Digital Radiography in Total Hip Arthroplasty: Technique and Radiographic Results.

Background: Obtaining the ideal acetabular cup position in total hip arthroplasty remains a challenge. Advancements in digital radiography and image analysis software allow the assessment of the cup position during the surgical procedure. This study describes a validated technique for evaluating cup position during total hip arthroplasty using digital radiography.

Effects of metformin versus placebo on vitamin B12 metabolism in non-diabetic breast cancer patients in CCTG MA.32.

Background: Metformin is associated with low levels of vitamin B12 (VitB12) in patients with diabetes. The CCTG/MA.32 trial investigates the effects of metformin vs placebo on breast cancer (BC) outcomes in non-diabetic high-risk BC patients.

Adult precursor T-lymphoblastic leukemia/lymphoma with myeloid-associated antigen expression is associated with a lower complete remission rate following induction chemotherapy.

Prognostic studies of T-cell lymphoblastic leukemia/lymphoma (T-ALL) have been performed in small patient cohorts with conflicting results. We systematically reviewed 67 adult T-ALL patients diagnosed and treated at our institute to identify clinical and pathologic prognostic factors. The median initial WBC was 21.

In-house calibration of the international sensitivity index or calibration curve for determination of the international normalized ratio.

Context: The international normalized ratio (INR) has been used since 1983 to standardize prothrombin time results for patients on oral anticoagulants. However, significant interlaboratory variations have been noted. Attempts have been made to address these differences with the use of instrument-specific International Sensitivity Index (ISI) values and in-house calibration of ISI values.

Pure red cell aplasia due to parvovirus following treatment with CHOP and rituximab for B-cell lymphoma.

A 26-year-old woman, diagnosed with diffuse large B-cell lymphoma, was treated with CHOP (cyclophosphamide, hydroxydaunomycin, oncovin, prednisone), rituximab and radiotherapy. She developed transfusion-dependant anaemia, which persisted following chemotherapy. Bone marrow aspirate and biopsy were consistent with pure red cell aplasia and parvovirus infection.

Acquired factor VIII inhibitor in a patient with chronic myelogenous leukemia receiving interferon-alfa therapy.

Objective: To report a case of an acquired factor VIII inhibitor associated with the use of interferon-alfa.

Case Summary: A 58-year-old white man with newly diagnosed chronic myelogenous leukemia (CML) was initially treated with hydroxyurea. Interferon-alfa therapy was started six weeks later in order to enhance the response, with gradual reduction and eventual discontinuation of hydroxyurea.

The utility and prediction of allogeneic blood transfusion use in orthopedic surgery.

It is possible to predict the likelihood of postoperative blood transfusion using patient variables. The information could be used to target the high-risk group for intervention(s) that would subsequently reduce the risk of exposure to allogeneic blood. The cost of several of the alternatives to allogeneic blood precludes their use on all surgical patients, and hence the need to identify those patients who are most likely to benefit from such therapy.

Calculation vs calibration curve for INR determination. Results of an interlaboratory proficiency scheme.

We surveyed 271 laboratories participating in a quality assessment program to ascertain whether the use of a calibration curve for determining the international normalized ratio (INR) would improve interlaboratory accuracy and precision. Lyophilized warfarinized samples with INR values assigned through manual calibration against internationally assigned rabbit reference thromboplasts were assayed for prothrombin time. Calibration analysis on the results was performed by linear regression.

Prospective validation of a point score system for predicting blood transfusion following hip or knee replacement.

Background: The purpose of this study was to validate a previously published point score system for predicting the likelihood of a postoperative blood transfusion following hip or knee replacement.

Study Design And Methods: Data were collected prospectively on 460 sequential patients undergoing elective hip and knee replacement at two academic hospitals. Blood transfusion frequency was determined for patients in each of the four risk strata, as defined by the point score system.

Body weight does not predict for anti-Xa levels after fixed dose prophylaxis with enoxaparin after orthopedic surgery.

Enoxaparin after joint arthroplasty is effective prophylaxis against venous thromboembolism. This is usually given as a fixed dose without monitoring of anti-Xa levels. This study assesses the relationship between trough anti-Xa levels, body weight, and venous thromboembolism.

A point score system for predicting the likelihood of blood transfusion after hip or knee arthroplasty.

Background: Given the high cost of autologous blood donation for elective surgery, it would be desirable to predict which patients are most likely to benefit from the procedure. The purpose of this study was to develop a point score system for predicting the likelihood of blood transfusion in hip and knee arthroplasty.

