An evaluation of the posterior cruciate ligament function in total knee arthroplasty with regard to its morphology and clinical properties.

The aim of the study was to determine the degree of posterior cruciate ligament (PCL) degeneration and the reduction in the number of its mechanoreceptors, in patients with advanced degenerative joint disease. PCLs taken from study group of 50 patients in the mean age of 70.7 (53-84) years with a diagnosis of advanced idiopathic osteoarthritis undergoing condylar total knee arthroplasty were compared to those taken form the control group of 10 knee joints of cadavers. Groups were matched with regard to sex and age. Histological examination of PCLs of the study group showed changes of an inflammatory process and no significant signs of osteoarthritis in the control group. A close correlation was found between the severity of degenerative changes on the X-ray images according to the Ahlbäck scale, and the increased mucoid degeneration (p < 0.0001), the severity of the degeneration of the collagen structure (p < 0.0001) and the presence of proprioceptors of PCLs (p < 0.0001). Conserving the PCL by the use of type cruciate retaining knee arthroplasty does not guarantee the preservation of correct proprioceptive sensation.

Increased responsiveness to toll-like receptor 4 stimulation in peripheral blood mononuclear cells from patients with recent onset rheumatoid arthritis.

BACKGROUND: Cell signaling via Toll-like receptors (TLRs) leads to synovial inflammation in rheumatoid arthritis (RA). We aimed to assess effects of TLR2 and TLR4 stimulation on proinflammatory cytokine production by peripheral blood mononuclear cells (PBMCs) from patients with recent-onset RA, osteoarthrosis (OA), and healthy control (HC). METHODS: PBMCs were stimulated with LPS, biglycan and cytokine mix. Cytokines were analyzed in supernatants with ELISA. Expression of toll-like receptors mRNA in leukocytes was analyzed using real-time qPCR. RESULTS: PBMCs from RA patients spontaneously produced less IL-6 and TNFalpha than cells from OA and HC subjects. LPS increased cytokines' production in all groups. In RA patients increase was dramatic (30 to 48-fold and 17 to 31-fold, for respective cytokines) compared to moderate (2 to 8-fold) in other groups. LPS induced 15-HETE generation in PBMCs from RA (mean 251%) and OA patients (mean 43%), although only in OA group, the increase was significant. TLR2 and TLR4 gene expressions decreased in response to cytokine mix, while LPS enhanced TLR2 expression in HC and depressed TLR4 expression in OA patients. CONCLUSION: PBMCs from recent-onset RA patients are overresponsive to stimulation with bacterial lipopolysaccharide. TLR expression is differentially regulated in healthy and arthritic subjects.

Psychotherapy in the goldfish bowl: the role of the indigenous therapist.

The therapeutic advantages and liabilities that accrue to the indigenous therapist (be he professional or paraprofessional) because of the indigenous state were explored, utilizing the five-year experience of ten indigenous therapists in Boston's North End. The current and historical proximity of therapists who live in the same neighborhood as their patients do provides both with increased access to, longitudinal knowledge about, and a blurred role concept of the other that may help or hinder the therapeutic process. Similarities in culture and values can foster alliance formation, differentiation of psychopathology, and therapeutic interventions, but also may interfere when therapy abuts culturally shared blind spots. These data are relevant to the private general psychiatrist as an indigenous therapist in non-metropolitan America.

Evaluation of physeal behavior in response to epiphyseodesis with the use of serial magnetic resonance imaging.

The stages in the closure of the growth plate after percutaneous epiphyseodesis were studied in fourteen patients (eight girls and six boys) with coronal T1-weighted spin-echo images and coronal field-echo images of the knee. A total of thirty-three magnetic-resonance imaging studies of the knee were made the first week, the fourth month, the eighth month, or one year after the epiphyseodesis. A mature bridge of bone was seen at the operative sites approximately eight months after the operation. In the central undisturbed area between the operative sites, there was a progressive decrease in the width of the physeal cartilage that remained visible eight months after the operation. Growth recovery lines were not seen postoperatively in any patient, and the physis closed in all of the patients. The physis of the adjacent untreated bone served as a control bone and showed neither a change in width nor any growth recovery lines. Magnetic resonance-imaging studies provide excellent visualization of the anatomical changes that lead to closure of the physis after an epiphyseodesis, and we believe that these studies provide a method of assessment of the physis after an injury.

