To study the cost-effectiveness of clinical screening with ultrasonography (USG) of hip for diagnosing developmental dysplasia of the hip (DDH) in new borns

Aim: To study the cost-effectiveness of clinical screen with ultrasonography (USG) of hip for diagnosing developmental dysplasia of the hip (DDH) in new borns. Methodology: Prospective study was conducted in DVVPF's Medical College and Hospital, Ahmednagar over a period of two years. Term new borns had (i) target scan at 6 weeks—family history of DDH or breech presentation—and (ii) early scan—abnormal clinical screen. Results: In all, 58 babies had USG scan. Five early scans (Graf's classification; three Type IIA, one Type IIC and one Type IIIB] and 15 target scans (Type IIA) were reported abnormal. All Type IIADDH had subsequent 12 weeks' scans normal. Babies with Type IIIB and IIC had hip reduction surgery at 6 and 16 months of age, respectively. At cost Rs. 200 INR/- scan, total Rs. 1,47,200/- INR was incurred against two possible hip replacements prevented. Conclusion: Universal clinical screen with USG of hip can aid in early diagnosis of DDH in newborns. Large population-based studies from developing countries need to look in its cost-effectiveness.

Displasia del desarrollo de la cadera: tamizaje y manejo en el lactante / Developmental dysplasia of the hip: screening and management in the infant

La displasia del desarrollo de la cadera comprende un conjunto de anormalidades que afectan la articulación coxofemoral: la displasia, subluxación y luxación de la cadera. El concepto de "displasia" describe anormalidades en la estructura femoral, acetabular o ambas. Corresponde a la patología ortopédica más frecuente del recién nacido y lactante, lo que genera mucha preocupación e intranquilidad entre los padres, en los primeros controles sanos de sus hijos. Es una patología en la que un diagnóstico oportuno y precoz son la clave para poder realizar un tratamiento efectivo, obteniendo como resultado una cadera clínica y radiológicamente normal al finalizar el desarrollo esquelético. Para esto es fundamental conocer la patología e ir activamente en su búsqueda. Actualmente existe mucha discusión sobre la manera de pesquisar esta patología. En Chile, se realiza tamizaje universal con imagen -radiografía de pelvis- a todos los niños a los 3 meses de edad. El objetivo de la siguiente revisión, es traer a la práctica clínica actual de todos aquellos profesionales que se enfrentan en distintos escenarios a esta patología: médicos de atención primaria, enfermeras, médicos en etapas de destinación y formación en distintas regiones del país, pediatras y ortopedistas, aquellas características y signos de sospecha propios de esta enfermedad y detallar las herramientas para un correcto diagnóstico y oportuno tratamiento.

Developmental dysplasia of the hip (DDH) comprises a set of abnormalities that affect the hip joint: hip dysplasia, subluxation, and dislocation. It is the most frequent orthopedic pathology of the newborn and infant, and it generates great concern among parents during the first health check-ups of their children. It is a condition in which a timely and early diagnosis is key to be able to carry out an effective treatment, obtaining as a result of a clinically and radiologically normal hip at the end of skeletal development. For this, it is essential to know this orthopedic condition and actively search for it. Currently, there is much discussion about how to screen DDH. In Chile, universal screening with imaging - pelvic radiography - is performed on all children at 3 months of age. The objective of the following review is to bring to the current clinical practice of all those professionals who face this pathology in different scenarios: primary care physicians, nurses, physicians in training stages in different regions of the country, pediatricians and orthopedic surgeons, signs of suspicion typical of the disease and detail the assessment tools for a correct diagnosis and timely treatment.