Study Design And Methods: A database of 599 patients undergoing elective surgery at a teaching hospital was used for the analysis.

Reliability evaluation of classifying radial head fractures by the system of Mason.

Inter-observer and intra-observer reliability for classifying radial head fractures by the system of Mason was analyzed. Twenty-three cases of isolated radial head fractures and twenty-five sets of corresponding AP and lateral radiographs representing these fractures were assembled. The cases were reviewed and assessed independently according to the system of Mason by twenty practicing orthopedic surgeons.

Total knee replacement. A guideline to reduce postoperative length of stay.

In a retrospective study in an academic, acute-care community hospital, we studied the possible safety and effectiveness of a practice guideline recommending early discharge from the hospital for patients having uncomplicated total knee replacement. Of 206 patients receiving knee replacements, 162 (79%) were classified by the guideline as being at low risk for complications between the 4th and 7th postoperative days. Use of the guideline could have reduced the postoperative length of stay from 7.

The management of gunshot wounds to the femur.

This article is an overview of the management of femoral shaft fractures resulting from gunshot wounds. It deals with the initial patient evaluation, operative techniques of fracture stabilization and wound care, associated complications, and the postoperative rehabilitation of these complex fractures. The recommendations are based upon a large patient experience in an urban trauma center.

Scaphoid fractures and scaphoid nonunion. Diagnosis and treatment.

Scaphoid nonunion can cause pain, loss of wrist motion, and loss of grip strength. Because initial roentgenograms are not always definitive, patients suspected of having a scaphoid fracture despite negative initial radiographs should undergo bone scan. Treatment of acute nondisplaced fracture of the scaphoid generally nonoperative, involving immobilization in a cast.

The distal radioulnar joint following Galeazzi's fracture.

Fourteen patients underwent evaluation of the distal radioulnar joint following Galeazzi's fracture. Five of 12 patients who underwent a preoperative magnetic resonance imaging scan of the wrist had evidence of injury to the triangular fibrocartilage complex. These 5 patients also had abnormal intraoperative radiocarpal arthrograms.

Hip joint arthrodesis utilizing anterior compression plate fixation.

Sixteen patients who had undergone hip arthrodesis utilizing an anteriorly placed compression plate were evaluated at an average of 4.5 years after surgery. The technique was designed to facilitate future conversion to a total hip arthroplasty by preserving the abductor musculature.

Antibiotic impregnated bone cement in total hip arthroplasty. An in vivo comparison of the elution properties of tobramycin and vancomycin.

A prospective in vivo quantification was performed to measure the elution of tobramycin and vancomycin antibiotics from two commonly used bone cements. Forty patients were divided into four groups: Group I, tobramycin-Simplex; Group II, tobramycin-Palacos-R; Group III, vancomycin-Simplex; and Group IV, vancomycin-Palacos-R. Antibiotic levels were measured from hemovac wound drainage, urine, and serum and compared with control groups who received either intravenous tobramycin or vancomycin.

Dislocation following THA: comparison of two acetabular component designs.

One hundred ninety-seven consecutive primary cemented total hip arthroplasties using 22 mm heads were evaluated for the rate of dislocation. All surgery was performed by one surgeon through a posterior approach. A Charnley type femoral component was used in each case.

Coverage strategies in total joint replacement.

The strategy for soft-tissue management following total joint arthroplasty begins with prevention. The medical status of the patient is optimized preoperatively. Meticulous surgical technique with liberalized indication for flap closure primarily will reduce soft-tissue failures.

Lupus anticoagulant testing: effect of the platelet count on the activated partial thromboplastin time.

The activated partial thromboplastin time (APTT) is often used as a test to diagnose patients with lupus anticoagulants. It is recommended that platelet-poor plasma be used in the APTT test. In this study the effects of residual platelet contamination on lupus anticoagulant and antiphospholipid antibody testing are described.

Ancrod versus heparin for anticoagulation during vascular surgical procedures.

Purpose: The purpose of this study was to compare the conduct and early results of infrainguinal vascular reconstructions with use of ancrod or heparin for anticoagulation.

Methods: To test the hypothesis that ancrod was an effective alternative to heparin, 28 patients requiring infrainguinal bypass surgery were randomized to receive heparin during operation or ancrod before operation over a period of 12 hours to deplete circulating fibrinogen (0.2 to 0.