Ankylosed hips caused by heterotopic ossification after traumatic brain injury: a difficult problem.

BACKGROUND: Heterotopic ossifications develop around major joints after severe traumatic brain injury and decrease the range of motion of the joints. METHODS: From 1982 to 1994, we operated on 22 ankylosed hips caused by heterotopic ossifications after traumatic brain injury. Our 15 patients had been hospitalized in the intensive care unit for a period of 8 to 57 days. Their preoperative neurologic status was evaluated precisely. Special interest was given also to the accurate estimation of the extent and location of the ectopic bone by using x-rays and computed tomography, as well as to the maturity of the bone by using Tc99 bone scan and measurements of serum alkaline phosphatase levels. Intraoperatively, we resected as much ectopic bone as was needed to achieve functional range of motion in the hip. Postoperatively, all the patients were administered 100 mg of indomethacin (suppository) per day for a month, antibiotics, and anticoagulants. They were also exposed to 1,000 cGy of radiation in two equal doses. RESULTS: We achieved a least functional range of motion in 15 of 22 hips. Of the seven hips with poor results, six cases were attributable to the uncontrolled neurologic syndrome and only one poor result was attributable to severe heterotopic ossification recurrence. Wound complications did occur. CONCLUSION: Ankylosed hips caused by heterotopic ossifications after traumatic brain injury are a difficult problem to manage. Accurate evaluation of the preoperative neurologic status is essential for the desired final outcome and the treatment options.

Hybrid total hip replacement. A 5-10-year follow-up study of 106 patients.

Between 1987 and 1992, 135 hybrid total hip replacements (THR) were performed in 124 patients. 106 patients, mean age 63 (52-77) years with 113 hips were followed for a an average of 6 (5-10) years. Porous coated PCA cups with 2 pegs were used in 21 cases, the Universal porous coated PCA in 62 and the Kirschner integrity cup in 30. Anatomic PCA stems were used in 83 cases and Kirschner dimension PC stems in 30. The preoperative Harris Hip Score (HHS) was 47. At follow-up, patients were evaluated clinically and radiographically. The position of the acetabular and femoral components were measured and the condition of the cement mantle and the bonecement interface were determined. Postoperatively, the mean HHS was 89. 92% of the patients were symptom free. 3 THR were revised; 2 due to acetabular component loosening and 1 due to failure of the femoral component. The remaining cases were considered stable, although 3 cups were suspected of future loosening.

Characterization of Giardia duodenalis isolates from a waterborne outbreak.

Isolates were retrieved from drinking water and from animal and human sources associated with a waterborne outbreak of giardiasis. This is the first report of water-source and epidemic-associated Giardia isolates being adapted to in vitro propagation. Outbreak-associated, non-out-break-associated, and reference isolates were characterized using isoenzyme electrophoresis and pulsed-field gel electrophoresis (PFGE). All outbreak-associated and 2 other isolates were in one of eight zymodemes. The chromosomal complement of the outbreak-associated isolates was relatively homogeneous; this PFGE karyotype was distinguishable from other karyotypes. Overall results of both characterization methods were similar, although PFGE appears to be a more discriminating biotyping technique. Banding patterns of the outbreak-associated Giardia isolates remained the same even though the parasite passed through different hosts during the outbreak. Heterogeneity of isolates was also demonstrated for the first time within a single community not associated with the outbreak.

Pulsed-field gel electrophoresis as a method of biotyping of Giardia duodenalis.

Pulsed-field gel electrophoresis (PFGE) has allowed karyotypic characterization of protozoa at a species and a subspecies level. Different methods of PFGE have been applied to analysis of Giardia isolates from the major morphologic groups and of isolates from the G. duodenalis group. We developed a four-day method of contour-clamped homogeneous electric field PFGE that produced reliable chromosomal band separation for isolates from the G. duodenalis group. When a significant waterborne outbreak of giardiasis occurred in a town in British Columbia, this biotyping method was assessed by characterization of isolates associated with the outbreak. Results were compared with karyotypes obtained from isolates retrieved in other parts of the province, as well as with reference isolates. Isolates in this study were found to have 4-6 chromosomal bands estimated to be between 1 and 4 Mb in size. The chromosomal complement of the outbreak-associated isolates was relatively homogeneous and distinguishable from the non-outbreak-associated British Columbia and reference isolates. The present study showed this PFGE method to be useful in biotyping isolates of G. duodenalis. This study also exemplifies the degree of heterogeneity displayed at the genotypic level of Giardia, as well as the apparent stability of the outbreak-associated karyotype during transmission from original infecting animal through a water vehicle to human cases.