ABSTRACT
The outcome of 32 patients with 33 primary total hip replacements performed using noncemented uncoated polyethylene acetabular cups (RM cup) with cemented titanium alloy monoblock stems (STH-2 stem) was reviewed. At a mean followup of 6.3 years (range, 6 months-10 years), the failure rate was 57%, more than 14 times higher than the rate typically seen with cemented polyethylene acetabular cups used with the STH stem. Failure was characterized by rapidly progressive acetabular or femoral osteolytic lesions that resulted in extensive bone loss, often in patients who had no symptoms. In addition to the debris that typically is generated by a metal on plastic bearing couple, an abundance of polyethylene particles of submicron size were produced at the cup-bone interface. Tissues retrieved from areas of osteolysis revealed the presence of intracellular submicron polyethylene particles in macrophages. It is recommended that patients with no symptoms who have RM noncemented, uncoated acetabular cups be followed up yearly and undergo early revision surgery when faced with osteolysis to prevent extensive bone loss.
Subject(s)
Acetabulum/surgery , Arthroplasty, Replacement, Hip , Hip Prosthesis , Polyethylenes , Prosthesis Design , Prosthesis Failure , Alloys , Cementation , Female , Femur/surgery , Follow-Up Studies , Foreign Bodies/etiology , Foreign Bodies/pathology , Humans , Macrophages/pathology , Male , Middle Aged , Osteolysis/etiology , Particle Size , Polyethylenes/adverse effects , Reoperation , Retrospective Studies , Titanium , Treatment OutcomeABSTRACT
Hospitalization of patients who have undergone renal transplantation is often extended because of the need to complete complex antirejection infusion therapy. Because of the costs associated with prolonged hospitalization, medical professionals who provide care to these patients are developing programs that will facilitate attainment of quality care in the outpatient setting. The authors describe the effective implementation of a home Muromonab-CD3 (OKT3) intravenous administration program among renal transplant recipients based on thorough planning and close collaboration between the transplant service and home care staff.
Subject(s)
Home Care Services/organization & administration , Kidney Transplantation/nursing , Muromonab-CD3/administration & dosage , Patient Care Planning , Hospital Departments , Humans , Infusions, Intravenous , PennsylvaniaABSTRACT
We examined the association between clinical status and exposure to tobacco smoke in 44 patients homozygous for the F508 cystic fibrosis mutation. Heavy exposure to tobacco smoke was significantly associated with lower Shwachman scores, poorer results of pulmonary function tests, and a fivefold increase in the number of pulmonary-related hospitalizations during the previous year.
Subject(s)
Chromosome Deletion , Cystic Fibrosis/physiopathology , Homozygote , Tobacco Smoke Pollution/adverse effects , Adolescent , Adult , Child , Child, Preschool , Cystic Fibrosis/genetics , Female , Forced Expiratory Volume , Humans , Infant , Male , Vital CapacitySubject(s)
Abnormalities, Multiple , Adenofibroma/complications , Breast Neoplasms/complications , Heart Septal Defects, Atrial/complications , Pulmonary Artery/abnormalities , Exophthalmos/complications , Female , Humans , Infant , Kidney/abnormalities , Kidney/diagnostic imaging , Macroglossia/complications , Radiography , SyndromeABSTRACT
Studies of eight patients with this syndrome confirm the characteristic pattern of abnormalities and the autosomal recessive mode of inheritance. The incidence is estimated to be approximately 1 in 100,000 live births. The liver lesion proved to be variable, with features of progressive parenchymal damage rather than a developmental defect of small bile ducts as previously suggested. Elevated levels of pipecolic acid were found in blood and urine and may be related to the basic defect.