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Atsumi T purchase 10mg paxil amex treatment bladder infection, Yamano K (1997) Superselective angiography in osteonecrosis of the femoral head In: Urbaniak JR 30 mg paxil with mastercard medicine merit badge, Jones JP (eds) Osteonecrosis: etiology, diagnosis, and treatment. Sugano N, Atsumi T, Ohzono K et al (2002) The 2001 revised criteria for diagnosis, classiﬁcation, and staging of idiopathic osteonecrosis of the femoral head. Imura S, et al (1995) Japanese Orthopaedic Association hip score system. Fairbank AC, Bhatia D, Jinnah RH, et al (1995) Long-term results of core decompres- sion for ischemic necrosis of the femoral head. J Bone Joint Surg [Br] 77:42–49 Limitations of Joint-Preserving Treatment for Osteonecrosis of the Femoral Head: Limitation of Free Vascularized Fibular Grafting 1 1 1 Kenji Kawate , Tetsuji Ohmura , Nobuyuki Hiyoshi , 2 3 1 Tomohiro Teranishi , Hiroyuki Kataoka , Katsuya Tamai , 1 1 Tomoyuki Ueha , and Yoshinori Takakura Summary. Fifty-six hips of 46 patients undergoing free vascularized ﬁbular grafting for the treatment of osteonecrosis of the femoral head were investigated. The average age at surgery was 39 years, and the average follow-up period was 6 years. Associated etiological factors included a history of high-dose steroids for 27 hips, consumption of alcohol for 25, and idiopathy for 4 hips. The radiographic appearance, determined according to the staging system of the Japanese Investigation Committee, was stage 1 for 2 hips, stage 2 for 28, stage 3A for 15, stage 3B for 10, and stage 4 for 1 hip. The radiographic type of necrosis, determined according to the radiographic classiﬁcation of the Japanese Investigation Committee, was type B for 4 hips, type C-1 for 20, and type C-2 for 32 hips. The clinical results of steroid-induced osteonecrosis were poorest among the etiologies. There was a signiﬁcant relationship between preoperative stage and radiographic progression. There was also a signiﬁcant relationship between preoperative type and radiographic progression. In conclusion, the current results show that vascularised ﬁbular grafting is a good proce- dure for the precollapse stages and a valuable alternative for patients with stage 3A. Osteonecrosis of the femoral head, Free vascularized ﬁbular grafting, Indication, Etiology, Collapse Introduction Various procedures for salvaging the femoral head affected by osteonecrosis, such as core decompression, osteotomy, and curettage of the lesion followed by bone grafting, have been reported, especially in young patients, because total hip arthroplasty (THA) in young patients is associated with a high rate of revision surgeries [1–3]. The results for core 1Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan 2Department of Orthopaedic Surgery, Nara Prefectural Rehabilitation Center, Tawaramoto, Japan 3Department of Orthopaedic Surgery, Nara Prefectural Gojo Hospital, Gojo, Japan 97 98 K. Varus osteotomy is indicated only for patients with hips with a small area of necrosis. Sugioka’s rotational osteotomy is effective for hips that have already collapsed but is not suitable for hips with a large area of necrosis. Curettage of the lesion followed by bone grafting is thought to be insufﬁcient for revascularization. Therefore, free vascularized ﬁbular grafting, which is expected to provide both biological function and biomechanical support, has been used in our institution since 1992. The present study focused on the limitations of free vascularized ﬁbular grafting. Materials and Methods Fifty-six hips of 46 patients undergoing free vascularized ﬁbular grafting for treat- ment of osteonecrosis of the femoral head were investigated in the present study. There were 38 male and 8 female patients, whose mean age at surgery was 39 years (range, 22–60 years). The indications for surgery were age less than 60 years and pain at the time of pre- operative evaluation. Associ- ated etiological factors included a history of high-dose steroids for 27 hips, consump- tion of alcohol for 25 hips, and idiopathic for 4 hips. The radiographic appearance, determined according to the staging system of the Japanese Investigation Committee, was stage 1 for 2 hips, stage 2 for 28 hips, stage 3A for 15, stage 3B for 10, and stage 4 for 1 hip (Table 1). The radiographic type of necrosis, determined according to the radiographic classiﬁcation of the Japanese Investigation Committee, was type B for 4 hips, type C-1 for 20, and type C-2 for 32 hips (Table 2). The Japanese Orthopaedics Association Hip Score (JOA score) was used for clinical evaluation in the present study. Follow-up examination consisted of radiography and clinical evaluation using the JOA score every half-year. Clinical assessment was made using four classes: excellent, no hip pain, and a hip rating more than 90 points; good, a hip rating of 80 to 89 points; fair, a hip rating of 70 to 79 points; and poor, a hip rating less than 69 points. Preoperative stage determined according to the staging system of the Japanese Investigation Committee Stage A 3B 4 Steroid-induced ON Alcohol-related ON Idiopathic ON Total Data are number of cases ON, osteonecrosis Limitations of Free Vascularized Fibular Grafting for Osteonecrosis 99 Table2.
