Oligosegmental correction of post-traumatic thoracolumbar angular kyphosis

Seventeen patients with rigid throacolumbar angular kyphosis due to neglected fractures or dislocations were treated by a standardized single-stage monosegmental or bisegmental anterior discectomy and posterior closing extension wedge osteotomy. The two- or three-level reduction-fixation (RF) instrumentation was used posteriorly for correction and fixation. Choosing angled pedicle screws according to preoperative measurements, the method can always correct the kyphosis to the approximate sagittal curvature that is planned to create preoperatively. The average precorrection of thoracolumbar kyphosis was 39 degrees and was restored to 1.2 degrees for an average correction of 37.8 degrees (range, 22 degrees-56 degrees) with subsequent average loss of 1.1 degrees at final follow-up. Before operation, the complaints were slow progression of kyphotic deformities, fatigue, and pain. All these problems were solved by this procedure. Complications were minimal and mild. No neurologic complications occurred. Follow-up averaged 2.8 years. This method can correct rigid post-traumatic thoracolumbar angular kyphoses to normal geometric relationships as planned preoperatively without much negative effect in lumbar motion and any sacrifice of safety.

External and middle ear status related to evoked otoacoustic emission in neonates

OBJECTIVE

Screening auditory status prior to neonatal hospital discharge to identify newborns with severe hearing impairment is an important pediatric care priority. Evoked otoacoustic emission (OAE) testing is a quick noninvasive method. The purpose of this study was to determine the relationship between external auditory canal and middle ear status with click-evoked OAE. It was hypothesized that vernix caseosa, debris in the ear canal, and middle ear fluid contribute to the OAE fail rate.

DESIGN

All neonates had an initial OAE examination. A second investigator, "blinded" to the results, examined all ears otoscopically, cleaned any obstructing debris, and repeated with a second OAE test.

SETTING

All neonates were tested in a designated nursery at a mean age of 43 +/- 21 hours.

PATIENTS

Forty-one full-term neonates were prospectively enrolled.

INTERVENTION

The ear canals with debris were cleaned under direct vision with a pediatric swab dampened by an alcohol wipe.

OUTCOME MEASURE

The primary outcome measure was the postcleaning OAE pass rate.

RESULTS

The preotoscopic examination pass rate of 82 ears was 76%. The OAE pass rate improved to 91% after debris removal.

CONCLUSIONS

The results indicate that the examination and cleaning of the external ear canal are important components of the neonatal screening process.

Mechanics of anatomic reduction of thoracolumbar burst fractures. Comparison of distraction versus distraction plus lordosis, in the anatomic reduction of the thoracolumbar burst fracture

The adequate reduction of vertebral burst fractures is dependent on successful application of distractive forces in combination with the restoration of normal spinal lordosis. However, the optimal sequence of distraction in comparison to distraction plus lordosis in the anatomic restoration of the fractured thoracolumbar spine has not been described. Burst fractures of the L1 vertebra were first created and the reduced in vitro using three differing reduction techniques. In six fresh human cadaver spine specimens, the mean fracture severity based on the degree of canal compromise was 31% (SD +/- 20%) after fracture. Reductions were performed using the AO Fixator Intern, the Reduction Fixation (RF) Device, and the Steffee plate systems following standard clinical techniques. The AO Fixator Intern provided independent but variable control of distraction and lordosis, the RF device provided variable distraction with independent, but preset, correction of lordosis and the Steffee system provided set distraction and stabilization. Both the AO and RF devices restored the lordosis (7.6 degrees +/- 5.2 degrees and 9.7 degrees +/- 4.5 degrees, respectively) better than the Steffee plate system (0 degrees +/- 1.6 degrees). However, the AO device provided poorest restoration of the posterior vertebral body height (92% vs 96% for the RF device and 99% for the Steffee plate). The RF device, which restored both lordosis and posterior vertebral body height to the near anatomic prefracture level, provided significantly better canal clearance (9% +/- 8%) than the other techniques, P < 0.05. The study demonstrates that instrumentation systems that provide independent correction of distraction and lordosis can best restore anatomic alignment, with indirect neurodecompression of the compromised spinal canal.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of H2 antagonists on outcome of simple closure for perforated duodenal ulcer

The treatment of perforated duodenal ulcer is controversial. Since the advent of H2 antagonists, the number of ulcer operations has declined tremendously. We wanted to find out if the addition of a H2 antagonist after simple closure of a perforated duodenal ulcer would change the outcome and therefore reviewed 46 patients treated in this fashion. Our results show that this is a safe and effective way of treating patients with perforated duodenal ulcer.

