The Furlong hydroxyapatite-coated total hip replacement in patients under age 51. A 6-year follow-up study.

Forty-five Furlong hydroxyapatite-coated total hip replacements were reviewed at an average of 71 months (46-89) after surgery. Patient's average age at surgery was 46 years (31-50). The average Harris hip score at the time of final review was 89, and 38 hips (84%) had no pain (28) or only slight pain (10). Three hips were revised, none for aseptic loosening. Two cups were loose. The remainder of the cups and all the stems were radiographically stable with positive evidence of bone ingrowth and no signs of impending failure. One cup showed definite wear of the polyethylene liner. Focal progressive osteolytic lesions occurred in the calcar region in 3 stable hips (7%). To date the Furlong hydroxyapatite-coated implant has produced encouraging results in this group of young patients, although longer follow-up is needed to determine its durability.

The Furlong hydroxyapatite-coated femoral prosthesis. A 4- to 7-year follow-up study.

We report the clinical and radiograph outcome of 77 Furlong hydroxyapatite fully coated femoral prosthesis in 71 patients undergoing primary total hip replacement, with mean follow-up of 65 months (range 48-82 months). The patients' average age at surgery was 55 years. The clinical results, as determined by Harris hip score, were excellent or good for 84% of the hips. Thigh pain which was not disturbing was present in 9% of the hips. No femoral component had been revised for aseptic loosening, and none were considered loose radiographically at the time of final follow-up evaluation. Serial radiographs revealed an excellent quality of bone around the prostheses, with positive evidence of bone ingrowth and no signs of impending failure.

Bladder capacity in infants.

Bladder capacity was measured at micturating cystourethrography and normal ranges were established for children up to 1 year of age. Bladder capacity was compared with patient weight and distance from first lumbar to third lumbar vertebrae (L1 to L3). The simplified formula--Capacity (mL) = 7 x weight (kg)--was shown to give a reliable estimate of the expected bladder capacity in infants independent of age; this is useful in those infants whose weight lies outside the normal range for their age. Similarly, a formula was deduced relating expected bladder capacity to the measured L1 to L3 distance on an anteroposterior radiograph, which is of potential use to radiologists.

Urinary tract dilatation in constipated children.

Abnormalities of the upper urinary tract were sought retrospectively in 180 children with constipation who had been investigated surgically over a 5-year period. Of those in whom an intravenous urogram had been performed, the incidence of dilatation of the upper renal tract was high, but only 12% of the patients with non-organic constipation had been so investigated.

Oesophageal stenosis distal to oesophageal atresia.

Oesophageal atresia with or without tracheo-oesophageal fistula is often associated with a functionally abnormal distal oesophagus. The association of oesophageal atresia and a distal oesophageal stenosis is less well recognized and is usually regarded as a rarity. We describe four cases of oesophageal stenosis distal to oesophageal atresia and review the literature relating to this condition.

The changing pattern of chronic lung disease of prematurity.

Thirty four infants with chronic lung disease of prematurity were reviewed and divided into two groups on the appearance of the chest radiograph. Type 1 disease (n = 19) was defined as homogeneous or patchy ill defined opacification in the lungs without coarse reticulation, and type 2 disease (n = 11) had the classical appearance of bronchopulmonary dysplasia. Four patients could not be classified. We conclude that type 1 disease represents typical chronic lung disease of premature infants, and type 2 is usually complicated by pulmonary interstitial emphysema. As no infant with type 1 disease died, its histopathological basis is unknown.

Quality of urograms in infants: a comparison of sodium diatrizoate, metrizamide and iohexol.

A consecutive series of 314 intravenous urograms performed in infants were reviewed and assessed for quality. The first 106 examinations were performed using sodium diatrizoate (Hypaque 270) as the contrast medium, the next 98 patients received metrizamide (Amipaque 280) and the final 110 received iohexol (Omnipaque 300). Thirty-five patients had to be excluded from the study for a variety of reasons, after which there were totals of 98 in the diatrizoate, 90 in the metrizamide and 91 in the iohexol groups. Assessing quality in terms of nephrographic and pyelographic density, sodium diatrizoate was found to be better than the non-ionic agents. Although the differences reached statistical significance they are small and unlikely to affect the information obtained in clinical practice. There was no difference in overall quality between metrizamide and iohexol. Comparing the degree of pyelographic distension and ureteric visualization using the three agents, no difference was found between the groups.

The management of intussusception.

