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11.
J. -A. Epinette 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》1999,9(2):99-102
Infection is without any doubt the worst and the most dreaded complication in joint replacement. We decided to investigate the role of hydroxyapatite (HA) coatings in the context of potential or established infection, as one of the aspects of our ongoing study of the use of HA for the fixation of implants.
Infection after joint replacement is a major human and financial disaster. It follows that every means of preventing and controlling such infections should be explored. We feel that one way of combating infection is the use of HA-coated implants, and would strongly plead in favour of further research and study. 相似文献
1) | Prevention: Histological studies show that — unlike porous coated implants — HA-coated devices are not surrounded by an interposed layer of fibrous tissue. We may assume that the absence of local cement-induced lesions, and the direct and intimate apposition of bone to the implant without fibrous tissue interposition, leave the host's local defence mechanisms largely intact and allow optimal distribution of prophylactic antibiotics. The results published in the HA SOFCOT monograph reflect the various authors' personal experience in almost ten thousand cases of HA-coated implants, and at a minimum of 5 years' follow-up. The rate of early deep infection shown is 0.26%, of which 0.11% required implant removal for infection without associated loosening. Thus, the total number of implant removals for infection with or without loosening was 15 cases out of a total of almost 10,000 implants (0.16%). |
2) | Control of deep infection: It should be noted again that HA does not have any inherent anti-infectious properties. However, it assists in the control of infection in two important ways: Firstly, it would appear to cause less interference with host defence mechanisms and to provide a well vascularized periprosthetic environment; and secondly, the direct contact established between the implant and the host bone, without any interposed fibrous tissue, forms an effective seal that prevents infected particles from the joint space tracking along the implant. In our own patients treated with HA-coated stems, over a period of 7 years, there were 6 cases of deep infection. All of these cases were managed with early reoperation. In none of these cases was the implant removed, since all the devices appeared soundly fixed. All the infections resolved. |
12.
J T Callaghan B H Petersen W C Smith W W Epinette R C Ransburg 《Clinical immunology and immunopathology》1983,26(1):102-110
Sixty-one subjects, preselected for mumps sensitivity, were entered into a double-blind protocol to standardize Mumps Skin Test Antigen. Four lots of mumps antigen selected on the basis of in vitro potency tests were used. Four other antigens, Histoplasmin, Dermatophytin-O, Dermatophytin, and fluid tetanus toxoid were also tested; positive reactions for these four antigens occurred in 48, 68, 25, and 43% of individuals, respectively. The mumps lots exhibited delayed hypersensitivity with positivity ranging from 63 to 67% at 20 CFU/ml and 77 to 84% at 80 CFU/ml in the acceptable lots. Side effects were primarily local and minor in nature. Mumps Skin Test Antigen is a useful measure of the integrity of the immune system, but lacks complete specificity because of local dermal factors. 相似文献
13.
Possible small-bowel neoplasms: contrast-enhanced and water-enhanced multidetector CT enteroclysis 总被引:4,自引:0,他引:4
PURPOSE: To prospectively evaluate the sensitivity and specificity of contrast material-enhanced and water-enhanced multidetector computed tomographic (CT) enteroclysis in depicting small-bowel neoplasms in symptomatic patients, with endoscopic, tissue, and follow-up findings as reference standards. MATERIALS AND METHODS: The study protocol was approved by the Human Research Committee of the institution, and all patients gave written informed consent. Two hundred nineteen patients (108 male, 111 female; age range, 17-98 years; mean, 53.1 years) with clinical suspicion of small-bowel neoplasm underwent contrast- and water-enhanced multidetector CT enteroclysis after normal findings of upper and lower gastrointestinal endoscopy. The prospective interpretations of CT enteroclysis results include evaluation of focal bowel wall thickening, small-bowel masses, small-bowel stenosis, mesenteric stranding, enlarged mesenteric lymph nodes, and visceral metastasis. Positive enteroclysis findings were compared with results of pathologic examination after surgical (n = 35) or endoscopic (n = 20) procedures. Negative results were compared with results of surgery (n = 8), enteroscopy (n = 15), capsule endoscopy (n = 14), and clinical follow-up (n = 127). Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated on a per-patient basis with 95% confidence intervals. RESULTS: Findings of CT enteroclysis were positive in 55 cases and negative in 164. The overall sensitivity and specificity in identifying patients with small-bowel lesions were 84.7% and 96.9%, respectively. The negative and positive predictive values were 94.5% and 90.9%, respectively. Findings of pathologic examination confirmed small-bowel tumor in 50 patients with carcinoid tumor (n = 19), adenocarcinoma (n = 7), lymphoma (n = 5), jejunal adenoma (n = 9), stromal tumor (n = 5), ectopic pancreas (n = 2), angiomatous mass (n = 2), or metastasis (n = 1). Five examinations resulted in false-positive findings. CONCLUSION: Contrast- and water-enhanced multidetector CT enteroclysis had an overall accuracy of 84.7% for depiction of small-bowel neoplasms. 相似文献
14.
