Hip Arthroplasty: Back to the Future?

This review examines the future of total hip arthroplasty, aiming to avoid past mistakes

Burn injury and management in Liberia

Burn care in developing countries remains a challenge. This paper reviews the acute burn care of 21 patients admitted during a 1-year period to a hospital in Liberia. Lack of supplies and education, coupled with the local belief system, reflect on patient management. The study population totalled 21 patients, ranging from 1 to 62 years of age. TBSA burns ranged from 2 to 60 per cent (mean 21 per cent), 61 per cent of patients were grafted. The time between burn and graft varied between 5 and 96 days (mean 29.8). Graft take varied between 40 and 100 per cent (mean 81 per cent). Of the grafted patients 66.6 per cent received blood (average 732 ml). At the time of presentation 61.9 per cent of patients had other illness. The average number of hospital days was 37.9 (range 2-76). The mortality rate was 14.2 per cent. When managing burns in a developing country, adoption of a simple, clearly defined method of treatment, together with education of the care-givers, is suggested. As in the developed world, however, prevention is the critical factor.

Analysis of life expectancy and living status of elderly patients surviving a burn injury

This study evaluates the long-term outcome of elderly patients discharged from hospital after a burn injury. Ninety-three patients over the age of 60 years, admitted to a regional burn center, were included in the study from January 1981 to January 1986. The in-hospital mortality rate was 49.4%. Patients' living status was graded according to dependency: 47% of patients were reduced to a more dependent living status on discharge, and 36% of the survivors were followed up for between 1 and 5 years. During this time seven (19.4%) patients died, three (8.3%) became more independent, four (11.1%) less independent. Life table analysis of discharged patients showed no accelerated death rate in comparison with the normal population. The high mortality associated with burns in the elderly was confirmed. Half the survivors were at least temporarily less independent. Projected life expectancy for the elderly surviving a burn is comparable with his/her uninjured counterpart.

Antibody response to xenogeneic proteins in burned patients receiving cultured keratinocyte grafts

Cultured keratinocytes (CK) have been used to resurface large burn wounds with some success. These CK are grown in the presence of fetal bovine serum (FBS) and mouse fibroblasts (MF). Serum from ten patients who received CK grafts as part of burn wound coverage was studied by ELISA technique for antibody to these xenogeneic antigens. All patients had some amount of antibody to FBS but no detectable antibody to MF. The amount of antibody to FBS varied between patients and with respect to time after graft application. Generally, the levels of antibody to FBS were moderate by 30 days, declined, and then rose slowly by 5 to 6 months. The majority of antibody to FBS was against bovine serum albumin (BSA), demonstrated by Western blot technique. The presence of such antibody to FBS might produce clinical problems of graft rejection, anaphylaxis, and serum sickness in patients receiving CK grown in FBS supplemental medium. Further investigation will need to determine the likelihood and potential severity of such clinical problems.

Effect of burn injury on the kinetics of in vivo polymorphonuclear neutrophil (PMN) chemotaxis to Staphylococcus aureus

This study investigated the effect of time after burn injury on the kinetics of polymorphonuclear neutrophil (PMN) chemotaxis to Staphylococcus aureus. Rats with 30% body surface area back burns, and nonburned control rats, received several identical inocula of S aureus 3, 6, and 10 days after injury, and in vivo chemotaxis was measured by tissue myeloperoxidase at varying intervals. Animals six and ten days postburn had a delay, as well as a decrease, in maximal chemotactic response. This delay in response appears to be another mechanism by which PMN chemotaxis is affected by burn injury.

Lack of correlation between decreased chemotaxis and susceptibility to infection in burned rats

This study examined the relationship between chemotaxis and susceptibility to infection. Rats were subjected to a 30% BSA burn to the dorsum of the back and resuscitated. Rats with burns from 1 to 11 days old were injected with varying inocula of S. aureus into nonburned skin. Animals with burns more than 6 days old had significantly decreased PMN chemotaxis into the inoculation site but had no increase in susceptibility to infection. This lack of correlation between PMN chemotaxis and susceptibility to infection suggests that PMN motility is not the dependent factor in resistance to infection from S. aureus in this burn model.

An evaluation of pelvic lymphoscintigraphy in the staging of colorectal carcinoma

Lymphoscintigraphy was used to delineate the lymphatic drainage of the rectum and distal colon in 18 patients with carcinoma of the rectum or sigmoid colon, in four with inflammatory disease of the large bowel and in 20 controls without colorectal pathology. Abdominal imaging was performed after submucosal injection of either 4 mCi 99mTc-antimony sulphide colloid or 0.5 mCi 99mTc-dextran into the rectum through a proctoscope. In nine patients with colorectal carcinoma, abdominal imaging was performed immediately pre-operatively and the excised specimen of large bowel was also imaged in vitro immediately postoperatively. The presence or absence of nodal uptake of radionuclide on abdominal scanning did not discriminate between normal and diseased large bowel, and the extent of nodal uptake demonstrated either by abdominal scans or by in vitro scans of excised specimens bore no relationship to the presence or absence of nodal metastases demonstrated histologically in the cancer patients. Pelvic lymphoscintigraphy as performed in this study has no demonstrable value in the diagnosis or staging of colorectal cancer.