1/7. Salvage of contaminated fractures of the distal humerus with thin wire external fixation.Fractures and osteotomies of the distal humerus that are contaminated or infected represent a difficult management problem. Stable anatomic fixation with plates and screws, the acknowledged key to a good result in the treatment of bicondylar fractures, may be unwise. A thin wire circular (Ilizarov) external fixator was used as salvage treatment in such complex situations in five patients. The fixator allowed functional mobilization of the elbow while allowing achievement of the primary goal of eradicating the infection or colonization. Two patients required a second operation for fixation of a fibrous union of the lateral condyle. One patient with a vascularized fibular graft later required triple plate fixation for malalignment at the distal host and graft junction. Four of five patients ultimately achieved complete union. The fracture remained ununited in one patient who has declined additional intervention. All five patients achieved at least 85 degrees ulnohumeral motion, two after a secondary elbow capsulectomy performed after healing was achieved. This experience suggested that the Ilizarov construct, although not a panacea, represents a reliable method of skeletal stabilization that allows functional mobilization while elimination of infection or colonization is ensured. If necessary, stiffness and incomplete healing can be addressed with an increased margin of safety at subsequent operations.- - - - - - - - - - ranking = 1keywords = achievement (Clic here for more details about this article) |
2/7. Renal failure in surgical patients. Treatment with intravenous essential amino acids and hypertonic glucose.solutions containing balanced quantities of essential L-amino acids, hypertonic glucose, and other essential nutrients were administered by vein to ten patients who had acute or chronic renal failure associated with or resulting from catastrophic complications precluding use of the gastrointestinal tract for alimentation. weight gain, wound healing, and positive nitrogen balance occurred uniformly during periods of total intravenous nutrition, while blood urea nitrogen remained stable or decreased and the signs and symptoms of azotemia resolved. Restoration of nutritional balance and achievement of protein synthesis is possible in patients who have renal failure and gastrointestinal dysfunction by the judicious administration of high biologic value diets exclusively by vein.- - - - - - - - - - ranking = 1keywords = achievement (Clic here for more details about this article) |
3/7. Labyrinthine fistula: an unreported complication of the Grote prosthesis.OBJECTIVES: To alert the otological surgeon that labyrinthine fistula is a rare and avoidable complication of the Grote hydroxyapatite ceramic external auditory canal (EAC) prosthesis. The reasons for its causation and strategies to prevent its formation are discussed. STUDY DESIGN: Case study and retrospective review of the literature. methods: Labyrinthine fistula that occurred after the use of the Grote hydroxyapatite ceramic EAC prosthesis is presented. The literature is reviewed retrospectively for various methods of reconstruction of the EAC following canal wall down mastoidectomy. Strategies and principles are outlined to avoid complications associated with reconstruction of the mastoid and EAC. RESULTS: The Grote hydroxyapatite (HA) prosthesis is a reliable prosthesis for reconstruction of the external auditory canal (EAC) in the absence of a draining mastoid cavity or cholesteatoma and with adequate soft tissue cover. Contact of the medial end of the prosthesis with the lateral semicircular canal must be avoided. immobilization or rigid fixation and avoidance of infection are essential for optimal prosthesis stability and osseointegration. Covering the prosthesis with vascularized soft tissue appears to be important for the achievement of a successful reconstruction. CONCLUSION: The Grote prosthesis is safe and effective provided it does not contact the lateral semicircular canal, is stabilized, and covered by vesicular tissue, in the absence of infection.- - - - - - - - - - ranking = 1keywords = achievement (Clic here for more details about this article) |
4/7. Lymphomas following cardiac transplantation. Case report and review of the literature.The success of allogeneic organ transplantation is in great part due to pharmacologic advances in the area of immunosuppressive therapy. However, this achievement has been attained at the price of an unexpectedly high incidence of malignancies in this transplant population. Lymphoid malignancies predominate in this and other immunodeficiency states. There is some controversy in the literature over the clonal or malignant nature of these proliferations. This paper presents a case of Burkitt-like lymphoma occurring after cardiac transplantation. The role of Epstein-Barr virus in the pathogenesis of this disorder is reviewed as are multidisciplinary approaches to its management.- - - - - - - - - - ranking = 1keywords = achievement (Clic here for more details about this article) |
5/7. Neurological and neuropsychological effects of cerebral spinal fluid shunting in children with assumed arrested ("normal pressure") hydrocephalus.Normocephalic children found to have ventriculomegaly during evaluation of long-standing (4.5-8.5 years) neurological disorder were tested for academic achievement, intellectual quotient and neuropsychological functioning. Radioactive iodinated serum cisternography, pre and post-shunt electrophysiological studies (visual evoked responses, brainstem auditory evoked potentials, sleep electroencephalograms) and radiological studies (skull radiographs computed tomography) were recorded. Four children who have been followed more than one year after insertion of ventricular-peritoneal shunts are presented. All demonstrated improvement in psychometric findings along with some improvement in CT scan and EEG studies. The most marked initial changes were noted on measures of neuropsychological performance, accompanied later by improvement in measures of intelligence. achievement test scores showed no consistent pattern of change. This sample suggests that there is a group of asymptomatic children with apparent clinically stable (arrested) hydrocephalus in whom abnormal neuropsychological testing indicates the need for cerebrospinal fluid shunting, with subsequent improvement.- - - - - - - - - - ranking = 1keywords = achievement (Clic here for more details about this article) |
6/7. The use of neuropsychological data to detect altered neurological functioning in a child with myelomeningocele.Although children with myelomeningocele often display atypical patterns on psychometric testing, this case study demonstrates the sensitivity of neuropsychological instruments to detect altered neurological functioning in a patient with spina bifida. The subject had a history of myelomeningocele at the lumbosacral level and placement of a ventriculoperitoneal shunt. During a routine neuropsychological evaluation, a 44-point discrepancy between his verbal (verbal IQ = 98) and nonverbal abilities (performance IQ = 54) on the Wechsler intelligence for Children-Revised was found. In comparison to high average academic achievement, test findings suggested depressed memory skills and extreme slowing in psychomotor speed. A pattern of acute decline in overall cognitive functioning was suggested. magnetic resonance imaging revealed a left frontoparietal brain mass, which was surgically removed. Follow-up neuropsychological testing 9 months postsurgery indicated an increase in nonverbal intelligence with improved psychomotor speed and information processing. This case study illustrates the importance of obtaining baseline evaluations in this neurologically high-risk population as well as the clinical usefulness of psychometric data in diagnostic workups.- - - - - - - - - - ranking = 1keywords = achievement (Clic here for more details about this article) |
7/7. Intraspinal high-grade astrocytoma in a child--rationale for chemotherapy and more intensive radiotherapy?Intraspinal high-grade astrocytoma in children is an extremely rare tumor entity with disappointingly short survival times despite multimodality treatment. We report on a girl with anaplastic astrocytoma at level T9-11, who was treated with tumor resection, multidrug chemotherapy and irradiation. Local recurrence was diagnosed after 16 months. With reference to other cases reported in the literature, the course of disease, achievements and limitations of currently available therapeutic options, and potential future strategies are discussed.- - - - - - - - - - ranking = 1keywords = achievement (Clic here for more details about this article) |