Cementless total knee arthroplasty in obese patients. A comparison with a matched control group

The heaviest 45 patients (50 knees) who underwent cementless total knee arthroplasty were compared with a matched control group of 45 total knee arthroplasty patients (50 knees) with respect to clinical and radiographic data. Surgery was performed over a 10-year period (1980-1989) and follow-up evaluation averaged 7 years (range, 2-11 years). The control group consisted of nonobese patients matched to the obese group with respect to age, sex, diagnosis, preoperative deformity, and length of follow-up evaluation. Clinical evaluation was made using the Knee Society rating scale as well as an analysis of multiple other clinical parameters. Radiographically, each patient was evaluated with long-standing anteroposterior views, lateral and patellar views, and spot fluoroscopic views of the involved knee. This evaluation included an analysis of lucencies, bead shedding, and prosthetic alignment. The final average clinical score in the obese group was 88 points with four revisions, and that for the control group was 91 points with two revisions. There were no significant differences in the combined percentage of good and excellent results between the two groups. On the basis of the results of this study, it is believed that weight as a factor by itself should not compromise the early (7-year average follow-up period) results of total knee arthroplasty.

Regulatory differences in the stress response of hippocampal neurons and glial cells after heat shock

During periods of stress, cells depend on a transient, highly conserved, and regulated response to maintain homeostasis. This "heat shock response" is mediated transcriptionally by a multigene family of heat shock factors (HSF). The presence of multiple HSF suggests that activation of a given HSF is stress-specific. Using Western blot analysis, we have demonstrated the inability of primary cultured rat hippocampal neurons to induce a heat shock response after hyperthermia. In contrast, secondary cultured rat glial cells demonstrated a robust response. Examination of whole-cell extracts from the two cell types with gel shift mobility analysis and Western blot analysis revealed that although glial cells express HSF1 and HSF2, hippocampal neurons only express HSF2. Incubation of whole-cell extracts with monoclonal antisera raised against HSF1 and HSF2 before gel shift mobility analysis demonstrated HSF1 DNA-binding activity in glial cells and HSF2 DNA-binding activity in neurons. HSF1 has been shown to be the principal mediator of heat-induced heat shock gene expression. These results suggest that the deficient heat shock response of hippocampal neurons at this developmental stage is attributable to a lack of HSF1 expression. Furthermore, these results suggest that considerations of selective neuronal vulnerability to environmental stress should include the principal mediators of the stress response, the HSF.

Protection of CCL4-induced liver damage in rats by some calcium channel blockers

Liver necrosis was produced in rats by administering 3 doses o a mixture o carbon tetrachloide+olive oil, 2 ml/kg, ip. The liver damage was evidenced by the elevated levels serun aspartate aminotrans ferase (AST), alanine aminotransferase (AIT) and gamma glutamyl transpeptidase (gamma-GT) and by histopathological observations of liver sections. Nitrendipine, nimodipine and nisoldipine (1 mg/100 g of rat, ip) significantly reduced these elevated levels of AST, AIT and gamma-GT. Carbon tetrachloride induced liver necrosis was also found to be significantly reduced in nitrendipine, nimodipine and nisoldipine pre-treated animals as observed macroscopically and histologically.

Effect of nitrendipine, nimodipine and nisoldipine on experimentally induced myocardial infarction in rats

Cardiac necrosis was produced in rats by administering isoproterenol sulphate (85 mg/kg, sc for 4 days). The myocardial damage was proved by observing the elevated levels of serum aspartate aminotransferase, ++alanine aminotransferase and lactate dehydrogenase and the changes were confirmed by his topathology. Nitrendipine, nimodipine and nisoldipine (10 mg/kg, ip) significantly reduced the elevated levels of these enzymes. The average degree of cardiac necrosis in these rats when observed microscopically and histologically was also found to be significantly reduced on pretreatment with these drugs. Nisoldipine was more effective in preventing cardiac necrosis as compared to nitrendipine and nimodipine.