Parietal peritoneum graft for duodenum injuries in an animal model / Enxerto de peritônio parietal em lesão duodenal: modelo animal

ABSTRACT Background: Duodenal injuries and their surgical procedure cause a high morbidity and mortality. Aim: To assess the overall effectiveness of the auto-graft of peritoneum in the treatment of the perforation of the duodenum, aiming to reduce surgery time, costs, complexity and mortality. Methods: Twelve New Zealand rabbits, ages 4-6 months, both sexes, underwent designed surgical grade III duodenal injuries that were repaired 18 h after. Rabbits were surgically treated with the proposed auto-graft of peritoneum. Results: No postoperative deaths were observed; the animals presented corporal weight increase and were euthanized six months later. There was no significant difference between both groups relating to the postoperative evolution or in the histological changes. Conclusion: Auto-graft of the peritoneum and posterior fascia is a useful option for duodenal repair and that is worth of evaluation for humans.

RESUMO Racional: Lesões duodenais e seu procedimento cirúrgico causam alta morbimortalidade. Objetivo: Avaliar a eficácia geral de retalho peritoneal no tratamento da perfuração do duodeno, visando reduzir o tempo, os custos, a complexidade e a mortalidade cirúrgicas. Métodos: Doze coelhos da raça Nova Zelândia, com idades entre 4-6 meses, ambos os sexos, foram submetidos a lesões duodenais cirúrgicas de grau III, que foram reparadas 18 h depois. Coelhos foram tratados cirurgicamente com a proposta de auto-enxerto de peritônio. Resultados: Não foram observados óbitos pós-operatórios; os animais apresentaram aumento de peso corporal e foram eutanasiados seis meses depois. Não houve diferença significativa entre os dois grupos em relação à evolução pós-operatória ou nas alterações histológicas. Conclusão: A auto-enxertia do peritônio e da fáscia posterior é uma opção útil para o reparo duodenal e vale a pena ser avaliada em seres humanos.

Injerto costal para reconstrucción nasal: experiencia de 6 años en el Hospital San Juan de Dios / Costal graft for nasal reconstruction: 6 years experience in San Juan de Dios Hospital

Introducción: El injerto de preferencia para cirugía nasal es el cartílago septal. El Injerto de cartílago costal otorga gran material para trabajo ya que posee características similares al cartílago septal. Este injerto se utiliza generalmente para cirugías de dorso nasal, nariz en silla de montar, laterorrinias, disfunciones de la válvula nasal interna y/o externa, poca proyección nasal y rinoplastías de revisión. Objetivo: Conocer las características, resultados y complicaciones de las rinoplastías con injerto de cartílago costal realizadas en el Hospital San Juan de Dios (HSJD) entre los años 2010 y 2016. Material y método: Estudio retrospectivo con revisión de fichas clínicas de pacientes sometidos a cirugías de reconstrucción nasal con injerto de cartílago costal en el HSJD entre enero 2010 y agosto 2016. Resultado: Entre los años 2010 y 2016 se realizaron 20 rinoplastías con uso de cartílago costal: 14 eran hombres (70%) y 6 eran mujeres (30%). En 14 pacientes se usó el cartílago costal en la primera cirugía. No se presentaron complicaciones a corto, mediano y largo plazo. Conclusión: El injerto de cartílago costal es una herramienta útil a la hora de enfrentarse a cirugías complicadas. La técnica quirúrgica no es dificultosa y tiene una baja tasa de complicaciones.

Introduction: The ideal graft for nasal surgery is septal cartilage. The costal cartilage has similar characferistics to the septal cartilage. This particular graft is generally used for nasal dorsum, saddle nose, nasal deviations, dysfunctions of the internal or external nasal valve, poor nasal projection and revision rhinoplasty. Aim: Determine the characteristics, outcomes and complications of rhinoplasty with costal cartilage graft made in the San Juan de Dios Hospital (HSJD) between 2010 and 2016. Material and method: Retrospective study with reviewing medical records of all patients underwent nasal surgery reconstruction with costal cartilage graft in the HSJD between January 2010 and August 2016. Results: Between 2010 and 2016 a total of 20 rhinoplasties were performed with use of costal cartilage. Of these 14 were men (70%) and 6 were women (30%). In 14 patients we used the costal cartilage in the first surgery. No complications in short, medium and long term were presented. Conclusion: The rib cartilage graft is a useful tool when dealing with complicated surgeries. The surgical technique is not difficult and has a low complication rate.

