Experience of the posterior lip augmentation device in a regional hip arthroplasty unit as a treatment for recurrent dislocation.

INTRODUCTION: Dislocation after total hip arthroplasty (THA) remains a significant complication of the procedure and is the third leading cause for revision THA. One technique for treatment of this complication is the use of the posterior lip augmentation device (PLAD). We describe our experience using the PLAD including complication rates. METHODS: A retrospective review of 55 PLADs (54 patients) was carried out following identification from electronic theatre records. Basic patient demographics, operative records and radiographs were collected and reviewed and data was analysed using Microsoft Excel. Failure of the PLAD was defined as further operative intervention after PLAD insertion and included: dislocation, implant breakage, infection and revision of the THA for loosening of either component. RESULTS: 55 PLADs were implanted in 54 patients with an average age of 77 years. There was a significant preponderance of females and a variety of surgical approaches had been used for the original hip replacement, including trochanteric osteotomy, posterior and antero-lateral. 9 (16%) patients had recurrent dislocations,1 (2%) failed secondary to screw breakage, 3 (5%) had and infection requiring intervention and 2 (4%) underwent further revision for aseptic loosening of the femoral component. The overall failure rate was 25% with 14 patients requiring intervention post PLAD. CONCLUSION: Our results are inferior to other published results and indicate that the PLAD should be used with caution for recurrent dislocations of the Charnley hip replacement.

Electronic in-plane symmetry breaking at field-tuned quantum criticality in CeRhIn5.

Electronic nematic materials are characterized by a lowered symmetry of the electronic system compared to the underlying lattice, in analogy to the directional alignment without translational order in nematic liquid crystals. Such nematic phases appear in the copper- and iron-based high-temperature superconductors, and their role in establishing superconductivity remains an open question. Nematicity may take an active part, cooperating or competing with superconductivity, or may appear accidentally in such systems. Here we present experimental evidence for a phase of fluctuating nematic character in a heavy-fermion superconductor, CeRhIn5 (ref. 5). We observe a magnetic-field-induced state in the vicinity of a field-tuned antiferromagnetic quantum critical point at Hc ≈ 50 tesla. This phase appears above an out-of-plane critical field H* ≈ 28 tesla and is characterized by a substantial in-plane resistivity anisotropy in the presence of a small in-plane field component. The in-plane symmetry breaking has little apparent connection to the underlying lattice, as evidenced by the small magnitude of the magnetostriction anomaly at H*. Furthermore, no anomalies appear in the magnetic torque, suggesting the absence of metamagnetism in this field range. The appearance of nematic behaviour in a prototypical heavy-fermion superconductor highlights the interrelation of nematicity and unconventional superconductivity, suggesting nematicity to be common among correlated materials.

The influence of magnetic order on the magnetoresistance anisotropy of Fe1 + δ-x Cu x Te.

We performed resistance measurements on [Formula: see text]Cu x Te with [Formula: see text] in the presence of in-plane applied magnetic fields, revealing a resistance anisotropy that can be induced at a temperature far below the structural and magnetic zero-field transition temperatures. The observed resistance anisotropy strongly depends on the field orientation with respect to the crystallographic axes, as well as on the field-cooling history. Our results imply a correlation between the observed features and the low-temperature magnetic order. Hysteresis in the angle-dependence indicates a strong pinning of the magnetic order within a temperature range that varies with the Cu content. The resistance anisotropy vanishes at different temperatures depending on whether an external magnetic field or a remnant field is present: the closing temperature is higher in the presence of an external field. For [Formula: see text] the resistance anisotropy closes above the structural transition, at the same temperature at which the zero-field short-range magnetic order disappears and the sample becomes paramagnetic. Thus we suggest that under an external magnetic field the resistance anisotropy mirrors the magnetic order parameter. We discuss similarities to nematic order observed in other iron pnictide materials.

Magnetic breakdown in the electron-doped cuprate superconductor Nd(2-x)Ce(x)CuO4: the reconstructed Fermi surface survives in the strongly overdoped regime.

We report on semiclassical angle-dependent magnetoresistance oscillations and the Shubnikov-de Haas effect in the electron-overdoped cuprate superconductor Nd(2-x)CexCuO4. Our data provide convincing evidence for magnetic breakdown in the system. This shows that a reconstructed multiply connected Fermi surface persists, at least at strong magnetic fields, up to the highest doping level of the superconducting regime.

Evolution of the Fermi surface of the electron-doped high-temperature superconductor Nd(2-x)Ce(x)CuO(4) revealed by Shubnikov-de Haas oscillations.

We report on the direct probing of the Fermi surface in the bulk of the electron-doped superconductor Nd(2-x)Ce(x)CuO(4) at different doping levels by means of magnetoresistance quantum oscillations. Our data reveal a sharp qualitative change in the Fermi surface topology, due to translational symmetry breaking in the electronic system which occurs at a critical doping level significantly exceeding the optimal doping. This result implies that the (pi/a, pi/a) ordering, known to exist at low doping levels, survives up to the overdoped superconducting regime.

Gadolinium-induced nephrogenic systemic fibrosis in a patient with an acute and transient kidney injury.

