Jurnal Reading Dr Aris

7/18/2019 Jurnal Reading Dr Aris

http://slidepdf.com/reader/full/jurnal-reading-dr-aris 1/22

urnal Reading

IRFANI RYAN ARDIANSYAH

G4A014041

Pembimbing : dr ARIS HANDOKO Sp.OT

Clubfoot Etiology, PathoanatomBasic Ponseti Technique, and

Ponseti in Older Patients



Clb!""# $#i"l"g%& P'#("'n'#"m)'*i+ P"n*e#i Te+(ni,e& 'ndP"n*e#i in Older P'#ien#*

)% Al'ri+ Ar""-i*& S(',e Pir'ni& )ibe/& )'n*/"#'& A*Km'r )'n*/"#' d'n D'id A. Spiegel

Gl"b'l Or#("pedi+*



In#r"d+#i"n

•

Clb!""# "r +"ngeni#'l #'lipe* e,in"'r* CT$23 i* ' (ind!""# de!"rmb% m'l'lignmen# '# #(e #'l"+'l+'ne"n'i+l'r +"mple Fig. 54.1 3. Clbe +l'**i ed '* idi"p'#(i+& p"*#r'l& *%ndr"mi+& 'nd ner"l"gi+. T(e +lb!""# i* 'ppr"im'#el% 1 in 1&000 lie bir#(* 6"rld6ide. T(e e#i"l"g%idi"p'#(i+ +lb!""# rem'in* deb'#ed& b# #(e 6eig(# "! eiden+e *ggegene#i+ e#i"l"g%& #("g( #(e in(eri#'n+e p'##ern i* n+le'r. A p"*#r'l de #" in#r'#erine p"*i#i"ning 'nd ei#(er re*"le* *p"n#'ne"*l% "r i*#re'#ed b% gen#le m'nipl'#i"n "r *eer'l +'*#*. S%ndr"me* +"mm"nl%

6i#( +lb!""#• in+lde 'r#(r"gr%p"*i* ml#iple +"ngeni#'l 'nd e'rl% 'mni"#i+ rp#re

"r +"n*#ri+#i"n b'nd *%ndr"me S#ree#er7* d%*pl'*i'3. Clb!""# i* 'l*" *'rie#% "! ner"m*+l'r +"ndi#i"n*& m"*# n"#'bl% m%el"mening"+ele'**"+i'#ed 6i#( *%ndr"mi+ 'nd ner"m*+l'r +"ndi#i"n* #end* #" be m'nd di! +l# #" #re'# 6(en +"mp'red 6i#( idi"p'#(i+ +lb!""#.

•



•

Fig. 54.1 ' 3 An 'mbl'#"r% +(ild 6i#( n#re'+lb!""#. b3 8'l/ing "n #(e l'#er'l b"rder "! #(e+'n le'd #" e+e**ie *("e 6e'r 'nd */in bre'/d



• Fig. 54.9 '3 Clb!""# i* ' (ind!""# de!"rmi#%in"ling m'l'lignmen# be#6een #(e #'l*& +'l+'ne*'nd n'i+l'r C"ngeni#'l Clb!""#& Fnd'men#'l* "! Tre'#men# b% P"n*e#i 1;3 Fig. A p.1<. )% permi**

"! O!"rd =nier*i#% Pre**3. b 3 O**e"* +"mp"nen##(e

• d e!"rmi#% 're ill*#r'#ed "n #(i* m"del. +3 Clini+'l+"mp"nen#* "! #(e de!"rmi#% in+lde 13 +'*mid!""#3& 93 'dd+#* mid!""#3& 53 'r* (ind!""#

'nd 43 e,in* (ind!""#3• 'b



•

Fig. 54.5 ' 3 T(e #'l* m*# be ed in *p'+m'nipl'#i"n 'nd +'*#ing. b3 T(e r*# me#'#'ele'#ed #" +"rre+# #(e mid!""# +'*& 'nd #(e !"re!""# i* 'bd+#ed 6(ile m'in#'ining pre**re #'l*. d 3