Uso de cuero cabelludo como zona donadora de injertos cutáneos de espesor parcial / Use of the scalp as a donor area for partial thickness skin grafts

Objetivo: Demostrar los beneficios del uso de cuero cabelludo como área donadora de injertos cutáneos de espesor parcial. Método: Estudio retrospectivo descriptivo realizado de 2013 a 2015 en la Unidad de quemaduras pediátricas del hospital Roosevelt de 111 pacientes en que se utilizaron injertos del cuero cabelludo. Resultados: La mayoría de los pacientes sufrieron quemaduras por inmersión en líquidos calientes con disponibilidad limitada de zonas donadoras de injertos. El otro uso que se le dio a los injertos de cuero cabelludo fue en quemaduras y lesiones faciales debido a la similitud de la pigmentación de estas áreas. Este estudió demostró el corto tempo de epitelización de esta zona donadora (3.5 días), lo que permitió que se utilizara en varias ocasiones. La principal complicación fue la alopecia (1.8%) resultado de una toma de un injerto muy grueso. Conclusión: El estudio sugiere que el cuero cabelludo es una zona donadora útil cuando las principales áreas donadoras están limitadas. Más investigación tendrá que realizarse para establecer otros beneficios observados del uso de esta región como zona donadora de injertos cutáneos.

Objectve: Demonstrate the benefts of using scalp as a donor area of partal split thickness skin grafs. Methods: Retrospectve descriptve study from 2013 to 2015 shows 111 patents that required a skin graf from the scalp in a pediatric burn unit. Results: Most of the patents were burn victms, but few other cases are described as well. The most common use of this donor area was for patents that had sufered pot immersion scalds where the back, gluteus and lower limbs were afected and no longer available as skin donor areas. The other main use was in facial burns and traumas, because the color similitude between the face and scalp renders a beter cosmetc result of facial skin grafs. This study demonstrates the short period of healing (3.5 days) of the donor area making possible its reuse in a shorter period of tme. The main complicaton was alopecia (1.8%) where the graf take was too deep. Conclusions: The study suggests the use of scalp donor area when other main donor areas are not available and for facial burns. Further studies should be performed in order to establish other observed benefts of the scalp as a donor area for split thickness skin grafs.

Resultados clínicos de injertos óseos autólogos en bloque / Clinical results of autologous bone block grafts

Introducción: En muchas ocasiones, el sitio edéntulo del paciente no cuenta con el sufi ciente volumen óseo para albergar un implante. El injerto óseo autólogo en bloque (IOAB) es una opción para acondicionar al individuo y poder realizar la colocación del implante. Objetivo: Determinar el porcentaje de éxito y fracaso de los IOAB y sus factores relacionados...

Introduction: Very often, there is insufficient bone volume available in the edentulous site of a patient to allow dental implant placement. One way to prepare such patients for an implant placement is to usean autologous bone block (ABB) graft. Objective: To determine the success and failure rates of ABB grafts and their associated factors...

Os pais da psicanálise com crianças / The fathers of child psychoanalysis / Les pères de la psychanalyse avec les enfants / Los padres del psicoanálisis con niños / Die Väter der Kinderpsychoanalyse / 儿童精神分析学之父

Durante meio século, a história da psicanálise com crianças guiou-se pelas linhas mestras estabelecidas no Colóquio sobre análise infantil, que em 1927 entronou Melanie Klein e Anna Freud como suas genuínas mães. Um dos efeitos que se produziram foi a psicanálise com crianças se haver consagrado como um campo de mulheres. Contudo, anteriores a essas mulheres, estão os que podemos considerar os pais da psicanálise com crianças — mas que não foram reconhecidos como tais. Entre eles, Karl Abraham, Carl Jung e Max Graf. O que se esconde nesse apagamento? Que efeitos isso teve na prática psicanalítica com crianças? O artigo levanta a hipótese de que a fantasia do pai sedutor dissuadiu os homens de se aventurarem nesse campo.

