Clinical characteristics of central European and North American samples of pregnant women screened for opioid agonist treatment.

BACKGROUND: Little comparable information is available regarding clinical characteristics of opioid-dependent women from different countries. In the present study, women from the USA, Canada and a Central European country, Austria, screened for participation in the Maternal Opioid Treatment Human Experimental Research study, were compared with respect to their demographic and addiction histories. METHODS: Pregnant women (n = 1,074) were screened for study participation using uniformed clinical criteria and instruments. The screening results were compared with regard to exclusion, demographics, drug use, and psychosocial and treatment histories. RESULTS: Compared to the screened US and Canadian women, Austrian women were more likely to be younger (p < 0.001), white (p < 0.001), had significantly lower levels of educational attainment (p < 0.001), were less likely to use opioids daily (p < 0.001) and more likely to have been prescribed buprenorphine (p < 0.001). Compared to both rural and urban US groups, the Austrian group was less likely to have legal issues (p < 0.001) and was younger when first prescribed agonist medication (p < 0.001). CONCLUSION: The differences between North American and European groups may offer unique insights concerning treatment and pregnancy outcomes for opioid-dependent pregnant women.

Total knee arthroplasty in human immunodeficiency virus-infected hemophiliacs.

Twenty-six knee arthroplasties were performed in 15 patients with hemophilia A and human immunodeficiency virus infection from 1984 to 1991. Patient age range was 27 to 48 years. After an average follow-up period of 6.4 years (range, 1-9 years) all patients were alive and none of the implants had become infected. T4 lymphocyte counts showed some deterioration, which was not clinically significant. All of the patients were improved following surgery. Nineteen implants were rated excellent, four good, and three fair. Infection with human immunodeficiency virus did not adversely affect the clinical outcome of knee arthroplasty at follow-up periods up to 9 years.

Total ankle arthroplasty. A procedural review.

Total ankle arthroplasty is a demanding surgical procedure, but the advantages of maintaining motion in the tibiotalar joint in the patient with systemic arthritis are known. Although the technology of ankle implant arthroplasty is still evolving, current results in properly selected patients approach the results of other leg implants.

Total ankle arthroplasty in rheumatoid arthritis: a long-term follow-up study.

Patients with rheumatoid arthritis who had undergone total ankle arthroplasty and had a minimum of 2 yr follow-up were studied. Of the original 21 patients 17 were available for review. Twenty-three ankle replacements with an average follow-up of 5.6 yr were studied. On follow-up 2 ankles were rated excellent, 13 were rated good, 4 were rated fair, and 4 were rated poor. Thus, 83% were satisfactory on follow-up. Radiographic analysis revealed migration and settling of the talar component in 14 of 15 cases. Bone cement radiolucencies were found in 14 of 15 cases. Bone cement radiolucencies were found in 14 of 15 tibial components with tilting in 12 of these components. The postoperative position of the implant did not correlate with the development of radiolucencies or migration of the implant.

Total hip arthroplasty in rheumatoid arthritis. A long-term follow-up study.

This study was undertaken to assess the clinical and radiographic results of total hip arthroplasty in rheumatoid arthritis patients with a minimum of 10 years of follow-up evaluation. Eighty-three hips in 51 of the original 104 patients were available for follow-up study an average of 12.1 years following surgery. The average age of the patients at the time of surgery was 39.9 years (range, 14-72 years). Fourteen hips were revised, 11 for mechanical loosening and 3 for late infection. The overall revision rate is 16.7%; the revision rate for mechanical loosening was 13.3%. According to Merle D'Aubigne-Postel hip rating scores in the 69 hips that did not require revision, 19 hips were excellent (28%), 37 were good (54%), 11 were fair (15%), and 2 were poor (3%). Therefore, 67 of 83 hips (80.7%) were satisfactory on follow-up study. Radiographic evidence of loosening in nonrevised hips was found in 11 acetabular and 2 femoral components.

Predicting the healing of the displaced subcapital hip fracture via postoperative roentgenographic factors.

