Patient activity after total hip arthroplasty: a comparison of three different bearing surfaces.

Patients who receive hip arthroplasty today desire prostheses that not only have great longevity, but are also suitable for a very active lifestyle. Advances in metallurgy, tribologic behavior, surgical technique, as well as improvements in strength and microstructure, have made ceramic-on-ceramic and metal-on-metal bearings available for young patients requiring a great deal of mobility. The purpose of this study was to assess if the bearing surface had an effect, if any, on postoperative activity levels and clinical outcomes in patients receiving three different types of hip arthroplasty.

Inheritable risk factors for venous thromboembolism in patients undergoing lower extremity total joint arthroplasty.

Venous thromboembolism is a common and undesirable complication of both total hip and knee arthroplasty. The basic biology and major modifiable risk factors predisposing to thromboembolism are well established, but a complete understanding of the role and management of inherited coagulopathies is lacking. In this manuscript, we have attempted to review the fundamental pathophysiology of the coagulation cascade, analyze recent literature on heritable coagulopathies leading to venous thromboembolism in patients undergoing lower extremity joint arthroplasty, and discuss how an understanding of such factors may affect clinical practice.

Dopaminergic imaging: clinical utility now and in the future.

Over the past ten years, dopaminergic imaging has become increasingly part of the assessment and diagnosis of dementia. There are numerous PET and SPECT ligands available that target different steps in the process of neurotransmission. Abnormalities in dopaminergic imaging measures are consistent features of dementia with Lewy bodies (DLB) and other parkinsonian syndromes, and can be used to facilitate diagnosis, particularly in distinguishing between DLB and Alzheimer's disease.

Normal variation in intraepithelial lymphocytes of the terminal ileum.

The number of intraepithelial lymphocytes (IELs) is often increased in the terminal ileum of patients with immune-mediated inflammatory diseases of the colon. However, data regarding their number in normal ileal mucosa of asymptomatic patients are lacking. We aimed to establish the acceptable range of IELs in biopsy specimens of normal ileal mucosa.

Aspirated bezoar in a pediatric patient: a case report.

This case report describes an 11-year-old boy with a known esophageal bezoar admitted to surgery for esophagogas-troduodenoscopy with biopsy and possible removal of the bezoar. On induction, a copious amount of fluid and solid food particulate was noted in the posterior oropharynx, interfering with immediate intubation. After clearing of the oropharynx, the patient was intubated.

Correlation between severity of endoscopic findings and apnea-hypopnea index in patients with gastroesophageal reflux disease and obstructive sleep apnea.

Aim: To assess the relationship between severity of gastroesophageal reflux disease and apnea-hypopnea index (AHI) as an indicator of the severity of obstructive sleep apnea.

Methods: Data of 57 patients with proven obstructive sleep apnea and gastroesophageal reflux disease were analyzed. Patients were divided into two groups according to severity of the sleep apnea: "mild-moderate" (A)-AHI >or=5-30, n = 27, "severe" (B)-AHI >30, n = 30.

The relationship between gastroesophageal reflux disease and obstructive sleep apnea.

There has been an accumulating body of research concerning the extraesophageal complications of gastroesophageal reflux disease over the past decade. Given the cardiological, pulmonological, laryngeal, and dental aspects of such complications, an interdisciplinary approach is required. The most recognized manifestations are noncardiac chest pain, bronchial asthma, chronic bronchitis, chronic cough, and posterior laryngitis, as well as the acidic damage of dental enamel.

Radiology review of the UKCCCR Breast Screening Frequency Trial: potential improvements in sensitivity and lead time of radiological signs.

Aim: To review all previous mammograms of breast cancer cases diagnosed during a randomized trial comparing 3 yearly to annual mammographic screening with a view to identifying and quantifying cases that might potentially have been diagnosed earlier.

Methods: Mammograms of 602 breast cancer cases (399 screen-detected and 203 interval cases) were reviewed in chronological order and suspicious radiological features noted for each mammogram, up to and including the diagnostic mammogram.

