Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up.

Background: There is a renewed interest in unicompartmental knee arthroplasty. The present report describes the minimum ten-year results associated with a unicompartmental knee arthroplasty design that is in current use.

Methods: Sixty-two consecutive unicompartmental knee arthroplasties that were performed with cemented modular Miller-Galante implants in fifty-one patients were studied prospectively both clinically and radiographically.

Temperature inaccuracies during cardiopulmonary bypass.

Cerebral hyperthermia caused by perfusate temperature greater than 37 degrees C during the rewarming phase of CPB has been linked to postoperative neurologic deficits. The purpose of this study was to determine the accuracy of the coupled temperature measurement system and the CDI 500 arterial temperature sensor. Seventeen patients undergoing CPB were divided into four groups, each with a different temperature probe coupled to the oxygenator.

Do intraoperative total serum and ionized calcium levels, like intraoperative intact PTH levels, correlate with cure of hyperparathyroidism?

Intraoperative parathyroid hormone (ioPTH) monitoring is useful in the operative management of hyperparathyroidism. Measurement of intraoperative total serum calcium (TSC) and ionized calcium (ICa) levels may be less expensive and more readily available methods of intraoperative guidance during neck dissection than ioPTH levels, the gold standard. We compared the accuracy of monitoring intraoperative TSC and ICa to that of ioPTH for predicting surgical cure during parathyroidectomy.

Transepithelial phototherapeutic keratectomy/photorefractive keratectomy with adjunctive mitomycin-C for complicated LASIK flaps.

Purpose: To evaluate the efficacy of transepithelial phototherapeutic keratectomy/photorefractive keratectomy (PTK/PRK) with prophylactic mitomycin-C for the treatment of refractive errors and maintenance of corneal clarity following flap complications in laser in situ keratomileusis (LASIK).

Setting: Outpatient tertiary care center, Chicago, Illinois, USA.

Methods: Ten eyes of 10 patients with LASIK flap complications had transepithelial PTK/PRK for correction of ametropia.

Animal models relevant to cementless joint replacement.

This review focuses on animal models used to study certain aspects of 'cementless' joint replacement. Implants used in this application are designed to become attached to the host skeleton through either bone ingrowth into porous surfaces or bone apposition (ongrowth) onto other types of surfaces. Biological fixation of cementless joint replacement implants relies on intramembranous bone regeneration.

Sarcoidosis and immunoglobulin lambda II light-chain amyloidosis diagnosed after orthotopic heart transplantation: a case report and review of the literature.

Cardiac involvement by sarcoidosis and concomitant deposition of AL amyloid is an uncommon association. We describe the case of a 53-year-old African-American man with a 7-year history of dilated nonischemic cardiomyopathy and severe cardiac failure who underwent orthotopic heart transplantation. His prior cardiac biopsies had only mild myocyte hypertrophy and minimal interstitial fibrosis.

Irritable bowel syndrome. 10% to 20% of older adults have symptoms consistent with diagnosis.

Although irritable bowel syndrome (IBS) is a common disorder, IBS is traditionally considered to be a condition that primarily affects young and middle-aged adults. However, increasing evidence suggests that prevalence of IBS in older adults may be similar to that in younger adults; therefore, the diagnosis should be considered when a geriatric patient presents with unexplained abdominal symptoms. Because incidences of other conditions with similar symptoms are higher in the geriatric population, use of certain diagnostic tests (eg, colonoscopy) is warranted in this patient population.

Interleukin-10 blunts the human inflammatory response to lipopolysaccharide without affecting the cardiovascular response.

Objective: The objective of this study was to assess the efficacy of variations in dose and timing of administration of recombinant human IL-10 (rhIL-10) on inflammatory and cardiovascular responses in a human endotoxemia model of sepsis.

Design: The authors conducted a randomized, placebo-controlled, double-blind trial.

Setting: The study was conducted in a procedure room of an intensive-care unit.

Noninvasive intracranial compliance and pressure based on dynamic magnetic resonance imaging of blood flow and cerebrospinal fluid flow: review of principles, implementation, and other noninvasive approaches.

Current techniques for intracranial pressure (ICP) measurement are invasive. All require a surgical procedure for placement of a pressure probe in the central nervous system and, as such, are associated with risk and morbidity. These considerations have driven investigators to develop noninvasive techniques for pressure estimation.

Intraoperative intact parathyroid hormone level monitoring as a guide to parathyroid reimplantation after thyroidectomy.

Objective: The goal of this study was to determine whether intraoperative intact parathyroid hormone (IOiPTH) levels can predict the functional status of remaining parathyroids at the end of total thyroidectomy and thereby be a guide for parathyroid autotransplantation when glands are deemed not functional.

Study Design: Prospective study involving 23 patients undergoing either total thyroidectomy or completion thyroidectomy

Methods: During surgery, an attempt was made to identify all four parathyroid glands. Normal size vascular glands were preserved, whereas avascular glands were microdissected and reimplanted.

Behavioral sleep medicine: a historical perspective.

