Evaluation of medical knowledge using electronic textbooks and ExaMe program on Internet.

In the paper we describe the function of the ExaMe program that serves for evaluation of students knowledge using Internet. Evaluation is based on the knowledge base of a given course. Two types of evaluation tests are described. The fixed test is appropriate for examination of students by the teacher in computer classroom connected to Internet. By this test the evaluation is done in the limited time period and all students are tested with the same evaluation test. The automatic test is appropriate for self-evaluation and self-study by students on remote places. The student can ask the ExaMe program for the test of different difficulty levels and state the number of questions required. Finally the first experience with the ExaMe program in practice is given. The application of the ExaMe program is shown in connection with IT EDUCTRA electronic products and electronic textbook on biomedical statistics.

Evolution of femoral head deformity during the healing phase of Legg-Calvé-Perthes disease.

Progressive changes in the roundness of the femoral head were noted during the healing phase of hips with Legg-Calvé-Perthes disease. Forty-nine of 136 hips studied became progressively rounder, and 15 hips became progressively flatter after onset of reossification of the femoral head. The femoral head was more likely to undergo progressive flattening in older patients, in those with more severe lateral pillar involvement, and in those with prolonged reossification. These changes occurred during a 3- to 4-year reossification period after cessation of treatment.

Spinal fusions to the pelvis augmented by Cotrel-Dubousset instrumentation for neuromuscular scoliosis.

Eighteen patients with spinal deformity secondary to a neuromuscular disorder were treated with posterior fusion using Cotrel-Dubousset instrumentation (CDI) to the pelvis. The mean frontal plane curve was 70 degrees preoperatively and 38 degrees postoperatively. The mean loss of correction was 3 degrees at an average follow-up of 28 months. Pelvic obliquity improved in nine patients from a preoperative mean of 22 degrees to 11 degrees at follow-up. Lumbar lordosis was maintained with preoperative and postoperative means of -36 degrees. Complications included perioperative hardware failure in one case and one late, deep infection. There were no neurologic complications, pseudarthroses, or rod breakage. Posterior spinal fusion with CDI to the pelvis is an effective treatment for patients with neuromuscular scoliosis.

The lateral pillar classification of Legg-Calvé-Perthes disease.

To determine the predictive value of a new classification system for Legg-Perthes, 93 hips in 86 patients with radiographic follow-up to maturity were reviewed. All patients were treated by bracing at the Texas Scottish Rite Hospital from 1970 to 1980. Hips were classified during the fragmentation stage of disease into three groups based on radiolucency in the lateral pillar of the femoral head. Final radiographs were reviewed at skeletal maturity, and the outcome was determined according to the Stulberg classification. Group A had a uniformly good outcome (100% Stulberg I and II results); Group B had a good outcome in patients who were less than 9 years at onset (92% Stulberg I and II, 8% Stulberg III results), but a less favorable outcome in patients who were greater than 9 years at onset (30% Stulberg II, 50% Stulberg III, and 20% Stulberg IV results). In Group C, the majority of femoral heads became aspherical in both age groups (29% Stulberg II, 52% Stulberg III, and 19% Stulberg IV results). The group C hips also had a longer duration of fragmentation and reossification stages. Members of the Legg-Perthes study group agreed 78% of the time when applying the classification to unknown radiographs. The classification group was a stronger determinant than age of onset in predicting final outcome. This classification system is easy to apply during the active stage of the disease and has a high correlation in predicting the amount of flattening of the femoral head at skeletal maturity.(ABSTRACT TRUNCATED AT 250 WORDS)

Femoral neck fractures. A biomechanical study of a new form of internal fixation using multiple telescoping variable length compression screws.

Biomechanical tests of a new method of fixation for intracapsular hip fractures compared with other types of mechanical fixation were investigated under one specific loading condition. Human femora fixed in formalin were classified by the Singh index for degree of osteoporosis. Specimens of Grade III or less were grouped as osteoporotic, and Grade IV or greater, normal. Both normal and osteoporotic bones were tested. A transverse osteotomy in the subcapital region was fixed by one of two techniques: (1) Asnis screws (AS) or (2) variable length telescoping compression screws (VLCS). Each specimen was roentgenographed after fixation to assess the placement of the devices and reduction. Each femur was held in an angle vise that was placed on rollers on a table mounted on the servohydraulic testing machine. Compression was applied at a constant displacement rate of 10 mm per second to failure. Load and displacement were monitored; specimens were photographed and roentgenographed after failure. In osteoporotic bone, the VLCS provided yield and ultimate load values several times greater than those of the AS. Resistance to combined compression varus loading was significantly higher with the experimental system in osteoporotic bone. In normal bone there was no significant difference between the two systems.