Low back pain and radiating pain in the leg are the main symptoms of the spondylolisthesis and various surgical treatments are recommended after having enough conservative treatments. The spinal fusion in situ either posterior, posterolateral or anterior route is the usual method for symtomatic spondylolisthesis or to prevent progression of slipping but the neurogenic symptoms in the legs are not well solved, so the decompression procedures are necessary. The authors reviewed 26 cases of isthmic spondylolisthesis having low back pain and sciatica which are operated during the 10 years since 1973 at Fatima Hospital and the followings are obtained. 1. There were 15 males and 11 females with ages from 18 years to 63 years having average 40.1 years. 2. The displaced vertebrae were 5th lumbar in 18 and 4th lumbar in 8 cases and the degree of displacement was Grade I in 14, Grade II in 10, Grade III in 1 and no slipping in 1 case. 3. The types of surgery were decompression and H-graft in 22, simple posterior fusion in 3 and Gll's procedure in 1 case. 4. The laminas were considerably loose in all cases and there were small fibrous mass at the pars area in half of the cases. .5. The spine became very stable immediately after H-grafting and the intervertebral foramen became widened freeing nerve root. 6. Bony union obtained in 88% and satisfactory result in 85% at the follow-up from 6 months to 7 years and 2 months with average 1 year and 7 months. 7. The decompression is necessary for the radiating pain in the leg and H-grafting is satisfactory and simple procedure after decompression laminectomy.
Decompression ; Female ; Follow-Up Studies ; Humans ; Laminectomy ; Leg ; Low Back Pain ; Male ; Methods ; Sciatica ; Spinal Fusion ; Spine ; Spondylolisthesis

Primary subacute pyogenic osteomyelitis is defined as a bone infection of insidious onset lasting for more than several weeks without any acute systemic toxic reactions and is known to have the problem of diagnosis because there is no inflammatory symptoms or signs and X-ray findings are similar to various bone tumors. Authors reviewed 29 cases of primary subacute pyogenic osteomyelitis of long bones admitted at Fatima hospital during the years between 1976 and 1984. The osteomyelitis of infants and the osteomyelitis modified by antibiotics were excluded. The diagnosis of the cases was confirmed by bacteriological examination and/or tissue examination. The results were as follows. 1. The cases were 18 males and 11 females and 19 adults and 10 children. Male predominence was noted in children. 2. The involved bones were 11 tibias, 10 femurs and all other long bones. The involved sites were 18 metaphysis and 11 shafts. 3. All of the cases has insidious onset of local pain without any acute systemic symptoms and most of the cases has local tenderness but local deep swelling noted in about half of the cases. 4. There were many cases with elevated ESR and a few cases of slight leukocytosis. 5. The confirmed infecting organism was all staphylococcus in 16 cases of the cultures from the 25 lesions. 6. The X-ray findings were Brodies abscess in 10, illdefined cavity in 3, diffuse bones absorption in 5, diaphyseal lesion of adult with localized cortical sclerosis in 5 and with localized medullary abscess in 3 and diaphyseal lesion of children with localized medullary abscess and periosteal reaction in 3 cases. 7. All of the cases cured rapidly with rare recurrence after treatment by simple local excision in 4 and curettage in 22 cases combined with antibiotic therapy and local immobilization.
Abscess ; Absorption ; Adult ; Anti-Bacterial Agents ; Child ; Curettage ; Diagnosis ; Female ; Femur ; Humans ; Immobilization ; Infant ; Leukocytosis ; Male ; Osteomyelitis ; Recurrence ; Sclerosis ; Staphylococcus ; Tibia

PURPOSE: To compare the clinical outcomes and complications of hemiarthroplasty (HHR) and total shoulder arthroplasty (TSR) in non-traumatic arthritis patients. MATERIALS AND METHODS: Thirty-two patients (34 shoulders) underwent shoulder arthroplasty for nontraumatic shoulder arthropathy. There were sixteen patients with rheumatoid arthritis, nine with osteoarthritis, four with avascular necrosis and etc. HHR was performed in eleven shoulders and TSR in twentythree shoulders. RESULTS: In HHR, the pain score decreased from preoperatively 7.09 to 0.91 postoperatively. The mean forward elevation was 137degrees and the mean external rotation at the side and abduction were 55degrees and 131degrees, respectively. The mean ASES score was 82.4. In TSR, the pain score decreased from 7.04 preoperatively to 1.17 postoperatively. The mean forward elevation, external rotation at the side and abduction were 132degrees, 44degrees, and 132degrees, respectively. The mean ASES score was 81.2. In rheumatoid arthritis, the mean ASES score of the HHR and TSR were 77.8 and 78.1, respectively. In osteoarthritis, the mean ASES score was 84.7 and 90.8, respectively. During the follow up, glenoid erosion was observed in three HHR cases, and glenoid loosening in two TSR case. CONCLUSION: HHR and TSR produced similar results in terms of the functional improvement. The clinical results were much better in patients with osteoarthritis than in those with rheumatoid arthritis, and TSR was performed on most cases of rheumatoid arthritis.
Arthritis* ; Arthritis, Rheumatoid ; Arthroplasty* ; Follow-Up Studies ; Hemiarthroplasty* ; Humans ; Necrosis ; Osteoarthritis ; Shoulder*