•

Abd+#i"n *iml#'ne"*l% +"rre+#* 'dd+#i"n 'nn"#e #(e eer*i"n "! #(e +'l+'ne* 'nd #(e +"rrein#" 'lg* !r"m 'r*



•

Fig. 54.4 ' 3 >"ng leg +'*#* 're 'pplied 6i#( # b 3 pr"gre**iel% 'bd+#ed. On+e !ll 'bd+#i"n'+(ieed& e,in* i* #re'#ed b% +'*#ing "r #end"#en"#"m%



•

Fig. 54.? T 6" di@eren# 6'%* #" ("ld #(e !""# 6'ppl%ing #(e +'*#. T(e di'per *("ld 'l6'%* be r6(en 'ppl%ing #(e pl'*#er #" en*re #('# #(e +'*e#end p #" #(e gr"in



Fig. 54.; T(e +'*# +'n be rem"ed b% r*#*"'/ing in 6'rm 6'#er 'nd #(en gen#l% nr"lling#(e 6e# pl'*#er



•

Fig. 54. ' 3 )e!"re ' per+#'ne"* A+(ille*#en"#"m% i* +"n*idered& #(e (ind!""# m*# be 'bp"*i#i"ned in 'lg* 6i#( !ll p'**ie 'bd+#i"n.

T(e #en"#"m% i*

• per!"rmed 6i#( 'n '**i*#'n# d"r*iB eing #(e !""

m'in#'in #en*i"n "n #(e #end"n. + 3 D"r*iB ei"#(e #en"#"m%. d 3 T(e #"e#"gr"in +'*# i* 6"rn 6ee/*



Fig. 54.< ' & b 3 A !""# 'bd+#i"n "r#("*i*. N"#e

#(e r"nd 6ind"6 '# #(e (eel *" p'ren#* +'n +"nrm #('# #(e (eel i* d"6n in #(e br'+e



•

Fig. 54. ' & b 3 Sb+#'ne"* #r'n*!er "! ##ibi'li* 'n#eri"r #" #(e l'#er'l +nei!"rm



•

Fig. 54.10 ' 3 A ;%e'r"ld 6i#( 'n n#re'#ed+lb!""# 6'* b d 3 *++e**!ll% #re'#ed 6i#( #(P"n*e#i #e+(ni,e



•

Fig. 54.< ' & b 3 A !""# 'bd+#i"n "r#("*i*. Nr"nd 6ind"6 '# #(e (eel *" p'ren#* +'n +"n rm#(e (eel i* d"6n in #(e br'+e



•

Fig. 54. ' & b 3 Sb+#'ne"* #r'n*!er "! ##ibi'li* 'n#eri"r #" #(e l'#er'l +nei!"rm



•

Fig. 54.10 ' 3 A ;%e'r"ld 6i#( 'n n#re'#ed+lb!""# 6'* b d 3 *++e**!ll% #re'#ed 6i#( #(P"n*e#i #e+(ni,e



•

Fig. 54.11 8(ile '3 #(i* p'#ien# i* 'ble #" *,n"rm'll% !"ll"6ing #re'#men#& m'n% ('e #" #ili b 3 m"di ed *,'# #" '++"mm"d'#e per*i*#ee,in*& een 6(en d"r*iB ei"n i* *! +ien# !"'mbl'#i"n

• 'b

Fig. 54.19 ' & b 3 An "lder p'#ien# #re'#ed b% #P"n*e#i me#("d& in+lding 'n "pen #end"'+(ille*leng#(ening !"r *eere e,in*& ('d ' rel'p*e



• T(e p'#("'n'#"m% "! +lb!""# prim'ril% in"le* 'bn"rm'li#ie* in #(e #'l"+'l+'ne"n'i+l'r +"m

