Hybrid hip arthroplasty in the younger patient. Quality of life.

In a hybrid hip arthroplasty, the acetabular component is uncemented. Without screw fixation, early stability depends on a press-fit. The demands placed on it by the younger patient may therefore be important. Eighty patients under the age of 70 before and after hybrid or Charnley hip arthroplasty were studied. Scores for disability and distress were used to generate quality-of-life (QOL) scores using the Rosser Index Matrix immediately before and at 1 year after surgery. All patients increased their QOL scores (P < .00006). Both groups had similar QOL scores before surgery (P = .596). At 1 year, patients with the hybrid prosthesis had slightly higher scores (P = .015). Changes in QOL scores were, however, very similar (P = .697). The use of a hybrid prosthesis does not impair early outcome.

Hemangioma of the esophagus.

Hemangioma of the esophagus is a rare tumor. Fewer than 100 cases have been found in the literature. The present case report describes a patient who experienced a sudden massive hematemesis and demonstrated unusual changes on the computed tomographic scan.

Quality-of-life improvement compared after hip and knee replacement.

Total hip and total knee arthroplasty both provide a considerable improvement in quality of life, but there is no evidence to suggest that one is more successful than the other. We studied 72 patients in a prospective trial before and after total hip or total knee replacement. We recorded scores for disability and distress derived from the Harris hip score and the British Orthopaedic Association knee assessment score, and used them to generate quality of life (QoL) scores using the Rosser Index Matrix immediately before and at one year after surgery. The patients awaiting knee replacement had significantly lower QoL scores than those awaiting hip replacement (p = 0.011). The QoL scores at one year were high and almost identical for both groups (p = 0.46). Further analysis showed that gender and weight were not significant predictors of improvement of QoL scores, but age (p = 0.03) and whether the hip or knee was replaced (p = 0.006) were significant factors.

Distal fibulectomy for Ewing's sarcoma.

We treated five children with non-metastatic Ewing's sarcoma of the distal fibula by distal fibulectomy. At a mean of eight years after surgery they all had nearly normal levels of painfree function. Distal fibulectomy is a good alternative to the more radical amputations recommended in the past.

Arthroscopic surgery of the hip: current status.

Arthroscopy of the hip is now recognised as a valuable diagnostic and therapeutic procedure [23]. It is still relatively new and remains largely in the hands of a few specialist centres, but orthopaedic surgeons are increasingly willing to provide it as part of their own service. This article outlines its background and details its clinical and technical application.

Intrapulmonary foreign body: sponge retained for 43 years.

We present a patient who had a left thoracotomy 43 years previously. Since that surgery he experienced intermittent hemoptysis, and a recent thoracotomy revealed an intrapulmonary foreign body (retained sponge) in the left lower lobe. The liability potential of this case is discussed.

Serum immunoglobulin changes in relation to tonsil and adenoid surgery.

In the course of clinical trials of tonsillectomy, adenoidectomy, and adenotonsillectomy, we measured serum levels of immunoglobulins G, A, and M by rate nephelometry in 268 subjects at baseline and at intervals after receipt or nonreceipt of surgery. Up to 30 months after baseline we observed a consistent pattern of change only in levels of immunoglobulin G, decreases in which tended to occur more commonly and be of greater magnitude in subjects who received tonsillectomy or adenotonsillectomy than in corresponding control subjects. However, in both surgical and control subjects the subsequent incidence of throat infection showed no relationship to either contemporaneous immunoglobulin levels or changes from baseline levels. A decline in serum immunoglobulins following tonsillectomy appears not to be a risk factor for developing throat infection, and may reflect a reduction in antigenic stimulation.

Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement. Results of parallel randomized and nonrandomized trials.

