Preparation of the femoral bone cavity in cementless stems: broaching versus compaction

Background and purpose — Short-term experimental studies have confirmed that there is superior fixation of cementless implants inserted with compaction compared to broaching of the cancellous bone.

Patients and methods — 1-stage, bilateral primary THA was performed in 28 patients between May 2001 and September 2007. The patients were randomized to femoral bone preparation with broaching on 1 side and compaction on the other side. 8 patients declined to attend the postoperative follow-up, leaving 20 patients (13 male) with a mean age of 58 (36–70) years for evaluation. The patients were followed with radiostereometric analysis (RSA) at baseline, at 6 and 12 weeks, and at 1, 2, and 5 years, and measurements of periprosthetic bone mineral density (BMD) at baseline and at 1, 2, and 5 years. The subjective part of the Harris hip score (HHS) and details of complications throughout the observation period were obtained at a mean interval of 6.3 (3.0–9.5) years after surgery.

Results — Femoral stems in the compaction group had a higher degree of medio-lateral migration (0.21?mm, 95% CI: 0.03–0.40) than femoral stems in the broaching group at 5 years (p = 0.02). No other significant differences in translations or rotations were found between the 2 surgical techniques at 2 years (p > 0.4) and 5 years (p > 0.7) postoperatively. There were no individual stems with continuous migration. Periprosthetic BMD in the 7 Gruen zones was similar at 2 years and at 5 years. Intraoperative femoral fractures occurred in 2 of 20 compacted hips, but there were none in the 20 broached hips. The HHS and dislocations were similar in the 2 groups at 6.3 (3.0–9.5) years after surgery.

Interpretation — Bone compaction as a surgical technique with the Bi-Metric stem did not show the superior outcomes expected compared to conventional broaching. Furthermore, 2 periprosthetic fractures occurred using the compaction technique, so we cannot recommend compaction for insertion of the cementless Bi-Metric stem.     

FDG PET/CT in cancer: comparison of actual use with literature-based recommendations

Purpose

The Region of Southern Denmark (RSD), covering 1.2 of Denmark’s 5.6 million inhabitants, established a task force to (1) retrieve literature evidence for the clinical use of positron emission tomography (PET)/CT and provide consequent recommendations and further to (2) compare the actual use of PET/CT in the RSD with these recommendations. This article summarizes the results.

Methods

A Work Group appointed a professional Subgroup which made Clinician Groups conduct literature reviews on six selected cancers responsible for 5,768 (62.6 %) of 9,213 PET/CT scans in the RSD in 2012. Rapid Evidence Assessment was applied, using the methodology of systematic reviews with predefined limitations to search PubMed, Embase and the Cochrane Library for articles published in English/Danish/Swedish/Norwegian since 2002. PICO questions were defined, data recorded and quality appraised and rated with regard to strength and evidence level. Consequent recommendations for applications of PET/CT were established. The actual use of PET/CT was compared with these, where grades A and B indicated “established” and “useful” and grades C and D “potentially useful” and “non-recommendable” indications, respectively.

Results

Of 11,729 citations, 1,729 were considered for review, and 204 were included. The evidence suggested usefulness of PET/CT in lung, lymphoma, melanoma, head and neck, and colorectal cancers, whereas evidence was sparse in gynaecological cancers. The agreement between actual use of PET/CT and literature-based recommendations was high in the first five mentioned cancers in that 96.2 % of scans were made for grade A or B indications versus only 22.2 % in gynaecological cancers.

Conclusion

Evidence-based usefulness was reported in five of six selected cancers; evidence was sparse in the sixth, gynaecological cancers. Actual use of PET/CT agreed well with recommendations.

     

T(peak)T(end) interval in long QT syndrome

Background

The T_peakT_end (T_pT_e) interval is believed to reflect the transmural dispersion of repolarization. Accordingly, it should be a risk factor in long QT syndrome (LQTS). The aim of the study was to determine the effect of genotype on T_pT_e interval and test whether it was related to the occurrence of syncope.

Methods

Electrocardiograms were taken in 95 patients with LQTS drawn from the Danish long QT registry (44 patients with KvLQT1, 43 with HERG, and 8 with SCN5A mutations) and manually evaluated for the QT, QT_peak, and RR interval.

Results and conclusion

(1) T_pT_e cannot be used to distinguish symptomatic from asymptomatic patients with LQTS; (2) HERG patients have longer T_pT_e than KvLQT1 patients; and (3) there is no need to heart rate-correct T_pT_e intervals in patients with LQTS.     

Effect of separate malocclusion traits on concern for dental appearance

Effects of separate traits of malocclusion on concern for dental appearance were isolated by means of multiple regression analysis in a 15-yr follow-up study of 30-yr-old Danes. On the basis of questionnaires (response rate 86%, n = 841), the dependent "concern-for-dental-appearance" variable was constructed from the respondents' replies about recalled perceptions and societal reactions concerning their dental appearance at the time of adolescence. In the same individuals, separate traits of malocclusion had been recorded clinically 15 yr earlier. These traits were inserted as independent dummy variables into the regression model. In both sexes the closest relationship with the dependent variable was displayed by the most conspicuous traits in the anterior region of the dentition. Some traits showed significant associations only in women, whose regression coefficients were, in general, higher than those of men. About half of the variation in the dependent variable was explained by the model.     

