Angelchik Antireflux Prosthesis—Its Usefulness and Review of Literature

In the last 12 months, two patients with severe reflux esophagitis intractable to conventional medical therapy were treated with surgical implantation of Angelchik prosthesis. Both patients improved. The cases are discussed and literature reviewed.     

Human immunodeficiency virus-related conditions in children and adults with hemophilia: rates, relationship to CD4 counts, and predictive value

To further elucidate the natural history of human immunodeficiency virus (HIV) infection, we studied intermediate HIV-related conditions occurring before acquired immunodeficiency syndrome (AIDS) in a prospectively observed multicenter cohort of 738 HIV-infected persons with hemophilia. We analyzed the frequency in adults and children of common HIV-related conditions and the relative risk of AIDS after occurrence of these conditions, controlling for age at seroconversion and the percentage of CD4+ lymphocytes. Thrombocytopenia was the most frequently observed condition with cumulative incidences of 43% +/- 7% in adults and 27% +/- 6% in children and adolescents by 10 years after seroconversion. Oral candidiasis, fever, weight loss, and non-AIDS pneumonia were two to four times more common in adults than children, whereas herpes zoster risk was similar in the two age groups. HIV- related conditions were infrequent during the first 4 years of infection, particularly in children. With the exception of thrombocytopenia, mean CD4 counts were less than 350 cells/microL at the onset of the conditions. The relative hazard of AIDS after oral candidiasis was 18 in children and 3.8 in adults. Relative hazard in adults was also increased after persistent fever (10), weight loss (3.2), and non-AIDS pneumonia (2.2). Herpes zoster and thrombocytopenia were not significantly associated with AIDS in either age group. We conclude that intermediate HIV-related conditions occur more frequently in adults than in children with hemophilia. Persistent fever is the strongest predictor of AIDS in adults, whereas oral candidiasis is the strongest predictor in children. These findings should facilitate the design and conduct of clinical trials as well as the management of HIV- infected children and adults.     

Can total knee arthroplasty be safely performed in patients with chronic renal disease?: An evaluation of perioperative morbidity in 2,686 procedures from a Total Joint Replacement Registry

Background and purpose

The prevalence of chronic renal disease (CRD) is rising worldwide. Patients with CRD are more likely to have associated medical problems and are at greater risk of postoperative morbidity and mortality. We evaluated patient characteristics and risk of early revision, surgical site infection (SSI), thromboembolic events, mortality, and re-admission of patients with CRD undergoing total knee arthroplasty (TKA). We hypothesized that this patient population would have higher rates of complications.

Patients and methods

We conducted a retrospective analysis of data that had been prospectively collected by a Total Joint Replacement Registry. All primary TKAs performed from 2005 through 2010 were included. 41,852 primary TKA cases were evaluated, of which 2,686 (6.4%) TKA procedures had been performed in CRD patients. Patient characteristics, comorbidities, and general health status were evaluated. Cox proportional hazard regressions and logistic regressions were used to evaluate the association of CRD with outcomes while adjusting for confounding variables.

Results

The mean age of the CRD cohort was 67 years and approximately two-thirds of the patients were female. The median follow-up time was 2.1 years. Compared to TKA patients without CRD the CRD patients were older, had poorer general health, and had a higher prevalence of comorbidities. They had a higher incidence of deep SSI (0.9% vs. 0.7%), superficial SSI (0.5% vs. 0.3%), deep vein thrombosis (0.6% vs. 0.4%), any-time mortality (4.7% vs. 2.4%), 90-day mortality (0.4% vs. 0.2%), and 90-day re-admission (10% vs. 6.0%) than patients without CRD. However, after adjustment for confounding variables, CRD patients were at 1.9 times (95% CI: 1.1–3.5) increased risk of superficial SSI, 1.3 times (CI: 1.1–1.6) increased risk of re-admission within 90 days, and 1.5 times (CI: 1.2–1.8) increased risk of mortality at any point after the procedure. The risks of all other complications were not statistically significantly different in patients with CRD compared to patients without CRD.