We studied the efficacy of adenoidectomy in 213 children who had received tympanostomy-tube placement because of persistent and/or recurrent otitis media and had again developed otitis media after tubal extrusion. Ninety-nine of the children were assigned randomly to either an adenoidectomy group or a control group; in a separate trial, 114 children whose parents withheld consent for randomization were assigned according to parental preference. In both trials, control group outcomes appeared to have been biased favorably by the withdrawal of certain severely affected subjects from control status to receive adenoidectomy. Nonetheless, in both trials, adenoidectomy group outcomes were more favorable than control group outcomes during the first 2 follow-up years. Statistically significant differences were found mainly in the randomized trial, where during the first and second years, respectively, adenoidectomy subjects had 47% and 37% less time with otitis media than control subjects and 28% and 35% fewer suppurative (acute) episodes than control subjects. We conclude that adenoidectomy is warranted on an individualized basis for children who develop recurrent otitis media after extrusion of tympanostomy tubes.

Incidence of cerebral infarction after radiotherapy for pituitary adenoma.

The incidence of cerebral infarction was studied in 156 patients irradiated for treatment of pituitary adenomas. Seven patients experienced strokes at intervals of 3.2 to 14.6 years after irradiation. The observed incidence was not significantly greater than the expected value of 3.5 strokes (P = 0.078). Six strokes occurred in patients receiving equivalent doses (ED) of 1070 ret or more (observed to expected ratio 3.87, significantly elevated; P less than 0.001). Univariate log-rank analysis showed that the risk of stroke was significantly higher (P = 0.010) in patients receiving an ED of 1070 ret or more (4180 cGy/22 fractions) than those receiving lower doses. Multivariate analysis, however, demonstrated that the increased risk of stroke was associated only with increasing age (P less than 0.0001), not ED (P = 0.148). Due to these inconsistent statistical results, no definitive conclusions could be reached about the relationship between radiation dose to the pituitary and subsequent cerebral infarction.

Function of parietal and frontal shunts in childhood hydrocephalus.

This study was performed to determine if cerebrospinal fluid (CSF) shunts inserted via the frontal and parietal regions function for similar lengths of time. The medical records of 114 children with CSF shunts were reviewed. In 83 of these cases computerized tomography scans were also available. Ninety percent of the operations were to insert the child's first shunt. The site of insertion, cause of hydrocephalus, patient's age, surgeon, duration of function (time from insertion to malfunction or to latest follow-up evaluation), presence of infection, catheter location within the ventricle, and duration of function of the subsequent shunt were recorded. Data were analyzed by the chi-square, logistic regression, and life-table methods. Shunts had been inserted via the frontal route in 62 children and via the parietal route in 52. The children's ages, causes of hydrocephalus, and infection rates were similar in both groups. Duration of shunt function was predicted by the site of shunt insertion and the catheter position within the ventricles: shunts inserted via the frontal region functioned significantly longer than parietally inserted shunts, both as the initial shunt (Wilcoxon, p = 0.0008) and after a malfunction, and catheters positioned within the ipsilateral frontal horn functioned significantly longer than those in other ventricular locations (Wilcoxon, p = 0.03).

Survival after stereotactic biopsy of malignant gliomas.

For many patients with malignant gliomas in inaccessible or functionally important locations, stereotactic biopsy followed by radiation therapy (RT) may be a more appropriate initial treatment than craniotomy and tumor resection. We studied the long term survival in 91 consecutive patients with malignant gliomas diagnosed by stereotactic biopsy: 64 had glioblastoma multiforme (GBM) and 27 had anaplastic astrocytoma (AA). Sixty-four per cent of the GBMs and 33% of the AAs involved deep or midline cerebral structures. The treatment prescribed after biopsy, the tumor location, the histological findings, and the patient's age at presentation (for AAs) were statistically important factors determining patient survival. If adequate RT (tumor dose of 5000 to 6000 cGy) was not prescribed, the median survival was less than or equal to 11 weeks regardless of tumor histology or location. The median survival for patients with deep or midline tumors who completed RT was similar in AA (19.4 weeks) and GBM (27 weeks) cases. Histology was an important predictor of survival only for patients with adequately treated lobar tumors. The median survival in lobar GBM patients who completed RT was 46.9 weeks, and that in lobar AA patients who completed RT was 129 weeks. Cytoreductive surgery had no statistically significant effect on survival. Among the clinical factors examined, age of less than 40 years at presentation was associated with prolonged survival only in AA patients. Constellations of clinical features, tumor location, histological diagnosis, and treatment prescribed were related to survival time.(ABSTRACT TRUNCATED AT 250 WORDS)