Patellofemoral joint arthroplasty: patient selection,surgical technique and outcomes

Isolated patellofemoral arthritis is an increasingly recognized entity, and is usually associated with previous patellofemoral dysplasia or instability. Patellofemoral arthroplasty (PFA) has evolved significantly in recent years, both in terms of implant design and importantly in the understanding of appropriate patient selection. This review outlines the indications and investigations for PFA, provides a brief history of the development of contemporary implants, and presents the clinical outcomes for the prostheses most commonly used in the UK. In addition, it provides a detailed surgical technique for implantation of an onlay implant, with tips on how to optimize patellofemoral biomechanics and thus achieve a consistently good outcome.     

Bone mineral density changes after parathyroidectomy are dependent on biochemical profile

Background

Bone mineral density (BMD) has been found to improve after parathyroidectomy (PTX) in patients with primary hyperparathyroidism. There are few data on the effect of PTX on BMD in normocalcemic and normohormonal primary hyperparathyroidism.

Antenatal card for illiterate traditional birth attendants

The training and use of trained birth attendants (TBAs) in Guinea Bissau was started in 1977 as part of the primary health care program. The majority of TBAs are illiterate, making accurate record-keeping of antenatal visits ineffective. This paper presents an antenatal card developed by the Ministry of Health and Social Affairs in use since 1982. The card was designed for several purposes: to help nurse-supervisors find and correct mistakes, to help TBAs remember what to look for during antenatal visits, and to enable them to identify at-risk pregnancies and refer them if necessary. The card requires no writing other than the initial visit, when it is suggested that a literate person assist the TBA in recording name, age, and village. Pictorial symbols are used on the rest of the card, which is retained by the patient between visits. The card is divided into 3 areas: a history (number of live children, number of dead children, number of abortions) recorded by placing the correct number of ticks in the proper column; examination (weight if possible, signs of anemia and edema indicated by a +or-, height of uterus, presence of fetal heart sounds); care (reminding TBAs to give nutritional advice, malaria prophylaxis, dispense iron tablets, determine if referral is necessary). The card needs to be field tested by nurses and midwives who will be training the TBAs, and then evaluated for its use in detecting at-risk pregnancies, making any additions or changes as necessary.