Conclusions

CRD patients undergoing TKA have more comorbidities and a higher risk for superficial SSI, 90-day re-admission, and any-time mortality.The Centers for Disease Control and Prevention (CDC) has estimated that the prevalence of chronic renal disease (CRD) is 35% in adults with diabetes and greater than 40% in individuals over the age of 60 (Collins et al. 2011). The degree of renal dysfunction in CRD is graded in 5 stages. Stages 3–5 represent individuals who have lost at least half of normal adult renal function. Impaired renal function of this degree is related to the dysfunction of multiple organ systems, and its effect on the health of an individual is well documented (CDC 2010, Collins et al. 2011). This detrimental effect has been manifested in a growing percentage of the population, with the number of individuals suffering from end-stage renal disease (ESRD) rising by 600% over the last 30 years (CDC 2010).In studies that have investigated outcomes of arthroplasty in individuals with ESRD (Lieberman et al. 1995, Sunday et al. 2002, Shrader et al. 2006, Debarge et al. 2007, Garcia-Ramiro et al. 2008), higher mortality rates, infection rates, and revision rates were reported. However, these studies focused on total hip arthroplasty (THA), and ESRD patients constitute only 3% of all patients with chronic renal insufficiency (Collins et al. 2011). Patients with ESRD, the most advanced form of CRD, are usually in need of kidney replacement therapy (dialysis or transplantation). To our knowledge, no published studies have examined the effects of CRD on total knee arthroplasty (TKA) when performed in a population of individuals suffering from a wide range of stages of renal dysfunction.There is evidence to suggest that less advanced forms of the disease may have an appreciable effect on individuals undergoing TKA surgery. Patients with CRD are more likely to have associated medical problems (Go et al. 2004), the disease is a risk factor for postoperative complications (Shorr et al. 2012), and the impact of renal impairment on patients undergoing orthopedic procedures has been documented (Lejus et al. 2012, Pumberger et al. 2012). Furthermore, arthroplasty patients have previously been shown to have reduced renal function as they recover from this surgery (Nergelius et al. 1997).Here we describe patient characteristics and surgical outcomes of patients with CRD who underwent TKA, and we evaluate association of CRD with the surgical outcomes of TKA procedures in a community-based sample of patients. We hypothesized that CRD patients undergoing TKA would have higher rates of perioperative complications, of re-admission, and of early implant revision.     

Multidrug resistance protein and glutathione S-transferase P1-1 act in synergy to confer protection from 4-nitroquinoline 1-oxide toxicity

Model cell lines developed from MCF7 breast carcinoma cells were used to examine the roles of glutathione S-transferase P1-1 (GSTP1-1) and multidrug resistance protein (MRP) in the protection of cells from 4- nitroquinoline 1-oxide (4NQO) toxicities. Increased expression of GSTP1- 1 alone in MCF7 cells results in limited protection from the formation of 4NQO-derived covalent adducts of nucleic acids but affords no protection from 4NQO-mediated cytotoxicity. Increased expression of MRP alone conferred modest protection while co-expression of GSTP1-1 with MRP produced high-level protection from both 4NQO-derived adduct formation and 4NQO cytotoxicity. This synergistic resistance to 4NQO toxicities (both nucleic acid adduct formation and cytotoxicity) is associated with a GSTP1-1-dependent increase in 4NQO-glutathione (QO- SG) conjugate formation and a MRP-dependent increase in QO-SG efflux. These data indicate that MRP is an important export transporter for the glutathione conjugate of the carcinogen, 4NQO. Moreover, this MRP- dependent efflux activity is necessary to achieve the full protection from 4NQO toxicity-protection that is potentiated by GSTP1-1-mediated QO-SG formation.      