Prenatal diagnosis of intestinal obstruction due to ileal atresia

A case of intestinal obstruction due to ileal atresia where the diagnosis was made prenatally by ultrasound is presented. Close monitoring of the fetus was done ultrasonographically to look for any evidence of meconium peritonitis. The baby was delivered preterm but weighed 3.3 kg. Laparotomy and enterostomy was done and the baby is currently well.

A reduction-fixation system for unstable thoracolumbar burst fractures

Thirty-three patients with unstable burst fractures of the lower thoracic and lumbar spine were treated with a reduction-fixation system. The new system is used both as a reduction and a fixation device for disorders of the lower thoracic and lumbar spine. In treatment of spinal fractures, it provides symmetric lordotic distraction to obtain the best possible reduction of intracanal fragments, and rigidly stabilizes the fractured vertebra while involving the minimum number of segments. All patients had a minimum follow-up of 24 months. Most patients in this series had a near-anatomic reduction of all three columns in the involved segment. The "indirect" neurologic decompression was successful in cases treated early after injury. The fixation was rigid enough to allow early mobilization and rehabilitation in a light orthosis within 1 week after surgery, and there was minimal loss of reduction during the follow-up period. The complications were minor. The reduction-fixation system achieved the surgical goals of posterior instrumentation for treatment of unstable thoracolumbar burst fractures.

Carcinoma in multinodular goitre

A retrospective review of 107 patients operated on for multinodular goitre was carried out to determine the incidence of carcinoma. Of the group 7.5 per cent harboured incidental carcinomas with papillary carcinoma being the most common variety. The indications for removal of multinodular goitre should be compressive symptoms, suspicion of malignancy and cosmesis.

Persistent müllerian duct syndrome--a case report

An eighteen month old phenotypically and genotypically normal male child was admitted with a left inguinal hernia and a right undescended testis. At operation, he was found to have a uterus, bilateral fallopian tubes, and a vagina in the left hernial sac. Bilateral orchidopexies and excision of the persistent Mullerian duct structures were carried out. This rare case of persistent Mullerian duct syndrome is due to a defect in Mullerian regression, which is in turn controlled by the Mullerian inhibiting substance (MIS). Orchidopexy with excision of the persistent Mullerian duct structures is usually not possible without damage to the vas deferens which is closely adherent to the wall of the uterus. The alternative of leaving the persistent Mullerian duct structures alone and performing a staged or primary orchidopexy has been suggested.

Continuing root formation following apexification treatment

A case report is presented in which continuing root formation occurred in an immature mandibular second premolar after calcium hydroxide apexification treatment. An apical hard tissue barrier was accompanied by a separate disto-apically growing root 18 months posttreatment. Histologic evaluation of the root revealed immature hard tissue mixed with calcium hydroxide, connective tissue and bone, apically in the original root canal. In the separate new formed part of the root, pulp tissue, odontoblasts, predentin, cementum and an apical foreman could be identified.

[A study on the chairside dental assistants in the Republic of Korea]

It is recommended that the chair-side dental assistant should be utilized in order to increase the production of dental health care by World Health Organization. In the Republic of Korea, there was no chair-side dental assistant by legally. So the authors investigated and discussed for the development of chair-side dental assistant in Korea. Obtained results were as follows 1. In order to increase the production of dental health care chair-side dental assistants should be developed. 2. Institution of chair-side dental assistant will be established legally. 3. Trained chair-side dental assistant will be positioned in dental clinics for dentist and health centers for dental public health.

High-performance single-mode fiber polarization-independent isolators

The design and performance of polarization-independent isolators that are substantially insensitive to variations of temperature and wavelength are presented. Three single-mode fiber isolators have been designed, constructed, and tested. The first isolator is a 1.3-microm two-stage isolator that has more than 40 dB of isolation and less than 2.0 dB of insertion loss over the temperature range of 15-70 degrees C. The second isolator is a two-stage dual-wavelength isolator with an insertion loss of less than 4 dB and an isolation of better than 35 dB at 1.3 and 1.52 microm over the temperature range of 15-75 degrees C. The third isolator is a three-stage isolator with an insertion loss of less than 2.5 dB and an isolation of better than 63 dB over the wavelength range 1275-1355 nm.

