Clinical results evaluation of the Girdlestone's procedure after hip arthrography

Background. To date very little work has Bern done on the clinical evaluation of the hip in patients who hale ultimately has a prosthesis removed. This operation, known in English as the Girdlestone procedure, is referred to in Poland as "pendent hip". The present authors have evaluated clinical outcomes of this procedure, taking into account its "rescue" nature.
Material and methods. 22 patients were evaluated, ranging in age from 68 to 87 years, operated in our Clinic between 1979 and 1999 (women: 62,8%; averageage of patientswhen the Girdlestone procedure was performed: 67,2 years). The average observation period after removal of the endoprosthesis was 5,2 years (ranging from 1 to 21 years). The anterolateral approach to the hip joint was used. On each occasion the wound was closed with layer sutures, leaving 4 drains. Postoperative limb traction was maintained for a period lasting form 2 to 4 weeks. The patients were allowed to walk after 4 weeks, with progressively increased load on the operated leg. Clinical evaluated of "pendent hip" was performed using the Harris scale. Shortening of the operated leg (in cm) was also included as well as successful treatment of inflammation (for a period of at least I year) with normalization of the biochemical markers of infection X-ray examinations included periarticular calcification, the remains of cement, and the degree of proximal displacement after surgery on the proximal end of the femur. The patient's subjective evaluation was also included in the overall outcome.
Results. The outcome of surgery was evaluated as good by 12 patients (54,6%), and as satisfactory by 9 (40,9%). These patients did not fully accept the shortening of the limb, the relatively small range of motion, and the need for permanent orthopedic aids (orthopedic shoes to compensate for shortening and elbow cruthes). 1 patient evaluated the outcome as poor due to persistent infection. In 95,5% of the sases the Girdlestone procedure freed the patients of infection and pain, or noticeably reduced it. Only in 1 case did it prove impossible to manage infection completely (4,5%). 18 patients had shortened limbs > 3 cm, while insufficiency of the buttock muscles with positive Trendelenburg and Duchenne signs were the cause of great difficulties and rapid fatigue during walking. The average evaluation of pendent hip using the Harris scale was 58,6 points. In radiological evaluation we often encountered the remains of bone cement. In the case of aseptic loosening this had no impact on the healing process and the late outcome of surgery. Only in I case did it prove impossible to control infection without complete removal od fragments of bone cement. Osteoporosis of the pelvis and proximal end of the femir was found in all patients.
Conclusion. The Girdlestone procedure is a sensible rescue technique both for infected hip prostheses and in situation where reimplantation of the prosthesis is technically impossible.     

Preliminary results of objective audiological assessment of children with hearing impairment selected in neonatal hearing screening

The aim of the paper was to present the results of the objective audiological assessment of 48 babies and infants at the age of 1-16 months, referred the Department of Phoniatrics and Audiology in Poznań (Poland) from January 2001 to July 2002. The children were selected in neonatal hearing screening, based on the OAE, questionnaire of hearing loss with high risk factors. We discuss high percentage of false positive results of OAE, late referrals for hearing screening, difficulties of follow-up.     

An Artificial Neural Network Approach to Diagnosing Epilepsy Using Lateralized Bursts of Theta EEGs

Determining the cause of seizures is a significant medical problem, as misdiagnosis can result in increased morbidity and even mortality of patients. The reported research evaluates the efficacy of using an artificial neural network (ANN) for determining epileptic seizure occurrences for patients with lateralized bursts of theta (LBT) EEGs. Training and test cases are acquired from examining records of 1,500 consecutive adult seizure patients. The small resulting pool of 92 patients with LBT EEGs requires using a jack-knife procedure for developing the ANN categorization models. The ANNs are evaluated for accuracy, specificity, and sensitivity on classification of each patient into the correct two-group categorization: epileptic seizure or non-epileptic seizure. The original ANN model using eight variables produces a categorization accuracy of 62%. Following a modified factor analysis, an ANN model utilizing just four of the original variables achieves a categorization accuracy of 68%.     