+'l+'ne* 'nd n'i+l'r r"#'#ing 'r"nd #(e #'l*. )"#( in#r'"**e"* m"rp("l"gi+3 'nd in#er"**'lignmen#3 'bn"rm'li#ie* 're pre*en# 'nd 're '++"mp'nied b% *"!# #i**e +"n#r'+#re*. Abn"rm'lignmen# 're ill*#r'#ed *ing ' m"del in Fig. 54.9'& b . Clini+'l nding* in+lde 13 mid!""# +''dd+#*& 53 (ind!""# 'r*& 'nd 43 (ind!""# e,in* CA2$3 Fig. 54.9+ 3. T (e #'l* i* *m'lle6i#( medi'l 'nd pl'n#'r dei'#i"n "! #(e (e'd 'nd ne+/. T(e 'n#er"medi'l *r!'+e 'r#i+l'#e* 6n'i+l'r& 6(ile #(e 'n#er"l'#er'l *r!'+e i* n+"ered. P'r'd"i+'ll%& #(e #'l* i* e#ern'll% r"#''n/le m"r#i*e. T(e +'l+'ne* i* 'dd+#ed 'nd iner#ed nder #(e #'l* 'nd ('* d%*pl'*#i+ !'+e#**#en#'+lm #'li i* nderdeel"ped. T(e n'i+l'r i* B '##ened 'nd medi'll% di*pl'+ed rel'#ie(e'd 'nd in *eere +'*e* 'r#i+l'#e* 6i#( #(e medi'l m'lle"l*. T(e +b"id i* medi'll% di*pl'+erel'#ie #" #(e #'l*& 6i#( "bli,i#% '# #(e +'l+'ne"+b"id -"in#. A# #(e 'n/le -"in#& #(e #ibi' 'r#i+#(e m"*# p"*#eri"r p'r# "! #(e #'l*& 'nd in *eere de!"rmi#ie* #(e p"*#eri"r #ber"*i#% "! #(e +'l

#"+( #(e p"*#eri"r *r!'+e "! #(e #ibi'. S"!# #i**e +"n#r'+#re* '++"mp'n% #(e*e 'bn"rm'li#im"rp("l"g% 'nd 'lignmen#. T(e m*+l"#endin"* ni#* "! #(e deep p"*#eri"r +"mp'r#men# #ibB e"r digi#"rm l"ng*& 'nd B e"r ('ll+i* l"ng*3 're +"n#r'+#ed& 6(ile #(e m*+le* "! #(e 'nl'#er'l +"mp'r#men#* #ibi'li* 'n#eri"r& per"ne* l"ng*& 'nd brei*3 're el"ng'#ed. T(e (eel +"'nd +"n#r'+#ed 'nd i* in*er#ed *lig(#l% medi'l "n #(e +'l+'ne*. T(e deep pl'n#'r m*+le* "! #(+"n#r'+#ed& '* 6ell '* #(e 'bd+#"r ('ll+i*. T(e di*#'l #ibi" bl'r -"in#& #(e p"*#eri"r 'nd medi#ibi"#'l'r 'nd *b#'l'r -"in#*& #(e #'l"n'i+l'r -"in#& 'nd #(e +'l+'ne"+b"id -"in# be+"me +"n#r#ime. C"n#r'+#re* "! ml#iple lig'men#* 're *een& in+lding #(e p"*#eri"r #ibi"#'l'r& #'l" bl'r&bl'r& del#"id& 'nd #("*e "n #(e pl'n#'r '*pe+# "! #(e !""# *+( '* #(e *pring lig'men#.



• )'*i+ P"n*e#i Te+(ni,e

• T (e 'im "! +lb!""# #re'#men# i* #" "b#'in ' ! n+#i"n'l& p'in !ree& pl'n#igr'de !""# 6i#( 'de,'#e m"bili#%. Re+"gniEing #('# e#en*ie *"!#

