Unsatisfactory results of a first-generation modular femoral stem implanted without cement. A 4- to 9-year follow-up study

In a attempt to clarify the effects of methylprednisolone pulse therapy on the insidious (subacute) type of crescentic glomerulonephritis with slow, but steady deterioration of renal function and poor response to treatment, we analyzed the clinical course of 24 patients (male:female = 15:9) with a mean age of 48.5 years. They fulfilled the following criteria: 1) crescents were observed in more than 50% of the glomeruli, 2) the increment of serum creatinine (Cr) could be determined sequentially on three or more occasions before treatment, and reciprocals of serum Cr declined with slopes of less than 1.0 x 10(-2) dl/mg/day, 3) corticosteroids and/or immunosuppressants were administered. The patients were divided into two groups: pulse therapy group (P) (15 patients), to which methylprednisolone 500 or 1,000 mg a day was administered intravenously for three consecutive days, and a conventional therapy group (C) (9 patients). There were no differences between groups P and C in clinical parameters, including sex, age, underlying diseases, urinary protein, blood pressure, serum Cr and slope of 1/Cr before treatment, and pathological findings, including percentages of glomeruli with crescents and degree of interstitial lesions. However, improvement of serum Cr, which was defined as a decline to the normal range or less than half of the pretreatment level, was observed in 9 (60%) in group P vs. only 1 (11%) in group C (p < 0.05). Re-biopsies were performed after treatment in 6 patients of group P with an improvement of serum Cr, and showed a decrease in the rate of crescent formation and almost complete loss of cellular crescents. At 1, 2 and 3 years follow-up, the renal survival rates were 86, 70 and 53%, respectively, in group P vs. 67, 14 and 14% respectively, in group C (p < 0.05). No serious side effects were observed in group P. These results suggest that methylprednisolone pulse therapy may be very effective for the insidious type of crescentic glomerulonephritis.     

The effect of surface coating of femoral prostheses implanted without cement: a 2- to 4-year follow-up study

The complement system covalently attaches C3d to microbial antigens which binds to CR2 on B lymphocytes, leading to a markedly enhanced adaptive immune response to that antigen. The enhancement is mediated by the cross-linking of the CR2-CD19 complex to mIg which augments the activation of several intracellular signalling pathways. Two additional receptors of the B lymphocyte, FcgammaRIIB and CD22, have opposing effects when cross-linked to mIg, the former suppressing signalling by recruiting the inositol phosphatase, SHIP, and the latter by activating the phosphotyrosine phosphatase, SHP-1. Two principles emerge from these studies: innate immunity guides the adaptive immune response, and activation of the B lymphocyte is determined by co-receptors which evaluate the biological characteristics of antigen.     

Predictive value of early radiographic findings in cementless total hip arthroplasty femoral components: an 8- to 12-year follow-up

Total hip replacement was performed in 119 patients (124 hips) with an uncemented Ortholoc femoral component between 1982 and 1987. Eight patients (9 hips) died, and 13 patients (15 hips) were lost to follow-up, leaving 98 patients (100 hips) followed for 8 to 12 years. Pain scores and anteroposterior and lateral radiographs of the femoral component from the 2-year follow-up visit were evaluated. Twenty-four of the 100 hips were revised for aseptic loosening. Radiographic criteria were highly effective in predicting those cases that would require revision. Radiolucent lines occurred at a higher frequency in all Gruen zones of the revision group radiographs, and the differences were statistically significant in zones 1, 7, 8, and 14 (P < .001). Proximal radiolucent lines were present in all of the revision cases and in 45% of the nonrevision cases. Radiolucent lines occurring on the lateral view alone were a statistically significant predictor of future need for revision (P < .001). Presence of radiolucent lines around the porous coating was 100% sensitive and 55% specific in predicting future revision. Absence of radiolucent lines around the porous coating was 100% sensitive and 45% specific in predicting no need for revision in the first 8 years.     