BACKGROUND: Although the instability severity index score (ISIS) is widely used to predict recurrence after arthroscopic anterior instability surgery, its reliability, especially on the weightings and cutoff values, is questionable. The goal of the current retrospective study was to investigate recurrence after arthroscopic capsulolabral reconstruction to evaluate whether each domain of the ISIS has the appropriate predictive power for recurrence by using logistic regression analyses with odds ratios (ORs). METHODS: This study included 120 consecutive patients who underwent arthroscopic capsulolabral reconstruction between 2004 and 2016. We retrospectively reviewed patients' preoperative history and radiographs, postoperative recurrence or sensation of instability, and risk factors related to the ISIS. The mean postoperative follow-up was 27.6 months (range, 12 to 96 months; median, 21 months). Twenty-six patients with recurrence or positive apprehension were classified as the recurrence group; 94 patients without any symptoms were classified as the non-recurrence group. Logistic regression analyses with ORs were used to verify the utility of each domain of the ISIS for predicting recurrence. RESULTS: The mean ISIS did not differ significantly between the recurrence and non-recurrence groups (4.3 ± 1.8 vs. 3.4 ± 2.1 points; p = 0.063). Among the domains of ISIS, factors related to bone defects, the presence of a Hill-Sachs lesion and glenoid bone loss had the lowest ORs (0.77 and 0.38, respectively). CONCLUSIONS: Not all ISIS domains accurately predicted recurrence after arthroscopic capsulolabral reconstruction. The ISIS may not be a proper reference for determining Latarjet procedure in patients with anterior shoulder instability.
Follow-Up Studies ; Humans ; Logistic Models ; Odds Ratio ; Recurrence ; Retrospective Studies ; Risk Factors ; Sensation ; Shoulder ; Shoulder Dislocation

OBJECTIVE: To identify the factors affecting the complete fetal loss following multifetal pregnancy reduction (MFPR). DESiGN: Retrospective clinical study. METHODS: A total of 256 consecutive treatments of MFPR in iVF-ET cycles performed between 1992 through 2000 in Samsung Cheil hospital were analyzed. MFPR was done around 8 weeks of gestation by transvaginal ultrasono-guided aspiration in multiple pregnancies and reduced to singleton or twins. Stepwise logistic regression was performed to identify the factors affecting the final outcome of pregnancy after MFPR. Dependent variable was complete fetal loss and the independent variables were maternal age, paternal age, initial number of gestational sac (iGSNO), initial number of fetal heart beat, the number of remaining live fetus after MFPR, and chorionicity. RESULTS: The total survival rate was 87.9%, and total fetal loss rate after MFPR was 12.1%. Total fetal loss occurred within four weeks from MFPR procedure was 1.95%. Total loss occurred after four weeks of procedure and before 24 gestational weeks was 8.2%. Seventy nine percent (202/256) of pregnancies delivered after 34 weeks of gestation. The survival rate of pregnancies reduced to singleton was significantly higher than that of pregnancies reduced to twins (93.5% vs. 86.7%, p<0.05). The mean (+/-SEM) gestational age at delivery was 36.2+/-1.0 and 34.1+/-0.5 weeks for pregnancies reduced to singletons and twins, respectively (p=0.065). Logistic regression analysis revealed that the maternal age, the number of initial gestational sac (iGSNO), and the number of remaining live fetus after MFPR significantly affected the rate of total fetal loss (Z = 0.174'age + 0.596'iGSNO + 1.324'remaining fetuses-12.07), (p<0.05). CONCLUSiONS: MFPR seems to be a relatively safe and efficient method to improve the obstetric outcome in high order multiple pregnancy. Because the maternal age, the number of initial gestational sac and the remaining live fetuses after MFPR affect the total fetal loss rate, restriction of the number of transferred embryos according to the age and MFPR to singleton fetus could be considered for the better obstetric outcome in iVF pregnancy.
Chorion ; Embryonic Structures ; Female ; Fetal Heart ; Fetus ; Gestational Age ; Gestational Sac ; Humans ; Logistic Models ; Maternal Age ; Paternal Age ; Pregnancy ; Pregnancy Reduction, Multifetal* ; Pregnancy, Multiple ; Retrospective Studies ; Survival Rate

The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.