Fixation, polyethylene wear, and pelvic osteolysis in primary total hip replacement

A multicenter retrospective review was performed analyzing 1081 primary total hip replacements in 944 patients using the Harris Galante-I cementless acetabular component with screw fixation. All patients were followed up for a minimum of 5 years with a mean followup of 81 months. Linear polyethylene wear averaged 0.11 mm/year (range, 0-0.86 mm/year). Pelvic osteolysis was seen in 25 patients (2.3%). Migration of the acetabular component was seen in four hips. A subgroup of patients was reanalyzed at a minimum followup of 10 years. The mean linear polyethylene wear rate remained 0.11 mm/year. In this group, only one socket had migrated. There was an association between wear rate and age. On average, younger patients had higher wear rates. The risk for having pelvic osteolysis develop and the need for revision surgery also was age-related. Twenty-two percent of hip replacements (15 hips) in patients younger than 50 years of age at the time of their index operation had pelvic osteolysis develop. In contrast, for patients older than 50 years of age at the time of surgery only 7.8% (eight hips) had osteolysis of the pelvis develop. For patients older than 70 years of age at the time of primary total hip replacement, none had pelvic osteolysis develop.     

The fate of stable cemented acetabular components retained during revision of a femoral component of a total hip arthroplasty

BACKGROUND: The decision as to whether to revise or retain a well fixed cemented acetabular component during revision of a femoral component is especially difficult; the rate of loosening of cemented acetabular components is high, whereas that of porous-coated acetabular components inserted during revision is low. However, removal of a well fixed cemented acetabular component can result in increased operative morbidity and cost and in loss of acetabular bone. Data that can be used to predict the long-term survival of retained well fixed cemented acetabular components are therefore needed. METHODS: We studied the five to thirteen-year clinical and radiographic results in a group of twenty-six consecutive patients in whom a well fixed cemented acetabular component had been retained during revision of a femoral component. Typical demographic data on the patients and information about the components were recorded, and the cemented acetabular components were graded as A through F, according to the system of Ranawat et al., at the time of the femoral revision. The average duration of follow-up was 8.4 years (range, 5.0 to 12.7 years). No patient was lost to follow-up. RESULTS: Four acetabular components (15 percent) had progressive radiolucency (at forty-eight, forty-eight, fifty-nine, and seventy-five months after the femoral revision) and were considered radiographically loose despite not being associated with symptoms. All four components were graded as either E or F at the time that they were retained during the femoral revision; radiographic loosening was significantly related to these two grades (p < 0.01). No acetabular component with a grade of A, B, C, or D loosened. The components that loosened had been in vivo for a relatively shorter, as opposed to longer, duration before the femoral revision compared with the components that did not loosen (p < 0.05). CONCLUSIONS: Retention of the well fixed cemented acetabular components was associated with good clinical results but with a 15 percent rate of loosening. Revision of a cemented acetabular component solely on the basis of the duration that it was in vivo or whether a previous revision had been done does not appear to be warranted. Our findings suggest that acetabular components with a grade of A, B, C, or D at the time of a femoral revision may be retained, as these components continued to function at the time of the five to thirteen-year follow-up in the current study.     

Experimental microgyri disrupt the barrel field pattern in rat somatosensory cortex

Transcranial freeze lesions in neonatal rat pups produce microgyri and adjacent epileptogenic regions of neocortex that can be used to model human polymicrogyria. The hypothesis that the presence of microgyri is associated with abnormal cortical organization occurring within as well as adjacent to the microgyri was tested by creating microgyri within the face representation of somatosensory cortex. Microgyri were associated with a widespread disruption of the stereotypic whisker barrel field pattern delineated with cytochrome oxidase (CO) staining. CO-stained patches resembling barrel hollows were absent within the microgyrus, and were abnormally shaped and distributed outside of the microgyrus. Adjacent Nissl- or acetylcholinesterase-stained sections demonstrated that both cell clusters and thalamocortical afferents contributed to the abnormally organized paramicrogyral zone identified in CO-stained sections. Field potential recordings showed that this region of heavy CO staining corresponded to the epileptogenic zone adjacent to the microgyrus. Results support our hypothesis that the epileptogenic paramicrogyral zone develops an abnormal organization of cell clusters and thalamocortical projections that could contribute to epileptogenesis in the paramicrogyral zone.     

