Acarbose enhances human colonic butyrate production.

Earlier studies suggest that butyrate has colonic differentiating and nutritional effects and that acarbose increases butyrate production. To determine the effects of acarbose on colonic fermentation, subjects were given 50-200 mg acarbose or placebo (cornstarch), three times per day, with meals in a double-blind crossover study. Fecal concentrations of starch and starch-fermenting bacteria were measured and fecal fermentation products determined after incubation of fecal suspensions with and without added substrate for 6 and 24 h.

The role of radiotherapy in the management of operable locally advanced breast carcinoma: results of a randomized trial by the Eastern Cooperative Oncology Group.

Background: The purpose of this study was to test the role of radiotherapy following total mastectomy, axillary dissection, and adjuvant systemic therapy in the management of operable locally advanced breast carcinoma.

Methods: After undergoing mastectomy and axillary dissection, 426 patients with locally advanced breast carcinoma were registered on study and stratified by patient characteristics and risk factors. All patients were then treated with six courses of chemohormonotherapy.

Effect of cementless acetabular cup geometry on strain distribution and press-fit stability.

Use of cementless acetabular cups, which are slightly larger than the reamed acetabulum, can provide press-fit stability without screws; however, the ideal cup geometry to maximize stability is not clear. Acetabular strain distribution, deformation, and implant stability were studied using an axisymmetric finite-element model, and mechanical stability was assessed by testing lever-out and extraction forces required to displace different cup geometries from foam bones. The implants tested included four nonhemispheric cup geometries and 1- and 2-mm oversized hemispheric geometries.

Effect of total hip arthroplasty on cardiovascular fitness.

Thirty patients who underwent total hip arthroplasty and 18 patients with medically treated arthritis participated in this study. Both groups of patients underwent a cardiovascular fitness exercise test on entering the study and 6 months, 1 year, and 2 years later. Fitness was assessed by patient performance on a graded maximal exercise test using a bicycle ergometer and metabolic cart.

Acetabular strains produced by oversized press fit cups.

The purpose of this study was to determine the amount of acetabular deformation that occurs when acetabular components of different sizes are press fit. The change in acetabular volume was calculated for 1- to 3-mm oversized cup diameters with acetabuli ranging from 40 to 80 mm. An axisymmetric finite element model was used to determine the maximum acetabular strain that occurs when oversized cups are inserted in different acetabuli.

Extended tibial tubercle osteotomy in total knee arthroplasty.

Thirty tibial tubercle osteotomies were performed to obtain exposure and facilitate patellar tracking in 29 patients who underwent total knee arthroplasty. The thickness and width of the bone fragment were gradually tapered from proximal to distal. Fixation was obtained with three or four titanium screws.

Fatigue strength of polyethylene after sterilization by gamma irradiation or ethylene oxide.

The oxidation level of ultrahigh molecular weight polyethylene specimens sterilized by gamma irradiation in either air or Ar gas was compared with that of unsterilized and ethylene oxide sterilized ultrahigh molecular weight polyethylene. The fatigue strength of ultrahigh molecular weight polyethylene specimens sterilized by gamma irradiation in air was compared with that of unsterilized and ethylene oxide sterilized ultrahigh molecular weight polyethylene. At the specimen surface, oxidation was highest for ultrahigh molecular weight polyethylene gamma irradiated in air, lower for ultrahigh molecular weight polyethylene gamma irradiated in Ar gas, and absent in unsterilized and ethylene oxide sterilized ultrahigh molecular weight polyethylene.

Improvement in cardiovascular fitness after total knee arthroplasty.

Patients who have osteoarthrosis involving weight-bearing joints typically have a gradual decline in physical activity, which is often associated with cardiovascular deconditioning. After joint replacement, many patients resume routine walking and recreational activities, which may improve aerobic capacity. The purpose of the present study was to determine the effect of total knee arthroplasty on cardiovascular fitness.

Safety and efficacy of ethylene oxide sterilized polyethylene in total knee arthroplasty.

Eleven unassembled metal backed patellar interfaces were inoculated with 0.1 ml of Sportol (Bacillus subtilis variety niger spore) and then assembled. Ten of the 11 implants were exposed to 1/2 of a standard ethylene oxide sterilization cycle.

Varus migration of PCA stems.

Forty-seven patients with cementless, porous-coated anatomic hip replacements were evaluated after a minimum 2-year follow up with specific attention to varus migration of the stem. A cadaver study was done to define a relationship between projected size of the lesser trochanter seen radiographically, rotation of the femur, and stem position. Seven (15%) of the stems migrated into varus with the distal tip moving laterally.

Inhibition of unstimulated exocrine pancreatic secretion by peptide YY in the rat.

Peptide YY is an ileocolonic peptide known to inhibit postprandial and cholecystokinin-induced pancreatic exocrine secretion. It has also been shown to increase intestinal water and electrolyte absorption. These findings implicate PYY as being potentially useful for controlling watery diarrhea.

Intraoperative modular stem lengthening to treat periprosthetic femur fracture.

Fracture of the femur around a femoral prosthesis can be a difficult problem to manage. Treatment options consist of traction, allograft struts, or plating with cerclage fixation, and revision arthroplasty. Intramedullary stabilization is usually preferable to plating for treatment of diaphyseal femur fractures; however, for a fracture around a cementless stem, disruption of the biologically fixed proximal area of the implant and revision to a long-stem component are generally required to permit intramedullary fixation of the fracture.

Impacted cancellous autograft for contained bone defects in total knee arthroplasty.

Techniques of bone grafting for peripheral tibial defects in total knee arthroplasty are well described using solid bone graft or metal wedges. Central contained defects may be irregularly shaped and not easily managed with bulk grafts or wedges. Morselized grafts loosely packed into the defect may allow cement to intrude into the interstices between the graft fragments.

Biologically active recombinant rat granulocyte macrophage colony-stimulating factor produced in Escherichia coli.

Rat granulocyte macrophage colony-stimulating factor (rGM-CSF) cDNA was amplified and cloned, and recombinant-rGM-CSF (R-rGM-CSF) was expressed and isolated from Escherichia coli. The synthesis of R-rGM-CSF was directed by a modified, inducible maltose binding protein (MBP) gene fusion expression vector, pMTR-23, and secreted to the periplasm. The vector pMTR-23 contains a new multiple cloning site encoding a unique thrombin-sensitive cleavage site and short spacer arm which facilitates separation of the MBP from the foreign protein domain of hybrid proteins.

Another RSNA Malaysian journey.

The RSNA International Visiting Professor program gave us an opportunity to live in a different and exciting country for 6 months. We had adequate travel opportunities to visit in Southeast Asia. Most of all, the feeling of appreciation and accomplishment we received from the master students as exemplified by their concern for us made our adventure extremely rewarding.

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.