Feasibility of maximal cardiopulmonary exercise testing in patients with end-stage arthritis of the hip and knee prior to total joint arthroplasty.

Study Objective: Although no studies exist, to our knowledge, that examine the feasibility and safety of stress testing in a consecutive series of patients with severe arthritis, musculoskeletal conditions are often listed as relative contraindications to graded exercise testing. The current study was designed to examine the feasibility of maximal exercise testing in patients with end-stage arthritis prior to total joint arthroplasty.

Design: An observational and descriptive study in a consecutive series of patients with severe arthritis.

Nonsteroidal antiinflammatory drugs are associated with gastric outlet obstruction.

Nonsteroidal antiinflammatory drug associated gastric ulcerations are often prepyloric and painless; when recurrent, such ulcers may lead to pyloric scarring and gastric outlet obstruction. We performed a retrospective case control study to seek an association between gastric outlet obstruction and nonsteroidal antiinflammatory drug use. The use of nonsteroidal antiinflammatory drugs in cases with gastric outlet obstruction was compared to an age- and sex-matched outpatient control group undergoing endoscopy.

Relationship between severity of gonarthrosis and cardiovascular fitness.

Cardiovascular fitness was assessed in 3 groups of patients having varying severity of gonarthrosis. Group I consisted of 16 patients with severe knee symptoms scheduled for total knee arthroplasty. Group II included 17 patients with medically treated osteoarthrosis who were not considered surgical candidates because knee symptoms were not severe.

Eleven years' experience with pericardial-peritoneal window in the management of malignant and benign pericardial effusions.

Background: Before 1983 we routinely used subxiphoid drainage for the management of pericardial effusions. Pericardial-pleural window through a left anterior thoracotomy was used in selected patients. Due to frustration over the rate of recurrent pericardial effusions with subxiphoid drainage alone and concern over the higher morbidity with thoracotomy, the creation of a 3-cm pericardial-peritoneal window in the fused portion of the pericardium and diaphragm overlying the left lobe of the liver was added to subxiphoid drainage in 1983.

Adverse drug reaction reporting in a multicenter surveillance study.

Objective: To evaluate the performance of a multicenter, prospective surveillance program in identifying adverse events, and to seek explanations for misclassification bias.

Design: The design was a prospective observational study of patients with documented or suspected bacterial pneumonia.

Setting: Data were collected in 74 acute care hospitals across the US.

Role of a central laboratory in implementing national cholesterol education panel guidelines in rural practices: model system for managed care.

We describe the use of a central laboratory to identify patients who may be candidates for a hypercholesterolemia treatment program and to direct their referral into this program. The laboratory, providing service for 16 medical practices in a rural area of upstate New York, served as the entry point to the treatment program for those patients with serum cholesterol > or = 5.18 mmol/L.

Femoral head autograft in simultaneous primary and revision total hip arthroplasty.

Bilateral total hip arthroplasty during one anesthetic procedure can be beneficial in properly selected patients. For patients who have a failed hip arthroplasty requiring revision and a contralateral arthritic hip requiring primary arthroplasty, bilateral surgery permits the resected femoral head from the primary procedure to be used as a fresh autogenous bone-graft during the revision procedure. Four patients underwent combined primary hip arthroplasty and contralateral revision hip arthroplasty during one anesthetic procedure.

Lactate release and uptake in hepatoma 7288CTC perfused in situ with L-[(U)-14C]lactate or D-[(U)-14C]glucose.

Arteriovenous differences (AVD) for glucose and lactic acid measured across tissue-isolated rat tumors in vivo have shown that individual tumors with similar rates of glucose consumption may either release or utilize lactic acid. The experiments described here investigated the relationships among arterial blood lactate concentrations and tumor lactate and glucose balances. AVDs for lactate, pyruvate, glucose, 14CO2, PO2, PCO2, pH, and lactate specific activities were measured across 17 tissue-isolated 7288CTC hepatomas perfused in situ with arterial blood containing 2.

Occupational asthma in a latex doll manufacturing plant.

Background: Occupational asthma caused by latex has been reported in health care workers and workers in glove manufacturing plants.

Objective: We report occupational asthma from latex in a newly identified occupational setting, a latex doll manufacturing plant.

Methods: We evaluated an index case of asthma associated with work in a latex doll manufacturing plant by performing a workplace challenge and evaluating the work environment.

Fatal massive adrenal hemorrhage after bilateral total knee arthroplasty.

Adrenal hemorrhage can occur in association with postoperative stress, trauma, myocardial infarction, infection, and chronic medical illness. Other risk factors for the development of spontaneous adrenal hemorrhage include a thromboembolic state and anticoagulation therapy, although it has rarely been observed following orthopedic surgery. The authors report the case of an otherwise healthy 61-year-old woman who died suddenly 9 days after bilateral total knee arthroplasty.

Osteolysis associated with cemented total knee arthroplasty. A case report.