A femoral component inserted without cement in total hip arthroplasty. A study of the Tri-Lock component with an average ten-year duration of follow-up

Seventy-four total hip arthroplasties in sixty-six patients were performed, between 1983 and 1986, with use of a Tri-Lock femoral component inserted without cement. This tapered cobalt-chromium component has a fixed head and a circumferential proximal porous coating. Follow-up was conducted with use of a questionnaire, physical examination, and radiographic analysis. At the time of the latest follow-up, fifteen patients (eighteen hips) had died, three patients (four hips) had been lost to follow-up, and one patient (one hip) had refused to participate in the follow-up study; however, the status of fifteen hips at the time of death could be verified. Thus, clinical follow-up data were available for sixty-six of the original seventy-four hips. The average age at the time of the operation was sixty-two years (range, seventeen to eighty-four years), and the average interval between the operation and the latest follow-up evaluation was 10.0 years (range, 8.3 to 11.6 years). The Harris hip score was determined for forty-three hips (forty-one patients) in which the prosthesis was in situ at the time of the latest follow-up. The score was good for thirteen hips and excellent for twenty-eight, so the rate of clinical success was 95 per cent. Two patients had a fair result. One of them had persistent pain and the other had limited motion, but neither had radiographic evidence of loosening of the femoral or acetabular component. All forty-one patients were satisfied with the result. The probability (with standard error) of survival of the femoral component at ten years, with revision as the end point, was 0.95 +/- 0.03. The rate of revision of the femoral component because of aseptic loosening was one (2 per cent) of sixty-six. The overall rate of aseptic loosening of the femoral component in the hips that were followed radiographically was two (4 per cent) of forty-seven. Only one (2 per cent) of the forty-seven acetabular cups had evidence of aseptic loosening. There was no radiographic evidence of distal osteolysis around the prostheses that were well fixed. Proximal osteolysis was present in five (11 per cent) of forty-seven hips, but none of the lesions compromised the stability of the prosthesis or the bone and there were no associated fractures. At an average of ten years postoperatively, the Tri-Lock femoral component functioned well overall and patient satisfaction was high.     

Failure of the Mecring screw-ring acetabular component in total hip arthroplasty. A three to seven-year follow-up study

We prospectively studied the results of 411 consecutive total hip arthroplasties with a Mecring screw-ring acetabular component inserted without cement combined with a Stanmore femoral stem inserted with cement. The duration of follow-up ranged from three to seven years (mean, four years and six months). Three hundred and thirty-one patients (378 hips) were available for physical examination and had a complete set of radiographs. The clinical result was good or excellent for 82 per cent (309) of the 378 hips. However, the rate of radiographic loosening of the acetabular component, as evidenced by migration at the most recent follow-up examination, was alarmingly high: 25 per cent (ninety-five) of the 378 hips. In general, these patients did not have serious clinical symptoms. The cups in women migrated significantly more often (p = 0.003) than those in men. Migration was also more frequent in patients who were less than fifty-one years old and in patients in whom the index procedure was a revision arthroplasty, but these differences were not significant. Twenty-one (6 per cent) of the acetabular cups were revised for aseptic loosening. The high rate of radiographic loosening has led us to abandon the use of the Mecring screw-ring acetabular component.     

The Stanmore total hip arthroplasty. A 15- to 20-year follow-up study

An ongoing study was made of 804 primary Stanmore total hip prostheses implanted in 839 patients between 1973 and 1991. The earliest surviving implants were brought back for radiologic and clinical review in 1995 at an average of 17 years after surgery. The remainder of the patients still living were sent a questionnaire to assess their current status. Survivorship was 95% at 10 years, 85% at 15 years, and 73% at 20 years. The average Merle d'Aubigné-Postel score was excellent up until 14 years. Patient satisfaction remained high until 22 years. Overall, 10% of the prostheses had failed. The results of this study suggest that the Stanmore prosthesis is capable of producing satisfactory long-term results that compare favorably with those of other cemented prostheses.     

Subcostal, 3-4 cm, mini-cholecystectomy. A 3-year follow-up

The authors report the results of mini-cholecystectomy performed through a 3 to 4 cm long subcostal incision in 29 patients with the diagnosis of acute or chronic cholecystitis, from February 1991 to November 1922. Some of the patients were obese, diabetics or presented as emergency cases. The patients were operated on in the morning, as in laparoscopic cholecystectomy, began oral intake in the afternoon and were discharged on the day after surgery. Dissection of the gallbladder was facilitated by the use of a modified gynecologic valve and long thin instruments. Duration of surgery varied from 40 to 140 minutes. Patients could return to work on the third day after surgery. Notably, the costs/benefits were on the third more favorable than those of laparoscopic cholecystectomy.     