Antimicrobial susceptibility and plasmid analysis of Campylobacter jejuni isolated from diarrhoeal patients and healthy chickens in northern India

Seventy-five strains of Campylobacter jejuni isolated from humans with diarrhoea (45 strains) and healthy chickens (30 strains) were tested for their susceptibility to different antimicrobial agents: ampicillin, tetracycline, erythromycin, gentamicin, kanamycin, furazolidine and quinolones (nalidixic acid, norfloxacin, ciprofloxacin). The frequencies of resistance to ampicillin and tetracycline were 16 and 9.3% respectively. Two strains (2.7%) exhibited resistance to quinolones as mentioned. One strain (1.3%) was resistant to erythromycin, and both ampicillin plus tetracycline. One strain (1.3%) exhibited resistance to multi-drugs (ampicillin, tetracycline and erythromycin). Resistance to ampicillin was higher in human strain (22.2%) compared to chickens (6.7%). On the contrary, the frequency of resistance to tetracycline was higher in chicken strains (13.3%) than in human (6.7%). All the ampicillin-resistant strains produced beta-lactamase. None of the ampicillin, erythromycin and quinolone-resistant strains contained any plasmid but all the tetracycline-resistant strains contained 23 kilobase (kb) plasmid which could be transferred to an ampicillin-resistant C. jejuni strain. This study thus shows that ampicillin and tetracycline resistance in C. jejuni are common in northern India. Ampicillin resistance is chromosomally determined but tetracycline resistance is mediated through 23 kb plasmid.

Fibrolamellar hepatocellular carcinoma

Fibrolamellar hepatocellular carcinoma, a histological variant of hepatocellular carcinoma, distinct pathological and clinical features and a better prognosis than other types of hepatocellular carcinoma. We report here a patient who was treated on successful surgically.

Deficient induction of human hsp70 heat shock gene transcription in Y79 retinoblastoma cells despite activation of heat shock factor 1

One of the basic features of the inducible heat shock response is the activation of heat shock factor which results in the rapid transcriptional induction of the heat shock genes. Although it is widely considered that the heat shock response is ubiquitous, several reports have indicated that the transcriptional response can vary in both intensity and kinetics and often in a tissue-specific manner. Of interest have been studies on the expression of heat shock genes in the brain, particularly observations that certain cultured neuronal cells exhibit a diminished heat shock response. We demonstrate that transcription of the gene encoding a 70-kDa heat shock protein (hsp70) is diminished upon heat shock in Y79 human retinoblastoma cells (which are of neuronal origin) despite both the activation of heat shock factor 1 and induced transcription of another heat shock gene, hsp90 alpha. This uncoupling of stress-induced transcription of the hsp70 and hsp90 alpha genes, which are typically coordinately regulated in response to stress, appears to be due to the selective inability of trans-acting factors, including heat shock factor 1, to bind in vivo to the hsp70 promoter as the result of a chromatin-mediated effect.

Isokinetic concentric versus eccentric training of shoulder rotators with functional evaluation of performance enhancement in elite tennis players

Thirty elite tennis players were randomly assigned to three groups to evaluate shoulder isokinetic internal and external rotation training: an isokinetic concentric group, an isokinetic eccentric group, and a control group with no training. Subjects were tested before and after training both concentrically and eccentrically using an isokinetic dynamometer. Functional output before and after training was assessed by the average and peak velocity of six maximal serves. The effect of training on serve velocity endurance was also assessed. Statistically significant concentric and eccentric strength gains (11%) were obtained in both training groups when compared with controls (decreased total average strain of 2%) (P < 0.0004). Serve velocity increased by greater than 11% in both training groups, which was a significant increase from the average of 1% in the control group (P < 0.0001). In the endurance study, training group subjects displayed a tendency to maintain their serve velocity (loss of approximately 2%) greater than controls (loss of 6.4%) (P < 0.05). Isokinetic training led to increases in objective and functional output in elite tennis players. This training regimen may have significance in the final stages of the rehabilitation of injured shoulders as well as in improved performance and reduced injury risk.

Esophageal endoscopic sclerotherapy in children using 3% aqueous phenol

OBJECTIVE

To study the efficacy of endoscopic variceal sclerotherapy (EST) in controlling acute variceal bleeding and preventing recurrence of bleeding from esophageal varices in children.