For half a century, the history of child psychoanalysis was based on guidelines established by the Symposium on Child Analysis, which, in 1927, enthroned Melanie Klein and Anna Freud as its genuine mothers. One of the results produced was child psychoanalysis being consecrated as a field for women. However, before these women, there are those who we can consider the fathers of child psychoanalysis — but who were never recognized as such: among them, Karl Abraham, Carl Jung and Max Graf. What lies below this erasure? What effects did this have on child psychoanalysis practice? This paper raises the hypothesis that the seductive father fantasy dissuaded men from venturing into this field.

Pendant un demi-siècle, l’histoire de la psychanalyse avec les enfants a été guidée par les lignes directrices énoncées dans le Colloque sur l’analyse des enfants, qui, en 1927, définit Mélanie Klein et Anna Freud comme ses véritables mères. L’une des conséquences a été la consécration de la psychanalyse avec les enfants comme un domaine réservé aux femmes. Toutefois, derrière ces femmes, il y a ceux que nous pouvons considérer comme les pères de la psychanalyse avec les enfants — mais qui n’ont pas été reconnus comme tels: parmi eux, Karl Abraham, Carl Jung et Max Graf. Que se cache-t-il derrière cet effacement? Quels ont été les effets sur la pratique psychanalytique avec les enfants? L’article soulève l’hypothèse que le fantasme du père séducteur a dissuadé les hommes de s’aventurer dans ce domaine.

Durante medio siglo, la historia del psicoanálisis con niños se pautó por los lineamientos que se establecieron en el Coloquio sobre el análisis de niños que, en 1927, entronizó Melanie Klein y Anna Freud como sus madres genuinas. Uno de los efectos que se produjeron fue que el psicoanálisis con niños se consagró como un campo de mujeres. Sin embargo, hay detrás de ellas aquellos que podemos considerar sus padres, que no fueron reconocidos como progenitores: entre ellos están Abraham, Jung y Max Graf. ¿Qué se esconde detrás de esa desaparición? ¿Qué efectos tubo sobre la práctica psicoanalítica con niños? El artículo levanta la hipótesis de que la fantasía del padre seductor alejó a los hombres a aventurarse en ese campo.

Während eines halben Jahrhunderts entwickelte sich die Geschichte der Kinderpsychoanalyse anhand von Richtlinien, die sich aus dem Kolloquium über Kinderpsychoanalyse ergaben, welches im Jahr 1927 Melanie Klein und Anna Freud als die wahren Mütter der Kinderpsychoanalyse prägte. Als Folge etablierte sich die Kinderpsychoanalyse als ein Berufsfeld für Frauen. Hinter diesen Frauen ahnen wir jedoch diejenigen, die wir als Väter betrachten können, unter ihnen Abraham, Jung und Max Graf. Was führte dazu, dass sie in den Hintergrund traten? Wie wirkte sich dies auf die angewandte Kinderpsychoanalyse aus? Dieser Artikel stellt die Hypothese auf, dass die Phantasie des verführerischen Vaters die Männer davon abgehalten hat, sich in dieses Feld zu wagen.

在半个世纪的时空，儿童精神分析学的历史由几条主要路线指引。这几条路线在1927年由Melanie Klein和 Ana Freud提出，这两位也就成为人们公认的儿童精神分析学的创始人。由于这个原因，儿童精神分析学成为一个以妇女为主导的领域。 但是，在这两位女创始人之前，实际上已经有好几位男性专家关注了儿童精神分析学，但是他们并没有被认为是这个领域的创始人。他们是：Karl Abraham, Carl Jung 和 Max Graf。是什么原因使得人们忘记这几位男性学者呢？这又会对儿童精神分析这个行业造成什么影响呢？本论文提出一个假设，也就是，人们对父亲诱骗的幻觉使得男性精神分析专家不愿涉足儿&#...