Aline Barcelo Jean Claustre Férial Toumi Ghislaine Burlet Jean-Alain Chayvialle Jean-Claude Cuber Pascale Plaisancié 《Digestive diseases and sciences》2001,46(6):1223-1231
Mainly composed of mucins, mucus secreted by goblet cells in the intestinal epithelium is critically involved in the protection of the gastrointestinal mucosa. The hypothesis that bile and some bile salts can induce mucus secretion was tested in the isolated perfused rat colon. Mucus release was evaluated using enzyme-linked immunosorbent assays and supported by histological analysis. Luminal administration of bile extract (1%) provoked mucus secretion in the rat colon. Deoxycholate (0.5–10 mM) induced a dose-dependent increase in rat colonic mucus release. Chenodeoxycholate (10 mM) and hyodeoxycholate (10 mM) also evoked mucus discharge, whereas 10 mM cholate, 10 mM ursodeoxycholate, or Tween-20 did not release mucus. Taurine-conjugated bile salts (deoxycholate, hyodeoxycholate, and chenodeoxycholate) were less potent mucus secretagogues than the corresponding unconjugated forms. The deoxycholate-induced mucus discharge was not altered by pharmacological blockers (tetrodotoxin, atropine), indomethacin, mast cell stabilizers (ketotifen, doxantrazole), H1 histamine receptor antagonist (pyrilamine), or 5-HT receptor antagonists (ketanserin, ondansetron, SDZ 205-557). Our findings suggest that some bile salts, especially in the unconjugated form, may provoke colonic mucus secretion, probably through a direct action on mucus-secreting cells. 相似文献
15.
Patellar resurfacing during total knee arthroplasty (TKA) is an actively debated issue. This prospective study addresses fundamental questions regarding whether to resurface the patella. To do this, we compared clinical results of Scorpio PS knees with and without patellar resurfacing to determine whether there was any statistically significant difference in survivorship, function, pain, and radiographic analyses. Our study failed to demonstrate any statistical difference between the 2 groups (resurfaced versus nonresurfaced) according to knee pain, walking abilities, stair climbing, range of motion, and radiologic findings, as well as cross-correlations between patellar pain and age, gender, obesity, or etiology. Our radiologic findings did not reveal any failures of bony structures facing the metallic flange. Some knee designs can thus be seen as "patella friendly." Given the significant cost of patella resurfacing and the resulting well-known complications, we continue to avoid systematic resurfacing of the patella during Scorpio TKA. 相似文献
16.
Walter T Chardon L Chopin-laly X Raverot V Caffin AG Chayvialle JA Scoazec JY Lombard-Bohas C 《European journal of cancer (Oxford, England : 1990)》2012,48(12):1766-1773
IntroductionChromogranin A (CgA) is the principal tumour marker for gastroenteropancreatic neuroendocrine tumours (GEPNET). Combining serum CgA and pancreatic polypeptide (PP) levels may increase the sensitivity of tumour markers in the diagnosis of GEPNET.Objectives(1) To evaluate the sensitivity of PP and CgA in GEPNET. (2) To compare changes in serum CgA and PP levels with the morphological evolution of the tumours.Patients and methodsSixty-six pancreatic and 49 gastrointestinal NET, with at least one serum determination of CgA and PP at the same time were retrieved from an institutional data base. Secondly, the variations in serum CgA or PP at successive determinations were compared to Response Evaluation Criteria in Solid Tumours (RECIST) criteria in 57 patients (112 follow-up visits) with high serum CgA levels and in 21 patients (37 follow-up visits) with high serum PP levels.ResultsAmong the 115 patients included in the study group, an increase in serum CgA (normal <98 μg/L) or PP (normal <100 pmol/L) was found in respectively 79 (69%) and 36 (31%) cases. Seven patients had normal CgA and elevated PP levels. Both markers were significantly more elevated in metastatic disease (74% versus 51% for CgA and 37% versus 18% for PP). The concordance rates between serum markers and RECIST criteria were 51% for CgA and 54% for PP.ConclusionsSerum PP determination identify few false-negative results of serum CgA determination in GEPNET. Our study does not validate the use of CgA or PP as surrogate markers for detecting changes in tumour burden. 相似文献
17.