re*l# in *#i@ne** 'nd #(e need !"r 'ddi#i"n'l *rgi+'l pr"+edre*& #(e P"n*e#i me#("d ('* '+(ieed gre'# p"pl'ri#% 6"rld6ide in re+en# %ebe de*+ribed '* e#r''r#i+l'r 'nd minim'll% in'*ie r'#(er #('n n"n*rgi+'l. T(i* me#("d in"le* *eri'l +'*#ing& 6i#( #(e m'-"ri#% "! pper+#'ne"* #en"#"m% "! #(e #end"'+(ille*. >"ng#erm br'+ing i* e**en#i'l #" m'in#'in #(e +"rre+#i"n. Tre'#men# i* ide'll% *#'r#ed *("r#l% 're!err'l i* "!#en del'%ed in *e##ing* 6i#( limi#ed re*"r+e*. $iden+e !r"m b"#( e+"n"mi+'ll% deel"ped 'nd deel"ping +"n#rie* *gge*#* 'pplied b% n"n"r#("pedi+ "r een n"nmedi+'l +'regier* 6i#( g""d re*l#*. T(e /e% +"n+ep# i* #('# #(e #'l'r (e'd *ere* '* #(e !l+rm !m'l'lignmen# i* +"rre+#ed b% r"#'#i"n "! #(e (ind!""# b"ne* 'r"nd #(e #'l*& 6(i+( rem'in* ed in *p'+e Fig. 54.5'3 . In #(e ini#i'l +'*#&d"r*iB eed #" +"rre+# #(e +'* Fig. 54.5b 3. Pr"gre**ie 'bd+#i"n "! #(e !""# i* *ed #" *iml#'ne"*l% +"rre+# 'dd+#* 'nd 'r* Fig.'bd+#i"n i* '+(ieed& #(e 'n/le e,in* i* +"rre+#ed& *'ll% b% ' per+#'ne"* #en"#"m%. >"ng leg +'*#* 're #iliEed '# 'll *#'ge* "! +'*#inm"re rel'ed #(e +(ild& #(e e'*ier #(e +'*#ing& 'nd i# i* pre!er'ble #" ('e #(e +(ild bre'*# !eed immedi'#el% pri"r #" 'nd dring +'*#ing. An ("lding #(e !""# 'nd pper #(ig(. 8i#( #(e p'#ien# *pine& #(e per*"n m'nipl'#ing #(e !""# *#'biliEe* #(e leg '# "r 'b"e #(e m'lle"li 6i#("+'l+'ne*. T(ere 're #6" +"mm"nl% *ed ('nd p"*i#i"n*& depending "n 6(i+( ('nd i* *#'biliEing #(e leg 'nd 6(i+( i* ("lding #(e m'nipl'#inde nger p#* pre**re "n #(e l'#er'l *ide "! #(e #'l'r (e'd 6(ile #(e #ip "! #(e #(mb ele'#e* #(e r*# r'% 'nd 'bd+#* #(e !"re!""#. Inp"*i#i"n& #(e #(mb p#* pre**re "n #(e (e'd "! #(e #'l* 6(ile #(e inde nger d"r*iB ee* #(e r*# r'% 'nd 'bd+#* #(e !""# Fig. 54.? 3

• )e+'*e #(e n'i+l'r i* medi'll% di*pl'+ed 'nd i#* #ber"*i#% i* 'lm"*# in +"n#'+# 6i#( #(e medi'l m'lle"l*& "ne +'n !eel #(e pr"minen# (e'd '* #(e r*# b"n% pr"minen+e& -*# 'n#er"l'#er'l #" #(e l'#er'l m'lle"l*. Dring #(e r*# +'*#ing& #(e mid!""# +'* i* +"rre+#ed b% d"

