methods Type of slip Pinning Osteotomy In situ pinning (ARO, VFO) Acute Chronic Acute on chronic Total 11 9 9 ARO, anterior rotational osteotomy; VFO, valgus ﬂexion osteotomy Table 2. Complications Complication Males Females Number (%) Infection Avascular necrosis of (24. Additional operations using bone grafts were performed for avascular necrosis of the femoral head in 2 hips. Case 1 A 12-year-old boy suffered from acute SCFE with a PTA of 65° that was reduced to 22° by skeletal traction for 2 weeks. We performed epiphysiodesis by a cancellous bone screw in this position. Neither defor- mity of the femoral head nor necrosis was found in the ﬁnal follow-up period, and he had an excellent postoperative course (Fig. Posterior tilting angle (PTA) Type of slip Admission Postoperative Final follow-up Acute 54. Acute slipped capital femoral epiphysis (SCFE) in a 12-year-old boy with poste- rior tilting angle (PTA) of 65° on admission (a). We performed epiphysiodesis with cannulated screw ﬁxation, PTA was 20° (b). At 6 months after epiphysiodesis, the cancellous bone screw was removed with excellent results (c) 12 M. We performed an anterior rotational osteotomy (ARO) of the femoral head using an F-system device. A limitation of internal rotation was seen 4 years postoperatively; however, X-rays and clinical examination ﬁndings were excellent during the course (Fig. After anterior rotational osteotomy (ARO) of the femoral head using an F-system device, PTA was 32° (b). Limitation of internal rotation was seen 4 years postoperatively (d) Treatment of Slipped Capital Femoral Epiphysis 13 c Fig. Continued Case 3 A 13-year-old boy suffered from acute SCFE with a PTA of 85°.
In this case they found an alternative solution in alternative approaches to health and healing order levitra 10 mg amex impotence 20 years old. THE WIDER SOCIO-CULTURAL CONTEXT I have argued that these informants’ initial use of alternative therapies is an instance of problem-solving reflective of generic social processes. But in what social context does this generic process of problem-solving take place? Or more precisely, is the choice of alternative therapy as a solution to problems of ill health reflective of larger socio-cultural change whereby alternative solutions constitute a new option in health-seeking behaviour? In addressing this issue, authors have explained lay participation in alternative therapies by placing it within the context of larger socio-cultural changes in beliefs about health, illness, and the body, which include the following: disillusionment with medical science; lay demands for a larger share of control over health and healing; and a belief in holistic health care, where “health is more than a lack of disease... However, when the frame of analysis is one of the problem-solving actions of individuals, the image which emerges is one of consistency rather than change. To illustrate, the ideological components of the alternative model of health espoused by these people are not new in any objective sense. Culturally speaking, these ideas about health and healing were always there (Archer 1988). For example, elements of these informants’ notion of holism harkens back to Galen and the four humours school (Ziegler 1982). Accordingly, it is not that the elements of the ideology are necessarily new; rather, it is that these beliefs 52 | Using Alternative Therapies: A Qualitative Analysis have now been taken up by these informants in order to articulate a model of health care they perceive as alternative therapy. These ideological components are cultural symbols, ultimately subjective in nature (Cohen 1985:15). Moreover, there has always been a plurality of healing options available to the individual (O’Connor 1995). For instance, in the 1663 volume of the diary of Samuel Pepys, we read of his attempts to solve his health problems by choosing between remedies offered by the apothecaries and those advo- cated by the doctors of physique (Latham and Mathews 1995). Likewise, Connor (1997:59) points out that it was only in the latter part of the nineteenth century that healing options were seen to narrow for Canadians: In addition to those practitioners who would be recognized as physicians by today’s criteria … there existed a smaller group of other medical practitioners... The same phenomenon is evident in the British context, where “the evolving boundaries between orthodox and unorthodox medical knowledge... More to the point, the boundaries that emerged did not eradicate all forms of health care other than allopathic medicine; rather, they remained within the health care system (Bakx 1991), their ideological underpinnings part of the symbolic framework of “ideas which at any given time have holders,” ready to be used by people in their efforts to solve health problems (Archer 1988:xix). Hypothetically, even if non-allopathic approaches to health care had been wiped out during this brief period, the individual always had the option of self-care or the option of doing nothing about his or her health problems. Therefore, the nature of the actions of individuals in choosing this option can not be said to have changed; rather, they were, and remain, attempts at solving problems of ill health. On the other hand, what has changed is that there is now something people call alternative therapy, or complementary health care, or integrative medicine, the symbolic components of which have always been part of the ideology of health care options available to people in solving health problems. Conceptualizing health-seeking behaviour as a Why People Turn to Alternative Therapies | 53 generic process of problem-solving allows us to account for whichever solution, alternative or otherwise, individuals choose. While alternative health and healing ideology was not a significant factor in motivating the people I spoke with to begin using alternative health care, its importance should not be discounted, as these beliefs are some- thing that individuals acquire through their participation in alternative health care and something that holds importance for them in their continued use of alternative therapies. Moreover, these ideologies form their alternative models of health and healing. See also Anyinam (1990); Fulder (1996); Furnham and Smith (1988); Monson (1995); Northcott (1994); and Taylor (1984). See also Coward (1989); Dunfield (1996); Easthope (1993); Furnham and Beard (1995); Furnham and Bhagrath (1993); Murray and Rubel (1992); Northcott (1994); and Vincent and Furnham (1996). See also Anyinam (1990); Dunfield (1996); Furnham and Bhagrath (1993); Northcott (1994); and Vincent and Furnham (1996). It is important to note that no pattern emerged in the analysis between type of therapy used, or length of time using a therapy, and reasons informants gave as to why they first began using alternative forms of health care. See also Coward (1989); Dunfield (1996); Easthope (1993); Furnham and Bhagrath (1993); Murray and Rubel (1992); Northcott (1994); Vincent and Furnham (1996); and Yates et al. See also Anyinam (1990); Dunfield (1996); Furnham and Bhagrath (1993); Northcott (1994); and Vincent and Furnham (1996). See also Anyinam (1990); Furnham and Smith (1988); Monson (1995); and Northcott (1994). See also Anyinam (1990); Dunfield (1996); Easthope (1993); Fulder (1996); Furnham and Bhagrath (1993); Furnham and Smith (1988); Murray and Rubel (1992); Riley (1980); and Vincent and Furnham (1996).
