Two-stage revision of infected total knee replacements using articulating cement spacers and short-term antibiotic therapy.

We present a series of 48 patients with infected total knee replacements managed by the use of articulating cement spacers and short-term parenteral antibiotic therapy in the postoperative period. All patients had microbiological and/or histological confirmation of infection at the first stage of their revision. They all underwent re-implantation and had a mean follow-up of 48.5 months (26 to 85). Infection was successfully eradicated in 42 of the 48 patients (88%). Six had persistent infection which led to recurrence of symptoms and further surgery was successful in eliminating infection in four patients. These rates of success are similar to those of other comparable series. We conclude that protracted courses of intravenous antibiotic treatment may not be necessary in the management of the infected total knee replacement. In addition, we analysed the microbiological, histological and serological results obtained at the time of re-implantation of the definitive prosthesis, but could not identify a single test which alone would accurately predict a successful outcome.

Triple pelvic osteotomy for the management of painful developmental hip dysplasia in the young adult.

We present a consecutive series of 24 adolescent and young adult patients who have undergone a triple pelvic osteotomy as treatment for symptomatic developmental dysplasia of the hip. With a mean duration of follow-up of 6.5 years (range 2 -16 years) we report good improvements with regard to pain and function in 22 of the 24 patients. Radiological improvements were consistently demonstrated in the centre edge angle and the acetabular index. There were no major complications. When dealing with this difficult problem in young patients we maintain that a redirectional pelvic osteotomy is an appropriate means of treatment in symptomatic patients with a congruent joint.

Operating on patients wearing personal identity devices: a report of two cases.

We report on two patients who have recently required emergency surgery and who were wearing personal identity devices at the time of presentation. The devices bear a telephone number and a message stating that, if found, the management company should be informed of the whereabouts of their owner. We discuss the issues relating to the disclosure of information to a third party in this situation and whether there is any legal obligation to do so. The conclusion of a review of the relevant literature is that the only reason to divulge information to a third party would be if a patient posed a serious risk of death or serious harm to another party. In the majority of foreseeable circumstances, this would not be the case.

A study of light-induced proton transfer from gas phase (radical) cations to reference bases. Bracketing of proton transfer from excited ions and associated reaction kinetics.

By use of Fourier transform ion cyclotron resonance, it is shown that protonated naphthalene when excited with laser light of 488 nm is more reactive in proton transfer to reference bases than in its ground state. The excitation leads to reaction with bases for which proton transfer in the ground state is endothermic up to a detected maximum of 60 kJ/mol. For indene radical cations excited at 514.5 nm, it is shown that the rate constant for proton transfer to 3-pentanone is either about 10 or about 100 times lower than the rate constant for relaxation by collisions with 3-pentanone. From the energy deposited in the ions, 0.5-0.6 eV is available for proton transfer to a base which seems reasonable when taking into account a complete randomization of the initially deposited energy.

Complete fusion of the vocal cords; an unusual case.

A case is presented of a woman who sustained a 35% body surface area mixed depth cutaneous burn, together with a significant inhalational injury. The patient required emergency resuscitation with endotracheal intubation and subsequently tracheostomy. This resulted in an unfortunate complication of a total adhesion between the vocal cords which extended into the subglottic area, causing complete occlusion of the airway.

An analysis of the relationship between bile duct stones and periampullary duodenal diverticula.

Previous studies have suggested a relationship between bile duct stones and periampullary duodenal diverticula. The aim of the present study was to examine this association in more detail, including step-wise logistic regression to identify independent predictors for the presence of diverticula. Clinical, endoscopic and radiological data were analysed from 794 consecutive subjects with bile duct stones; 44 with primary duct stones (without gall-bladder stones) and 750 with bile duct stones associated with current or previous gall-bladder stones. Frequencies of diverticula in subjects with bile duct stones were compared with those in age-matched controls who had undergone upper gastro-intestinal endoscopy using a side-viewing endoscope (n = 100) or who had undergone endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic cancer (n = 100). The frequencies of diverticula in subjects with primary duct stones (70%) and bile duct stones with current or previous gall-bladder stones (25%) were significantly higher than in both control groups (7 and 8%, respectively). When subjects with bile duct stones were analysed by step-wise logistic regression, age and bile duct diameter were independent predictors of the presence of diverticula, but diverticula were unrelated to gender, mode of presentation, number of bile duct stones and outcome after endoscopic sphincterotomy. A significant association exists between duodenal diverticula and bile duct stones, perhaps because diverticula predispose to stone formation through the combined effects of bile stasis and bacterial contamination of bile.

Diet, acetylator phenotype, and risk of colorectal neoplasia.

BACKGROUND: Inherited or acquired differences in metabolic pathways that activate or inactivate dietary carcinogens may influence the risk of developing cancer. A polymorphism in N-acetyltransferase classified people into fast and slow acetylators. This enzyme catalyses the formation of mutagenic products from foodstuffs, especially cooked meat and fish. Some data suggest that fast acetylators are at higher risk of colorectal cancer. We have studied the adenoma and cancer risk in relation to meat intake and acetylator status. METHODS: In a case-control study, we compared 110 patients with colorectal cancer, 89 patients with colorectal adenomatous polyps, and 110 controls. Acetylator status was assessed by the rate of acetylation of sulphamethazine given orally. FINDINGS: The fast-acetylator phenotype was associated with odds ratios of 1.1 (95% Cl 0.6-2.1) and 1.8 (1.0-3.3) for adenoma and colorectal cancer, respectively. The highest risk occurred in the youngest tertile (< 64 years) of cases (2.5 [0.7-9.4] and 8.9 [2.6-30.4], respectively). There was no difference between the sexes. The risk of adenoma or cancer increased with increasing intake of meat in fast but not in slow acetylators: covariate-adjusted odds of disease over three levels of meat consumption were 2.1 (0.9-4.7) for adenoma, 1.7 (0.9-3.5) for cancer, and 1.9 (1.0-3.7) for all tumours. INTERPRETATION: Our findings indicate that acetylator status modulates the risk of colorectal neoplasia associated with meat intake.

Ab initio calculations on the isomerization of the 1,3-hexadien-5-yne radical cation to the benzene structure and to nonclassical ion structures.

Ab initio calculations at the MRCI//ROHF/6-31G** level show that the barrier for isomerization of the 1,3-hexadien-5-yne radical cation to nonclassical structures with a five-membered ring and an exocyclic CH bond is about 15 kcal mol(-1). The barrier for a subsequent isomerization to the benzene structure is calculated to be slightly higher.

The neurological presentation of sick sinus syndrome.

There is growing awareness of sick sinus syndrome (SSS) and related arrhythmias as treatable causes of epilepsy, syncope, dizziness, confusion and some psychoses, as well as non-neurological symptoms such as episodic congestive heart failure, pulmonary edema and palpitations. Six cases are presented which occurred in family practice in a period of 18 months; four required ventricular pacing, one declined and one is asymptomatic.