Effect of rotational alignment on patellar tracking in total knee arthroplasty

Forty-four consecutive patients (65 knees) who underwent identical condylar type total knee arthroplasty were evaluated retrospectively. In 22 of the patients (32 knees), the femoral component was set parallel to the posterior condylar axis (neutrally aligned group). In the remaining 22 patients (33 knees), it was set in an external rotation position of 3 degrees to 5 degrees relative to the axis (externally aligned group). Of the total knee arthroplasties in the neutrally aligned group, 34% required lateral release, compared with only 6% in the externally aligned group; patellar tracking in the externally aligned group was significantly better than that in the neutrally aligned group. Postoperative measurements performed using computed tomography scans showed that the mean angle between the prosthetic posterior condylar axis and the transepicondylar axis was 7.9 degrees in the neutrally aligned group and 3.2 degrees in the externally aligned group. The external rotation setting of the femoral component diminished the need for lateral retinacular release and may decrease the rate of patellofemoral complications that occur after total knee arthroplasty.     

Validation of a quality of life questionnaire for critically ill patients

Objective Development and validation of quality of life questionnaire for critical care patients.Design Prospective study.Setting Intensive care unit (ICU) of a general hospital and ICUs of 83 Spanish hospitals.Sample Patients admitted to the ICU>18 years of age; close family members.Method A committee of experts designed a questionnaire with characteristics judged essential for intensive care use: easy, quick administration (5–10 min); capable of completion by patient or close family member, by direct or telephone interview. Fifteen items relevant to critical care patients were grouped in three subscales: basic physiological activities, normal daily activities, and emotional state. Reproducibility of interobserver, intraobserver, patient/family member and telephone/direct interviews was analysed and also internal consistency, responsiveness, and main components.Results Internal consistency (578 patients): Cronbach's alpha coefficient=0.85. Reproducibility: intraobserver reproducibility (n=150): Spearman correlation coefficient=0.92. Interobserver (n=85); correlation=0.92. Patient/family member (n=81): correlation=0.92. Telephone/direct interview (n=54): correlation=0.96. Validity: factorial analysis confirmed that the three subscales were fundamental questionnaire components. There was good concordance between questionnaire/subscale and Glasgow Outcome Scale (GOS) results. Responsiveness: quality of life score changes between preadmission and 6 months' postdischarge correlated with GOS findings (weighted kappa index=0.56).Conclusions Questionnaire meets objectives recommended for critical care use, and fulfills essential requirements of validity and reproducibility when applied to critically ill patients.This study forms part of the PAEEC (Project for the Epidemiological Analysis of Critical Care Patients), and was supported by a grant from the Fondo de Investigaciones Sanitarias (F.I.S.-91/0703), and by the Granada University Research Group (Number 3244)     

Chronic, Habitual Cocaine Abuse and Kindling-Induced Epilepsy: A Case Report

Kindling has been suggested as a possible mechanism for cocaine-induced seizures in chronic cocaine abusers, even though no convincing examples have been reported. We report a 37-year-old woman who initially experienced generalized tonic-clonic seizures (GTC) only immediately after "crack" use. She had a normal examination, negative family or past history for seizures, and normal cranial computed tomography and EEG. After she had abused cocaine almost daily for 2 years, her EEG demonstrated bitemporal slowing with independent spikes, and seizures were no longer temporally associated with acute cocaine use. Thereafter, despite complete abstinence from cocaine and treatment with phenytoin, she continued to experience four to six GTC a month. In light of the lack of other predisposing factors for epilepsy, this case may represent an example of cocaine-induced kindling in humans.     

Persistent human herpesvirus 8 viremia before Kaposi's sarcoma development in a liver transplant recipient

HHV8 DNA has been detected in essentially all Kaposi's sarcoma (KS) lesions investigated, including those associated with transplantation. However, the possibility of human herpesvirus 8 (HHV8) detection in serum before appearing in the tumor is unknown. We therefore studied the natural history of HHV8 infection in a liver transplant recipient who developed KS 9 months after receiving the hepatic allograft. The presence of HHV8 DNA was retrospectively analyzed by using polymerase chain reaction in frozen stored follow-up serum specimens and KS tissues (skin and lymph node biopsies). Although KS was diagnosed the day +279 posttransplant by histopathological examination of KS tissues, retrospective analysis showed that HHV8 DNA was present in all successive serum specimens taken from the day +119 onward. Accordingly, asymptomatic and persistent HHV8 viremia may precede the appearance of typical KS lesions. Monitoring transplant recipients for HHV8 could be useful for developing therapeutic and prophylactic strategies.     

Cranial CT interpretation by senior emergency department staff

The aims of the present study were to determine the rate of misinterpretation of non‐contrast cranial CT scans by emergency specialists and trainees compared with specialist radiologists, and the proportion of misinterpretations that is consequential. A 12‐month prospective blinded cohort study was performed. One‐hundred and ninety of 1282 scans (14.8%) were misinterpreted, and 78 of these (41.1%) were of potential or actual consequence. We conclude that the performance of senior emergency department staff in non‐contrast cranial CT interpretation is no better than moderately good, and a large proportion of misinterpretations are of potential or actual clinical consequence.     

Angiogenesis in the bone marrow of patients with breast cancer.

PURPOSE: Pathologic angiogenesis has been correlated with tumor growth, dissemination, metastasis, and prognosis in solid tumors including breast cancer. Angiogenesis has also been implicated in the pathophysiology of, and shown to be a therapeutic target in tumors arising in the bone marrow. The status of angiogenesis in the bone marrow of breast cancer patients is unknown. The aim of this study was to estimate the extent of bone marrow angiogenesis in this subset of patients. EXPERIMENTAL DESIGN: We studied 42 women with breast cancer in whom a bone marrow biopsy was done. Bone marrow samples were sorted according to their infiltration status by breast cancer cells. In all bone marrow sections, blood vessels were highlighted by staining endothelial cells with an antibody directed against the CD34-related antigen. A hematopathologist blind to the status of infiltration of breast cancer did the bone marrow vessel count. RESULTS: Nineteen patients (45%) had bone marrow metastasis. The bone marrow microvessel density was significantly higher in patients with bone marrow metastases compared with patients without bone marrow metastases (P < 0.0005). Median bone marrow microvessel density was 2 for the negative bone marrow group, and 15 for the positive bone marrow group. An increased microvessel density was correlated with presence of disease at last follow-up. CONCLUSIONS: This is the first study showing that bone marrow microvessel density is significantly higher in breast cancer patients with bone marrow metastases, when compared with breast cancer patients without evidence of bone marrow metastatic disease. Further research is needed to shed light into the prognostic and therapeutic relevance of this finding.