The porous-coated anatomic total hip prosthesis, inserted without cement. A prospective study with a minimum of ten years of follow-up

Because persistent tumor necrosis factor (TNF)-alpha activation may play a pathogenic role in human immunodeficiency virus infection, TNF component levels were assessed over 78 weeks in plasma and peripheral blood mononuclear cells (PBMC) during highly active antiretroviral therapy (HAART) in 40 HIV-infected patients. HAART induced a significant decline in plasma levels of TNF-alpha and soluble TNF receptors and was associated with a fall in the abnormally increased unstimulated and a rise in the abnormally low Mycobacterium avium complex-purified-protein derivative-stimulated TNF-alpha released from PBMC. However, concentrations of these TNF components were not normalized. Patients with virologic and immunologic treatment failure after 52 weeks had higher levels of several TNF components than other patients early after initiation of therapy, also during periods with adequate virologic response. Although TNF components significantly decreased during HAART, these results support data indicating that full immunologic normalization is not achieved during such therapy. The persistent activation of the TNF system in a subgroup of persons may be involved in treatment failure.     

Results with a cementless alumina-coated cup with dual mobility. A twelve-year follow-up study

Two groups of 12 young bulls, as similar as possible with respect to age and weight, were fed a basic diet of hay and concentrates ad libitum for 170 days. The concentrate fed to one of the groups was supplemented with 0.20 mg of organic chromium per kg DM from a fodder yeast product so that the concentration of chromium in the total dry matter of their diet was 0.90 mg/kg, compared with 0.72 mg/kg in the diet of the control group. No significant differences were observed between the two groups of animals in terms of either their daily weight gain or any of the parameters of carcass quality examined. It is therefore concluded that in Sweden there is no reason to add chromium routinely to the diet of intensively fed, growing bulls.     

Effect of improved cementing techniques on the longevity of fixation in revision cemented femoral arthroplasties. Average 8.8-year follow-up period

Forty-six revision cemented femoral arthroplasties in which second-generation cementing techniques were used have been reviewed. After an average follow-up period of 8.8 years, 91% of the femoral components remained in place and 87% remained well fixed. Only 7% were rerevised for aseptic loosening. These results demonstrate a marked improvement over those of first-generation cementing techniques.     

A 3- to 6-year follow-up of former long-stay psychiatric patients in Northern Ireland

Little is known about the first patients who left hospital before and during the official implementation of the hospital discharge policy in Northern Ireland. This study describes patterns of residential provision for former long-stay patients (approximately two-thirds of whom had an ICD-9 diagnosis of schizophrenia) discharged from the six major psychiatric hospitals in Northern Ireland between 1987 and 1990 (n = 321). It also employs several instruments within a retrospective survey design to examine outcomes for a 35% sample of people (112/321) discharged between 1997 and 1990 and followed up in 1993. Almost two-thirds (61%) had been discharged to independent living or low-staffed statutory settings. None of the group was homeless, one person was in prison and three people had committed suicide during the first 2 years after discharged. Almost one-third had to be re-admitted at some stage during the 6-year period and 13% had died. 'Moderate' to 'major problems' with most daily living skills were reported for less than 25% of people, while 15% or less had problem behaviour. Approximately 90% or more were satisfied with most aspects of their new homes and most also reported feeling happier (77%), healthier (63%) and more independent (78%) since discharge. However, social, recreational and occupational opportunities were limited. Purchasers, providers and practitioners need to review ways in which former long-stay patients might be empowered to live more meaningful and integrated lives in the community, particularly as the current government strategy for health and social well-being (1997-2002) in Northern Ireland points to the closure of existing psychiatric hospitals.     