Tracheo-esophageal puncture (TEP) for voice rehabilitation in laryngectomised patients blom-singer® Vs Provox® Prosthesis: Our experience

Background: Stage III and IV cancers of larynx and hypopharynx often require total laryngectomy which leaves the patient with severe communication handicap. In such laryngectomised patients tracheo-esophageal puncture is the best way for voice rehabilitation using either Blom-Singer® prosthesis or Provox® indwelling valve.     

IDEAL PAIN RELIEF FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY

In a previous report the effectiveness of intraperitoneal bupivacaine in reducing pain following laparoscopic cholecystectomy was demonstrated. Other methods of pain relief are commonly used but none has been compared following laparoscopic cholecystectomy. In two further studies we have compared the analgesic effect of intraperitoneal bupivacaine against wound infiltration with bupivacaine, and against intraperitoneal bupivacaine with the addition of a non-steroidal anti-inflammatory drug (NSAID) in patients undergoing laparoscopic cholecystectomy. Two consecutive studies were performed. In the first, patients in group 1 were given 20 ml of 0.25% bupivacaine into the peritoneal cavity; patients in group 2 were given 20 ml of 0.25% bupivacaine injected into the trocar wounds. In the second study, patients in group 1 were given 20 ml of 0.25% bupivacaine into the peritoneal cavity; patients in group 2 were given 20 ml of 0.25% bupivacaine into the peritoneal cavity and a diclofenac suppository (100 mg) one hour before surgery. Postoperative pain was assessed with a visual analogue pain scale. There was no difference in pain scores in the two groups in either study. Intraperitoneal bupivacaine is as effective as wound infiltration. The addition of an NSAID makes no difference in the reduction of postoperative pain following laparoscopic cholecystectomy.     

Effects of L-5HTP with and without carbidopa on plasma ß-endorphin and pain perception

L-Tryptophan (L-TP) has been used in migraine and other pain conditions. The mechanism underlying the analgesic effect is still partly undefined. In this study the effects of subchronic administration of L-5-hydroxy-tryptophan (L-5HTP) (with and without carbidopa) on plasma beta-endorphin (beta-EP) levels and subjective pain threshold and tolerance were investigated in seven healthy volunteers. To measure also an objective indicator for pain, the nociceptive flexion reflex threshold was studied. L-5HTP treatment with and without carbidopa administration increased beta-EP levels significantly (p less than 0.05). L-5HTP plus carbidopa induced an increase in beta-EP significantly (p less than 0.05) higher than that after L-5HTP alone. Neither subjective pain threshold and tolerance nor RIII threshold was modified by either treatment. Our data seem to point to the existence of a complex linkage between plasma opioid levels and pain perception.     

Peptic ulcer and gastric carcinoma: diagnosis with biphasic radiography compared with fiberoptic endoscopy

The diagnostic value of biphasic radiographic examination of the stomach and duodenum was compared with that of fiberoptic endoscopy in a prospective, blinded study of 385 patients with dyspepsia. This investigation was directed at gastric malignancies and peptic ulcers. Methodologically there is no absolute standard for a study of this kind because histologic examination is useful for detection of cancer but inadequate for ulcers. As an alternative, kappa indexes and the sensitivity and specificity, as derived by Hui and Walter, were calculated and compared. For the detection of gastric carcinoma, radiographic and endoscopic findings had almost perfect agreement beyond chance. For gastric ulcers, radiography and endoscopy had substantial agreement, which became perfect if small ulcers (less than 5 mm) were excluded. For duodenal ulcers, radiography had a lower sensitivity than endoscopy; this disagreement disappeared if small ulcers were excluded. Both methods have equal merit; choice of the initial diagnostic procedure will therefore depend on cost, discomfort to the patient, and risk of complications.