Cement migration after THR. A comparison of charnley elite and exeter femoral stems using RSA

Studies using roentgen stereophotogrammetric analysis (RSA) have shown that the femoral components of cemented total hip replacements (THR) migrate distally relative to the bone, but it is not clear whether this occurs at the cement-implant or the cement-bone interface or within the cement mantle. Our aim was to determine where this migration occurred, since this has important implications for the way in which implants function and fail. Using RSA we compared for two years the migration of the tip of the stem with that of the cement restrictor for two different designs of THR, the Exeter and Charnley Elite. We have assumed that if the cement restrictor migrates, then at least part of the cement mantle also migrates. Our results have shown that the Exeter migrates distally three times faster than the Charnley Elite and at different interfaces. With the Exeter migration was at the cement-implant interface whereas with the Charnley Elite there was migration at both the cement-bone and the cement-implant interfaces.     

An examination of ALDH2 genotypes, alcohol metabolism and the flushing response in Native Americans

OBJECTIVE: The study was designed to examine the relationship between aldehyde dehydrogenase (ALDH2) genotype and the flushing response in a population of Native Americans. METHOD: Objective measures of the flushing response were obtained by monitoring skin temperature, heart rate, blood pressure, as well as blood alcohol concentrations, in flushing and nonflushing Native Americans (n = 105) as well as in Oriental (n = 15) and white (n = 15) control subjects following a dose of alcohol (0.2 or 0.4 gm/kg). ALDH genotypes were determined via polymerase chain reaction followed by hybridization to 32P or biotin-labeled allele-specific oligonucleotide probes. RESULTS: There were no ALDH2 mutations detectable in Native Americans reporting the flushing response, nor any objective evidence of an Oriental-like response to alcohol. The rate of alcohol metabolism was shown to be the same among whites, Native flushers and Native nonflushers. CONCLUSIONS: The results demonstrate that the flushing reaction experienced by Native Americans appears to be milder and less unpleasant than the "Oriental" flushing reaction, with little effect on drinking frequency and amount. In addition, the flushing is not mediated by the ALDH2 mutation or elevated blood acetaldehyde. A critical analysis of the discrepancies in the literature regarding alcohol metabolism in Native Americans is provided.     

Perinatal mortality trends in a referral hospital

A comparative study of perinatal mortality patterns over a period was conducted at a teaching hospital of South India. Among the 6,048 babies born from January 1984 to December 1985 (Group A), there were 265 (43.8/1000) still births and 127 (22.0/1000) early neonatal deaths. Three hundred and thirty seven (41/1000) babies were still born and 235 (29.8/1000) early neonatal deaths out of 8,215 deliveries during 1992–93 (Group B). The perinatal mortality rate (PMR) in Group A and B were 57.9/1000 and 57.7/1000 respectively. Unbooked cases accounted for the majority (> 75%) of perinatal deaths during both the periods. The overall mortality rates in unbooked cases were three to four times higher than booked cases. Among the various causes of still births, antepartum haemorrhage and uterine rupture had increased. Septicaemia was the major cause of early neonatal deaths in Group A, but in Group B birth asphyxia and prematurity were the leading causes. Effective interventions like creating awareness among the target population to utilise maternal and child health services and early referral of high risk cases with improved intranatal and perinatal care can decrease the perinatal mortality.     

HIV vaccine research continues despite setbacks

New agents for treating asthma and allergic disease are now under development. From Arris Pharmaceutical comes recombinant neutral endopeptidase (rNEP), ^* an agent that may prove effective as prophylaxis against symptomatic episodes in patients with moderate-to-severe asthma. A group of compounds known as tryptase inhibitors may also be of use in inflammatory diseases such as asthma, as preclinical studies have shown that they can prevent airway inflammation in sheep. In addition, Tanox Biosystems is developing therapies that target immunoglobulin E (IgE), which is a key mediator of atopic allergic disease. News of recent progress with these agents was presented at an IBC USA conference on Asthma [ Philadelphia, US; October 1995 ].     