A bitewing radiographic study of a population of diabetic and nondiabetic rhesus monkeys.

A population of 7 diabetic and 13 nondiabetic rhesus monkeys (Macacca mulatta) were examined radiographically using bitewing imaging techniques. Each subject was scored radiographically for bone levels, periodontal ligament (PDL) widening, radiographic calculus, and carious lesions. Prior to examinations blood samples were obtained for fasting blood glucose levels. Results indicated that all clinical variables were generally greater for the diabetic group, with bone loss being the only statistically significant parameter. Calculus levels, however, were found to be greater radiographically in the nondiabetic group. In viewing the study population as a single group of 20 monkeys, decreased bone levels were found to be positively correlated with PDL widening and blood glucose levels suggesting an association of hyperglycemic states with possible decreased resistance to infection. It was concluded that carbohydrate intolerance with hyperglycemia in diabetes mellitus may be associated with the radiographic variable of increased bone resorption using an objective system of measurement for evaluation and scoring. Without a quantitative system of measurement such as devised in this study, other radiographic variables such as PDL widening, calculus deposits, and carious lesions may not be accurately tested against one another or correlated with other experimental clinical parameters.

The treatment of pseudarthrosis using the Ilizarov method.

This paper presents a method for treating pseudarthrosis in the lower limbs using the Illizarov method. 20 patients were treated, including 3 cases with infected false joints. Bone union was attained in cases with infected false joints. Bone union was attained in cases of pseudarthrosis without infection within an average time of 8 months. In cases of infected false joints the time required to achieve bone union was 12 months. On the basis of the authors' observations the method described here proved to be suitable for the treatment of disturbed bone union. The value of this method is further increased by the slow, steady correction of axial disorders in the limb accompanied by simultaneous equalization. Bone union was achieved in 94,2% of the cases studied.

The application of shock waves in the treatment of delayed bone union and pseudoarthrosis in long bones.

Lithotripsis using shock waves generated extracorporeally was administered to 46 patients with pseudarthrosis or delayed union of long bone fractures. From 1500 to 3000 high energy shock waves were administered one time only on an outpatient basis. Anesthesia was not required. No complications were observed. Complete recovery was obtained in all 25 patients with delayed union, and in 12 of the 21 patients with pseudoarthrosis (57%). The initiation of callus formation was observed 6-12 weeks after treatment. These results confirm that bone union can be stimulated by shock waves. The treatment procedure, advantages, contraindications and reasons for failures are discussed. This method appears to be a valuable supplement to the treatment of bone union disturbances.

Revision hip arthroplasty in aseptic loosening of total hip replacement.

Background. Problems encountered during revision hip arthroplasty are presented, based on 30 years of experience at the Orthopedic Clinic of the Medical University of Lodz.
Material and methods. During this period of time 96 cases (5,13%) with aseptic hip loosening were diagnosed. All patients were evaluated clinically based o the Merle d'Aubigne-Postel criteria, and radiologically by means of De Lee and Gruen migration zones.
Results. In our material hip loosening was most frequently observed in cases where a McKee-Farrar hip prosthesis had been used, and in cases with a PM uncemented acetabulum or uncemented Mittelmeier pin.
Conclusions. The study showed that surgical technique plays the most significant role in aseptic loosening of hip replacement. The aseptic loosening of hip prostheses should be diagnosed early, and revision hip arthroplasty should be performed as soon as possible. This surgery must be preformed in specialized centers with adequate equipment and a team of experienced surgeons.

Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.