METHODS

Ninety children (mean age 7.3 +/- 3.0 years) with portal hypertension [extra-hepatic portal venous obstruction (EHPVO) 83, cirrhosis 7] presenting with hematemesis and/or melena were subjected to EST using 3% phenol in water as sclerosant.

RESULTS

Active variceal bleeding could be controlled in 31 of 34 (91%) cases. Varices could be obliterated in 87% of patients with a mean of 5.4 +/- 2.5 injection sessions. Pre-obliteration variceal rebleeding was observed in 15% of patients. Complications such as esophageal ulceration, stricture and perforation were observed in 32%, 4.5% and 1% of patients respectively. Strictures responded to dilatation whereas perforation responded to conservative treatment. Recurrence of varices was seen in 22% of patients at a mean interval of 5.8 +/- 1.9 months. The mortality in the emergency group was 9.5% and nil in the elective group. Ten percent of patients required surgical intervention.

CONCLUSION

EST with 3% phenol in water is effective in controlling active bleeding as well as preventing recurrent bleeding from esophageal varices in children.

Total hepatic vascular exclusion for major hepatic resection

Use of vascular occlusion techniques during hepatic resection has besides decreasing blood loss improved the feasibility of surgical extirpation of large hepatic tumors. We report successful use of this technique to resect a large hepatoma in the right lobe of the liver. The hemodynamic and biochemical changes in the perioperative period are documented.

Mannose-resistant haemagglutination by Campylobacter jejuni--a preliminary communication

Ten strains of C. jejuni each isolated respectively from patients with diarrhoea and from chicken intestine (10 strains from each source) were examined for presumptive colonization factor(s) by measuring their cell surface hydrophobicity and haemagglutination. None of the strains expressed cell surface hydrophobicity. However, 14 strains (7 from either source) showed variable haemagglutination pattern with human, sheep and rabbit erythrocytes in the presence of 0.5 per cent D-mannose. Thus, mannose resistant haemagglutinin(s) may be involved in the colonization of intestinal mucosal surfaces by C. jejuni.

Endoscopic esophageal variceal sclerotherapy using 3% aqueous phenol

Endoscopic esophageal variceal sclerotherapy was performed in 301 patients with portal hypertension (emergency, 72 and elective, 229) using 3% aqueous phenol as sclerosant. The cause of portal hypertension was cirrhosis of the liver in 189 patients (Child's class A-48, B-66, and C-75), extrahepatic portal venous obstruction (EHPVO) in 90, and non-cirrhotic portal fibrosis in 22 patients. In the emergency group, active bleeding was controlled in 87% of cases. Re-bleeding occurred in 101 of 290 (35%) surviving patients. Obliteration of varices was achieved in 228 (84%) patients, with a mean of 5.14 +/- 2.27 sclerotherapy sessions. Of 301 patients, 29 (9.6%) had an early in-hospital mortality (30.5% in emergency and 3% in elective group), with 16 deaths due to variceal bleeding. Of the remaining 272 patients, 40 (15%) died during follow-up, of which only 11 died of variceal bleeding. Complications, such as superficial ulcers, dysphagia, and strictures, were observed in 14%, 7% of emergency, and 3% of elective patients. None of the patients developed systemic toxicity. In conclusion, 3% aqueous phenol is an effective, safe, and economical sclerosant for esophageal variceal sclerotherapy.

Cholescintigraphic detection of biliary leaks

We report four cases in whom post-traumatic or post-surgical biliary leak was detected using dynamic 99mtechnetium-iminodiacetic acid (IDA) cholescintigraphy. This technique is a non-invasive, safe, simple and sensitive method of documenting the presence, location and extent of biliary leaks. Further, it can be repeated and hence, is useful in evaluating the response to treatment. Surgery is indicated when a moderate extravasation of labeled bile suggests that the leak is the chief pathway of bile drainage, with relatively little bile entering the intestine.