me#'#'r*'l& 6(i+( *pin'#e* #(e !"rep'r# "! #(e !""# 'nd 'lign* #(e !"re!""# 6i#( #(e (ind!""#& 6(i+( rem'in* in 'r*. T(e !""# *("ld neerin+re'*e* #(e +'* 'nd l"+/* #(e +'l+'ne* in 'r*. D ring #(e ne# *eer'l +'*#*& #(e !"re!""# i* pr"gre**iel% 'bd+#ed rel'#ie #" #(e (*iml#'ne"* +"rre+#i"n "! #(e 'dd+#* 'nd 'r*. C're *("ld be #'/en #" /eep pre**re "n #(e regi"n "! #(e #'l'r (e'd dring m'nipl'#"#(er6i*e #(e #'l* 6ill r"#'#e l'#er'll% '* #(e !""# i* 'bd+#ed& p*(ing #(e l'#er'l m'lle"l* p"*#eri"rl%& re*l#ing in *pri"* +"rre+#i"n. T(mild pl'n#'r B ei"n dring #(i* ini#i'l *erie* "! +'*#*& le'ing +"rre+#i"n "! e,in* n#il l'#er +'*#ing*. Ini#i'll%& ' bel"6/nee +'*# i* 'pplie+"mple#ed& #(i* i* e#ended #" 'n 'b"e/nee +'*#. T(e +'*# m*# e#end #" #(e gr"in& '* *("r# leg +'*#* d" n"# ("ld #(e +'l+'ne* 'bd+#eb'+/ in #(e +'*#. Rem"'l "! #(e +'*# *("ld be d"ne '# #(e #ime "! +'*# +('nge 'nd n"# #(e nig(# pri"r. S"'/ing 'nd n6r'pping #(e pl'*#e+(ild!riendl% #('n *ing ' +'*# *'6 "r +'*# /ni!e Fig. 54.; 3. T(e p'ren#* 're #'g(# #" /eep #(e pl'*#er dr% 'nd +le'n 'nd #" e'mine #(e #bli*( di*+"l"r'#i"n #('# mig(# indi+'#e #('# #(e +'*# i* #"" #ig(#. T (e g"'l i* 0 'bd+#i"n& 6(i+( *'ll% re,ire* #(ree #" *i +'*#*. On+#(e (eel i* in 'lg*& #(e re*id'l e,in* i* 'ddre**ed. A##emp#* #" +"rre+# #(e e,in* be!"re (eel 'r* 'nd !"re!""# *pin'#i"n 're +"rr"+/erb"##"m de!"rmi#%. T'/e +'re #" '"id e#ern'l r"#'#i"n "! #(e #ibi'l 'i*& 6(i+( +'n '+(iee *pr i"* +"rre+#i"n b% p*(ing #(e l'#er'l A #en"#"m% "! #(e #end"'+(ille* i* re,ired !"r re*id'l e,in* 'n/le d"r*iB ei"n J103 in 'ppr"im'#el% 0 "! p'#ien#* "n+e #(e



• "#(er +"mp"nen#* "! #(e de!"rmi#% 're +"rre+#ed Fig. 54. 3. Tend"'+(ille*

+'n be per!"rmed nder l"+'l "r /e#'mine 'ne*#(e*i' in #(e "#p'#ien# +lini+. Td"r*iB eed b% #(e '**i*#'n#& /eeping #(e /nee in e#en*i"n& m'/ing #(e #end"i* e'*il% p'lp'#ed '# i#* in*er#i"n. T(e *+'lpel bl'de i* in#r"d+ed 'ppr"i

• m'#el% 1 +m 'b"e #(e in*er#i"n 'nd dire+#ed !r"m medi'l #" l'#er'l. T(e bl'de0 #" rem'in ("riE"n#'l "n #(e 'n#eri"r *r!'+e "! #(e #end"n& m'/ing #(e #enin*ide #" "#. A *dden p"p i* !el# 'l"ng 6i#( 'n in+re'*e in d"r*iB ei"n. A dre+"mpre**i"n b'nd'ge i* 'pplied& 'nd #(e +(ild i* immedi'#el% ('nded #" (i*L(e!eeding. On+e #(e +(ild be+"me* p'+i ed 'nd #(e bleeding *#"p*& ' #"e#"gr"'pplied 6i#( #(e !""# in m'imm d"r*iB ei"n *'ll% 1? "r m"re b# neer;0 " 'bd+#i"n. T(i* +'*# i* 6"rn !"r 5 6ee/*& '!#er 6(i+( 'n 'bd+#i"n "r#("*)r'+ing i* re,ired #" m'in#'in +"rre+#i"n 'nd m'n% br'+e de*ign* 're ''il'b+"mm"n i* ' p'ir "! "pen#"ed (ig(#"p *#r'ig(#l'*# *("e* '##'+(ed #" ' b'r T(e br'+e i* *e# '# ;00 'bd+#i"n !"r #(e +lb!""# *ide 'nd 5040 'bd+#i"n"rm'l *ide. T(e 6id#( "! #(e b'r i* #(e *'me '* #(e *("lder 6id#(. T(e b'r *ben# ?10 in #(e +en#er& 6i#( #(e +"nei#% '6'% !r"m #(e +(ild& #" ("ld #(e !ed"r*iB ei"n. A *m'll 6ind"6 +# '# (eel



