The value of skeletal scintigraphy in predicting the need for revision surgery in total knee replacement.

We have reviewed the results of 99mtech-netium-methylene diphosphonate (Tc-MDP) bone scintigrams performed on patients following total knee arthroplasty. In addition, 67gallium (Ga) citrate scintigrams were carried out sequentially on 29 patients. Three groups of patients were identified: those with asymptomatic knees (undergoing scans for other reasons); those with aseptic or septic loosening; and those with pain without radiologic evidence of loosening.

Association of the fusion protein NSF with clathrin-coated vesicle membranes.

N-ethylmaleimide-sensitive fusion protein (NSF) is a component of intracellular transport reactions. In order to understand the role of NSF during the fusion of endocytic transport vesicles with the endosome, we have investigated the binding of NSF to purified clathrin-coated vesicle components. First, we have examined whether detergent-solubilized coated vesicle membranes will support formation of NSF-containing 'fusion complexes'.

Neonatally tolerant rats actively eliminate donor-specific lymphocytes despite persistent chimerism.

Rats from the allotype-marked PVG-RT7b and PVG-RT1u-RT7b strains were injected at birth with semi-allogenic F1 bone marrow (BM) cells from athymic nude rats (PVG-rnu/rnu x PVG-RT1u-rnu/rnu) to induce neonatal tolerance. As adults, 97% of the animals accepted donor-specific allogeneic skin grafts and a majority (65%) of rats were chimeric, expressing the major histocompatibility complex class I and allotype marker of the donor strain. Similar results were obtained when PVG-RT1u-RT7b rats were injected at birth with fully allogeneic PVG-rnu/rnu nude BM cells: as adults, 94% accepted donor-specific skin allografts and 76% of recipients were chimeric.

A randomized, double-blind placebo controlled cross-over study to investigate the effects of RW94 on the absorption of dietary fat in healthy volunteers.

RW94 is a permitted additive in the food industry, which precipitates fatty acids in vitro. In vivo, this could result in reduced fatty acid absorption by the body, and may, therefore, influence the amount of fat excreted in the faeces. An investigation into the effects of RW94 on bodily fat absorption and excretion was undertaken.

Laser reduction of inferior turbinates in children.

Perennial nasal obstruction in children refractory to medical treatment may be managed by turbinate reduction. Turbinectomy may involve a risk of significant postoperative bleeding and requires nasal packing. Submucosal diathermy is followed by nasal congestion and crusting; recurrent nasal obstruction is frequent at fifteen months.

Histopathology and 241Am microdistribution in skeletal USTER Case 246.

Histopathology and qualitative autoradiography studies were undertaken on bone removed at autopsy from USTUR Case 246. The histopathology examination revealed extensive bone marrow peritrabecular fibrosis and decreased cellularity in most samples. In addition, histological indicators suggest that bone cell turnover was suppressed at most sites, although turnover was found to be essentially normal in a vertebral body sample.

Number of children as a risk factor for low back pain in men and women.

Objective: To estimate the influence of the number of liveborn children on the risk of low back pain.

Methods: The study design was a cross-sectional population-based survey. The 4,501 respondents to a postal survey were asked to provide data on the occurrence of low back pain and on any children they had.

The incidence of juvenile dermatomyositis: results from a nation-wide study.

There have been no previous attempts to estimate the incidence of juvenile dermatomyositis (JDM) in the UK and Ireland. Consultant paediatricians from these countries were asked to report all cases of JDM which were diagnosed in 1992 and 1993 to the British Paediatric Surveillance Unit. One-hundred-and-twenty-one reports were received, of which 48 were confirmed cases of JDM and three were confirmed cases of polymyositis.

Scleroderma.

In practice, the classification of scleroderma is less problematic than that of most other connective tissue diseases given the distinctive pattern of skin involvement. Classification of early and limited disease is more problematic and is difficult to separate from severe forms of Raynaud's phenomenon. Division of scleroderma into two groups depending on the presence or absence, early in the disease, of truncal skin involvement makes biological and clinical sense.

Relations between upper abdominal symptoms and gastric distension abnormalities in dysmotility like functional dyspepsia and after vagotomy.

Postprandial bloating and fullness are commonly found both in dysmotility like functional dyspepsia, and after vagotomy but the relation between gastric accommodation and symptom production has not been investigated. Intragastric pressure levels and symptoms developed during controlled distension of the gastric fundus were recorded in nine patients with functional dyspepsia, in seven patients after truncal vagotomy, and in 11 healthy volunteers. The procedure was repeated after ingestion of a liquid nutrient meal (250 ml; 250 kcal).

Preliminary assessment of a human recombinant antibody fragment to hsp90 in murine invasive candidiasis.

