The Nebraska medical journal
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Case Reports Comparative Study
Screw fixation for odontoid fracture; a comparison of the anterior and posterior technique.
Surgical treatment of atlantoaxial instability resulting from Type II odontoid fracture has evolved in recent years with newer approaches offering the surgeon more options. Our experience with anterior odontoid screw fixation and transarticular C1-2 fusion has exposed us to complications, indications, and contraindications different from those of more traditional posterior arch fixation and fusion procedures. The value and versatility of these two approaches were recently demonstrated in one case: a patient with a Type II odontoid fracture was treated with anterior odontoid screw fixation, suffered a second injury with dislocation and neurologic deficit and responded well to transarticular C1-2 fusion with decompression. A description of our surgical technique and a comparison of the two procedures is presented.
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A patient with unilateral bronchiolitis obliterans organizing pneumonia (BOOP) is described in this report. The disease responded well to glucocorticoid therapy, as is characteristic. Although BOOP is being more frequently recognized as bilateral disease to the best of our knowledge, only three previous cases of unilateral disease have been recognized and reported.
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The treatment of displaced intraarticular fractures of the calcaneus continues to challenge the orthopaedic community. The recent development of prognostic classification systems based on computerized tomography has clarified the roles of non-operative and operative treatment. It has also opened the door for further prospective study of the appropriate treatment of this injury and comparison of operative methods. Based on current literature and our experience, we recommend CT evaluation of all intraarticular fractures of the os calcis in patients who are operative candidates with treatment guided by fracture classification.
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The risk of prematurity, stillbirth, small for gestational age, and central nervous system damage are clearly a consequence of maternal cocaine use during pregnancy. There is also the risk of concommitent use of alcohol which may cause long term developmental problems. ⋯ It is important not to be too pessimistic about the term infant exposed to cocaine since it may lead to a "self-fulfilling prophecy". Supporting the cocaine exposed child and their family is an important task for all health professionals who deal with children.