Destot E (1905) La poignet et les accidents du travail: Etude radioagraphique et clinique buy discount paxil 20mg on line medicine 606. Destot E purchase 40mg paxil fast delivery medicine to stop runny nose, Vignard P, Barlatier R (1909) Les fractures du coude chez l’enfant. Hoeber, English trans- lation by FRB Atkinson Étienne DESTOT 1864–1918 Étienne Destot was born in Dijon and educated in Lyon, where in February 1896, less than 2 months after the announcement of the discovery of the x-ray by Rontgen, he was already making radi- ographs of patients in the Hôtel Dieu. He had great enthusiasm for this new method and devoted a major share of his time to developing the tech- nique and its application to clinical medicine. His work led to the publication of three monographs, the ﬁrst dealing with injuries of the wrist,2 the second with injuries of the elbow in children,3 and the third with injuries of the foot and ankle. In addition to his work in radiology, he was also interested in medical applications of electricity and neurology. In the course of his work he made many contri- Naughton DUNN butions to orthopedics. He was something of a tal- ented eccentric, a sculptor, and the designer of an 1884–1939 aerodynamic car with an aluminum body! Dunn was born in Aberdeen in 1884 and was World War I, and died as a result of pneumonia educated in the grammar school and university of in 1918. His During his life, Destot continued to revise his interest in orthopedic surgery began with his work. An English translation of the most recent appointment as house surgeon to the late Sir manuscript of his work on injuries of the wrist Robert Jones at the Royal Southern Hospital, was made by F. Wider recognition of the value and originality of his work came to him through his efforts during and after the Great War. He was one of that small band of British surgeons who were called on by Sir Robert Jones to carry out preventive and cor- rective surgery in the British Army, a task that they were able to accomplish only through the generous help of their American colleagues. Returning to Birmingham after the war, he con- tinued his work at the Royal Cripples’ Hospital and at the Robert Jones and Agnes Hunt Ortho- pedic Hospital in Oswestry, an institution in which he played a particularly vital part. Dunn received many honors, but of them all probably the one he treasured most was the honorary LLD, which was conferred upon him by Guillaume DUPUYTREN his own University of Aberdeen in 1937. He was connected with many hospitals in the Midlands, 1777–1835 both in an active and in an advisory capacity, and he held the very important post of Lecturer Guillaume Dupuytren was born in Pierre-Bufﬁère in Orthopedic Surgery at the University of near Limoges in 1777. He was one of the original members several surgeons in the Dupuytren family. In of the British Orthopedic Association and for a 1719, a surgeon Michel Dupuytren lived at Pierre- number of years served on the executive com- Bufﬁère, running the tobacco shop at the same mittee. François Dupuytren, grandfather of Orthopedic Section of the Royal Society of Med- Guillaume, drowned while returning from visit- icine and was a corresponding member of the ing a sick patient. Two brothers of François, American, French, and Australian Orthopedic Leonard and Jacques, were also surgeons, so that Associations. Dunn’s contributions to the liter- surgery, although his own father was a lawyer. It was during this period, from the pensated by their extreme soundness and breadth dawn of the Revolution in 1789 through the of vision. They were typical of the man—inher- bloody Reign of Terror in 1793–1794, that young ently sound, sane, and thoughtful—and charac- Dupuytren was a student in Paris. The changes terized by an underlying care for the patient, that the Revolution wrought were to affect deeply which was always his ﬁrst anxiety. Now the road to success was notable contribution, which brought him an inter- open to the talented, without distinction of birth national reputation, was his work on the operative or fortune. His father, however, insisted that, occurred on November 19, 1939, after a long, dis- in the family tradition, Guillaume become a 89 Who’s Who in Orthopedics surgeon. As a ﬁrst step in his training, he was These two were passed over because of their close enrolled in the medical-surgical courses in relationship with Napoleon, and Guillaume Limoges, but after a few months, Dupuytren set Dupuytren became Chirurgien en chef at the out for Paris, where he remained for the rest of Hôtel Dieu at just under 38 years of age. This period corresponds with Terror was over, there was money to be made in the restoration of the monarchy in France after the manufacture and commerce, glory to be grasped Revolution, and the Empire, with the return of in the battleﬁelds.
