Müller curved-stem total hip arthroplasty: long-term follow-up of 185 consecutive cases

We reviewed 185 consecutive Müller total hip arthoplasties ten to 14 years after operation. Of the 32 patients with 42 arthroplasties who had died within the ten-year period, three had had revisions and five had died of causes related to the operation, including two late infections. Sixty-five hips in 56 living patients were available for clinical and roentgenographic evaluation. An additional 30 hips had been revised for various reasons. When the roentgenographically loose components were combined with the revised ones, the overall incidence of aseptic loosening was 40% for the femoral component and 12.6% for the acetabular component. As previously reported, the combined incidence of loose and revised components at 6 1/2 years was 27.7% for the femoral component and 3.2% for the acetabular component. Therefore, in the intervening five years, the rate of femoral loosening remained about the same, while the rate of acetabular loosening increased. There was a positive correlation between the incidence of loosening of the femoral component and male sex, deficient cementing, and varus position. There was no significant wear of the acetabular component.     

Nurses as a key PHC link in Papua New Guinea

While many developing countries have endorsed primary health care (PHC) as a means of reaching Alma Ata's goal of health for all, effective implementation has been difficult. The major obstacle has been the historic emphasis on curative medicine in the training, licensing and job responsibilities of health care personnel and in the distribution of scarce resources. Moreover, few programmes have been geared to preparing the rural villager and the health delivery team--the two essential components of PHC--to work together to identify and solve problems. Too often health workers fear that the unrealistic expectations of community members will mean losing control of scarce resources. Clearly, central to any PHC programme is deciding where and how to begin developing the trust and interaction necessary to implement PHC beyound its curative aspects. In East New Britain, Papua New Guinea, nurses were the logical resource to reorient the rural health extension changeover to the noncurative aspects of PHC. Below, a report on this successful project.     

Results of a recently instituted programme of thrombolytic therapy in acute lower limb ischaemia

Twenty-eight patients with acute lower limb ischaemia received low dose intra-arterial thrombolytic therapy over a 2-year period. Eighteen patients received streptokinase and ten patients received recombinant tissue plasminogen activator (rTPA). Indications included arterial thromboemboli and graft failures. Mean ischaemic times were similar in both groups. Treatment time to achieve lysis was significantly less with rTPA (P less than 0.01). Subsequent vascular procedures, including angioplasty or reconstruction, were undertaken in 36 per cent of patients. Arterial puncture site bleeding occurred in eight (29 per cent) patients. Three (11 per cent) patients suffered rethrombosis after initial successful lysis. All rethromboses were successfully lysed with rTPA. There were two major amputations. Five (18 per cent) patients died, all lytic failures in the streptokinase treatment group. There were no cerebral haemorrhagic events and no patient died as a result of thrombolytic therapy. Good clinical outcome was obtained in nine of 18 patients treated with streptokinase and in nine of ten patients treated with rTPA. Intra-arterial thrombolysis provides effective therapy with high rates of limb salvage and a low mortality rate. This study suggests that rTPA may be a more effective agent, causing less morbidity, than streptokinase.     

Spontaneous recovery of renal function after resection of contralateral hypernephroma.

We report a case of nonfunction of an anatomically normal kidney associated with a contralateral hypernephroma. X-ray and radionuclide imaging suggested a disturbance of the contralateral renal blood flow at the microvascular level. Normal function resumed after tumor resection. The implications for management are discussed.     

Safety assessment of selected inorganic elements to fry of chinook salmon (Oncorhynchus tshawytscha)

The acute toxicities of arsenate, arsenite, cadmium, chromate, copper, mercury, silver, vanadium, and zinc were determined, individually and in two environmentally relevant mixtures, to two life stages of chinook salmon in reconstituted fresh and brackish waters that simulated potential conditions in the San Joaquin Valley, California. The relative individual toxicities of the elements varied over four orders of magnitude; from most toxic to least toxic, the rank order was cadmium > copper > mercury > zinc > vanadium > arsenite > arsenate > chromate (no definitive tests for silver). In general, young fish tested in fresh water were more sensitive to the individual elements and the two mixtures than were advanced fry tested in brackish water. A 13-element mixture simulating concentrations in the San Luis Drain had the same toxicity to fish as the same mixture plus selenate and selenite, thus demonstrating that the presence of selenium at its environmental ratio in the mixture contributed no toxicity in short-term tests. As judged by a comparison of the individual acute values for salmon to the expected environmental concentrations in the San Luis Drain, the margins of uncertainty for cadmium and copper in both waters, zinc in fresh water, and mercury in brackish water were less than 100, whereas for the two environmental mixtures the margins were less than 15 in both test waters. These low margins of uncertainty, especially for the mixtures, indicate a high potential for environmental hazard to chinook salmon in the reconstituted waters tested.