Functional outcome after total knee arthroplasty revision

The objective of this study was to perform a systematic literature review to describe patient outcome after total knee arthroplasty revision procedures using various global knee score ratings. English language articles published from 1966 through 2000 were identified through a computerized literature search and bibliography review. A multistage assessment was used to determine the articles containing data that could meet our objective. Meta-analyses of global knee scores were undertaken using a fixed effects model with the assumption that the variances of each individual measurement were identical across studies. The initial inclusion criteria were met by 58 articles with a total of 1,965 patients. There were 42 articles comprising 45 unique patient cohorts and a total of 1,515 patients that had sufficient global knee score data for analysis and were used in the meta-analyses. Revision total knee arthroplasty is an effective procedure for failed knee arthroplasties based on global knee rating scales.     

Missed and mismanaged injuries of the spinal cord

OBJECTIVE: The purpose of this study was to determine the incidence of missed and mismanaged injuries of the spinal cord, to identify factors contributing to a failure to recognize such injuries, and to assess the consequences of such failures. METHODS: Missed and mismanaged injuries were defined using previously validated statements. All medical records and radiographs of patients with acute traumatic spinal cord injury admitted to the Regional Spinal Cord Injury Unit in Sheffield, United Kingdom, over a period of 10 years from 1989 were evaluated. Patients with no neurologic deficits were excluded from the study. RESULTS: Of the 569 patients, the diagnosis of spinal cord injury was missed in 52 instances (9.1%). The patients were mismanaged in 34 instances, and the treatment offered to 30 was considered negligent. In 26 of 52 (50%), mismanagement resulted in neurologic deterioration. The study identified several factors that contributed to a failure to recognize a spinal cord injury. These include ambience and circumstances surrounding the injury, inadequate neurologic assessment, associated injuries, and radiographic errors. CONCLUSION: Despite a greater awareness of the potential for spinal injury after road traffic accidents, failure to recognize a spinal cord injury in the acute care setting appears to be increasing. Injuries are seldom missed because of an isolated cause, but rather because of a combination of several factors. Increased vigilance on the part of the primary care physicians and careful documentation may reduce allegations of medical negligence.     

Is Chlamydia pneumoniae found in spinal fluid samples from multiple sclerosis patients? Conflicting results

Cerebrospinal fluid samples from controls and patients with multiple sclerosis (MS) were split and sent to laboratories with different experiences for the detection of Chlamydia pneumoniae by polymerase chain reaction. Vanderbilt investigators identified C. pneumoniae in the majority of patients with MS and uncommonly in controls. Laboratories at Johns Hopkins University, University of Ume?, and the Centers for Disease Control and Prevention did not identify C. pneumoniae in any of the samples. Conflicting reports of C. pneumoniae detection in the some samples from patents with MS highlight the need to exchange detection techniques among laboratories involved in this controversy.     

Relative importance of enhanced glucose uptake versus attenuation of long-chain acyl carnitines in protecting ischemic myocardium

BACKGROUND: A number of experimental studies have shown that increasing glucose use or decreasing accumulation of long-chain acyl carnitines (LCAC) protect ischemic hearts. METHODS: To evaluate the relative importance of these two strategies in protecting ischemic myocardium, isolated rat hearts (n = 6 in each group) were paced at 300 bpm and subjected to 50 min of low-flow ischemia followed by 60 min of reperfusion. Buffer contained 0.4 m mol/l albumin, 0.4 m mol/l palmitate, and 70 mU/l insulin, and either normal glucose (5 m mol/l) (CON), high glucose (10 m mol/l total) (HG, known to increase glucose use), 5 m mol/l glucose and niacin (10 micromol/l) (NIA, known to increase glucose use and decrease LCAC) or carnitine (10 m mol/l) (CAR, known to increase glucose use and decrease LCAC). Separate groups of hearts were perfused in the presence of 10 micromol/l cytochalasin-B (CB), an inhibitor of insulin-sensitive glucose transporters. RESULTS: Ischemic injury, as assessed by creatine kinase (CK) release was diminished by an average of 50% in HG, NIA, and CAR hearts, and the percentage recovery of left ventricular (LV) function with reperfusion was enhanced by approximately 20% compared with CON hearts (P < 0.05 for each comparison). Cytochalasin-B abolished all of the salutary effects. Long-chain acyl carnitines levels were higher in HG hearts compared with NIA- and CAR-treated hearts ( P < 0.05), but ischemic protection and functional recovery was greater in HG hearts. CONCLUSIONS: The data support the adjunctive use of agents that promote glucose uptake during ischemia and suggest that increasing glucose use is more important than decreasing LCAC in the protection against ischemic injury or in the recovery of contractile function.     