Results: Of the 602 cases, 79 (13%) had features at diagnosis that were visible on previous mammograms, suggesting a sensitivity of interpretation of 87%.

Severe pulmonary hemorrhage in the premature newborn infant: analysis of presurfactant and surfactant eras.

We undertook a case-control study of premature infants who developed clinically significant, severe pulmonary hemorrhage (PH) in the presurfactant and surfactant eras to learn more about the cause of severe PH and whether the pathogenesis of severe PH has changed with the advent of surfactant therapy. Severe PH was defined as an acute onset of severe endotracheal bleeding with an acute drop in hematocrit and the development of multilobar infiltrates on chest radiograph. Eleven premature infants from the presurfactant era population and 17 premature infants from the surfactant era population met the criteria for severe PH, all with gestational ages <32 weeks and birth weights <1,500 g (very low birth weight infants).

Psychological predictors of attendance at annual breast screening examinations.

This retrospective analysis of psychological predictors of attendance studied the women from the annual screening arm of the United Kingdom Coordinating Committee on Cancer Research (UKCCCR) trial of annual screening mammography for the early detection of breast cancer. Some women attended screening at the first invitation in year 1 (attenders), others did not attend for screening at any time (non-attenders), whereas a third group delayed attending until year 2 (ambivalent attenders). A total of 147 women were recruited to the study: 80 attenders, 28 non-attenders and 39 ambivalent attenders.

Radial scars: a review of 30 cases.

Radial Scars/Complex Sclerosing Lesions are benign breast lesions that are seen more frequently now with the advent of screening mammography. These lesions need to be excised surgically in the absence of classical diagnostic features.

The value of the second view in screening mammography.

A prospective study of 33,734 women was undertaken during the prevalent round of the UK National Breast Screening Programme. The cancer detection rates and recall rates were compared between a one view and a two view technique. In one fifth of the women, only the single oblique view examination was read.

Twin transfusion syndrome: reassessment of ultrasound diagnosis.

Objective: To assess the antenatal ultrasonic diagnosis of the twin transfusion syndrome, an enigmatic disorder that results in an imbalance in the blood flow between monochorionic twins.

Study Design: Retrospective review of 16 cases of twin transfusion syndrome confirmed by placental pathology and neonatal data.

Results: A disparity in antenatal fetal weights, size difference between the two amniotic sacs and a single placenta were present in 81% (13/16) of confirmed cases.

Indomethacin in severe twin-to-twin transfusion syndrome.

Despite advances in maternal fetal medicine, the management of severe twin-to-twin transfusion syndrome in the second trimester presents a significant challenge. Presently, there is no uniformly accepted management protocol that is available for the treatment of this syndrome. We report the use of indomethacin in three cases of severe twin-to-twin transfusion syndrome in the second trimester.

Antepartum and intrapartum management of multiple pregnancy.

In antepartum management of multiple gestation, this review discusses studies covering the outcome of bedrest, use of ultrasound to assess fetal outcome, management of monoamniotic twins, and outcome of higher-order gestation. Studies comparing modes of delivery are also discussed.

A rapid visual test for predicting fetal lung maturity.

A rapid bedside test has been devised that enables an untrained observer to predict (p less than 0.001) when amniotic fluid will be greater than or equal to 0.15 at an optical density of 650 nm, lecithin/sphingomyelin ratio will be greater than or equal to 2.

Rho(D) immunoglobulin (RhoGAM): how it came into being.

The story of Rho(D) immunoglobulin (RhoGAM) begins in 1909 with Theobald Smith, Fabyan Professor of Comparative Pathology at Harvard, and ends in the 1960s with completion of the clinical trials. Important in the development of RhoGAM were the search for a safe diphtheria vaccine, an interest in butterfly mimicry, the discovery of the Rhesus factor, and the contribution of Sing Sing prison inmates--seemingly unrelated occurrences. But, when all were combined, the riddle of erythroblastosis fetalis was solved.