• leel 'll"6* #(e p'ren#* #" *ee 'nd !eel #('# #(e (eel d"e* n"# ri*e p in*ide #(e *("e. )r'+ing 6"r/* "

!ll +"rre+#i"n 6i#("# re*id'l e,in* ('* been '+(ieed& #(e br'+e i* +"m!"r#'ble& 'nd #(e p'ren#* m'in#'in ' r"#ine !"r i#* 'ppli+'#i"n. I # i* "!#en be*# #" pl'+e #(e +(ild in #(e br'+e pri"r #" bed#ime#(e *'me #ime #(e +(ild i* p# #" *leep. T(e br'+e *("ld be 6"rn d'% 'nd nig(# !"r #(e r*# 5 m"n#(!"r 19 ( '# nig(# 'nd 94 ( in #(e middle "! #(e d'% !"r ' #"#'l "! 141; ( ' d'%. T(i* pr"#"+"l +"n#inei* 4? %e'r* "! 'ge. Rel'p*e* 're *een in 'ppr"im'#el% 1? "! +'*e*. $'rl% rel'p*e* 're #re'#ed b% en#ire P"n*e#i +'*#ing& #en"#"m%& 'nd br'+e *e,en+e. >'#e rel'p*e*& #%pi+'ll% '!#er 9 %e'r* "! 'ge& "!m*+l'r imb'l'n+e de #" "er pll "! #(e #ibi'li* 'n#eri"r. In *+( +'*e*& #(e P"n*e#i me#("d i* repe'!ll 'bd+#i"n i* '+(ieed& p'#ien#* #%pi+'ll% re,ire ' repe'# #en"#"m% 'nd #(e #ibi'li* 'n#eri"r #end"#(e #(ird +nei!"rm Fig. 54. 3. >"ng#erm br'+ing i* n"# re,ired !"ll"6ing #ibi'li* 'n#eri"r #r'n*!er.

• P"n*e#i in Older P'#ien#*

• T ("*'nd* "! +(ildren 'nd 'dl#* in l"6 'nd middlein+"me +"n#rie* >MIC*3 !'+e #(e brden "! 'n

negle+#ed +lb!""# be+'*e "! de +ien+ie* in '++e** #" "r #iliE'#i"n "! (e'l#( *eri+e*. 8(ile #(e p+"n*e,en+e* "! 'n n#re'#ed +lb!""# in+lde in'bili#% #" 6e'r *("e*& p'in& 'nd imp'ired 'mbl'#i"n*"+i'l 'nd +l#r'l +"n*e,en+e* 'dd 'n"#(er dimen*i"n "! di*'bili#%. 8(ile *++e**!l re*l#* *ing #(me#("d ('e been d"+men#ed 6"rld6ide in p'#ien#* le** #('n 9 %e'r* "! 'ge& i# rem'in* n+le'r 6(+'n be "b#'ined in "lder p'#ien#* "r 6(e#(er #(e me#("d +'n red+e #(e m'gni#de "! *rger% re,ire+"rre+#i"n. 8(ile +"rre+#i"n i* '+(ieed #(r"g( pr"gre**ie *#re#+(ing "! +"n#r'+#ed *"!# #i**e*& +"nrem"deling "! #(e +("ndr""**e"* *#r+#re* i* re,ired !"r perm'nen# +"rre+#i"n. Ane+d"#'l eperie#('# rem"deling "! #(e "*#e"'r#i+l'r *r!'+e* i* le** reli'ble in p'#ien#* "lder #('n 'ppr"im'#el% < %



