Prospective randomized control trial comparing Biostop, a bioabsorbable cement restrictor with the standard Hardinge cement plug

This study is a randomized control trial comparing the effectiveness of Biostop, an absorbable cement restrictor with Hardinge, a nonabsorbable cement restrictor in 136 consecutive patients who had a Charnley total hip replacement inserted. Type of cement restrictor, the surgical approach, the surgeon, the viscosity of the cement, the cementing technique, and the femoral canal diameter were statistically compared to the distal migration of the cement. We found no statistical difference between any of these variables. In conclusion, Biostop is as effective as the Hardinge cement restrictor, and in the presence of adequate cement restriction, the above factors in vivo have little effect in distal migration of the cement mantle.     

Unit costs of community mental health services

The unit (hourly) costs of delivering services for six community mental health agencies in the greater Portland, Oregon area were computed. The calculations include an explicit methodology for allocating indirect costs associated with clinical services and with administrative overhead. Substantial variation among the six agencies in their unit costs was found and is explained by agency differences in: use of high cost (chiefly medical) personnel, the fraction of time staff spend in direct face-to-face client contact, and numbers of clients in treatment groups. The methodology as well as the results are increasingly important for community mental health programs in the era of managed mental health care.This study was partially supported by National Institute of Mental Health grant numbers P50 MH43458 and R01 MH45015.     

The value of direct radionuclide cystography in the detection of vesicoureteral reflux in children with normal voiding cystourethrography

Background

Vesicoureteral reflux (VUR) is one of the most important risk factors for urinary tract infection (UTI). Diagnosis and treatment of VUR is important to prevent irreversible complications, such as renal scarring and chronic renal failure. This study was conducted to assess the value of direct radionuclide cystography (DRNC) in the detection of VUR in children with UTI and a normal voiding cystourethrography (VCUG).

Methods

DRNC was performed in 35 children with a normal VCUG after an episode of febrile UTI who had hydronephrosis or hydroureter, abnormal acute dimercaptosuccinic acid (DMSA) scan results and/or febrile UTI recurrence. This study was conducted in the nephrology department of Mofid Children’s Hospital, Tehran (Iran).

Results

The results were statistically analyzed. Among the 70 ureters studied, 33 (49.1 %) were observed to have VUR. Of these, 17 (51.5 %) had mild, 14 (42.4 %) moderate, and 2 (6.1 %) severe reflux. A significant relationship was observed between DRNC results and DMSA renal scan findings (P?<?0.05).

Conclusions

Based on our results, we suggest that DRNC may reveal VUR despite a normal VCUG in children with hydronephrosis, abnormal acute DMSA, and/or recurrent febrile UTI.

     

Use of Lipid-Lowering Agents for the Prevention of Age-Related Macular Degeneration: A Meta-Analysis of Observational Studies

Purpose : To examine the effect of lipid-lowering agents in the development of age-related macular degeneration (AMD) through the techniques of meta-analysis. Methods : Case-control and cohort studies presenting relative risks and 95% confidence intervals were identified through a literature review. Inclusion was limited to studies where both the exposure of interest (lipid-lowering agents) and outcome (AMD) were explicitly defined. Pooled estimates were computed using the random effects model. To quantify heterogeneity we calculated the proportion of total variance of between study variance using the Ri statistic. The Q statistic for heterogeneity was also calculated. Results : Eight studies were identified. The pooled relative risk (RR) for all studies was 0.74 (95% CI, 0.55–1.00). When only those studies examining the use of statins were pooled (n = 7), the RR was 0.70 (95% CI, 0.48–1.03). Using the Ri statistic, the heterogeneity between studies was found to be 0.85 for all studies and 0.89 for studies examining statins. Conclusion : Lipid-lowering agents, including statins, do not appear to lower the risk of developing AMD, although clinically significant effects cannot be excluded. The use of these agents in the prevention of AMD cannot be recommended until well designed prospective studies with long follow up have demonstrated a benefit.     