18.
Guillaud O Dumortier J Bringuier PP Saurin JC Poncet G Boulez J Henry L Chayvialle JA Scoazec JY 《Gastroentérologie clinique et biologique》2006,30(2):320-324
Recent studies have pointed out a high incidence of GIST, usually multiple and of small intestinal location, in patients with type I neurofibromatosis. We here report an additional case, revealed by chronic gastro-intestinal bleeding and diagnosed at pre-operative imaging studies. A 56-year-old patient, with known type I neurofibromatosis, was referred to our department for the exploration of chronic gastro-intestinal bleeding during anti-aggregant therapy. Endoscopical examination was negative. Enteroscanner showed the presence of four tumor lesions, 3 in the jejunum and 1 in the ileum. Segmental surgical resections were performed. At histological examination, 2 of among the 3 jejunal lesions were diagnosed as typical GIST, of low risk of malignancy, CD117+, CD34+, whereas the last jejunal and ileal lesions were identified as fibroid tumors. Mutations of c-kit gene and of the gene coding for PDGF-Ralpha were not detected. Post-operative recovery was uneventful; no recurrent bleeding was observed. Our case report underlines the potential role of enteroscanner in the management of patients with type I neurofibromatosis with possible digestive complications. It also emphasizes the importance of an accurate diagnosis of the digestive tumors associated with type I neurofibromatosis: GISTs are frequent in this setting and must not be misdiagnosed as neurofibromas. 相似文献
19.
Thomas Walter Florence Mege-Lechevallier Jean-Yves Scoazec Xavier Martin Jean-Alain Chayvialle Catherine Lombard-Bohas 《Pathology, research and practice》2009
Endocrine tumors of the upper urogenital tract are extremely rare. We report the case of a patient with a primary well-differentiated endocrine carcinoma of the renal pelvis metastatic to the liver, in whom an objective response was obtained under octreotide treatment. A 36-year-old woman without symptoms was admitted for exploration of a solid nodule in the right kidney. A right nephrectomy was performed. The histological examination of the surgical specimen diagnosed a primary well-differentiated endocrine tumor of the renal pelvis. Tumor cells strongly expressed synaptophysin and were focally positive for chromogranin A; they displayed faint reactivity for PSAP. Three months later, multiple liver metastases, proved by biopsy, were diagnosed. After two lines of chemotherapy, octreotide treatment was initiated because of persistent high activity at scintigraphic examination. A marked decrease in tumor volume and in chromogranin A serum levels was obtained. Two years later, there was no further progression. The patient was treated with octreotide. Our report points out the unusual immunophenotypic features which may be encountered in well-differentiated endocrine carcinoma of the upper urogenital tract and the potential interest in somatostatin analogues in the treatment of metastatic cases. 相似文献
20.
The distribution of substance P (SP) in human anencephalic fetus spinal cord has been studied with the indirect immunofluorescence technique. The SP-like immunoreactivity was detected within plexuses of fibres localized in the superficial layers of the dorsal grey including the marginal zone and substantia gelatinosa, and also the dorsal funicular grey. The other spinal cord areas were devoid of SP-like immunoreactivity. Comparison with normal fetus spinal cord reveals that in both normal and anencephalic fetuses the dorsal SP-patterns are comparable. This study indicates that in human fetus spinal cord most of the SP-fibres dorsally localized, occur even if the brain itself does not develop. 相似文献