It is perfectly reasonable for a PRHO to ask an SpR to be on the ward within ﬁve minutes if your patient is‘going off’ buy discount paxil 40mg online medicine rising appalachia lyrics,but what a registrar does not want cheap 30 mg paxil overnight delivery treatment shingles,is to be asked to rush up to a ward to see an‘urgent’referral when in reality it could have waited six or even 24 hours. All the information required seems commonsense and indeed it is, but when you are anxious about speaking to a more senior doctor whom you may not know, it is easy to forget to give or ask the most important details. This is particularly the case in the adrenaline rush of speaking to a senior whom you have woken up or who seems annoyed that you have bothered them. Examination findings at presentation and provisional diagnosis What treatment have you given? Examination findings now Finally: What would you like them to do – see the patient now, later or just give advice? Specialist Specialist opinion Take over care Provide joint care investigation or management of the patient of the patient Figure 10. Referring and Requesting 63 Often,if you have woken someone up,they will be half asleep too and forget to ask you important information you have forgotten to volunteer. The patient had presented with an acute‘asthma attack’in the early hours of the morning. The medical SHO was dealing with an unwell patient on the ward and was tired. He accepted the referral without protest and left the unwell patient on the ward for the A&E department, thinking that the patient with the asthma attack would be more unwell and therefore take priority. On arrival in the A&E department he dis- covered the patient sitting up talking in full sentences, having been managed through the acute phase by the A&E staff. He rapidly returned to the ward without consequence to the other patient, but cursed himself for having left the ward without asking the vital question of‘how the patient was now’, not‘how were they on arrival’. The lesson here is that the A&E SHO did not refer the patient properly and the med- ical SHO did not‘take’the referral well. When these basic day-to-day tasks become second nature the job gets much easier, but hopefully if you have read this you will be well ahead of the game. These referrals may be urgent (patient seen within two weeks) or routine (patient not usually seen within at least six to eight weeks of referral). Out-patient clinics are run by a clinic manager (usually a senior sister or nurse who has taken on a part managerial, part clinical role). The team is expected to attend in full unless stated otherwise by your seniors. The clinic nurse(s) will pro- vide a computer-generated list of patients that are expected to attend, identifying new patients and follow-up attendees. The consultant will usually highlight those patients to be seen by the senior and junior members of the team. Junior doctors should present their patients to the specialist registrar (SpR) or the consultant (as per the instructions of the consultant) before instigating out-patient management (obviously). If patients are to be admitted from the clinic then they should be clerked and examined there and then. A drug and ﬂuid chart should be completed and any blood or radiographic investigations performed in the out-patients department before the patient goes to the ward. Fracture Clinics The casualty senior house ofﬁcer (SHO) or occasionally SpR refers patients directly from the accident and emergency (A&E) department. These patients have presented to the A&E department within the last few days with an acute injury. They will have a suspected or conﬁrmed fracture that has been treated in a‘back slab’(half plaster of Paris cast which allows soft tissue swelling in the few days after a bony injury). The patient and their fracture is either treated conservatively in plaster and followed up or admitted from the clinic for fracture ﬁxation (that is sur- gery). These clinics are excellent learning opportunities in orthopaedic management. Being in theatre can be the most incredible experience or your worst nightmare. Aspiring surgeons can hate being on a surgical ﬁrm (as I did as an undergraduate) and, equally, career physicians or general practitioners can love their theatre time. With a little knowledge regarding the staff and general running of theatres you will ﬁnd your time much more enjoyable.
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