Cystic carcinoma of the breast: a trap for the unwary.

Cystic breast masses are a common presentation to breast clinics. While the majority of cysts can be managed by simple aspiration, a small proportion are malignant. Histology records for a 10-year period have been examined to identify patients with cystic breast carcinomas. In all, 31 patients were identified. Of these, 18 had cystic degeneration of high-grade tumours, while 13 had intracystic papillary carcinoma. Both of these tumour types were diagnosed by a combination of cyst fluid cytology and breast imaging. The prognosis of high-grade tumours was poor, while that of intracystic papillary carcinomas was excellent. After cyst aspiration, bloodstained fluid should be sent for cytology and breast imaging arranged in all patients. Patients in whom a cyst refills within 2 week of aspiration require a careful re-evaluation. Cysts in postmenopausal women should be viewed with suspicion. Excision should be performed in patients with positive cytology or imaging.     

Glial fibrillary acidic protein and related glial proteins as biomarkers of neurotoxicity

A variety of '-omic' technologies are being increasingly applied in preclinical safety assessments. Such approaches, however, have not been implemented in neurotoxicity safety evaluations. Current regulatory guidelines for assessing neurotoxicity emphasise reliance on traditional histopathological stains and behavioural testing batteries. Although these methods may be sufficient to detect some neurotoxic effects, they lack both the sensitivity and specificity required for broad-scale neurotoxicity screening. The glial reaction to nervous system damage, often termed gliosis, represents a hallmark of all types of nervous system injury. As such, the development and implementation of gliosis biomarkers represents a broadly applicable approach for neurotoxicity safety assessment. Using a panel of known neurotoxic agents, the authors have shown that the astroglial protein, glial fibrillary acidic protein (GFAP), can serve as one such biomarker of neurotoxicity. Qualitative and quantitative analysis of GFAP has shown this biomarker to be a sensitive and specific indicator of the neurotoxic condition. The implementation of GFAP and related glial biomarkers in neurotoxicity screens may serve as the basis for further development of molecular signatures predictive of adverse effects on the nervous system.     

Splenic radiation and double-filtration plasmapheresis in crossmatch-positive live renal transplantation

Double-filtration plasmapheresis (DFPP) and splenectomy prior to transplant is used in a few centers for high-risk transplantations. We undertook a prospective study to examine the outcome of 16 kidney transplantations in crossmatch-positive patients using splenic radiation and DFPP as pretransplant immunomodification procedures. All patients received a single dose of Zenapax (50 mg intravenously [IV] 8 hours before transplant), before treatment with cyclosporine, mycophenolate mofetil, and steroids immediately posttransplant. Follow-up ranged from 3 months to 1 year. Hyperacute rejection requiring graft nephrectomy was necessary in one patient; acute rejection, which was seen in three patients, was reversed with five doses of Iort3 at 1-month posttransplant the mean creatinine was 1.3 +/- 0.6 mg/dL in patients who did not have rejection and 1.9 +/- 0.3 mg/dL in the three patients who had acute rejection. Six patients were switched from cyclosporine to sirolimus. At the end of 3 months the mean creatinine levels was 1.4 +/- 0.3 mg%. The infections included oral candida (n = 2), urinary tract infection (UTI) (n = 1), bacterial pneumonia (n = 1), and herpes zoster (n = 1). With the advent of modern immunosuppressants, pretransplant immunomodification with DFPP and splenic radiation is safe and effective. Splenic radiation is devoid of surgical risk and more acceptable to patients.     

Preventive action of food seasoning spices mixture on fructose-induced lipid abnormalities

High fructose feeding in rats induces insulin resistance, hyperinsulinemia, hyperglycemia and dyslipidemia. The present study was undertaken to determine the hypolipidemic effect of food seasoning spices mixture on fructose-fed insulin resistant rats. Male Wistar rats received a daily diet containing either 60% fructose or 60% starch. They were administered with the spices mixture at three different doses (10 mg, 30 mg or 50 mg/day/rat) orally 15 days later. At the end of 45 days of the experimental period fructose-fed rats displayed elevated plasma glucose and insulin levels and dyslipidemia which included elevated levels of cholesterol, triglycerides, free fatty acids, reduced high density lipoprotein cholesterol and increased very low density lipoprotein cholesterol. Alterations in tissue lipid levels were also observed. Simultaneous treatment with spices mixture along with fructose diet resulted in the normalization of plasma glucose and insulin levels and restoration of lipid levels in plasma and tissues. The insulin potentiating action of the active principles in these spices may contribute to the hypolipidemic effect of spices mixture in high fructose-fed rats.