Ultrasonographic screening of neonatal developmental dysplasia of hip / 中国医学影像技术

Objective To assess the role of hip ultrasonography in the early screening and following up of developmental dysplasia of the hip (DDH). Methods A total of 1324 hips of 662 infants younger than 6 months underwent ultrasonography with Graf method. The sonographic appearances of bony roof, superior bony rim, cartilaginous roof, as well as α and β angle measurements were classified according to the Graf method. Risk factors such as gender, sides, fetal position, and swaddling used were assessed. Following up were performed with ultrasonography in the cases of immaturity, dysplasia and dislocation that needed to be monitored or treated. Results Detection rate of selective ultrasound in screening of DDH of the hip was 7.42%. Both gender and fetal position was the risk factor of DDH. Twenty-seven infants with dysplasia hip and five with dislocation hip were followed-up with ultrasonography during treatment process. Thirteen infants with dysplasia turned to normal after abduction exercises, while other fourteen received treatment in Pavlik harness for no improvement in ultrasonography. All infants of dislocation received operation eventually because of failing to Pavlik harness. Conclusion Ultrasonography can objectively assess the development of DDH, monitor the course of following-up and treatment of DDH, and serve as a main tool in the early screening and following up of DDH in infants.

Favorable Outcome of Endovascular Stent-Graft Implantation for Stanford Type B Aortic Dissection

BACKGROUND AND OBJECTIVES: To evaluate the feasibility and the short- and mid-term follow-up outcomes of endovascular stent-graft implantation in patients with Stanford type B aortic dissection. SUBJECTS AND METHODS: Twenty-eight patients with Stanford type B aortic dissection were evaluated. An aortogram was performed immediately after the procedure and a follow-up computed tomography (CT) scan was performed within one week, between 3 and 6 months, and annually thereafter. Clinical status was also evaluated at the same time. RESULTS: Endovascular stent-graft implantation at the target site was successful in 27 patients (96.4%). There were primary endoleaks in 6 patients and one case of procedure failure owing to migration of the stent-graft; and no procedure-related mortality. The number of patients with early complications requiring treatment was 2 (2/27, 4%). Fourteen patients experienced postimplantation syndrome (14/27, 52%). The average follow-up period was 22.1+/-17.5 months. Complete resolution or thrombosis of the false lumen was achieved in 14 patients and partial thrombosis was achieved in 10 patients. Operative treatments were required in three patients due to a progressing dissection or new dissection. There were no deaths and no instances of aneurysm or aortic rupture during the follow-up period. CONCLUSION: Endovascular stent-graft implantation for Stanford type B aortic dissection is a feasible, safe, and effective treatment modality. All patients who underwent surgery had a persisting leak. Therefore, regular evaluation of the aortic dissection and management of endoleaks were crucial for a favorable outcome in endovascular stent-graft implantation for a Stanford type B aortic dissection.

Soft GRAF Fixation and Posterior Lumbar Interbody Fusion in Multiple Degenerative Lumbar Diseases

As a treatment of multiple degenerative lumbar disease, there is no doubt about wide decompressive laminectomy for neural decompression. But postlamenectomy instability caused by wide decompression can provoke neurologic deteriorations and further stabilization procedures may require to improve clinical symptom. Among stabilization procedures, posterior lumbar interbody fusion and posterior fixation with transpedicular screw can provide immediate stability postoperatively. But the posterior fixation with rigid rod or plate system can cause degenerative instability in adjacent segment and hardware failure due to hyperrigidity. Therefore, authors have tried posterior soft GRAF fixation and posterior lumbar interbody fusion with cages to avoid complications of rigid fixation systems and iliac bone graft in 124 patients with multiple degenerative lumbar diseases. The angular instability was improved from 14.9degrees+/-6.4degrees to 3.4degrees+/-3.5degreespostoperatively and translational instability was decreased from 6.4mm+/-1.1mm to 1.6mm+/-1.1mm (p<0.001). The height of intervertebral disc was increased from 9.8mm+/-2.1mm to 12.2mm+/-2.4mm significantly. The new instability on adjacent segment was not apparent during follow-up period. With this procedure, 88.7% of the patients were improved clinically. Results of this study show that soft GRAF fixation and posterior lumbar interbody fusion with cage(circumferential fusion or 360degreesfusion) can provide the three column stability immediately after operation without any hardware related complications. Also, it can give more physiologic property biomechanically than rigid fixation to degenerative spinal column.

