We performed total hip arthroplasty on a young male adult with paralytic dislocation of the hip due to poliomyelitis. Because of extreme shortening, as well as instability and weakness, the patient was unable to bear weight on the limb. Pastoperative course was complicated by ectopic ossification that compromised the hip and knee motion. Another young male adult with severe spastic cerebral palsy underwent total hip arthroplasty because of an intractable pain due to degenerative arthritis. Initial attempt coupled with adductor tenotomy and obtuator neurectomy ended in gross loosening and acetabular protrusion. Revision consisted of extensive soft tissue release and bone grafting of acetabular defect and use of a protrusion cup and an extra-long stem. Postoperative course was complicated by long-standing serous aseptic discharge from the wound which was controlled by antibiotics and prolonged recumbency. Indications for total hip arthroplasty in paralytic hips are rare and should be reserved for the most crippling conditions and one must be prepared fvr technical difficulties and a variety of complications with a prospecs for less than optimum results.
Acetabulum ; Adult ; Anti-Bacterial Agents ; Arthroplasty, Replacement, Hip ; Bone Transplantation ; Cerebral Palsy ; Dislocations ; Extremities ; Hip ; Humans ; Knee ; Male ; Ossification, Heterotopic ; Osteoarthritis ; Pain, Intractable ; Poliomyelitis ; Spectinomycin ; Tenotomy ; Wounds and Injuries

Neurofibromatosis is a disease which involves both neuroectodermal and mesodermal tissue, and is characterized by cafe-au-lait spot, multiple subcutaneous neurofibromas, elephantiasis neuromatosa, a positive family history, and specific dystrophic osseous changes such as scoliosis, penciling of ribs, vertebral scalloping, a paravertebral soft tissue tumor, and congenital pseudarthrosis. The classic type of scoliosis in neurofibromatosis was known as a sharp localized short curve that is often rapidly progressive and produces severe deformity with dystrophic changes, but another form with long gentle curve is reported. Since conservative treatment is usually unsuccessful, posterior fusion with or without Harrington instrumentation is the treatment of choice even in young age when the curve is progressive. This paper was aimed to review our experience with 11 patients having neurofibromatosis and scoliosis, who were treated with posterior fusion and Harrington instrumentation from Jan. 1971 to Dec. 1980, and the results were as follows: 1. The average age that spinal deformity was observed was 7.7 years old, but the average age at treatment was 14.4. 2. Cafe-au-lait spot was observed in all cases, subcutaneous nodule in 7 cases, local gigantism in 2 cases, and positive family history in 3 cases. 2 cases were combined with congenital spinal anormalies. 3. Specific pattern in spinal deformity was not significant. There were 7 short curves less than 5 vertebrae involved and 6 long curves more than 6 vertebrae involved. 4. There were 5 kyphosis which had more than 50°, and those were usually combined with severe scoliosis. 5. Preoperative average degree of scoliosis was 93.8, and the final correction was 41.2° (43.9%) with loss of correction 5.3°(5.7%) after 3.2 year follow-up in average. 6. It shouid be educated for early detection at home and school, and for the importance of early treatment for the scoliosis, to prevent rapid increase of scoliosis in neurofibromatosis.
Cafe-au-Lait Spots ; Congenital Abnormalities ; Elephantiasis ; Follow-Up Studies ; Gigantism ; Humans ; Kyphosis ; Mesoderm ; Neural Plate ; Neurofibroma ; Neurofibromatoses ; Neurofibromatosis 1 ; Pectinidae ; Pseudarthrosis ; Ribs ; Scoliosis ; Spine

BACKGROUND: Cytokeratins were subdivided into 20 different cytokeratins. It is known that cytokeratin 19 is particularly abundant in carcinoma of the lung. METHOD: A sandwich enzyme-linked immunosorbent assay called CYFRA 21-1, combining two monoclonal antibodies directed specifically aganist cytokeratin 19 was done by ES-300(Boehringer Mannheim, Germany). We investigated the diagnostic value of the new tumor marker CYFRA 21-1 in lung cancer in comparison to carcinoembryonic antigen(CEA) and neuron specific enolase(NSE) in the pilot study on 39 serum samples from lung cancer (17 squamous cell cancer, 11 adenocarcinoma, 11 small cell carcinoma) and 51 benign lung diseases and 41 normal healthy persons. RESULTS: Postulating a specificity 95% versus benign lung disease and healthy group, the diagnostic sensitivity of CYFRA 21-1 in lung cnacer independent of histologic type was 43.6% whereas CEA was 48.7% and NSE was 30.8%. The diagnostic sensitivity is increased to 69.2% by combining CYFRA 21-1 with CEA. Classifying the lung carcinomas following their histologic type, squamous cell carcinomas proved to possess the highest CYFRA 21-1 sensitivity(CYFRA 21-1 47.1%, CEA 23.5%, NSE 11.8%) and the combination with CEA 52.9% could not markedly increase the number of true-positive test results. In adenocarcinoma, CEA possessed the highest sensitivity (81.8%) whereas CYFRA 21-1 was 45.5% and NSE was 9.1%. In small cell carcinoma of lung, NSE possessed the highest sensitivity(81.8%) whereas CYFRA 21-1 was 36.4% and CEA was 54.5%. CONCLUSION: This study indicates that CYFRA 21-1 has a potential as a new marker for squamous cell lung cancer. If histologic type is unknown at the time of primary diagnosis. the combined determination of CYFRA 21-1 and CEA showed the best discrimination between benign and malignant lung disease.
Adenocarcinoma ; Antibodies, Monoclonal ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Discrimination (Psychology) ; Enzyme-Linked Immunosorbent Assay ; Humans ; Keratin-19 ; Keratins ; Lung Diseases ; Lung Neoplasms* ; Lung* ; Neoplasms, Squamous Cell ; Neurons ; Pilot Projects ; Sensitivity and Specificity

No abstract available.
Blood Platelets*

No abstract available.
Plasma Exchange* ; Plasma*

No abstract available.

No abstract available.
Craniocerebral Trauma* ; Disseminated Intravascular Coagulation* ; Head* ; Humans ; Latex*

No abstract available.
Liver Diseases* ; Liver*

No abstract available.
Cholesterol* ; Triglycerides*

No abstract available.
Bone Marrow*