Psychosocial assessment of children with short stature: a preliminary report

Previous studies that have examined the psychosocial adjustment of children with short stature have often been flawed, for two main reasons: first, a lack of sample homogeneity and, secondly, the measures of adjustment used have been limited in terms of their sensitivity. This paper examines psychological functioning in the following four broad areas: cognition, social behaviour, emotional adjustment and self-concept. A sample of children referred to growth clinics (mean height below -2 SDS) and a comparison group, recruited from the referred childrens'classes at school, were assessed. Children were prepubertal (age range, 6-11 years) and had no organic cause for their short stature. Parent, teacher and peer reports were used in the assessment, which included sociometric measures in the classroom. The children with short stature described themselves as equally well supported as the comparison children in terms of social support by parents, teachers, peers and friends. Peers reported the short children to be well accepted within their class. Compared with control children, there was a trend for short children to be described by their peers as socially better adjusted than average. Teacher and parental accounts revealed significant group differences in terms of reported behaviour, with poorer attention and more thought problems among the children with short stature. Further analysis suggested, however, that their slightly lower IQ than children of normal height (95.8 ± 18.7 (mean ± SD) compared with 105 ± 15.4) accounted for a greater proportion of the variance in these findings than short stature per se. There is little evidence to indicate that short prepubertal children are psychosocially maladjusted. Their academic performance was poorer than expected on the basis of their cognitive abilities. Reports of immature and impulsive behaviour may not be applicable to a sample of children not referred to a growth clinic.     

Pulmonary function in infants with cystic fibrosis: the effect of antibiotic treatment

Since 1982 all infants born within the East Anglian Regional Health Authority have been screened for cystic fibrosis. Between April 1985 and April 1992 infants identified in this way have been entered into a randomised prospective controlled trial of antibiotic prophylaxis. Approximately half the infants received continuous oral flucloxacillin and the remainder received antibiotics when clinically indicated. Infants underwent tests of respiratory function at 3-4 months and at 1 year of age. Measurements of thoracic gas volume and airway conductance were made with an infant whole body plethysmograph, and maximum expiratory flow by the 'squeeze' technique. A total of 73 tests was performed of 42 infants. To facilitate comparisons, measurements were expressed as scores. The mean values of the scores for the two groups of infants fell within normal limits. There was no difference between the treatment groups at either age. A reduction in airways conductance was observed between the two tests.     

Lung function after allogeneic bone marrow transplantation for leukaemia or lymphoma

Longitudinal data were analysed on the lung function of 25 of 29 survivors of childhood leukaemia or lymphoma, who had been conditioned with cyclophosphamide and total body irradiation before allogeneic bone marrow transplantation, to test whether children are particularly vulnerable to pulmonary damage after transplantation. None developed chronic graft-versus-host disease. Transfer factor and lung volumes were reduced immediately after bone marrow transplantation, but increased during the following years. However, at the last follow up, 4-13 years (median 8) after transplantation, patients had significantly reduced transfer factor, total lung capacity, and forced vital capacity (-1.0, -1.2, and -0.8 SD score, respectively), and increased ratio of forced expiratory volume in one second to forced vital capacity (+0.9 SD score). None of the patients had pulmonary symptoms, and changes were unrelated to their age at bone marrow transplantation. In conclusion, patients had subclinical restrictive pulmonary disease at a median of eight years after total body irradiation and allogeneic bone marrow transplantation.     

Growth versus stability: older primiparous women as a paradigmatic case for persistence

The early pregnancy experience of women over 30 offers paradigmatic evidence which supports the significance of persistence for the study of nursing phenomenon Pregnancy and first-time motherhood have come to be associated with change, growth and development This research, which was undertaken to describe the changes experienced by older primiparous women during early pregnancy, illustrates how research grounded in a particular paradigm, in this case the growth or developmental paradigm, can limit the interpretation of data When viewed from a developmental perspective, women in this sample were seen as resistant to change and could be said to be having trouble 'adapting' to their impending motherhood However, when these women were viewed from the perspective of stability they were seen to engage in activities that allowed them to persist in their current self-view In the biological sciences, persistence refers to a compensatory process which allows a system to maintain goal-directedness in spite of both internal and external disturbances Women in this sample used balancing and buffering to continue their self-patterns Balancing represented the verbal and behavioural processes women engaged in to integrate their experience of themselves as pregnant into their sense of themselves as not pregnant Buffering included those activities that women used to maintain a sense of themselves in the face of the threat posed by their impending motherhood Balancing and buffering represent mechanisms used in the service of persistence and reflect pattern maintenance activities