Access Technique for Retroperitoneoscopy

Purpose

The access technique for retroperitoneoscopy is not well established, and differs from transperitoneal laparoscopic access in 3 key aspects: 1) location and technique of primary trocar placement, 2) optimal positioning of the balloon dilator and 3) technique for safe placement of secondary ports. Our method of obtaining retroperitoneoscopic access addresses these issues.

Materials and Methods

A total of 37 patients underwent retroperitoneoscopic surgery of the kidney and upper ureter.

Results

Our technique facilitates balloon placement within Gerota's fascia, minimizes peritoneal injury and optimizes port placement during retroperitoneoscopic surgery.

Conclusions

Although our success rate for placing the balloon within Gerota's fascia has improved, additional experience is required to achieve subfascial balloon placement more consistently.     

The treatment of primary recurrence following laryngectomy for laryngeal carcinoma

Of the 397 patients undergoing total laryngectomy for squamous cell carcinoma by Professor P. M. Stell between 1963 and 1991, 73 are known to have suffered a local recurrence. Of these, 17 were treated by radiotherapy and/or further surgery. Secondary surgery was reserved for selected cases of peristomal and pharyngeal recurrence: of the 35 peristomal recurrences, eight were treated surgically. Previous reports of recurrence after total laryngectomy have focused on the problem of peristomal recurrence. Patients with pharyngeal recurrences can also be treated satisfactorily with microvascular surgical reconstruction techniques. Though rarely curative, secondary total pharyngectomy can be highly palliative and results in little additional morbidity.     

Effect of child loss on contraception acceptance

In India, interviews were conducted with 250 couples who had at least 2 living children and at least 1 son so researchers could examine the effect of child loss on contraceptive usage. The interviewees lived in the area served by the rural health center in Pohir. 67 couples had lost a child. The child loss group had an acceptance rate for contraception of 41.7% compared to 44.8% for the group who had not experienced child loss. The difference was insignificant. Caste, literacy, and parity did not affect contraceptive usage. These findings suggest that child loss does not play a crucial role in contraception acceptance. On the other hand, some studies show that it is a barrier to fertility limitation. Additional studies are needed to resolve the issue of child loss and fertility.     

Rapid and sensitive enzyme-linked immunosorbent assay for the microsomal epoxide hydrolase

A rapid and sensitive indirect enzyme-linked immunosorbent assay(ELISA) was developed for micrsomal epoxide hydrolase of ratliver. The assay, which is easily and readily performed, issignificantly more sensitive than most enzymatic epoxide hydrolaseassays routinely used and electroimmunoassays previously developed.The limit of sensitivity of the ELISA is between 2–5 ngof microsomal epoxide hydrolase. Using the ELISA microsomalepoxide hydrolases of mouse and rat liver were shown to be antigenicallyvery similar, while microsomal epoxide hydrolases of guineapig, monkey and human liver are antigenically distinct fromthose of rat and mouse. The ELISA developed here is capableof detecting microsomal epoxide hydrolase of rat and mouse livereven when significant enzymatic activity is lost. These resultsindicate that the antigenic sites recognized by the antibodiesused are distinct from the catalytic site of the epoxide hydrolase.Approximately 1.9% of rat microsomal protein was quantifiedas microsomal epoxide hydrolase by the ELISA. Low levels ofmicrosomal epoxide hydrolase were also detected in rat livercytosol (0.02% of the cytosolic protein) demonstrating thatmicrosomal epoxide hydrolase is not totally membrane bound orthat an immunologically related protein occurs in the cytosolof normal rat liver. The ELISA developed here will be valuablein investigating further the role of microsomal epoxide hydrolase.     

Papillary thyroid carcinoma in a thyroglossal cyst

The incidence of Papillary Thyroid Carcinoma in a Thyroglossal Cyst is rare. Only about 160 cases have been reported in the last 85 years. We report a case of Thyroglossal Cyst who underwent Sistrunk ’s Operation. The Cyst was reported to contain a focus of papillary thyroid carcinoma. In the absence of metastases in thyroid gland and neck nodes, only thyroid suppression with Thyroxine was given. After I year of follow-up there are no metastases. The importance of Sistrunk’s operation lies not only in complete removal of Thyroglossal Cyst but also in management of small foci of Papillary thyroid Carcinoma.