Resistant coagulase negative staphylococci from clinical samples

Antibiotic susceptibility testing against 17 antibiotics was done on 96 strains of various species of coagulase negative staphylococci by Stokes method. Hundred per cent sensitivity was found against vancomycin and cefotaxime and about 90 per cent against ciprofloxacin, clavulanate potentiated amoxycillin, cloxacillin and clindamycin. Strains showed highest resistance against cotrimoxazole (77.08%) and tetracycline (64.59%). Clavulanate potentiated amoxycillin was found to be highly active against penicillin, ampicillin and amoxycillin resistant organisms. The results highlight the importance of antibiotic resistance typing among coagulase negative staphylococci species which are increasingly being reported from serious clinical infections making empiric therapy and selection of antibiotics difficult in these infections.

Pneumatic dilatation in achalasia cardia results and follow-up

Pneumatic dilatation is one of the more recent methods in the management of achalasia cardia. Fifty dilatations were done in 42 patients with achalasia cardia over 5 years. There was a significant decrease in the maximum diameter of the oesophagus and a significant increase in diameter in the narrowed lower oesophageal segment in all the patients. Of the patients studied, 95.23% were relieved of their symptoms after only one to two sessions. There were no immediate complications. Out of the 38 patients on long term follow up, 8 (21.05%) had recurrence of symptoms. On repeat dilatations, 4 (50%) of them had good response. Late complication like reflux oesophagitis was observed in only 1 patient over a median follow up period of 22 months. It was thus concluded that pneumatic dilatation is a safe, simple and effective procedure in managing patients with achalasia cardia.

Morphological changes in esophagus following endoscopic sclerotherapy with 3% aqueous phenol

Autopsy studies have shown that a majority of sclerosants presently used for endoscopic variceal sclerotherapy achieve their end result by a process of necrotizing inflammation of the esophageal wall followed by fibrosis and thrombosis, rather than bland thrombosis of varices. We have been using 3% phenol in water for variceal sclerotherapy and found it to be an effective sclerosant. To study the effect of this sclerosant on varices and the esophageal wall, autopsies were performed in 15 patients who died following sclerotherapy. Histopathological examination of sections from the esophagus showed (a) fresh thrombus in the varices immediately following injection, (b) intimal damage with medial sclerosis and superficial mucosal ulceration after one week, (c) organisation and recanalization with marked medial sclerosis at 3-4 weeks, and (d) complete obliteration of varices after 6-12 weeks. None of the patients was found to have esophageal necrosis, perforation or mediastinitis. Thus, 3% aqueous phenol appears to be an effective and safe sclerosant for variceal sclerotherapy.

Comparative trial of three different schedules for endoscopic esophageal variceal sclerotherapy

We analyzed our experience in 125 patients with variceal bleeding to compare the efficacy and complications of various schedules of endoscopic variceal sclerotherapy. The schedules for the first three injections were as follows: (A) 3-5 ml of aqueous phenol injected at intervals of three weeks (Group I, n = 28), one week (Group II, n = 30) and three days (Group IIIa, n = 33), and (B) 2-3 ml of phenol at each site at intervals of 3 days (Group IIIb, n = 34). Subsequent injections were given at four week intervals for all groups. Varices could be obliterated significantly earlier (p less than 0.001) in patients injected at 3-day intervals (mean +/- SD 9.12 +/- 5.95 weeks) as compared with those injected at 1-week (13.50 +/- 10.28 weeks) and 3-week (20.55 +/- 7.77 weeks) intervals. The rebleeding rate was not significantly less in the 3-day interval group (Group IIIa--16.66% and Group IIIb--17.64%) as compared with the 1-week (23.3%) and 3-week (28.5%) groups. However the mortality due to rebleed was significantly less (p less than 0.05) in patients injected at 3-day interval (nil), as compared with those injected at 1-week (13.3%) and 3-week (10.7%) intervals. Mucosal ulcerations and stricture formation were observed significantly (p less than 0.001) more frequently in patients undergoing sclerotherapy at 3-day intervals (Group IIIa--51.5% and 18.18%) with 3-5 ml of phenol as compared with those injected similar volume at 1-week (16.66% and 3.3%) and 3-week (7.1% and 3.5%) intervals respectively.(ABSTRACT TRUNCATED AT 250 WORDS)