Influence of traumatic grief on suicidal ideation among young adults

OBJECTIVE: The purpose of this study was to examine the influence of traumatic grief on suicidal ideation. METHOD: The Beck-Kovacs Scale for Suicidal Ideation was administered to 76 young adult friends of suicide victims. RESULTS: Traumatic grief was associated with a 5.08 times greater likelihood of suicidal ideation, after control for depression. Comorbid traumatic grief and depression were not associated with a greater likelihood of suicidal ideation. CONCLUSIONS: Syndromal traumatic grief heightens vulnerability to suicidal ideation.     

The role of convexity in perceptual completion: beyond good continuation

Since the seminal work of the Gestalt psychologists, there has been great interest in understanding what factors determine the perceptual organization of images. While the Gestaltists demonstrated the significance of grouping cues such as similarity, proximity and good continuation, it has not been well understood whether their catalog of grouping cues is complete--in part due to the paucity of effective methodologies for examining the significance of various grouping cues. We describe a novel, objective method to study perceptual grouping of planar regions separated by an occluder. We demonstrate that the stronger the grouping between two such regions, the harder it will be to resolve their relative stereoscopic depth. We use this new method to call into question many existing theories of perceptual completion (Ullman, S. (1976). Biological Cybernetics, 25, 1-6; Shashua, A., & Ullman, S. (1988). 2nd International Conference on Computer Vision (pp. 321-327); Parent, P., & Zucker, S. (1989). IEEE Transactions on Pattern Analysis and Machine Intelligence, 11, 823-839; Kellman, P. J., & Shipley, T. F. (1991). Cognitive psychology, Liveright, New York; Heitger, R., & von der Heydt, R. (1993). A computational model of neural contour processing, figure-ground segregation and illusory contours. In Internal Conference Computer Vision (pp. 32-40); Mumford, D. (1994). Algebraic geometry and its applications, Springer, New York; Williams, L. R., & Jacobs, D. W. (1997). Neural Computation, 9, 837-858) that are based on Gestalt grouping cues by demonstrating that convexity plays a strong role in perceptual completion. In some cases convexity dominates the effects of the well known Gestalt cue of good continuation. While convexity has been known to play a role in figure/ground segmentation (Rubin, 1927; Kanizsa & Gerbino, 1976), this is the first demonstration of its importance in perceptual completion.     

Residual ethanol content of donor sclera after storage in 95% ethanol and saline rinse of various durations

PURPOSE: Some surgeons are wary of using alcohol-preserved sclera for allografts because they fear a toxic effect on surrounding tissue after placement. We set out to determine the amount of ethanol remaining in scleral allograft material after storage in 95% ethanol. METHODS: Sixty half scleras from 30 donors were preserved in 95% ethanol for an average of 31+/-14 days (range, 11 to 50 days). Rehydration was performed by soaking each half sclera in 4 ounces of balanced salt solution. Half scleras were randomly assigned to six groups of 10 each. Assays for ethanol were performed on the following groups: no balanced salt solution soak and balanced salt solution soak for 10 minutes, 20 minutes, 30 minutes, 40 minutes, and 50 minutes. Ethanol assay was performed by Headspace Gas Space Chromatography at ChemaTox Laboratory, Inc, Boulder, Colorado. RESULTS: The 10 half scleras without balanced salt solution soak had a mean ( SD) ethanol level of 175+/-14.1 mg per g of sclera. After 10 minutes of balanced salt solution s oak, the level decreased to 7.57+/-1.56 mg per g, then 3.77+/-3.02 mg per g at 20 minutes, 1.59+/-0.61 mg per g at 30 minutes, 1.07+/-0.30 mg per g at 40 minutes, and 0.96+/-0.26 mg per g at 50 minutes. Approximately 96% of the ethanol is leeched out of the half sclera by 10 minutes and 98% by 20 minutes. CONCLUSIONS: For sclera preserved in 95% ethanol, soaking in balanced salt solution for 20 minutes or longer leeches approximately 98% of the ethanol from the preserved donor sclera.     

A novel series of non-nucleoside inhibitors of inosine 5'-monophosphate dehydrogenase with immunosuppressive activity.