Orthop Surg 53:512–516 Treatment of Slipped Capital Femoral Epiphysis 17 7 purchase 10mg levitra amex causes of erectile dysfunction include quizlet. Kita A, Maeda S, Funayama K, et al (1995) Indication and procedure of manual reduc- tion and subcapital osteotomy for slipped capital femoral epiphysis. Castro FP Jr, Bennett JT, Doulens K (2000) Epidemiological perspective on prophy- lactic pinning in patients with unilateral slipped capital femoral epiphysis. Otani T, Fujii K, Tanaka T, et al (2004) Clinical result of closed manipulative reduction for acute-unstable slipped capital femoral epiphysis. Orthop Surg 55:771–777 Indications for Simple Varus Intertrochanteric Osteotomy for the Treatment of Osteonecrosis of the Femoral Head 1 1 1 Hiroshi Ito , Teruhisa Hirayama , Hiromasa Tanino , 1 2 Takeo Matsuno , and Akio Minami Summary. The purpose of this study was to evaluate the long-term results of simple varus intertrochanteric osteotomy for osteonecrosis of the femoral head. Forty hips in 31 patients were included, with an average age at the time of surgery of 34 years (range, 21–51 years). Osteonecrosis was high-dose-steroid-induced in 20 patients, alcohol-induced in 7 patients, and idiopathic in 4 patients. The JOA hip score increased from a preoperative average of 71 points to 85 points at the most recent follow-up. Thirty (75%) of the 40 hips showed good or excellent results, 10 (25%) hips had fair or poor results, and 4 hips needed prosthetic arthroplasty. In 28 hips with equal to or greater than 25% postop- erative lateral head index, 24 (86%) hips showed good or excellent results. Our ﬁndings indicate that if necrotic lesions are limited medially and the lateral part of the femoral head remains intact, good long- term results can be obtained by simple varus osteotomy. Osteonecrosis of the femoral head, Varus intertrochanteric osteotomy, Long-term clinical results, Lateral head index, Joint-preserving operation Introduction The treatment of osteonecrosis of the femoral head is clinically challenging. The extent and location of the necrotic lesion affect the prognosis of osteonecrosis [1–4]. Many studies have shown that the prognosis of this disease without treatment is poor [1–5]. It is important to preserve the hip joint, especially for young and active patients. Total hip arthroplasty in young patients is undesirable because of its limited endur- ance [6,7]. Joint-preserving procedures include core decompression [8,9], femoral osteotomies [1,8,10–27], and vascularized or nonvascularized bone grafting 1Department of Orthopaedic Surgery, Asahikawa Medical College, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan 2Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita-ku Kita-15 Nishi-7, Sapporo 060-8638, Japan 19 20 H. The purpose of osteotomy for osteonecrosis of the femoral head is to move the necrotic lesions away from the weight-bearing portions of the hip joint. The lesions of the weight-bearing portions should then be replaced by normal articular cartilage and subchondral bone by osteotomy [1,8,10–27]. Many studies have exam- ined the usefulness of various types of osteotomies for the treatment of osteonecrosis of the femoral head. Results of varus intertrochanteric osteotomies have been reported with various failure rates. The purpose of this study was to evaluate the long-term results of simple varus intertrochanteric osteotomy for osteonecrosis of the femoral head. Materials and Methods From January 1979 we performed simple varus intertrochanteric osteotomies for the treatment of osteonecrosis of the femoral head; 40 hips in 31 patients (20 men and 11 women) were included in this study. Average age at the time of surgery was 34 years (range, 21–51 years), and the mean duration of follow-up was 12. The diagnosis of osteonecrosis was made based on the clinical history, physical examination, and radiologic evaluation. Osteonecrosis was high-dose- steroid-induced in 20 patients, alcohol-induced in 7 patients, and idiopathic in 4 patients. All 31 patients complained of hip pain while walking at the time of operation. To be considered for osteotomy, the patients had to show a hip movement range of at least 90° for the ﬂexion-extension arc and 25° for abduction. Ten hips were stage II, 27 hips were stage III, and 3 hips were stage IV according to the Steinberg classiﬁcation. From 1985 on, we used magnetic resonance (MR) imaging to conﬁrm the diagnosis. Surgical Technique The patient was positioned in the lateral decubitus position with the extremity draped free on the table.