Graf Soft Fixation for the Treatment of Degenerative Lumbar Disease

Degenerative involution of the spine causes destruction of spinal stabilizer which consists of bone, ligament, joint capsule, and disc, which substantially leads to hypermobility and instability of the spine. Generally the hard fixation system has been used for the treatment of lumbar instability. However, it has many complications, including screw loosening, screw fracture, and instability on, above, and below the fusion segment. These complications of the hard fixation system has brought to the invention of a more physiologic fixation device, the soft fixation system. We have used the Graf soft fixation system as an instrument for degenerative lumbar disease. 106 cases were operated between August, 1993 and March, 1996. The clinical assessments, radiologic findings, and operative results were analyzed. The height of disc space significantly increased from 8.84mm to 9.84mm on L3/4, 9.28mm to 10.13mm on L4/5, and 9.44mm to 10.47mm on L5/S1. Flexion instability changed from -6.9 degrees to 5.5degrees on L3/4, -7.45 degrees to 5.04 degrees on L4/5, -2.09degrees to 10.81degrees on L5/S1, translation instability was corrected from 16.8% to 14.9% on L3/4, 19.9% to 12.4% on L4/5, 27.1% to 20.1% on L5/S1 after Graf soft fixation. The clinical results were as follows: excellent in 56%, 27% good, 9% fair, and 8% poor. These results suggest that Graf soft fixation system for degenerative lumbar disease would not only be useful and effective, but also be safer in terms of unwanted complications of the hard fixation system.

Surgical treatment of Degenerative Lumbar Spinal Disorders Using the Graf System: over three year results / 대한정형외과학회잡지

The Graf system has supposed advantages with its flexible nature, as compared with rigid fixation. But there have been no reports about effects in the adjacent motion segment after soft stabilization. The purpose of this study was to evaluate the radiologic changes occuring in the adjacent segments of the Graf system and to assess its ability stabilizing the lumbar spine. A retrospective review of radiographs and medical records was undertaken in 32 cases who had been treated with the Graf system in degenerative lumbar spinal disorders. The average age at operation was 52.5 years and the average follow up period was 49.6 months. The results of this study were as follows: clinical assesments based on the Kirkaldy-Willis criteria revealed excellent in 13 cases (40.6%), good in 16 cases (50%), fair in 2 cases (6.3%) and poor in 1 case (3.1%). Radiologically we analysed the adjacent segments in 25 cases except the cases which did not have the correspondence between the clinical findings and the radiological findings, and the fixated segments in 32 cases. The acceleration of degenerative changes were found in the above adjacent segments in 11 cases (44%) and in the below adjacent segments in 5 cases (27.7%). Also, those changes were found in the fixated segments with discectomy in 19 cases (50%) and in the fixated segments without discectomy in 9 cases (37.5%). In conclusion, we think that the Graf system in a lumbar region may biomechanically influence the adjacent segments. The mechanical effects of the device could be changed by the polyester bands which were followed for a longer period of time in the fixated segments. Therefore, randomized prospective studies comparing the Graf system to other treatement methods could provide clear indications for lumbar spinal disorders.