Characterization of two new cell lines derived from oral cavity human squamous cell carcinomas--OC1 and OC2

Two continuous cell lines, OC1 and OC2, have been established. Each one was derived from a surgical specimen of buccal mucosa squamous carcinoma from a Chinese man. Both cell lines grew as adherent monolayers and had an epithelioid morphology. The cell lines have now been grown in vitro for more than 200 passages over a 2-year period. Both cell lines were tumorigenic in nude mice. Histologic examination of the mice tumors showed a positive identification with those from the original human squamous cell carcinoma. Electron microscopic examination convincingly demonstrated their epithelial origin. Chromosomal numbers of the OC1 cell ranged from 58 to 78 and of the OC2 cells ranged from 62 to 82. Analysis of cytokeratin showed that all cell lines were positive. The carcinoembryonic antigen (CEA) tested negative in these two cell lines. The OC2 cell line showed the presence of HPV16, but the OC1 cell line did not. These cell lines should be useful for investigation of anticancer treatment and for their possible relationship to human papilloma virus (HPV).

[Elasticity and deviation angle of toothbrush in Korean adults]

The purpose of this experiment was to establish a simple and general recommendation criteria to evaluate the toothbrush whether it was usable or not. We gave 94 adults the same toothbrushes and required them to use only those toothbrushes and recollected them after 4 weeks' use. Then, we determined elasticity loss, deformation degree and deviation angle of the used toothbrushes. From the above data, we compared and analyzed the correlation between loss of elasticity loss and deviation angle. The obtained results were as follows: 1. In Korean adults, there was no statistical difference between elasticity loss and deviation angle according to both age and sex group (p greater than 0.05). 2. There was no statistical correlationship between elasticity loss and deviation angle (r = 0.15, p greater than 0.05). 3. It was regarded that the determination of deviation angle was more simple method than that of elasticity loss for the evaluation of useful period of toothbrush. 4. In Korean adults, the average usable period of toothbrush was estimated about 1 month.

Meconium peritonitis due to meconium ileus presenting as fetal ascites: a case report

A case of meconium peritonitis due to meconium ileus is described. The condition was detected antenatally as fetal ascites on ultrasonography. Plain X-ray of abdomen post-natally showed specks of calcification mainly at the flanks, while on ultrasonography specks of high echogenic areas were seen throughout the abdomen which has been described as "snow-storm sign". The aetiology of meconium ileus is briefly discussed.

High prevalence of human papillomavirus infection and possible association with betel quid chewing and smoking in oral epidermoid carcinomas in Taiwan

Seventeen oral epidermoid carcinomas, three oral papillomas, and 17 normal gingival tissues were tested for the presence of human papillomavirus (HPV) types 6, 11, 16, and 18 sequences by Southern blot hybridization. Episomal HPV-16 sequences in various amounts were detected in 76.4% of the oral carcinomas and in all three cases of papilloma. However, only one of the 17 normal tissues was HPV positive with an unknown type. None of the samples contained HPV-6, -11, or -18 sequences. Examination of the habits of the patients showed that 59% of the patients were betel quid chewers and 82% were smokers. Thus, the concurrent incidence of HPV infection and betal quid chewing and/or smoking habits in oral carcinoma patients observed in Taiwan is consistent with the view that both viral and chemical factors may be involved in the process of carcinogenesis.

Tuberculous liver abscess

Tuberculous liver abscess is uncommonly seen in our experience. We report a case of a 17-year-old boy who presented with typical clinical features of liver abscess, where a diagnosis of tuberculous liver abscess was made on laparotomy and biopsy of the abscess wall.

Activity of various endogenous compounds and pharmacologic agents at a glucose-oxidizing platinum electrode

The specificity of a glucose-oxidizing platinum electrode system was investigated in vitro using selected metabolic compounds and a wide range of pharmacologic agents. Many compounds were found that either augmented or inhibited the glucose effect on the electrode system, but relatively few had substantial effects at reasonable plasma levels. Should the platinum electrode system be incorporated into an artificial beta cell for diabetic patients, graduated clinical trials might be necessary for every new medication taken by the patients.