Postoperative roentgenograms of displaced subcapital hip fractures treated with a sliding, keyless compression screw were analyzed for the degree of osteoporosis, level of fracture, and adequacy of reduction. Reduction was graded by measuring the AP Garden angle, the lateral Garden angle, and displacement of the femoral head with comparison to the contralateral hip. Seventy-three displaced subcapital hip fractures were treated over a four-year period. On follow-up, 52 hips were available for analysis. Follow-up examination revealed that 28 hips had failed; these were converted to total hip arthroplasties, bipolar devices, or Girdlestones. Twenty-three hips had healed at a follow-up of 23.6 months. A 24th had become infected and was converted to a Girdlestone. A review of the postoperative roentgenograms revealed that the AP Garden angle was most successful in predicting healing. The lateral Garden angle and displacement of the femoral head on the AP and lateral roentgenograms were less successful predictors. The level of the fracture, the Singh index, and demographic factors, such as age and sex, were not found to be predictive or significant.

Intraspinal synovial cyst causing sciatica.

Four patients who had low-back pain and sciatica were diagnosed as having a lumbar intraspinal extradural synovial cyst adjacent to a facet joint between the fourth and fifth lumbar vertebrae. The patients ranged in age from forty-nine to seventy-one years, and the symptoms and signs involved the fourth or fifth lumbar-nerve roots. Roentgenographically, degeneration of the intervertebral discs and facet joints was noted in every patient. Degenerative spondylolisthesis was also a frequent finding. Myelography and computed tomographic scans aided in diagnosis, revealing a soft-tissue lesion, occasionally rimmed with calcification, adjacent to the involved facet joint. The treatment was surgical excision of the cyst, as well as complete laminectomy if there was concomitant spinal stenosis. Follow-up, ranging from eighteen to twenty-five months, revealed complete resolution of the sciatica in all patients.

Disseminated intravascular coagulopathy in a patient undergoing total hip arthroplasty for carcinoma. A case report.

A 78-year-old man was treated by total hip arthroplasty (THA) for metastatic carcinoma of the proximal femur. After operation, disseminated intravascular coagulopathy (DIC) developed. DIC is a known complication of malignancy but is reported infrequently as a complication of THA. Its occurrence in this patient may have been triggered by the release of coagulant proteins from surgical manipulation of the tumor. The disorder was characterized clinically by profuse uncontrollable hemorrhage from the surgical wound. Laboratory abnormalities indicated a consumptive coagulopathy. Guidelines for the diagnosis and management of a patient with DIC are available. Orthopedic surgeons should be alerted to the potential of this serious complication in patients treated by THA for metastatic bone abscess of the hip.

In vitro growth of bovine articular cartilage chondrocytes in various capacitively coupled electrical fields.

Isolated articular cartilage chondrocytes from 1- to 3-week-old male Holstein calf knee joints were formed into pellets containing 4 X 10(6) isolated cells and were grown in tissue culture medium (minimum essential medium/NCTC 135) containing either 1 or 10% newborn calf serum (NBCS) in plastic Petri dishes in 5% CO2 and air at 37 degrees C in saturation humidity. On the 4th postisolation day either [35S]sulfate or [3H]thymidine was added to the medium, and the pellets were exposed for 24 h to capacitively coupled electrical fields (10, 100, 250, and 1,000 V peak-to-peak, 60 kHz, sine wave signals). The pellets were then harvested, dialyzed, hydrolyzed, and assayed for DNA, protein, [35S]sulfate incorporation, and [3H]thymidine incorporation. Results indicated that at 250 V peak-to-peak there was a statistically significant increase in [35S]sulfate in 1% NBCS and a statistically significant increase in [3H]thymidine in 10% NBCS. At potentials above or below 250 V no changes were noted. Thus, articular cartilage chondrocytes grown in pellet form can be stimulated to increase glycosaminoglycan synthesis or to increase cell proliferation by an appropriate capacitively coupled electrical field. The importance of the serum concentration in the medium in evaluation of biosynthesis in vitro is noted.