Impacted corticocancellous allografts and cement for revision of the femur component in total hip arthroplasty.

Revision of the femur component in total hip arthroplasty using impacted morcellized bone allografts and cemented Lubinus SP-II prosthesis or Charnley standard prosthesis was performed in patients with loss of bone stock grade II through IV according to the Endo-Klinik classification from 1st to 8th revision. We report the results from 57 hips in 56 patients, with a median of 64 months' follow-up. Modified Merle d'Aubigne-Postel postoperative scores increased significantly from preoperative to postoperative values for the Lubinus group and for the Charnley group. Few complications were seen in this follow-up period. Five stems had minor subsidence. Rate of mechanical failure was 4% for both groups. Radiologic examinations provided evidence of frequent trabecular remodeling of the graft, especially for the Lubinus prosthesis.

Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation.

OBJECTIVE: To describe our experience with the use of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in adult patients with severe cardiopulmonary failure from Hantavirus pulmonary syndrome. DESIGN: Case series. SETTING: Tertiary referral center. PATIENTS: Patients with confirmed Hantavirus infection, who developed severe cardiopulmonary failure in which conventional therapy was assessed as being unsuccessful. INTERVENTIONS: Records of previous patients treated for Hantavirus pulmonary syndrome were reviewed and findings consistent with 100% mortality were found. MEASUREMENTS AND MAIN RESULTS: Findings associated with a 100% mortality rate were a) cardiac index of <2.5 L/min/m2; b) serum lactate concentration of >4.0 mmol/L (normal range 0.0 to 2.2); c) pulseless electrical activity or ventricular fibrillation or ventricular tachycardia; and d) refractory shock despite fluid resuscitation, and vasoactive medications. From 1994 to 1996, seven patients were admitted with confirmed Hantavirus pulmonary syndrome and severe cardiopulmonary failure. Three of the seven patients had at least two of the four criteria for a 100% mortality rate listed above, and appeared to be failing optimal conventional therapy. These three patients received support with venoarterial ECMO. The first patient was placed on ECMO during cardiac arrest and died. The next two patients who received ECMO for Hantavirus pulmonary syndrome survived after relatively short, uncomplicated ECMO runs, and were discharged without complications. CONCLUSIONS: ECMO successfully provided cardiopulmonary support in two patients with severe Hantavirus pulmonary syndrome who survived with a good outcome. Our experience suggests that ECMO is a beneficial therapy for patients critically ill with Hantavirus pulmonary syndrome.

Cardiopulmonary manifestations of hantavirus pulmonary syndrome.

OBJECTIVE: To describe the clinical characteristics of a group of patients infected with the newly recognized hantavirus in the Southwestern United States. DESIGN: Case series. SETTING: Tertiary referral center. PATIENTS: All patients with confirmed hantavirus infection admitted to the University of New Mexico Hospital between May 1, 1993 and January 1, 1994. INTERVENTIONS: Records of patients with hantavirus infection were reviewed to collect all pertinent clinical data. MEASUREMENTS AND MAIN RESULTS: Pulmonary disease in these patients was characterized by hypoxemia covering a wide range of severity. The cause of hypoxemia was an increased permeability (noncardiac) pulmonary edema which could be differentiated from hydrostatic (cardiac) pulmonary edema by its association with low pulmonary artery occlusion pressures and increased protein content of edema fluid. Hemodynamic measurements in severe cases showed a shock state characterized by a low cardiac index (range 1.6 to 3.0 L/min/min2), a low stroke volume index (range 10.5 to 29 mL/m2), and high systemic vascular resistance index (range 1,653 to 2,997 dyne.sec/cm5.m2). Progression to death was associated with worsening cardiac dysfunction unresponsive to treatment and causing oxygen debt and lactic acidosis. CONCLUSIONS: The two major life-threatening pathophysiologic changes in Hantavirus Pulmonary Syndrome are increased permeability pulmonary edema, and an atypical form of septic shock caused by myocardial depression and hypovolemia.

Hantavirus pulmonary syndrome: clinical, diagnostic, and virologic aspects.

