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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pain, weakness, or paralysis from involvement of the spinal cord and nerve roots secondary to invasion of the vertebrae by a malignant tumor often can be avoided or alleviated by stabilization of the spine. Twelve patients with neoplastic infiltration of the cervical vertebrae were so treated. The operation of wiring, augmentation bone-grafting, and decompression of the spinal cord was successful after conservative methods failed. Indications for operation were: (1) unremitting pain in the neck, not relieved by bracing or radiation therapy; (2) a major degree of vertebral destruction with loss, or impending loss, of support for the head; (3) collapse of a vertebral body; or (4) neural deficit from local tumor invasion. A classification of our twelve patients into three groups helped to delineate the surgical procedure needed. The value of obtaining spinal stability and a solid fusion above and below the tumor was evident in eleven patients. For almost all of their survival time, they were comfortable. Surgical treatment may not appreciably extend the lenght of a patient's survival, but it generally improves the patient's quality of life.
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PMID:Metastatic tumors involving the cervical vertebrae: surgical palliation. 8 Dec 9

Between 1975 and 1978, 35,000 to 40,000 Dutch men underwent sterilization operations per year. Sterilization is not indicated if the man is not married, has no children, if there are marital or mental problems, or if there are indications for contraception or sterilization for his wife. Vas ligation, vasotomy, and vasectomy are three operations to induce male sterility. Vasectomy is the most effective but least likely to be reversible. The operation can be performed in a polyclinic under local anesthesia and takes 15-30 minutes. The operation procedure is described in detail. The first sperm count should be taken 8 weeks after the operation. In most cases, azoospermia is demonstrated after 3 months following the operation. Complications of vasectomy which occur during the operation are vasovagal collapse (1-5%) and motor disturbance (2-10%). Early post-operative complications include: intrascrotal hematoma (2-7%), infection (1-6%), and pain (1-10%). Frequent late complications are sperm granuloma (1-18%), recanalization (0-6%), and development of sperm antibodies (50-62%). Restoration of fertility after a vasectomy is usually not possible. The best results are obtained with end-to-end reanastomosis with a splint to facilitate healing.
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PMID:[Male sterilization]. 25 Mar 5

Avascular necrosis of the femoral head is an unfortunate sequela of renal transplantation. The necessary exogenous steroids are felt to be the cause of the necrosis. The case histories of three patients with bilateral disease are presented. All 6 hips were initially treated with a Phemister bone graft. According to the classification of Marcus, et al., one hip was Stage 3, three hips were Stage 4, and two hips were Stage 5 at the time of grafting. Four of these hips have had minimal further collapse and have been functionally satisfactory for the patients. One femoral head has had marked collapse but is pain free. One femoral head has had marked collapse with pain sufficient to necessitate a total hip replacement. The two heads with marked collapse were both Stage 5 at the time of surgery. The Phemister bone graft is presented as a possible treatment for this problem, especially when the disease is treated before femoral head collapse occurs.
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PMID:Phemister bone graft for osteonecrosis post renal transplant. 32 2

A simple modification of Gallie's subtalar fusion is described as a salvage procedure in treating patients with pain from old fractures of the calcaneous involving the subtalar joint. Graft bone for the fusion is taken from the outer half of the calcaneus, thus avoiding disturbance of the tibia or iliac crest. Collapse of the donor site helps to narrow the widened heel present in these patients. The posterior approach allows the peroneal tendons to be freed from any adhesions, and at the same time release of the calcaneo-fibular ligament permits some correction of the valgus of the heel. The early results in six patients have been encouraging.
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PMID:Posterior subtalar fusion. A preliminary report on a modified Gallie's procedure. 33 May 41

Eight cases are reported of extensive retroperitoneal haemorrhage in patients receiving anticoagulant therapy who subsequently died and underwent postmortem examination. No patient had an obvious source of bleeding, and in 5 cases no other cause for death was apparent. Three patients had had vascular surgical procedures: the other 5 were given anticoagulants for suspected venous thrombo-embolism. Six cases presented as unexpected circulatory collapse with rapid demise. Four patients had in addition gastro-intestinal bleeding of varying degree, with no obvious source. This acute massive type of retroperitoneal bleeding contrasts with the commoner presentations of pain, swelling, bruising and compression neuropathy: a high index of suspicion and urgent treatment are required if mortality is to be reduced.
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PMID:Fatal retroperitoneal haemorrhage complicating anticoagulant therapy. 43 66