Functional relevance of patellofemoral thickness before and after unicompartmental patellofemoral replacement

The aim of this study was to assess the increase in the anterior height of the knee after unicompartmental patellofemoral replacement and the impact of this increase on the range of motion and function of the knee. Twenty-eight patients (34 knees) who underwent patellofemoral replacement with FPV(TM) prosthesis between 2005 and 2009 were identified and retrospectively analyzed using chart and radiological review. Trochlear height and patellar thickness were measured combined and compared pre and postoperatively. The range of movement and functional outcome scores after 6-12 months follow-up were noted. The effect of increased postoperative anterior-posterior height of the knee on the range of motion was studied. Postoperative mean range of flexion of the knee joint was 116°. The mean Oxford knee score was 21 points. The mean American Knee Society Knee Score was 80 points for pain and 61 points for function. The trochlear height and patellar thickness were increased by 3.5 and 2.5 mms respectively, resulting in average total increase of 6mm in the anterior-posterior height of the knee. We found no relationship between range of motion and function of the knee and the increase in the anterior-posterior height. We found a negative correlation between increase in the anterior-posterior height and preoperative anterior-posterior height. FPV patellofemoral replacement results in correct anatomical reconstruction of the trochlear height rather than 'overstuffing' of the patellofemoral joint. There is an increase in anterior-posterior height of the knee but this does not affect range of movement or clinical outcome.     

Primary diffuse large B‐cell lymphoma of the bone mimicking osteomyelitis

Consider primary bone lymphoma as an important differential diagnosis of osteomyelitis.In patients who are unresponsive to antibiotics and core needle biopsy result is incoherent with clinical symptoms, consider open biopsy for accurate diagnosis.     

Overuse or underuse of MRI scanners in private radiology centers in Tehran

OBJECTIVES: The semiprivate health system in Iran has created an opportunity for unnecessary uses of advanced medical equipments including magnetic resonance imaging (MRI). This study aimed to evaluate the evidence for MRI overuse in private diagnostic imaging centers in Tehran, Iran. The objectives of this study were to determine the frequency of use of MRI scans for different complaints and to explore frequency of normal MRI findings as a function of unnecessary MRI use. METHODS: We conducted a survey among private MRI centers in Tehran, Iran, to study the proportion of MRI scans that may result in significant clinical finding. All MRI reports at a specific point in time at selected MRI centers were reviewed by a physician and the findings were recorded as normal, abnormal, or substantial changes. RESULTS: Of all the MRI reports, 17.2 percent had resulted in normal findings; 9.8 percent ordered for examination of headache, and 4.8 percent for lower back pain. CONCLUSION: Unnecessary MRIs are most likely to result in normal finding; although not all the MRI with normal results could be identified as unnecessary. Negative findings from MRI scans may be reassuring to both clinicians and patients. The proportion of normal findings in MRI scans did not provide evidence of MRI overuse in Iran. The results of this study warrant formation of guidelines for the use of MRIs for headache and low back pain disorders.     

Community mental health program efficiency

Six urban community mental health centers participated in a capitated payment system designed for persons with severe mental illness who frequently used the state hospital. The centers and their funding agency agreed that a chief outcome measure would be the length of time clients were able to remain enrolled in the outpatient program. Clients of the six agencies were quite similar to one another. During the 18-month study length of enrollment in the outpatient program did not vary among the agencies whereas agency expenditures varied by more than three-fold. Although some of this expenditure variation was due to economies of scale at larger agencies, different practice styles also contributed to variable efficiency.This study was partially supported by the National Institute of Mental Health, grant numbers P50 MH43458 and R01 MH45015.     

Compartment syndrome of the shoulder girdle

. We report a case of subacute compartment syndrome involving the deltoid muscle of a young person. We discuss the presentation, predisposing factors, investigation and treatment of this otherwise rare condition. Résumé. Nous rapportons un cas de syndrome des loges chronique du delto?de chez un sujet jeune. Nous discuterons de la présentation, des facteurs prédisposants ainsi que de l'exploration et du traitement de cette affection par ailleurs rare.