Reinterventions in postoperative instability of the lumbar spine

Among the many reasons for reinterventions in the lumbar spine, postoperative instability was chosen as the subject for investigation. Abnormal mobility can be described more precisely in terms of pathological, segmental movement than in terms of instability, as such movement not only represents a greater range of motion of one vertebra towards the adjacent one, but also movement with a restricted (or normal) amplitude of a pathological pattern. Three conditions create pathological postoperative movement: (1) nonunion after attempted fusion; (2) pathologically increased movement because of removal of important weight-bearing structures; (3) compensatory movement of the segment next to a fusion. At the Wilhelm Schulthess Clinic in Zürich, 26 patients underwent one or more operations on the lumbar spine because of persisting pain as a result of postoperative pathological movement. In accordance with the results reported in the literature, good results were rare in reoperations on the lumbar spine (only 8 patients were completely free of pain); 14 patients had intermittent or continuous lumbar pain and 4 patients became worse. The indications for several interventions are carefully analyzed. Better results could probably have been obtained by more stable fixation techniques (transpedicular fixation, combined ventral and dorsal fusions), but the best means of avoiding reoperation is to observe the following guidelines: first, in disectomy cases, the osseous, weight-bearing structures (lamina, facet joint) should remain untouched. If even partial removal seems to be inevitable, fusion should be added done as well.(ABSTRACT TRUNCATED AT 250 WORDS)     

Semiconstrained elbow prostheses with special reference to the GSB III prosthesis

Fully constrained metal-to-metal elbow prostheses are not used anymore because of a high loosening rate. Today semiconstrained or condylar prostheses are the two possibilities when replacement of a destroyed elbow joint is considered. A careful analysis of the most recent publications in the world literature reveals a high complication rate for both types of prostheses, each one having specific advantages and disadvantages. The Gschwend-Scheier-B?hler (GSB) III prosthesis is a semiconstrained prosthesis, requires little bone resection, and is therefore easily salvaged. The results in regard to pain relief and improvement in range of motion are satisfactory in a high percentage of patients. The rate of lasting complications is lower than with most of the other prostheses. The authors' transtricipital approach is also a factor that contributes to the high success rate. In case of a failed arthroplasty the authors' method of reconstructing the humeral condyles allows a better salvage.     

Personality and quality of life: The importance of optimism and goal adjustment

This article concerns the relations between personality and quality of life. In the first part, we discuss different conceptualizations of personality and quality of life. We argue that personality affects quality of life by influencing how people approach and react to critical life situations. In the second part, we address the beneficial role played by two individual difference variables in promoting quality of life: dispositional optimism and goal adjustment. Literature is reviewed demonstrating that dispositional optimism facilitates subjective well-being and good health, mediated by a person's coping behaviors. In addition, we discuss studies that examine people who confront unattainable goals. The reported evidence supports the conclusion that individual differences in people's abilities to adjust to unattainable goals are associated with a good quality of life.     

The GSB knee arthroplasty

Summary The GSB knee joint is briefly described. Its main features are that it is a non-constrained hinge joint with a polycentric axis of rotation and the load is transmitted over a large area of condylar support. Two hundred and twenty-four patients operated upon in the preceeding 6 years have been reviewed and analysed by an independent observer and the results are presented.Complications that have been encountered are discussed.

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Résumé La prothèse de genou GSB est brièvement décrite. Ses principales caractéristiques sont les suivantes: il s'agit d'une articulation à charnière avec un axe de rotation polycentrique et la charge est répartie sur une large surface portante condylienne. Un observateur indépendant a revu et analysé 224 cas opérés depuis 6 ans. Ces résultats sont présentés.Les complications survenues sont également discutées.

     

Gaze bias both reflects and influences preference

Emotions operate along the dimension of approach and aversion, and it is reasonable to assume that orienting behavior is intrinsically linked to emotionally involved processes such as preference decisions. Here we describe a gaze 'cascade effect' that was present when human observers were shown pairs of human faces and instructed to decide which face was more attractive. Their gaze was initially distributed evenly between the two stimuli, but then gradually shifted toward the face that they eventually chose. Gaze bias was significantly weaker in a face shape discrimination task. In a second series of experiments, manipulation of gaze duration, but not exposure duration alone, biased observers' preference decisions. We thus conclude that gaze is actively involved in preference formation. The gaze cascade effect was also present when participants compared abstract, unfamiliar shapes for attractiveness, suggesting that orienting and preference for objects in general are intrinsically linked in a positive feedback loop leading to the conscious choice.     

Illness representations according to age and effects on health behaviors following coronary artery bypass graft surgery

OBJECTIVES: To determine if illness representations differ as a function of age and how these representations, in conjunction with age, predict postoperative health behaviors. DESIGN: Prospective study of patients undergoing coronary artery bypass graft (CABG) surgery. SETTING: A large metropolitan hospital providing regional cardiac care for patients in a tri-state area, located in Pittsburgh, Pennsylvania. PARTICIPANTS: All consenting patients (N = 309) from a consecutive series of patients scheduled for CABG surgery between January 1992 and January 1994. To be eligible for participation, patients could not be scheduled for any other coincidental surgery (e.g., valve replacement), and could not be in cardiac intensive care or experiencing angina at the time of the referral. Participants were predominantly male (70%) and married (80%), and averaged 62.8 years of age. MEASUREMENTS: Postoperative self-reported health behaviors. RESULTS: Older participants awaiting CABG surgery were significantly more likely to believe old age to be the cause of their coronary heart disease (CHD) and significantly less likely to believe genetics, health-damaging behaviors, health-protective behaviors, and emotions to be the cause of their CHD than were younger participants awaiting surgery. Furthermore, the older participants were significantly more likely to believe they had no control over the disease and that the disease would be gone after surgery, and reported fewer postoperative health behavior changes than did younger participants. CONCLUSION: These findings demonstrate significant differences in illness representations as a function of age. Furthermore, differences in postoperative health behaviors were consistent with differing illness representations.     

Orthopedic problems of the upper cervical spine in children and adolescents

Because of relatively low frequency of pathological changes of the upper cervical spine in childhood and adolescence, their management is not well known. Diagnostic problems occur due to the variety of malformations possible, persisting growth plates and ligamentous laxity. Because of this laxity, conservative treatment with immobilization is advocated even in severe dislocations as long as they are reducible. Persistent dislocations, chronic atlantoaxial instability (ADI greater than 5 mm), dens fractures type II and existing or progressing neurological deficits all indicate surgical intervention. Internal fixation allows easier postoperative care. Complications are rare. Patients with orthopedic problems of the upper cervical spine are presented, together with their management.     

Comparative study of cemented and cementless hip prostheses in the same patient

Summary In 20 patients with bilateral total hip replacements a cementless prosthetic implantation on one side and a cemented arthroplasty on the other side were performed. The mean follow-up period was 6 years for the cementless and 7.5 years for the cemented hip. The only significant difference found was concerning pain, which was more frequent on the cementless side. Otherwise we were unable to ascertain a significant difference concerning mobility, walking capacity, complications, and patient assessment. A longer observation time will be required. Where pain relief is concerned, the cemented version will continue to be the gold standard.