Open reduction for developmental dysplasia of the hip: failures of screening or failures of treatment?

Introduction

The aim of this study was to define the clinical indications and demographic characteristics of patients undergoing open reduction for developmental dysplasia of the hip (DDH), and determine the proportion due to preventable failures of contemporary clinical screening and early management.

Methods

Case notes were reviewed of consecutive primary open reductions performed for non-teratologic hip dislocation at the Great Ormond Street Hospital for Children over a five-year period. Forty-eight patients (64 hips) were suitable for inclusion. A telephone survey confirmed selective hip ultrasonography screening protocols were employed in all maternity hospitals in our referral base.

Results

There were no cases of open reduction for unilateral DDH following Pavlik treatment commenced by six weeks of age, highlighting the importance of early detection and treatment. Eleven cases (23%) may have been avoided by appropriate implementation of existing selective ultrasonography screening protocols. Thirty-four cases (71%) presented after four months of age, suggesting open reduction is associated with late diagnosis rather than failure of primary management. None of these patients had neonatal hip ultrasonography and only 12% (4 patients) had a risk factor that should have triggered a scan.

Conclusions

Compared with published results, the contemporary screening practices in our referral base are failing to eliminate late presenting DDH and the need for open surgical reduction. Changes in strategy and implementation are required to significantly improve screening efficacy.     

New method for fast MR imaging of the knee

Thirty-five patients with suspected internal derangements of the knee were examined with conventional two-dimensional (2D) spin-echo magnetic resonance (MR) imaging techniques and a new rapid three-dimensional (3D) method called 3D FASTER (field echo acquisition with a short repetition time and echo reduction). A 9-minute 3D FASTER data acquisition achieves nearly isotropic voxels for the calculation of any desired image plane without a significant loss in image quality. Image contrast is optimized for visualization of knee anatomy in a single sequence. An image-processing workstation is used to speed the multiplanar image calculation and display for more efficient analysis of the complex 3D data set. The 3D FASTER images were superior or equal to 2D images (which took three times longer to acquire) in demonstrating meniscal tears, ligament tears, bone marrow disease, and osteochondral defects. The combined advantages of improved imaging capability and efficiency could make 3D FASTER imaging a routine MR method for knee imaging.     

Retrograde transmission of Proteus mirabilis during platelet transfusion and the use of arbitrarily primed polymerase chain reaction for bacteria typing in suspected cases of transfusion transmission of infection

BACKGROUND: When bacteria are found, after a platelet transfusion, in the recipient's blood as well as in the platelet concentrate (PC), a causal relationship is normally suspected, with the PC as the causative agent. The other alternative, that the patient has bacteremia and contaminated the PC, is less well documented in the literature. CASE REPORT: Arbitrarily primed polymerase chain reaction (AP-PCR) was used for testing strains of Proteus mirabilis isolated from a patient's blood before and after a platelet transfusion and from the PC. Because of a febrile reaction after a platelet transfusion, bacterial culture was performed on the PC used, showing growth of P. mirabilis. The same species was found in the patient's blood after the transfusion. Posttransfusion sepsis caused by a contaminated PC was suspected, and anti-sepsis treatment was given to the recipient. Later, it became apparent that the patient had had bacteremia before the transfusion and that P. mirabilis was one of the species in the isolate. With AP-PCR, the identity of the three P. mirabilis isolates could be distinguished. CONCLUSION: AP-PCR is a useful technique for distinguishing the identity of bacterial isolates from patients and blood components. A patient with bacteremia can contaminate a PC in conjunction with a platelet transfusion. With AP-PCR, the PC could be ruled out as the cause of the posttransfusion sepsis.     

Diagnosis of liver cirrhosis with US: receiver-operating characteristic analysis of multidimensional caudate lobe indexes

To assess the utility of changes in the volume of the caudate lobe in the sonographic diagnosis of liver cirrhosis, the authors studied 58 patients with histologically proved cirrhosis, 18 patients with fatty liver, 28 patients with liver metastases, seven patients with lymphomatous liver involvement, and 75 healthy individuals. The longitudinal (CL), transverse (CT), and anteroposterior (CAP) diameters of the caudate lobe and the transverse diameter of the right lobe (RL) were measured, and one-, two-, and three-dimensional caudate lobe indexes and ratios were calculated. The analysis of the diagnostic performance of these criteria, compared by means of receiver-operating characteristic curves, revealed that the ratio of the three-dimensional caudate index (CI3) to the right lobe diameter (CI3/RL = [CL X CT X CAP]/RL) was superior to all other calculated criteria. At a specificity of 95%, the sensitivity of CI3/RL was 94.7%, compared with 73.3% for CT/RL. No significant differences were found between the control group and patients with fatty liver, metastases, or lymphomatous involvement. The study suggests that CI3/RL is the most reliable quantitative criterion for the US diagnosis of liver cirrhosis.     

ANTIHYPERTENSIVE EFFECTS OF dl- TETRAHYDROPALMATINE: AN ACTIVE PRINCIPLE ISOLATED FROM CORYDALIS

1. The effects of dl -tetrahydropalmatine (dl -THP) on cardiovascular function and hypothalamic release of monomines were assessed in rats under urethane anaesthesia. 2. Intravenous administration of dl -THP (1-10 mg/kg) produced hypotension, bradycardia, a decrease in hypothalamic serotonin and noradrenaline release and in increase in hypothalamic dopamine release in rats. 3. Intrahypothalamic administration of DOI (a serotonergic 5-HT₂ receptor antagonist) or apomorphine (a dopamine D₂-receptor agonist) produced the opposite effects and reversed dl -THP-induced hypotension and bradycardia. 4. The data suggest that dl -THP acts through the 5-HT₂ and/or D₂-receptor antagonism in the hypothalamus to induce hypotension and bradycardia in rats.     

Multiplanar arc boost radiation therapy for prostate cancer

Localized prostatic carcinoma may be treated with either radical surgery or radiation therapy. Radiation therapy techniques for localized prostatic carcinoma include mega-voltage external irradiation or interstitial implantation, usually with iodine-125 seeds. Two external-beam techniques, multiplanar arc and biplanar arc, are additional options for the treatment of localized prostatic carcinoma. Film dosimetry measurements were made in pelvic phantoms to compare the isodose distributions of various external-beam radiation therapy techniques for boost treatment of prostate target volumes. Idealized calculations were performed to determine the isodose distribution of an I-125 implant. A comparison of these techniques shows that the multiplanar and biplanar arc techniques produce isodose distributions that may be useful in the treatment of prostate carcinoma.     

Patient information preferences among breast and prostate cancer patients

Preferences for information about their disease and treatment were collected from 392 patients who had been treated for either breast or prostate cancer an average of 2 years previously. Type of information that they had received, their ratings of its value to them and their preferred format for further information were examined. The most common and most preferred form of information was through doctor interview, followed by educational booklets. Prostate cancer patients preferred videotapes; breast cancer patients tended to prefer individualized approaches including a tour of the department. Effects of age, educational levels, occupational backgrounds and self‐reports for anxiety and depression at the time of the survey and at time of diagnosis were analysed. Prostate cancer patients who were most severely depressed showed a preference for not receiving any information at all, perhaps reflecting a tendency towards withdrawal.