Behavioral sleep medicine (BSM) has recently emerged as a subspecialty area within the broader field of sleep medicine. Certain commonly used treatment approaches in BSM were first pioneered in the 1930s, and this article traces the developments within BSM to current practice. Important innovations include the expansion of BSM beyond the treatment of insomnia to include treatment of pediatric sleep disorders, circadian rhythm disorders, parasomnias, as well as desensitization procedures for patients undergoing treatment with nasal continuous positive airway pressure (CPAP).

The relationship between the dim light melatonin onset and sleep on a regular schedule in young healthy adults.

The endogenous melatonin onset in dim light (DLMO) is a marker of circadian phase that can be used to appropriately time the administration of bright light or exogenous melatonin in order to elicit a desired phase shift. Determining an individual's circadian phase can be costly and time-consuming. We examined the relationship between the DLMO and sleep times in 16 young healthy individuals who slept at their habitual times for a week.

Effects of menopausal status on sleep in midlife women.

Disturbed sleep is a common complaint of midlife women often attributed to menopause, though few studies have examined direct effects of menopausal status on sleep. Our objective was to assess this issue in healthy midlife women. We examined sleep polysomnographically on 2 consecutive nights in 25 women (ages 45 - 56 yrs) without sleep complaints (13 pre-menopausal; 12 post-menopausal).

Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty.

To assess the potential recovery rate of a minimally invasive total hip replacement technique with minimal soft tissue disruption, an accelerated rehabilitation protocol was implemented with weightbearing as tolerated on the day of surgery. One hundred consecutive patients were enrolled in this prospective study. Ninety-seven patients (97%) met all the inpatient physical therapy goals required for discharge to home on the day of surgery; 100% of patients achieved these goals within 23 hours of surgery.

Femoral fixation in the face of considerable bone loss: the use of modular stems.

Considerable femoral bone loss can be encountered in the multiply revised total hip arthroplasty patient. Deficient proximal bone requires either a bulk allograft or a femoral component that allows stable distal fixation. Extensively coated stems have shown excellent results for many revisions but have shown higher rates of failure among patients with femoral remodeling in retroversion, an enlarged endosteal diameter, or an ectatic canal.

Recent advances in analytical modeling of lumbar disc degeneration.

Study Design: Review of the most recent advances in the development of poro-elastic analytical models that include physiologic parameters used for understanding lumbar disc degeneration due to repetitive loading.

Objectives: To discuss how poro-elastic finite element models that include physiologic parameters such as strain-dependent permeability and porosity and regional variation of poro-elastic material properties of a motion segment can be used to understand the effect of disc degeneration due to cyclic loading on the disc biomechanical properties.

Summary Of Background Data: Mechanical response of the spine to various dynamic loading conditions can be analyzed using in vitro and in vivo studies.

Shoulder scoring scales for the evaluation of rotator cuff repair.

Various assessment tools have been proposed for evaluation of shoulder function. Analyses of comparability, validity, and reliability among shoulder assessment tools are lacking. The purpose of our investigation was to compare the results of three commonly used shoulder assessment tools in the evaluation of a specific shoulder condition.

Rheumatoid arthritis: evaluation and surgical management of the cervical spine.

Background Context: Rheumatoid arthritis is a debilitating polyarthropathic degenerative condition. Eighty-six percent of patients with rheumatoid arthritis have cervical spine involvement. Often these lesions are clinically asymptomatic or symptoms are erroneously attributed to peripheral manifestation of the patient's rheumatoid disease.

Does rigid instrumentation increase the fusion rate in one-level anterior cervical discectomy and fusion?

Background Context: Although plate fixation enhances the fusion rate in multilevel anterior cervical discectomy and fusion (ACDF), debate exists regarding the efficacy of nonplating to rigid plate fixation in one-level ACDF.

Purpose: To determine the efficacy of nonplating to rigid plate fixation in regards to fusion rate and clinical outcome in patients undergoing one-level ACDF with autograft.

Study Design: A review of 69 consecutive patients who underwent one-level ACDF with autograft and with or without rigid anterior cervical plate fixation.

Comparison of clinical and radiographic outcome in instrumented anterior cervical discectomy and fusion with or without direct uncovertebral joint decompression.

Background Context: Anterior cervical discectomy and fusion (ACDF) is an established procedure for the operative treatment of cervical disc disease in patients with radiculopathy resulting from impingement from uncovertebral joint osteophytes. Studies demonstrate that direct decompression of the lesion provides good result. However, known complications include vertebral artery injury, dural tears, nerve root injury, loss of biomechanical stability and increased operative time.

The progression of patellofemoral arthrosis after medial unicompartmental replacement: results at 11 to 15 years.

This study reports the 11-year to 15-year results of unicompartmental knee arthroplasty with an emphasis on failure mechanisms and progression of patellofemoral arthrosis. In a prospective study of 513 consecutive potential knee replacement candidates, 59 patients (12%) had medial unicompartmental arthroplasty of the knee. All 59 patients had isolated unicompartmental disease without clinical symptoms or radiographic evidence of patellofemoral arthritis.