Nephrogenic systemic fibrosis (NSF) describes a characteristic fibrosing disorder which typically presents with indurated plaques on the trunk and extremities of patients with advanced renal disease. We present a case of biopsy-confirmed NSF in a patient with severe acute kidney injury with no prior history of renal disease. A 64-year-old man with an acute and severe decrease in glomerular filtration rate underwent magnetic resonance imaging studies with gadolinium contrast (Omniscan) and subsequently developed NSF. His renal disease had normalized at the time his skin disease developed. Skin biopsies revealed findings of NSF and scanning electron microscopy with energy-dispersive X-ray spectroscopy confirmed insoluble gadolinium within lesional tissue.

Evaluation of chronic urticaria in patients with Hashimoto thyroiditis.

The coincidence of Hashimoto thyroiditis (HT) and chronic idiopathic urticaria (CIU) is a commonly observed phenomenon in western New York. Previous literature suggested that there may be a direct relationship between them. We undertook these studies to determine whether humoral or cell-mediated mechanisms might link HT and CIU. Skin biopsies from patients with CIU, with or without HT, were indistinguishable by light microscopy. No immune complex deposition was observed, although only the skin from patients with CIU and HT contained perivascular fibrin deposits. Similarly, immunohistochemical studies evaluating cellular expression of CD3, CD4, CD8, CD20, and CD68 failed to differentiate between CIU with or without HT. Analysis of Vbeta restriction in thyroid tissue of patients with HT and the skin of patients with CIU and HT by in situ polymerase chain reaction failed to reveal any oligoclonal T-lymphocyte subpopulations. In contrast, only patients with CIU and HT had anti-FcepsilonRI antibodies in their sera that could induce degranulation of normal basophils. Some sera from patients with CIU and HT caused degranulation of normal basophils in the absence of anti-FceRI. The factor causing basophil degranulation in these sera was not determined. Patients with CIU and HT failed to improve clinically with thyroid replacement therapy. All CIU patients were equally well managed with symptomatic therapies. In conclusion, HT likely represents a marker of other autoimmunity, rather than being a direct causative agent in CIU. Management of CIU, with or without HT and with or without anti-FceRI antibodies, should be the same. Future studies will have to examine whether cell-mediated responses participate in CIU, especially in association with HT.

Lipodystrophy.

Congenital lipodystrophy is an uncommon autosomal recessive disorder that occurs mainly in females and is characterized by loss of subcutaneous fat, insulin-dependent diabetes mellitus, and masculinization due to defective metabolism of fat. Acquired lipodystrophy is now most commonly encountered in patients infected with HIV who take protease inhibitors. We present an illustrative case of lipodystrophy and review the presenting signs allowing for an accurate clinical diagnosis.

Air bag injury and the dermatologist.

Most new car models have driver-side air bags and many also have passenger-side and side-impact air bags. Air bags are known to be dangerous to small children and may cause death, fractures, and cerebral spinal injury. However, the cutaneous manifestations of air bag injury are less well known. Additional potential air bag injuries include retinal damage and high-frequency hearing loss. The following case report illustrates significant burns from a low-impact air bag injury and reviews the pertinent literature.

Spiny keratoderma.

Spiny keratoderma is a descriptive term used to encompass a variety of unusual, disparate keratodermas. Spiny keratoderma has been associated with lipid abnormalities and has been limited to the palms and soles in some individuals. We describe an acquired case of spiny keratoderma in which an adult woman developed filiform lesions predominating on the trunk and proximal extremities. Treatment with topical emollients and keratolytic agents was unsuccessful, but topical tazarotene led to long periods of resolution. She has had no other associated abnormalities. The clinical features and differential diagnosis of spiny keratoderma are reviewed.

Inexpensive digital photography in clinical dermatology and dermatologic surgery.

Digital photography can be used to follow clinical improvement in a variety of dermatoses, document pre and postoperative results, and document histologic findings from skin biopsies. Images may be printed as part of text documents and can be filed in conventional medical charts. Images can be transmitted via electronic mail rapidly and to any location. We have found digital photography to be relatively inexpensive and a powerful tool to enhance dermatologic practice.

Contact hypersensitivity to mercury in amalgam restorations may mimic oral lichen planus.

Oral lichenoid lesions caused by hypersensitivity to mercury in amalgam fillings may mimic oral lichen planus on clinical and histologic examination. A positive patch test reaction to more than one mercurial allergen increases confidence in the diagnosis and justifies the removal and replacement of all amalgam fillings with those made of other materials. A complete remission may be expected about 3 months after the last amalgam filling is removed.

Striate palmoplantar keratoderma: a clinical and ultrastructural study.

Palmoplantar keratodermas are poorly understood heterogeneous disorders of cornification. Autosomal dominant and autosomal recessive keratodermas with a varied clinical presentation are recognized. Striate keratoderma is uncommon. We report the case of a 15-year-old girl with keratoderma that began at 5 months of age. Her clinical and ultrastructural findings are reviewed. Routine microscopic examination revealed eosinophilic inclusions in the granular cell layer as well as prominence of the granular cell layer. Electron microscopic examination revealed corneocytes with an imbricated pattern. Ultrastructural findings in this unique case are contrasted with those of other palmoplantar keratodermas.