Seroconversion to hsp90 is associated with recovery from systemic candidiasis in humans, and a murine monoclonal antibody to this hsp90 antigen (LKVIRK epitope) was protective in mice. A human recombinant antibody to the same epitope was assessed in acute and chronic models of murine invasive candidiasis. Lethal intravenous challenge with fluconazole-susceptible (strain 4) or fluconazole-resistant (strain 019) Candida albicans, followed 2 h later by a single dose of recombinant antibody, was associated with a statistically significant drop in mortality of > or = 40% (two experiments in BALB/c mice given strain 4; one experiment in CD-1 mice given strain 019) or 23% (BALB/c mice, strain 019).

Disease assessment indices: activity, damage and severity.

The methodology for developing and assessing disease status measures is now well-advanced. For some diseases, in particular SLE and RA, these methods have been applied and instruments either are being or have been validated. For other conditions, such as ankylosing spondylitis and Behçet's disease, there is still a need for reliable measures to be proposed and evaluated.

"Pseudoclusters" and typing by random amplification of polymorphic DNA of Aspergillus fumigatus.

This short report serves as a warning to the unwary of possible "pseudoclusters" of infection with Aspergillus fumigatus as shown by the typing system, random amplification of polymorphic DNA (RAPD). This was demonstrated by typing 10 epidemiologically distinct isolates of A fumigatus using two different preparations of Taq DNA polymerase. One of the enzymes did not discriminate between the isolates, giving the false impression that a cluster of infection had occurred.

The humoral response to an allograft.

Antibodies are known to damage grafted tissues by a variety of means, so it is important to know how the humoral response is initiated. In this paper we summarise the cellular events in B cell activation, the mechanisms of antibody-mediated rejection and the evidence that antibody apparently does not contribute to early corneal graft rejection. The role of antibodies in chronic graft loss is discussed.

Defining potential targets for immunotherapy in Burkholderia cepacia infection.

Burkholderia cepacia has become a serious source of infection in patients with cystic fibrosis. Antibiotic therapy is difficult as the bacteria are intrinsically resistant to most antibiotics. The present study compared the antibody response by immunoblot of 50 negative control sera, 22 patients with cystic fibrosis and no evidence of B.

Screening for anxiety and depression in elderly medical outpatients.

In a study of 45 consecutive new outpatients at geriatric medicine clinics, 17.8% were diagnosed as depressed and 2.2% as anxious using the Geriatric Mental Status Schedule.

Mast cell recovery following chronic treatment with compound 48/80.

Histochemical and functional properties of mast cells (MC) in Brown Norway rats recovering from chronic treatment with the MC secretagogue compound 48/80 were examined. In the skin, treatment for 5 days with compound 48/80 resulted in a marked decrease in MC subpopulations defined by differential alcian blue/safranin staining. Both safranin-positive connective tissue MC and alcian blue staining MC were reduced in number.

Regulation of transferrin receptor recycling by protein phosphorylation.

The effect of the protein phosphatase inhibitor okadaic acid on transferrin receptor internalization and recycling was examined in HeLa and K562 cells. Okadaic acid inhibited receptor uptake by more than 85% in both cell lines, whereas it affected transferrin recycling to differing degrees: recycling in HeLa cells was inhibited by greater than 90%, compared with only 65% in K562 cells. Okadaic acid also caused a marked redistribution of receptors in each cell line, which was accounted for by the difference in the extent to which transferrin uptake and recycling were inhibited.

Beta adrenergic modulation of human upper intestinal propulsive forces.

beta Adrenoceptor blockade is known to accelerate transit through the small intestine without changing either the number or pattern of intestinal contractions. This study therefore tested the hypothesis that an increase in intraluminal aboral propulsive force may contribute to this transit acceleration. Twenty paired studies were performed, in 10 healthy volunteers, after oral administration of either 100 mg atenolol (a selective beta 1 antagonist) or matched dummy tablets according to a double blind, randomised protocol.

Primary total knee arthroplasty in the elderly.

In a retrospective study, the authors investigated the outcome of primary total knee arthroplasty in patients aged 75 years or older. There is an increased risk of perioperative mortality and medical morbidity, but not surgical morbidity. The results were equal to the younger control group in terms of patient satisfaction, pain relief, stability, range of motion, residual degree of flexion contracture, and extension lag.

Interpreting the results of observational research: chance is not such a fine thing.

In a randomised controlled trial, if the design is not flawed, different outcomes in the study groups must be due to the intervention itself or to chance imbalances between the groups. Because of this tests of statistical significance are used to assess the validity of results from randomised studies. Most published papers in medical research, however, describe observational studies which do not include randomised intervention.