Osteolysis induced by particulate debris occurs within 5 years after cementless total knee arthroplasty, but has not been reported to be a problem after cemented total knee arthroplasty. It has been suggested that the bone-cement interface may form a barrier to polyethylene-debris migration, thereby limiting bone loss. The authors have observed osteolysis in a 75-year-old woman 9 years after cemented total knee arthroplasty.

The Rochester practice-based experience. An experiment in medical education.

Background: Recent changes in the organization and financing of medical practice have resulted in a shift of patient care from the hospital to ambulatory locations and dramatically changed the mix and severity of the inpatient population. Medical educators are concerned that hospitalized patients are not truly representative of the practice of internal medicine and may be unsuitable for the education of third-year medical students. The University of Rochester (NY) Department of Medicine recently established a "practice-based" component to complement the inpatient segment of the third-year medicine clerkship.

Effect of a fat- and calcium-rich breakfast on pharmacokinetics of fleroxacin administered in single and multiple doses.

The effect of a fat- and liquid-calcium-rich meal on the pharmacokinetics of single and multiple doses of fleroxacin in 20 healthy men and women was investigated in a randomized crossover fashion. Fleroxacin was administered as 400 mg daily for 3 days and as a single 400 mg dose. Concurrent administration of fleroxacin with food resulted in a statistically significant (P < or = 0.

KINI: a one compartment intravenous pharmacokinetic analysis program.

KINI is a microcomputer PC based software package which determines the one-compartment pharmacokinetic parameters for any drug using the Sawchuk-Zaske method. Through use of these programs, individualized pharmacokinetic analyses can be performed. The package allows for analysis of adult and pediatric patients, as well as offering a long and abbreviated data entry format.

Topology of 3 beta-hydroxy-5-ene-steroid dehydrogenase/delta 5-delta 4-isomerase in adrenal cortex mitochondria and microsomes.

3 beta-Hydroxy-5-ene-steroid dehydrogenase/delta 5-delta 4-isomerase (3 beta HSD) is a NAD(+)-dependent membrane-bound enzyme that catalyzes the oxidation of delta 5-3 beta-hydroxysteroids to delta 4-3-keto structures during adrenal, gonadal, and placental steroidogenesis. Enzyme activity is located in both microsomes and mitochondria. In these experiments we examined the membrane topologies of 3 beta HSD in rat and calf adrenal microsomes and mitochondria by comparing access to the active sites of coenzyme and the inhibitor mersalyl, a nonpenetrant organic mercurial anion.

Cost considerations in therapeutic drug monitoring of aminoglycosides.

Aminoglycoside antibiotics are very important in the treatment of Gram-negative infections and as synergistic agents for the treatment of staphylococcal and streptococcal (group B streptococci and enterococci) infections. However, these agents have a narrow therapeutic index. Thus, a number of new antibiotics have been introduced in an attempt to reduce the number of patients treated with aminoglycosides.

Measured versus estimated creatinine clearance in patients with low serum creatinine values.

Objective: To examine, in patients with a serum creatinine (SCr) < 85 mumol/L, whether the use of actual SCr versus the use of an SCr set at 85 mumol/L and applied to the Cockcroft-Gault method for calculation of creatinine clearance (Clcr), resulted in a similar ability to explain variance in prediction of Clcr.

Design: Included in the study were patients with stable renal function receiving total parenteral nutrition, who underwent a 24-hour urine collection and had an SCr < 85 mumol/L. Clcr was calculated (CalcClcr) using the Cockcroft-Gault method, and actual SCr, and an SCr value set at 85 mumol/L (AdjCalcClcr).

Posterior allograft bone-block for recurrent dislocation of the hip after hemiarthroplasty in noncompliant patients with neuromuscular disease.

Two mentally retarded patients with cerebral palsy developed recurrent dislocation of the hip after hemiarthroplasty. Instability had persisted despite release of contracted soft tissues, conversion to a bipolar arthroplasty, and cast immobilization in one patient and repeated closed reductions with abduction splinting and bed rest in the other. Both patients were treated with a posterior femoral head allograft bone-block that resulted in restoration of hip function and control of recurrent dislocations.

The first transplantation of the lung in a human revisited.

The first homotransplantation of the lung in a human was performed in early 1963, thirty years ago. It is the purpose of this review to evaluate the significance of this event and to determine its effects on the further development of lung transplantation.

Na+/H+ exchange and PLA2 activity act interdependently to mediate the rapid effects of 1 alpha, 25-dihydroxyvitamin D3.

1 alpha, 25-Dihydroxyvitamin D3 (1 alpha, 25-(OH)2D3) has been shown to rapidly increase cytosolic calcium in freshly isolated and cultured rat hepatocytes. The rise in cytosolic calcium is dependent on phospholipase A2 (PLA2) activation and cell alkalinization through the Na+/H+ antiport system. To further characterize the rapid effects of 1 alpha, 25-(OH)2D3, cultured hepatocytes were treated with inhibitors of PLA2 and the Na+/H+ antiport system.