[Lumbar hernia of the nucleus pulposi; not always conservative treatment initially].
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Biomedical subjects
Publications and source records attributed to R Deutman.
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In a continuous series of 770 patients with a herniated disk treated by chemonucleolysis, 16 patients had herniation of the L3-L4 disk (2.1%). There were no complications, and none of these 16 patients had open surgery after the initial treatment. A follow-up study was performed after 39 months (range, six to 80 months) in 15 patients. Three patients were for the most part satisfied and 12 patients were fully satisfied with the result of treatment. Residual pain was minor in most patients. Roentgenographic signs of increased disk degeneration were seen in six patients, and reexpansion of the disk to some degree was noted in four patients. Chemonucleolysis is effective for treatment of the herniated L3-L4 disk.
A retrospective analysis is reported of the results of partial acromioplasty of 22 shoulders in 19 patients with impingement problems. The population is younger than 40 years (mean 31). Four patients did not improve (18%). One (5%) showed a poor result and 14 patients (17 shoulders) (77%) had good or excellent results. The mean follow-up period was almost 3 years.
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Between February 1975 and August 1976, 195 total hip replacements using Stanmore components were performed; of these, 146 were in 135 patients who had not had previous hip surgery. At review 52 had died, but none of the others was lost to follow-up. Of the 52, two had had a second operation, one for infection and one for recurrent dislocation. In the remaining 83 patients (92 hips) five revisions were necessary: four for aseptic loosening, and one for stem fracture. The remaining 78 patients had little or no pain and little restriction of activity. After a follow-up period of at least nine years, the survival rate of the prosthesis was 95%. There had been migration of the femoral component in five cases and migration of the acetabular cup in one case, but no wear of the acetabular component could be demonstrated.
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Computed tomography (CT) was performed on 30 patients with herniated lumbar discs before chemonucleolysis and at three and 12 months postinjection. At three months the compression produced by the herniated disc was reduced in 20 of the 30 patients; at 12 months there was complete relief of compression in all but four patients. Twenty-four patients developed diffuse bulging of the annulus. There was good correlation between the clinical results at three months and the reduction in compression as shown by the CT scan. At 12 months, no correlation was found between the remaining focal abnormalities and the clinical result. None of the patients developed epidural fibrosis. Chemonucleolysis has thus been shown to be an effective treatment of herniated lumbar discs, but it is definitely not indicated in cases where compression of the nerve root or dural sac is due to a bulging annulus.
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Of 212 patients undergoing total hip replacement who were tested preoperatively for sensitivity to nickel, chromium, and cobalt, fourteen showed sensitivity. No sensitivity to the bone cement was recorded. Of 173 patients who had never had a metal implant before, 5.8 per cent showed a positive reaction. Two patients out of fifteen with a failed McKee-Farrar prosthesis were found to be sensitive. Of six patients who had a stable McKee-Farrar prosthesis in the other hip, none showed sensitivity to the metal. In four of sixty-six patients, sensitivity to nickel or cobalt developed after the implantation of a metal-to-plastic prosthesis. No patients were sensitized to the cement. The consequences of proved hypersensitivity in patients with metal-to-plastic prostheses, either present prior to insertion of the prosthesis or evoked by the implant material, are not known.
Sixty-six patients who had to undergo total hip replacement by means of a metal-to-plastic Stanmore prosthesis, were patch-tested prior to and 6 to 12 months after surgery with the standard ICDRG all allergens series and with acrylic monomer 5% in acetone. In 62 patients the history of metal allergy as well as the patch tests to all tested allergens were negative. One patient with a history of metal allergy reacted negatively before surgery; about 6 months after surgery the patch test to nickel sulphate was positive (2 plus). Three other patients developed positive patch test reaction after surgery: two reacted positively to nickel sulphate (2 plus) and one to cobalt chloride (2 plus). In none of the 66 patients have local side effects of the prostheses been found to date.