Posterior Lumbar Interbody Fusion and Graf Band Fixation for Lumbar Isthmic Spondylolisthesis

With current developments in surgical instrumentation, the surgical management of symptomatic isthmic lumbar spondylolisthesis is diversifying. Many authors agree, the basic elements for this condition, are decompression of compressed neural structure, bone fusion, and internal fixation with or without reduction. In eleven isthmic lumbar spondylolisthesis patients treated between Jannuary and December 1994, we applied band fixation instead of the usual metalic rigid fixation after decompression and posterior interbody fusion using carbon fusion cages. Serial lumbar X-rays were taken, and we studied the changes in displacement, disc height and bone fusion, as well as evaluating surgical outcome and complications. Preoperative percent-slip was 18.5+/-5.5, and this fell to 12.7+/-6.3 and 12.4+/-6.1 at postoperative 6 and 18 months respectively. Percent-disc height was higher than its preoperative value, and the increase was maintained(21.2+/-6.2 preoperatively; 30.0+/-6.0 and 29.7+/-5.1 at postoperative 6 and 18 months respectively). In all patients, fusion was good, and there were no surgical complications. Over 18 months, the outcome in nine patients was good or excellent, but in 2 patients, it was not good. The poor results may be because the tension band was too tight and possible neural damage or incomplete decompression. On the basis of these observations, we concluded that posterior lumbar interbody fusion with Graf band fixation is good for fusion and for the maintenance of displacement and disc height, and that if performed with care, this is a possible surgical option in cases of isthmic lumbar spondylolisthesis.

Graf Soft Fixation in Degenerative Lumbar Spine Instability: Preliminary Report

Although various kinds of spine stabilizing instruments have been developed over the past years, the subject is still controversial and contradictory reports are seen in the literature. Among such instruments, Graf instrument has attracted much interest because of the originality of the idea as a soft stabilizer. We have performed Graf instrumentation on 34 cases of degenerative lumbar spine diseases from September 1993 to March 1994, and after more than 3 months of postoperative follow-up, we conclude as follows: 1) Out of the 34 operated cases, the short term postoperative follow-up results for low back pain was excellent in 15 cases(44.1%), good in 5 cases(44.1%), fair in 3 cases(8.8%), and poor in 1 case(2.9%). 2) As a soft fixator developed on the basis of physiological mechanism, Graf instrumentation can avoid unwanted effects of hard fixation and is thought to be less destructive and more effective physiologically.

The clinical Results of Graf Instrumentation in Unstable Lumbar Spinal Disordors / 대한정형외과학회잡지

Various kinds of spinal instruments have been developed for the treatment of lumbar spinal disordors. Recently, the Graf instrument as soft stabilizer has been introduced in treating lumbar spinal disordors associated with instability. To determine the reliability of Graf instrument providung spinal stability we have analysed 19 cases of unstable lumbar degenerative disease treated with adequate decompression and Graf instrumentation between May 1991 and March 1992. There were 15 females and 4 males. Average age at operation was 50.8 years (Range, 35 to 70). Minimum follow up was 14 months. The main surgical indication was serious limitation of daily activity caused by intractable symptoms and signs with spinal instability. Clinical assesment based on authors modified criteria revealed satisfactory (Exellent/Good) in 16 cases (84.2%). The Graf instrument has many advantages over rigid implant such as enough stability without arthrodesis after extensive surgical decompression, rapid rehabilitation, less operative risk and preservation of spinal motion. These results suggests Graf instrument instead of rigid implant is highly recommendable in managing unstable lumbar disordors.

CULTIVATION OF EPIDERMAL CELLS USING COLLAGEN FILM AND GRAFLING: A PRELIMINARY REPORT / 第二军医大学学报

The isolation and purification of collagen from pig dermis is described,The collagen was spread on a F46 membrane. Human epidermal cells were cultured on the collagen film, and the epidermal cell sheets cultured for 5-13d were successfully autografted on excised or granulation wounds in 5 cases. Biopsy from cultured epidermal grafted area showed epidermization. These results suggest that collagen can promote the growth and attachment of epidermal cells.