Peri-acetabular resection and endoprosthetic reconstruction for tumours of the acetabulum

We treated 98 patients with peri-acetabular tumours by resection and reconstruction with a custom-made pelvic endoprosthesis. The overall survival of the patients was 67% at five years, 54% at ten years and 51% at 30 years. One or more complications occurred in 58.1% of patients (54), of which infection was the most common, affecting 30% (28 patients). The rate of local recurrence was 31% (29 patients) after a mean follow-up of 71 months (11 to 147). Dislocation occurred in 20% of patients (19). Before 1996 the rate was 40.5% (17 patients) but this was reduced to 3.9% (two patients) with the introduction of a larger femoral head. There were six cases of palsy of the femoral nerve with recovery in only two. Revision or excision arthroplasty was performed in 23.7% of patients (22), principally for uncontrolled infection or aseptic loosening. Higher rates of death, infection and revision occurred in men.

This method of treatment is still associated with high morbidity. Patients should be carefully selected and informed of this pre-operatively.

Anatomic basis for individuated surface EMG and homogeneous electrostimulation with neuroprostheses of the extensor digitorum communis

The extensor digitorum communis (ED) is generally regarded as a fairly undiversified muscle that gives extensor tendons to all fingers. Some fine wire electromyographic (EMG) investigations have been carried out to study individuation of the muscle parts to the different fingers. However, individuated surface EMG of the ED has not been investigated. This study analyses the anatomy of the ED muscle parts to the different fingers in detail and proposes optimal locations for surface or indwelling electrodes for individuated EMG and for electrostimulation with neuroprostheses. The dissections show that the ED arises from extensive origin tendons (OT), which originate at the lateral epicondyle and reach far in the forearm. The ED OT is V-shaped with shorter central tendon fibers but with a long radial and an even longer ulnar slip. The ED parts to the individual fingers consistently arise from distinct OT locations: the ED3 (medius) arises proximally, the ED2 (index) from the radial slip distal to ED3, the ED4 (ring finger) from the ulnar slip distal to ED3, and the ED5 (to ring/little finger) from the ulnar slip distal to ED4. This lengthwise widely spaced arrangement of ED parts compensates to some degree for the narrow ED width and suggests that ED parts should be individually assessable by indwelling and even by surface EMG electrodes, albeit in the latter case with variable mutual cross-talk. Conversely, the anatomic spacing of ED parts warrants that electromyographic stimulation with neuroprostheses by a single implanted electrode cannot likely homogeneously activate all ED parts.

Pacific Islands Families Study: risk factors associated with otitis media with effusion among Pacific 2-year-old children

OBJECTIVE

This study examined the risk factors associated with middle ear disease in a cohort of Pacific 2-year-old children residing in New Zealand.

METHODS

The data were gathered as part of the Pacific Island Families: first 2 years of life (PIF) study in which 656 2-year-old were screened using tympanometry to identify children at risk for otitis media with effusion (OME) and other otological disorders.

RESULTS

Within this 2-year-old cohort of Pacific children, one set of factors significantly associated with OME was clustered around the respiratory and auditory health of the child over the past year. OME was more likely for children who were regularly suffering from fluid/pus discharge from ears (OR=2.10, 95% CI: 1.01-4.35), children with five or more coughs/colds in the last year (OR=1.90, 95% CI: 1.22-3.00), and children who frequently/constantly snored (OR=2.60, 95% CI: 1.09-6.23) to have OME. Those children who were treated at home for breathing problems were more that two times more likely to have OME (OR=2.61, 95% CI: 1.55-4.42). A second set of factors was clustered around environmental risks that exposed children to a large number of other children. Children who attended a day care centre for more than 20h were five times more likely (OR=5.21, 95% CI: 2.90-9.35) and those who regularly attended church (OR=2.78, 95% CI: 1.05-7.40) were almost three times more likely to have OME.

CONCLUSIONS

These findings portray a child compromised by persistent ear infections and general coughs and colds as being at increased risk of contracting OME. In line with international research these findings raise questions about the negative child health effects associated with the day care environment for young children.

Health and safety intervention with first-time mothers

A health education program was evaluated which used child development specialists as home visitors and served a population of first-time mothers living in rural communities. The evaluation compared health and safety outcomes between intervention and control groups. The research staff, separate from the intervention staff, collected data in the homes of 156 intervention and 107 control mothers when the infants were 6 and 12 months old. Significant group differences were found on health and safety outcomes. As compared with controls, the intervention mothers (i) had safer homes; (ii) were more likely to use birth control, thus had fewer pregnancies since birth of their first child; (iii) reported smoking fewer cigarettes; (iv) knew more about effects of smoking on their child's health and (v) were more likely to use health department services. In sum, mothers who received early education home visits from child development specialists experienced positive health and safety outcomes. It is highly recommended that a program such as this be implemented as part of health delivery program with new mothers and infants.

Pacific Islands families study: the prevalence of chronic middle ear disease in 2-year-old Pacific children living in New Zealand

OBJECTIVE

The aim of this study was to determine the prevalence of chronic middle ear disease in 2-year-old Pacific children living in New Zealand.

METHODS

The data were gathered as part of the Pacific Islands Families: First Two Years of Life (PIF) Study in which 1001 two year olds were screened using tympanometry to identify children at risk for otitis media with effusion (OME) and other otological disorders. Those failing the screening tests were referred to Manukau Superclinic where they had a further tympanometry test, and if they failed this test, were followed up with a comprehensive otological examination by an otolaryngologist using otomicroscopy and pneumatic otoscopy.

RESULTS

Bilateral otitis media with effusion (OME) was the most common abnormality detected (N=102) with further cases of unilateral OME (N=8), and unilateral OME resolving (N=2). Other cases of OME were associated with acute otitis media (AOM), impacted wax (N=1), perforation (N=1), and mild retraction (N=2). Overall there were 118 children with unilateral or bilateral OME. AOM of any form was seen in nine cases. Retraction of the tympanic membrane was seen in 26 cases. The population prevalence among Pacific 2-year-old children was estimated as 25.4% for OME, 1.9% for AOM, and 26.9% for OME or AOM.

CONCLUSIONS

These findings reveal that over 25% of Pacific Island 2-year-old were affected by OME and recommend the consideration of national screening for OME and other otological disorders at this earlier age.

A custom-made prosthesis attached to an existing femoral component for the treatment of peri- and sub-prosthetic fracture

Peri- and sub-prosthetic fractures, or pathological fractures below an existing well-fixed femoral component, with or without an ipsilateral knee replacement, present a difficult surgical challenge.

We describe a simple solution, in which a custom-made prosthesis with a cylindrical design is cemented proximally to the stem of an existing, well-fixed femoral component. This effectively treats the fracture without sacrificing the good hip. We describe five patients with a mean age of 73 years (60 to 81) and a mean follow-up of 47 months (6 to 108).

The mean overlap of the prosthesis over the femoral component was 7.5 cm (5.5 to 10). There have been no mechanical failures, no new infections and no re-operations. We suggest that in highly selected cases, in which conventional fixation is not feasible, this technique offers a durable option and avoids the morbidity of a total femoral replacement.