Structural allograft in two-stage revisions for failed septic hip arthroplasty

We report 11 patients having revision of total hip arthroplasty using massive structural allografts for failure due to sepsis and associated bone loss. All patients had a two-stage reconstruction and the mean follow-up was 47.8 months (24 to 72). Positive cultures were obtained at the first stage in nine of the 11 patients, with Staphylococcus epidermidis being the most common organism. The other two patients had draining sinuses with negative cultures. There was no recurrence of infection in any patient. The mean increase in the modified Harris hip score was 45 and all the grafts appeared to have united to host bone. Two patients required additional procedures, but only one was related to the allograft. Complications included an incomplete sciatic nerve palsy and one case of graft resorption. Our results support the use of massive allografts in failed septic hip arthroplasty in which there is associated bone loss.     

Acute and chronic fetal hypoxia in monochorionic and dichorionic twins

OBJECTIVE: To assess the risk for acute and chronic fetal hypoxia in twin pregnancies. METHODS: We investigated 50 sets of twins (24-38 weeks' gestation, 660-3200 g birth weight) admitted consecutively to our neonatal intensive care unit. Seventy-six infants were appropriate for gestational age (AGA; tenth to 90th percentile), 20 were small for gestational age (SGA; below the tenth percentile), and four were large for gestational age (above the 90th percentile). Twenty-six singleton AGA term newborns served as controls. Umbilical arterial pH was used as a marker for acute and umbilical venous erythropoietin concentration for chronic fetal hypoxia. The results are given as median followed by quartiles. RESULTS: We identified 40 sets of diamniotic-dichorionic twins and ten sets of diamniotic-monochorionic twins with transplacental vascular shunts. In the second-born twin, umbilical arterial pH was lower (7.29, 7.23-7.33) than in the firstborn (7.31, 7.25-7.34) (P = .03), and the incidence of a low pH (less than 7.20) was higher (19 versus 11%). Two second-born twins and none of the firstborn twins had an umbilical arterial pH less than 7.05. In SGA twins, the erythropoietin concentration was elevated (34.8, 22.8-325 mU/mL) compared with that in AGA twins (16.2, 8.2-26.6 mU/mL) (P < .01). In AGA twins, erythropoietin concentration did not differ from that in AGA singleton newborns (19.6, 14.7-31.6 mU/mL). In 12 of 17 twin sets with weight discordancy greater than 15% and in all five twin sets with weight difference greater than 25%, erythropoietin concentration was higher in the smaller twin. The proportion of infants and of complete sets with elevated erythropoietin levels was higher (P < .01) in monochorionic than in dichorionic pregnancies. CONCLUSION: The second-born twin is at increased risk for acute birth asphyxia. Fetal growth restriction in twin pregnancies is associated with chronic fetal hypoxia. Monochorionic twins are at higher risk for chronic fetal hypoxia than are dichorionic twins.     

The distribution of HBV, HCV and HGV among livers with fulminant hepatic failure of different aetiology

BACKGROUND/AIMS: The aim of the study was to assess the impact factor of HCV and HGV in fulminant hepatic failure. METHODS: The 5'-untranslated regions of HCV RNA and HGV RNA and a segment of the core antigen sequence of HBV were amplified after extracting the nucleic acids from snap-frozen tissue aliquots from explanted livers of 26 consecutive patients undergoing orthotopic liver transplantation for fulminant hepatic failure preoperatively diagnosed as either autoimmune (n=2), HAV/HBV (n=8), toxic (n=4) or aetiologically unknown (n=12). RESULTS: HCV RNA was detected in five of 26 (19.2%) livers with fulminant hepatic failure. All five HCV RNA-positive livers belonged to the group of non-toxic, non-autoimmune liver failure (n=20), three of them were found in the group of liver failure with unknown aetiology (n=12) and two in the group of HBV-associated liver failure (n=7), making an HCV incidence of 25%, 25% and 28.6%, in the different groups, respectively. HGV RNA was detected in 10 of 17 (58.8%) explants and in all four groups of fulminant hepatic failure as defined preoperatively. HBV DNA was identified in six livers of 26 patients (23.1%) with fulminant hepatic failure. Neither HCV RNA nor HBV DNA was detected in the livers of patients with toxic or autoimmune fulminant hepatic failure. CONCLUSIONS: These results indicate that HBV and HCV, but not HGV, play an aetiologic role in fulminant hepatic failure. HCV-positive cases were concentrated either in the group of otherwise unexplained fulminant hepatic failure or in the group of HBV fulminant hepatic failure. HGV-positive cases, on the other hand, were found within all four preoperatively defined groups, indicating a role as cofactor rather than as single aetiologic agent.     

Review of Forms of feeling: The heart of psychotherapy.

Reviews the book, Forms of feeling: The heart of psychotherapy by Robert F. Hobson. Robert Hobson calls this book his autobiography as a therapist. As such it provides interesting glimpses into some of his more meaningful sessions with clients, illuminating his approach to therapy and enabling the reader to see a master therapist at work. Hobson also presents a new method of therapy, which he calls the conversational model. On this level, his book is considerably less satisfying. Hobson succinctly outlines the general principles of the conversational model and basic skills required of the therapist, but in so doing offers essentially little new information, however valid the points may be. According to Hobson, the conversational model is designed for clients whose problems arise from disturbances in their significant relationships, and those problems are best solved not by talking about them but by being in a relationship such as therapy that provides "a special kind of friendship." Hobson puts great stress on the use of metaphorical language in therapy and learning how to use the language of art as well as of science. He relies heavily on literary quotations, prefacing each section with one or two, and liberally interspersing many more within the pages of text. The net result is not so much illuminating as it is wearisome, and the general tone is slightly pretentious and, when Hobson addresses his "dear Reader" directly, somewhat condescending. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Something completely different: Informatik und Sport

Ohne Zusammenfassung     

Heat transfer mechanisms in gas fluidized beds. Part 3: Heat transfer in circulating fluidized beds

Part 1 of this contribution reported on the effects of system properties on heat transfer between heating or cooling surfaces and bubbling fluidized beds. This investigation produced four correlations which define the respective maximum heat transfer. Part 2 of this study suggests that the heat transfer between exchanger surfaces and bubbling fluidized beds depends on superficial gas velocity, expressed as dimensionless excess gas velocity. The present paper shows that heat transfer coefficients in circulating fluidized beds can be predicted by evaluation of a state diagram, which combines three dimensionless groups: Nusselt number, Archimedes number and a dimensionless pressure gradient. A comparison of coal combustion experiments with own cold model measurements indicates that the radiative component of heat transfer coefficients is only evident at very low dimensionless pressure gradients.     

On confluence versus strong confluence for one-rule trace-rewriting systems

Examples of one-rule trace-rewriting systems are given that are confluent but not strongly confluent. This contrasts with the situation for one-rule string-rewriting systems as well as with the situation for one-rule commutative string-rewriting systems.