• e+"gniEing #('# #(e P"n*e#i me#("d 6'* deel"ped !"r b'bie*& *eer'l 'd'p#'#i"n* ('e been #iliEed

p'#ien#*. =p #" 19 +'*#* m'% be re,ired 6i#( e'+( +'*# l'*#ing 9 in*#e'd "! 1 6ee/. T(i* re,ire* ' +"+"mmi#men#. 8(ile 0 'bd+#i"n i* #(e g"'l 6(en #re'#ing in!'n#*& "nl% 90?0 *("ld be epe+#ed T(e "p#im'l #re'#men# !"r e,in* ('* %e# #" be e*#'bli*(ed& 'nd 6(ile per+#'ne"* #en"#"m% ('* bper!"rmed in p'#ien#* p #" 11 %e'r*& 'n "pen #end"'+(ille* leng#(ening 6i#( "r 6i#("# p"*#eri"r relere,ired. 8(en 'de,'#e d"r*iB ei"n i* n"# '+(ieed '!#er per+#'ne"* rele'*e& *eri'l +'*#ing m'% +"rre+#i"n. Seere mid!""# +'* i* di! +l# #" +"rre+# 6i#( +'*#ing 'nd +'n re,ire pl'n#'r !'*+i' relei**e *rr"nd* #(e *e "! 'n "r#("*i* #" m'in#'in +"rre+#i"n in #(e "lder p'#ien#*. 8(ile 'mbl'#"r% pr'rel% 'd(ere #" !ll #ime *("e 'nd b'r 'bd+#i"n *plin#ing "n+e #(e l'*# +'*# i* rem"ed& m"*# '#("*"me #%pe "! *plin#ing 'bd+#i"n *plin#& 'n/le !""# "r#("*i*3 #" preen# re+rren+e '# le'*# n#il #(e +"ld& '* 'di*ed in #(e "rigin'l P"n*e#i me#("d '* 'pplied #"

• in!'n#*. In p'#ien#* "lder #('n ? %e'r*& nig(##ime *plin#ing !"r 1 %e'r +'n be +"n*idered. Fr#(er *#d%'ddre** #(e*e #e+(ni+'l +"n+ern*. T(e !e6 ''il'ble rep"r#* +"n+erning 'ppli+'#i"n "! P"n*e#i prin+ip"lder #('n 9 %e'r* *gge*# #('# ' pl'n#igr'de !""# +'n be '+(ieed in m'n% p'#ien#* p #" 10 %e'r* "54.10 3. M"*# p'#ien#* ('e mild re*id'l e,in*& 6(i+( m'% +re'#e #(e need !"r ' m"di ed *,'#in B ""r +l#re* Fig. 54.113 . T(e rel'p*e r'#e +'n be '* (ig( '* 9? in #(e*e "lder p'#ien#* Fig. 'ddi#i"n'l *rgerie* 're "!#en re,ired. Re+"gniEing #('# '"iding e#en*ie in#r' 'r#i+l'r *rger%#erm "#+"me* in #(e*e "lder p'#ien#* m*# be '**e**ed rel'#ie #" 'l#ern'#ie #re'#men#*& *+( '* *"rele'*e* 6i#( "r 6i#("# "*#e"#"m%& #riple 'r#(r"de*i*& 'nd gr'd'l +"rre+#i"n *ing 'n e#ern'l '#ee#en*ie *rger% 6ill be re,ired& "r 'ne+d"#'l eperien+e *gge*#* #('# +'*#ing red+e* #(e e#enpr"+edre*& *#re#+(e* #(e medi'l */in red+ing #(e ri*/ "! */in bre'/d"6n& 'nd 'll"6* !"r +'ll*e* 'nd T(i* i* ' 6"r/ in pr"gre**.

Jurnal Reading Dr Aris

Documents