He returned from Egypt with two war deco- rations levitra 20 mg mastercard erectile dysfunction 38 years old, one the Companion of the Bath and the other the Companion of St. He was about medium height, broad-shoul- dered and of distinguished appearance, his com- plexion slightly sallow, with pleasant blue-grey eyes that lent some attraction to his personality. He was an excellent conversationalist, his voice low-pitched and friendly. In 1890, he married Beatrice, the second daughter of William Payne of the Chamber of London. Alfred Tubby was old enough to be familiar with the traditions of pre-antiseptic surgery and young enough to embrace the teaching of Lister. He was therefore well placed to hand on a written account of what was of permanent value in the teaching Kauko VAINIO of the early pioneers and yet well qualiﬁed to lead in the advance, under antiseptic precautions, of 1913–1989 open operative correction of deformity. Further- more he stood ﬁrm by the deﬁnition of orthope- Kauko Vainio a Finnish orthopedic surgeon of dic surgery as the surgery of the entire locomotor outstanding international achievement, was born system. By his incomparable textbook of 1912, he on May 1, 1913 in Sääminki, Finland. The world- helped to raise the prestige of British orthopedic wide application of orthopedic surgery in the surgery. In 1956 he was appointed ﬁrst senior lecturer of orthopedic rheumatology at the 1. Plarr’s Lives of the Fellows of the Royal College of Since graduating from the Helsinki University Surgeons of England (1930) 2, 438. Bristol, printed Medical School in 1939, Vainio’s early pro- and published for the Royal College of Surgeons by fessional life was dominated by military ﬁeld John Wright & Sons Ltd 4. Tubby AH (1896) Deformities: a Treatise on surgery, ultimately as a major during Finland’s Orthopedic Surgery. Tubby AH (1912) Deformities Including Diseases followed by the postwar hardship. Tubby AH (1920) A Consulting Surgeon in the Near the Orthopedic Hospital of the Invalid Foundation East. Ltd with a residency at the Anderson Orthopedic Hos- pital in the United States in 1949. Long before the current challenges of the growing organized international university exchange programs and projects, Vainio made unbelievable efforts to- ward a better understanding and relationship between colleagues around the orthopedic world, with special reference to his life’s work—the operative treatment of the rheumatoid limb as an integrated part of the overall plan for the rheuma- toid patient. He is said to have established a 341 Who’s Who in Orthopedics school of about 1,000 residents and visitors from 1939. From 1938 to 1939, Verbiest studied neu- Belgium, Canada, Czechoslovakia, Great Britain, rosurgery in Paris. The outbreak of World War II Israel, Japan, Norway, Poland, Romania, Sweden, forced him to return to Utrecht where, because of and the United States at his department in Heinola wartime conditions, he was appointed head of the until his retirement in 1975. After the war, Ver- Anniversary Vainio Meeting in Heinola was biest became well known for his research, for his attended by 50 international specialists in clinical acumen, and for his surgical skills. He was During his career Verbiest received many a man with innumerable friends and spare-time honors from his own government and from the activities. At a rather early stage in his orthope- international neurosurgical community. He is, dic career, Vainio drew fundamental guidelines perhaps, best remembered for his description of for the operative treatment of the rheumatoid spinal stenosis. One of the classic symptoms of deformities of the foot based on a thorough clas- spinal stenosis, intermittent claudication of the siﬁcation of the typical abnormalities and their spine, is called Verbiest’s syndrome. Jean VERBRUGGE 1896–1964 Henk VERBIEST The Belgian medical world, and especially its 1909–1997 orthopedic surgeons, mourn the passing of an eminent surgeon, a good man, and an incompara- Henk Verbiest was born in Rotterdam in 1909. After brilliant intermediary studies at student, Verbiest did research in pigeons on Antwerp, he graduated and gained his degree, in several neurological problems. After graduation, 1921, as a doctor of medicine, surgeon, and obste- Verbiest worked in the department of neurology trician from the University of Brussels, with the until 1937. He was almost immediately this period, he was granted a doctoral degree in awarded a scholarship as a Fellow of the Com- 342 Who’s Who in Orthopedics mittee for Relief in Belgium (CRB Educational stances that could and, indeed, would lead to Foundation) and spent 2 years, up to 1924, at the forgiveness.
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