A scheme of management to achieve maximum success in hydrostatic reduction of intussusception is presented. This takes into account patient selection, radiological technique and the follow-up clinical assessment. By standardizing the management we have increased our success rate and avoided laparotomy in 64% of our patients. Most of the patients in whom the technique failed had infarcted bowel which required resection.

Congenital diaphragmatic hernia: the prognostic significance of the site of the stomach.

Congenital diaphragmatic hernia is associated with a significant mortality, despite intensive treatment. The degree of pulmonary vascular hypoplasia is the main factor affecting mortality. Various features have been considered to determine the prognosis in these infants. In this study a series of 50 consecutive cases of left-sided diaphragmatic hernia has been reviewed. The site of the stomach (abdominal or intrathoracic), demonstrated radiologically and confirmed at operation, has been related to the final outcome (survival or death). An abdominal site is associated with an excellent prognosis (6.2% mortality), while an intrathoracic site is associated with a 58.8% mortality.

Small bowel biopsy.

We describe our technique of small bowel biopsy, which has been used on 190 occasions over a four year period. In 77%, the examination was completed within 10 minutes, and fluoroscopy times were less than 10 seconds in 75% of the cases. The technique is easily taught, and it has made the examination a minor procedure.

Cardiac surgery in Wessex.

The results of 3000 consecutive operations using cardio-pulmonary bypass show that the overall early mortality was 6.1%, dropping from 8.9% in the first 1000 to 4.4% in the third 1000. Operations for valve disease have been the most common, the early mortality for aortic valve replacement being 3.1% and for mitral valve replacement 2.9%. Combined aortic and mitral valve replacement had an early mortality of 4.4%. The number of patients undergoing isolated coronary artery bypass grafting has increased from 59 in the first 1000 to 292 in the third 1000 operations, with an overall early mortality of 1.3%. Six hundred and ninety seven patients underwent surgery for congenital heart disease with an overall early mortality of 10.9% (7.5% in the last 2000 cases). The patients have been followed up from one to 8.5 years. A high proportion have returned to work and enjoy a normal life. At the time of review, 87% of the 3000 patients were alive. Long waiting times for outpatient and inpatient care indicate underprovision of facilities relative to regional demand.

Technetium 99Tcm pyrophosphate scanning in the assessment of the painful hip prosthesis.

Technetium 99Tcm pyrophosphate bone scans were done on 35 patients who complained of persistent hip following total hip replacement. The scans of six patients were normal and the symptoms of these patients either resolved (three) or greatly improved (three) without further treatment. Twenty-nine patients had abnormal scans. Seventeen of these were due to infection or loosening of the prosthesis. Paget's disease of bone, protrusion of the prosthesis and heterotopic ossification also caused scan abnormalities. These causes could not be distinguished from one another on the scan. A radiograph of the hip is essential for interpreting the scan correctly. Scanning of the painful hip prosthesis helps to detect patients in whom serious complications are present or are likely to develop.

The interrelationship between vesico-ureteric reflux, trigonal abnormalities and a bifid pelvicalyceal collecting system: a family study.

3 investigations have been undertaken to study the interrelationship between a bifid pelvicalyceal collecting system, vesico-ureteric reflux and lateral ectopia of the ureteric orifice. Firstly, in 30 families investigated to confirm the familial incidence of bifid and double ureters there were 3 families in which siblings were found with primary reflux. Secondly, reflux was found in 62 of 110 patients investigated with a duplex pelvicalyceal system. Reflux was to the ipsilateral kidney in 48 patients but occurred to the contralateral kidney, unaffected by duplicity, in 14. This high incidence of reflux is related to lateral ectopia of the ureteric orifice which may be either bilateral or unilateral. Thirdly, the incidence of a bifid pelvicalyceal system was determined in the parents and siblings of a series of 32 patients with primary reflux. The results support the hypothesis that primary reflux may be inherited by an autosomal dominant gene of variable penetrance in a manner similar to the inheritance of a duplex urinary tract. Thus there is a direct genetic relationship between primary vesico-ureteric reflux, lateral ectopia of the ureteric orifices and a duplex pelvicalyceal system.

Bird-fancier's lung and jejunal villous atrophy.

Sixteen patients with bird-fancier's lung were screened for evidence of coeliac disease by assessing their clinical features, red-bloodcell or serum folate levels, and serum for reticulin antibodies. Five of nine patients selected for jejunal biopsy showed villous atrophy, and in some this seemed to be a true gluten-sensitive enteropathy.