It is proposed that there are three fundamental adaptive systems that have developed in the course of evolution. One of these, learning, is the only one that is widely recognized. The other two consist of regulation of the energetic aspect of stimulation, and integration of the data of experience into an organized conceptual system. Corresponding to each of the three basic adaptive systems are three basic types of disorder, namely maladaptive learning, which is by far the most common source of behavioral problems; overstimulation, as in the traumatic neurosis; and collapse of the individual's conceptual integrative system, as in acute schizophrenic disorganization. Just as relearning is a natural adaptive process for correcting problems produced by learning, there are inherent processes for correcting the disorders produced by overstimulation and by a maladaptive integrative system. The present article is concerned with the natural process for correcting a poorly organized conceptual system. A second article (Epstein 1978) will be devoted to the natural process of coping with the energic aspects of stimulation. An acute disorganizational state can provide an opportunity for a new and more effective conceptual system to develop. As a desperate remedy, it is often unsuccessful. Nevertheless, an orderly process can be discerned in such states that can enhance the likelihood that new, and dissociated old, material will be assimilated into a new organization. If all goes well, the new organization will be more resilient than the old one; it will be better able to accomplish the functions of an implicit theory of reality, which are to integrate the data of experience, to maintain a favorable pleasure-pain balance, and to maintain self-esteem.
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PMID:Natural healing processes of the mind: I. Acute schizophrenic disorganization. 46 44

Thirty-eight hips in 26 patients with alcoholism associated ischemic necrosis of the femoral head (INFH) have been evaluated by measurement of intraosseous pressure, (IOP) pressure response to a 5 ml saline load injected intraosseously and intraosseous venography. All stages of INFH were characterized by elevated IOP and/or an increased pressure response to the saline load compared to normal controls. Intraosseous venography in INFH was characterized by poor or absent visualization of the main efferent veins draining the proximal femur, diaphyseal reflux and delayed evacuation of dye from the bone. It has been possible to identify both a preradiologic and even preclinical stage of INFH. Core decompression, the removal of an 11 mm plug of bone from the head and neck of the femur, has been carried out on all hips in the study. All patients had pain prior to surgery. Eight patients in Stage I (preradiologic stage) are symptom free and without radiologic progression at follow-up, average 24 months. Only one of 5 patients in Stage II (no collapse of the femoral head) has shown X-ray progression while all remain asymptomatic. In Stage III (collapse, without acetabular involvement), core decompression offers relief of symptoms but does not appear to prevent further head collapse.
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PMID:Alcoholism associated ischemic necrosis of the femoral head. Early diagnosis and treatment. 63 86

Scaphotrapezial trapezoidal degenerative arthritis as an isolated entity or as a preponderant part of a pantrapezial degenerative process was seen in 49 hands of 34 patients. Pain and weakness were the primary complaints. Point tenderness was present in all but two hands. Significant loss of grasp and pinch strength was noted in 18 hands, and loss of wrist motion occurred in 16 hands. Roentgenographic findings included narrowing of the scaphotrapezial trapezoidal joint space, subarticular cortical sclerosis, and cyst formation. A dorsiflexed position of the scaphoid, with a scapholunate angle of less than 45 degrees, was noted in 38 of the 45 hands. Late collapse of the intercarpal joint with dorsiflexion instability of the lunate also was noted. Twenty-nine hands were treated conservatively by protective splints, corticosteroid injections, and avoidance of exacerbating activities. Surgical treatments consisted of fibrous arthroplasty (four), silicone interposition arthroplasty (six), trapezial replacement arthroplasty (three), arthrodesis (five), joint debridement (one), and trapezial excision (one). Late results were more encouraging than were early results and were moderately satisfactory for each method. Improvement in grasp and pinch strength was most predictable for arthrodesis, although wrist motion was diminished.
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PMID:Scaphotrapezial trapezoidal arthrosis. 65 18

Three patients with clinical diagnosis of myocardial infarction are described, whose cardiograms are characterized by a transitory positivation of the negative T-waves. The confrontation of those changes with the clinical picture reveals that the transitory positivation of the T-wave coincides with the clinical and paraclinical signs of intensification of the myocardial hypoxia (pain, collapse, enzyme positivation). The possible electrophysiological mechanisms are discussed that could explain the transitory positivation of the negative T-waves, as a manifestation of the intensified ischemia.
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PMID:[Atypical hypoxic changes in the T wave]. 89 10

Spontaneous adrenal haemorrhages are rare but non exceptional. They mainly occur in elderly men (mean age: 61 years). The main risk factors are: anticoagulant therapy (prescribed for myocardial infarction, occlusive vascular ou thromboembolic disease), hypertension and chronic respiratory insufficiency, as in the present case. The clinical picture is one of abdominal of lumbar pain with abdominal distension, circulatory collapse, often delayed and sometimes preceeded by an hypertensive bout, quite often fever with leucocytosis. Hyponatraemia and hyperkalaemia, are not constant features. The diagnosis is often not made until laparotomy, and it even can be missed there. In fact, plasma cortisol level or, if unavailable, urinary corticosteroid measurements are the best diagnostic procedures, permitting adequate therapy and giving best chances of survival. They must always be made in a patient with abdominal signs falling into one of the above mentioned etiologic categories.
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PMID:[Spontaneous adrenal hemorrhage. Apropos of a case]. 96 41


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