Failed cementless total hip arthroplasty for osteoarthrosis due to hip dysplasia. A minimum five-year follow-up study

PROBLEM: Apoptosis has been accepted as a mechanism for maintaining tolerance in the immune system. The induction of apoptotic cell death can also be a possible outcome of the lymphocyte activation. Expression of Fas ligand (FasL) by the human trophoblast has been proposed as a mechanism providing protection against the lytic action of decidual immune cells. The aim of this study was to determine whether decidual T cells undergo apoptosis during abortion. METHOD OF STUDY: We studied apoptosis of T cells isolated from the first-trimester decidua in 12 women after spontaneous or elective abortion. We used gel electrophoresis to detect DNA fragmentation. Cells undergoing DNA fragmentation also were identified by DNA analysis using flow cytometry. This method was based on the accumulation of ethanol-fixed apoptotic cells in the sub-G0/G1 peak of the DNA content as a result of the loss of DNA fragments from the cells and because of a reduced DNA ability to be stained by propidium iodide. In addition, the expression of Fas antigen on the surface of decidual T cells (CD3+) also was determined. RESULTS: We did not detect apoptosis by the "ladder" technique. However, the apoptotic index (the percentage of positive cells per total number of cells) ranged from 2% to 24% using flow cytometry. CONCLUSIONS: Trophoblast cells usually fail to stimulate alloantigen-specific T cells, but they may express nonclassical major histocompatibility complex alloantigens to which mothers can produce immunoglobulin G alloantibody, which requires T helper cell activation. The apoptosis of T cells in the human decidua, probably through Fas-FasL signaling, may be a defense mechanism against rejection of the fetal allograft by the maternal immune system.     

Treatment of acute lateral ankle ligament ruptures. A prospective 9-13-year follow-up study of three different therapies in 79 patients

In a prospective study of 79 patients with arthrographically verified acute ruptured lateral ankle ligaments we have evaluated the long-term results of three different treatments: operation and walking-cast, walking-cast alone and elastic bandage. The average follow-up period was 11 (9-13) years, and 32 parameters concerning interview, clinical and radiographic examinations were statistically analysed. The three kinds of treatment were found to be equal, since only one parameter showed significant difference at a 5% level using Fisher's exact and the Mann-Whitney test, and no difference by using the Kruskal-Wallis test for homogeneity. Residual disabilities and late complications, such as instability, pain on activity, and the number of secondary ligament reconstructions and talocrural arthroses were low. It was concluded that nonoperative treatment provided adequate results even after a decade.     

Evaluation of a program to teach phonemic awareness to young children: A 2- and 3-year follow-up and a new preschool trial.

This article reports a follow-up study of children in Grades 1 and 2 who had been instructed in phonemic awareness in preschool. Compared to a control condition, the trained children were superior in nonword reading 2 and 3 yrs later and in reading comprehension at 3 yrs. Control children furnished a disproportionate number of readers dependent on sight word reading. The superiority of the experimental condition did not extend to measures of automaticity in reading. W. A. Hoover and P. B. Gough's (1990) "simple view" of reading (Reading Comprehension?=?Listening Comprehension?×?Decoding) was supported. In a supplementary experiment, preschool children were trained with the program by their regular teachers and showed greater progress in aspects of phonemic awareness than the control condition from the main experiment. However, they did not gain as much as those in the more intensely trained experimental condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pollicisation of the index finger. A 27-year follow-up study

We have reviewed 11 patients with congenital absence of the thumb, treated by pollicisation of the index finger, after follow-up for 20 to 38 years. Seven of the hands also had an associated radial club-hand deformity. Function as assessed by the Percival score was excellent in six, good in three, fair in two and poor in four; three of the poor results were in patients with radial club hand. Ten of the 15 transfers were used as normal thumbs, but in five hands function required trick movements. Of the seven unilateral cases, two transplants were used as the dominant hand, and in another two thumb strength was more than 50% of that on the opposite side. For patients with isolated congenital absence of the thumb, pollicisation of the index finger gives good functional and cosmetic results which are maintained. The results are less reliable for those with radial club hand.     

Predictive validity of the Kuder Occupational Interest Survey: A 12- to 19-year follow-up.

More than 1,000 men and women were located 12-19 yrs after taking an early form of the Kuder Occupational Interest Survey either in high school or in college. Satisfactory data were available for 882 Ss. 51% were employed at the time of the follow-up in an occupation that would have been suggested to them had their inventory been interpreted to them. This compared favorably with other validity findings for occupationally scaled interest inventories and represented about 90% of the possible validity as derived from concurrent validity figures. College major scales from a high school level administration correctly predicted 55%. Ss in occupations consistent with their early interest profiles did not report greater job satisfaction or success, but did show greater continuance in their occupational career. Better prediction was achieved when the occupation was one named on the profile and when the person had gone to or graduated from college or entered a high-level or scientific-technical occupation. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)