Hantavirus pulmonary syndrome is an acute pneumonitis with a high mortality rate that is caused by a newly recognized hantavirus. Four Corners virus (also known as Muerto Canyon virus and Sin Nombre virus) is enzootic among deer mice (Peromyscus maniculatus). Incidental transmission to humans can result in a disease characterized by rapidly progressive respiratory insufficiency, diffuse noncardiogenic pulmonary edema, vascular volume contraction with hemoconcentration, lactic acidosis, depressed cardiac output, and cardiac dysrhythmias preterminally. The onset of pulmonary edema is preceded by a prodrome of fever and severe myalgias. Characteristic laboratory abnormalities include thrombocytopenia, leukocytosis with prevalent immature myeloid cells, and the presence of immunoblastic lymphocytes in the peripheral blood. Agent-specific diagnosis is based on the detection of Four Corners virus-specific antibodies in serum by Western blot assays and the detection of Four Corners virus RNA in peripheral blood mononuclear cells by the reverse transcriptase-polymerase chain reaction. Effective treatment depends on the rapid institution of intensive care support.

Hyperoxic suppression of Fc-gamma receptor-mediated phagocytosis by isolated murine pulmonary macrophages.

Lower respiratory tract exposure to high oxygen (O2) concentrations is known to induce changes in pulmonary function through effects on several cell types located within the lung parenchyma, including pulmonary macrophages (PM). We studied the effects of hyperoxic exposure on phagocytosis via Fc-gamma receptors (FcR) on isolated murine PM. PM cultured in hyperoxic conditions exhibited little change in ingestion via FcR for up to 96 h, compared with significant increases in ingestion by PM cultured in 21% O2 over the same time period. This suppression was reversible and occurred whether 50 or 100% O2 concentrations were used for hyperoxic exposure. Addition of the potent macrophage-activating agent interferon-gamma (IFN-gamma) to cultured PM further increased FcR-mediated phagocytosis in normoxic PM but had no effect on PM cultured in 100% O2. Analysis of FcR expression by flow cytometry using monoclonal antibodies specific for two different FcR classes revealed that culture in normoxic conditions increased surface expression of both FcR classes. Hyperoxic culture inhibited up-regulation of the high-affinity FcR but did not affect low-affinity FcR up-regulation, suggesting that hyperoxic effects were not due solely to effects on regulation of FcR expression. However, hyperoxic exposure completely suppressed FcR-mediated actin polymerization. These findings suggest that hyperoxic exposure impairs PM ability to increase FcR-mediated phagocytic activity after appropriate stimulation, which could impair the lung's defenses against infection.

Manual therapy with steroid injections--a new approach to treatment of low back pain. A controlled multicenter trial with an evaluation by orthopedic surgeons.

Fifty-three acute or subacute patients with low back pain were given standardized but optimized activating conventional treatment by primary health care teams. Forty-eight patients received an experimental treatment that included specific manual treatment, such as manipulation and specific mobilization, muscle stretching, auto-traction, and cortisone injections. After 4 months, the experimental group had a less restricted range of movement in extension, less restricted side-bending to the right and to the left, less local pain caused by extension and side-bending to the right, less pain radiating to the right leg caused by side-bending to the left, and a less positive straight leg raising test (both sides) than the conventionally treated group. Manual treatment was superior to the conventional activating treatment in normalizing pathologic findings on physical examination of the lower back. These results agree with the positive influence on pain, drug consumption, sick-leave, disability rating, and quality of life reported in other reports from the same study.

The captopril renogram in percutaneous transluminal angioplasty of the renal arteries.

Technetium-99m DTPA renograms were performed before and after angioplasty in a 63-year-old man with bilateral renal artery stenosis (RAS), hypertension, and renal insufficiency. Decreased isotope uptake after captopril by the right kidney assisted in the selection of the right renal artery for angioplasty. Post-angioplasty improvement in both blood pressure control and renal function was accompanied by an absence of effect of captopril on the isotope uptake by the right kidney. In bilateral RAS, the captopril renogram is a useful tool for selecting the site for angioplasty, for assessing the adequacy of the procedure, and for long-term follow-up.

Loosening of the Charnley hip. Radiographic analysis of 102 revisions.

This retrospective study was based on 102 Charnley hip arthroplasties that underwent a revision operation. Radiographs of hips with loose prosthetic components were compared with those with firm components. Migration and tilting of the socket and subsidence and varus shift of the stem were associated with loosening.

Acromioplasty for impingement syndrome.

In 51 patients (27-67 years) with subacromial impingement syndrome, an acromioplasty according to Neer was performed. In 11 patients, acromioclavicular arthrosis was found, and in these patients the lateral end of the clavicle was resected as well. The patients have been followed for an average of 21 (6-42) months. The result was excellent or good in 33 patients. In seven patients there was no improvement.