History of blood gas analysis. VI. Oximetry

Oximetry, the measurement of hemoglobin oxygen saturation in either blood or tissue, depends on the Lambert-Beer relationship between light transmission and optical density. Shortly after Bunsen and Kirchhoff invented the spectrometer in 1860, the oxygen transport function of hemoglobin was demonstrated by Stokes and Hoppe-Seyler, who showed color changes produced by aeration of hemoglobin solutions. In 1932 in Göttingen, Germany, Nicolai optically recorded the in vivo oxygen consumption of a hand after circulatory occlusion. Kramer showed that the Lambert-Beer law applied to hemoglobin solutions and approximately to whole blood, and measured saturation by the transmission of red light through unopened arteries. Matthes in Leipzig, Germany, built the first apparatus to measure ear oxygen saturation and introduced a second wavelength (green or infrared) insensitive to saturation to compensate for blood volume and tissue pigments. Millikan built a light-weight car “oximeter” during World War II to train pilots for military aviation. Wood added a pneumatic cuff to obtain a bloodless zero. Brinkman and Zijlstra in Groningen, The Netherlands, showed that red light reflected from the forehead could be used to measure oxygen saturation. Zijlstra initiated cuvette and catheter reflection oximetry. Instrumentation Laboratory used multiple wavelengths to measure blood carboxyhemoglobin and methemoglobin is cuvette oximeters. Shaw devised an eight-wavelength ear oximeter. Nakajima and coworkers invented the pulse oximeter, which avoids the need for calibration with only two wavelengths by responding only to the pulsatile changes in transmitted red and infrared light. Lübbers developed catheter tip and cuvette fiberoptic sensors for oxygen tension, carbon dioxide tension, and pH.     

Isocentric rotational performance of the Elekta Precise Table studied using a USB-microscope

The isocentric three-dimensional performance of the Elekta Precise Table was investigated. A pointer was attached to the radiation head of the accelerator and positioned at the geometric rotational axis of the head. A USB-microscope was mounted on the treatment tabletop to measure the table position relative to the pointer tip. The table performance was mapped in terms of USB-microscope images of the pointer tip at different table angles and load configurations. The USB-microscope was used as a detector to measure the pointer tip positions with a resolution down to 0.01 mm. A new elastic model of the treatment table was developed. This model describes the performance of the treatment table quite well except from some deviations due to backlash effects. Geometric and elastic features are described through six parameters. These parameters are calculated using the linear least squares fitting technique. A new method to ensure optimal positioning of the table relative to the accelerator is presented. This method cannot eliminate systematic errors completely. To eliminate systematic errors we suggest that geometric and elastic models of the table and accelerator gantry arm are incorporated in the dose planning system.     

Interindividual differences in H reflex modulation during normal walking

Based on previous studies, at least two different types of soleus Hoffmann (H) reflex modulation were likely to be found during normal human walking. Accordingly, the aim of the present study was to identify different patterns of modulation of the soleus H reflex and to examine whether or not subjects with different H reflex modulation would exhibit different walking mechanics and different EMG activity. Fifteen subjects walked across two force platforms at 4.5 km/h (+/-10%) while the movements were recorded on video. The soleus H reflex and EMG activity were recorded separately during treadmill walking at 4.5 km/h. Using a two-dimensional analysis joint angles, angular velocities, accelerations, linear velocities and accelerations were calculated, and net joint moments about the ankle, knee and hip joint were computed by inverse dynamics from the video and force plate data. Six subjects (group S) showed a suppressed H reflex during the swing phase, and 9 subjects (group LS) showed increasing reflex excitability during the swing phase. The plantar flexor dominated moment about the ankle joint was greater for group LS. In contrast, the extensor dominated moment about the knee joint was greater for the S group. The hip joint moment was similar for the groups. The EMG activity in the vastus lateralis and anterior tibial muscles was greater prior to heel strike for the S group. These data indicate that human walking exhibits at least two different motor patterns as evaluated by gating of afferent input to the spinal cord, by EMG activity and by walking mechanics. Increasing H reflex excitability during the swing phase appears to protect the subject against unexpected perturbations around heel strike by a facilitated stretch reflex in the triceps surae muscle. Alternatively, in subjects with a suppressed H reflex in the swing phase the knee joint extensors seem to form the primary protection around heel strike.     

The genetic basis of Brugada syndrome: A mutation update

Brugada syndrome (BrS) is a condition characterized by a distinct ST‐segment elevation in the right precordial leads of the electrocardiogram and, clinically, by an increased risk of cardiac arrhythmia and sudden death. The condition predominantly exhibits an autosomal dominant pattern of inheritance with an average prevalence of 5:10,000 worldwide. Currently, more than 100 mutations in seven genes have been associated with BrS. Loss‐of‐function mutations in SCN5A, which encodes the α‐subunit of the Na_v1.5 sodium ion channel conducting the depolarizing I_Na current, causes 15–20% of BrS cases. A few mutations have been described in GPD1L, which encodes glycerol‐3‐phosphate dehydrogenase‐1 like protein; CACNA1C, which encodes the α‐subunit of the Ca_v1.2 ion channel conducting the depolarizing I_L,Ca current; CACNB2, which encodes the stimulating β2‐subunit of the Ca_v1.2 ion channel; SCN1B and SCN3B, which, in the heart, encodes β‐subunits of the Na_v1.5 sodium ion channel, and KCNE3, which encodes the ancillary inhibitory β‐subunit of several potassium channels including the Kv4.3 ion channel conducting the repolarizing potassium I_to current. BrS exhibits variable expressivity, reduced penetrance, and “mixed phenotypes,” where families contain members with BrS as well as long QT syndrome, atrial fibrillation, short QT syndrome, conduction disease, or structural heart disease, have also been described. Hum Mutat 30:1–11, 2009. © 2009 Wiley‐Liss, Inc.