Inhibitors of inosine 5'-monophosphate dehydrogenase (IMPDH, EC 1.1.1.205) are effective immunosuppressive drugs that may also have additional potential applications as antitumour and antimicrobial agents. The clinical value of the most potent and specific inhibitor of IMPDH, mycophenolic acid, is limited by its rapid metabolism in vivo to an inactive glucuronide derivative. There is, therefore, a considerable incentive to develop structurally novel, preferably non-nucleoside, inhibitors with greater metabolic stability than mycophenolic acid. Here, we describe a high throughput screen for inhibitors of IMPDH, which facilitated the discovery of a single novel non-nucleoside inhibitor from a collection of approximately 80,000 compounds. The inhibitor is a pyridazine, which, like mycophenolic acid, exerts uncompetitive inhibition of IMPDH. Analysis of the enzyme kinetics suggests that the inhibitory action of the pyridazine is similar to that of mycophenolic acid, which involves trapping of a covalent intermediate formed during the conversion of IMP to xanthosine monophosphate. Chemical modification of the lead compound resulted in pyridazine derivatives with enhanced potency against IMPDH and guanine nucleotide synthesis in cultured cells in vitro and also against guanine nucleotide synthesis in the mouse spleen in vivo. One of the compounds was available in sufficient quantity to demonstrate highly effective immunosuppressive activity in a model of delayed type hypersensitivity in mice. To our knowledge, the novel pyridazines described in this report represent the first non-nucleoside uncompetitive inhibitors of IMPDH with immunosuppressive activity since the discovery of the inhibitory activity of mycophenolic acid and its derivatives thirty years ago.     

Decreased sup 3 H-Thymidine Incorporation By Human Bladder Epithelial Cells Following Exposure To Urine From Interstitial Cystitis Patients

Purpose

Interstitial cystitis (IC) is a chronic bladder disease of unknown etiology. We sought to determine whether a cytotoxin is present in the urine of IC patients that could cause the epithelial damage seen in this disease.

Materials and Methods

Evidence for a cytotoxin was sought using both a neutral red uptake viability assay in T24 bladder epithelial cells, and a³ H-thymidine incorporation assay in primary normal adult bladder epithelial cells and FHS 738 Bl human fetal bladder cells.

Results

The neutral red assay in T24 cells indicated the presence of a cytotoxin in 2 of 9 IC patient urine specimens. However, the more sensitive assay of cell proliferation (sup 3 H-thymidine incorporation) in normal adult human bladder epithelial cells revealed antiproliferative activity in urine from 10 of 13 (77 percent) IC patients vs. 3 of 19 (16 percent) controls (two-way analysis of variance, p = .019). The antiproliferative activity of IC urine specimens was confirmed using FHS 738 Bl human fetal bladder cells. The antiproliferative urinary substance(s) appeared to be a low molecular weight (less than 10,000 Da), heat stable, trypsin-sensitive factor(s).

Conclusions

Because a denuded or damaged bladder epithelium is a central finding in IC, it is possible that the antiproliferative protein(s) contributes to the pathogenesis of this disease.     

Age and gender-related incidence of chronic renal failure in a French urban area: a prospective epidemiologic study

OBJECTIVE.: To determine the age- and gender-related incidence of chronicrenal failure in a French urban area. METHODS.: Prospective study of adult patients newly identified as havingestablished, chronic renal failure defined by serum creatinine(Scr) 200 µmol/l, with the cooperation of all nephrologyand dialysis units in the Ile de France district (10,660,000inhabitants) during a 1-year period. RESULTS.: 2775 patients (1780 males, 995 females) were referred with Scr200 µmol/l between July 1991 and June 1992, an overallincidence of 260/million population. 847 had advanced renalfailure (Scr 500 µmol/l) and 541 patients (19.5%) were75 years of age. The age-related incidence was 92, 264, 523and 619/million population in the age groups 20–39, 40–59,60–74 and 75 years old, respectively. The annual incidencewas twice as high in males than in females up to 75 years andthree times as high in patients 75 years (1124 vs 356/millionpopulation). Based on the proportion of patients reaching end-stagerenal failure within one year of referral, the minimal estimationof the need for supportive therapy is 81/million/year. CONCLUSIONS.: This epidemiological study in a large French urban area indicatesan incidence of 260 patients per million population annuallyreferred to nephrology units for chronic renal failure definedby Scr 200 µmol/l, with a marked preponderance of malesand a dramatic increase of incidence with age in both genders.