BACKGROUND: The contemporary American diet figures centrally in the pathogenesis of numerous chronic diseases-'diseases of civilization'. We investigated in humans whether a diet similar to that consumed by our preagricultural hunter-gatherer ancestors (that is, a paleolithic type diet) confers health benefits. METHODS: We performed an outpatient, metabolically controlled study, in nine nonobese sedentary healthy volunteers, ensuring no weight loss by daily weight. We compared the findings when the participants consumed their usual diet with those when they consumed a paleolithic type diet. The participants consumed their usual diet for 3 days, three ramp-up diets of increasing potassium and fiber for 7 days, then a paleolithic type diet comprising lean meat, fruits, vegetables and nuts, and excluding nonpaleolithic type foods, such as cereal grains, dairy or legumes, for 10 days. Outcomes included arterial blood pressure (BP); 24-h urine sodium and potassium excretion; plasma glucose and insulin areas under the curve (AUC) during a 2 h oral glucose tolerance test (OGTT); insulin sensitivity; plasma lipid concentrations; and brachial artery reactivity in response to ischemia. RESULTS: Compared with the baseline (usual) diet, we observed (a) significant reductions in BP associated with improved arterial distensibility (-3.1+/-2.9, P=0.01 and +0.19+/-0.23, P=0.05);(b) significant reduction in plasma insulin vs time AUC, during the OGTT (P=0.006); and (c) large significant reductions in total cholesterol, low-density lipoproteins (LDL) and triglycerides (-0.8+/-0.6 (P=0.007), -0.7+/-0.5 (P=0.003) and -0.3+/-0.3 (P=0.01) mmol/l respectively). In all these measured variables, either eight or all nine participants had identical directional responses when switched to paleolithic type diet, that is, near consistently improved status of circulatory, carbohydrate and lipid metabolism/physiology. CONCLUSIONS: Even short-term consumption of a paleolithic type diet improves BP and glucose tolerance, decreases insulin secretion, increases insulin sensitivity and improves lipid profiles without weight loss in healthy sedentary humans.

Summary of the discussions held at a conference of the behavioral sciences and family planning programs.

PIP: A conference was called in the hope that by applying the knowledge science can give, family planners can improve the form and efficiency of their programs. A summary of the major points made by the participants is presented. Philip Huaser urger employing a full battery of social scientists to do basic research into the theory and methodology of surveys. Michael Young proposed shifting the focus from individual use of contraception to social policies designed to reduce birthrates. Le Bogart commented on the ignorance about the psychological relationship between sexuality and procreation. Brewster Smith suggested a psychological perspective from which to examine questions involved in family planning. Orville Brim, Jr., argued that sociological theorists must learn to work with technologists to develop contraceptive devices and other tools of family planning programs. Richard Bell reported on the physical and mental impairments in children from large families with short birth intervals. Reuben Hill focused on family studies which see man as an initiator in the social process, as opposed to the passive picture painted by demographers. A lively discussion on the use of mass communications in the spread of family planning was ushered in by Daniel Lerner. Dr. Freedman wondered if family planning communications should be designed primarily for education or persuasion, seeing greater numbers of recruits in the former. Cultural innovations from an anthropological point of view were discussed by George Foster, who suggested that people are so pragmatic that they will accept any innovation that meets a need in their lives. Everett Rogers reported on research in the diffusion of agricultural innovations. A discussion on barriers to effective organization was introduced by Nicholas Demarath.^ieng

[Alloplasty of the hip joint and the proximal part of the femoral shaft]. / Alloplastyka stawu biodrowego wraz z blizsza czescia trzonu kosci udowej.

The possibilities of the use of untypical prostheses of the hip in cases with lesion of the proximal femoral end together with a part of the shaft have been presented. A hip prosthesis with the upper part of the femur was implanted in two cases for neoplastic disease, and in one case for pseudoarthrosis of the femur within the intertrochanteric region. Good early clinical and radiological results was obtained and the total range of motion in the implanted joint was 210 degrees. After operation the patients did not complain about pain and they walked with the aid of a cane.

One-stage hip reconstruction with Dega's transiliacal osteotomy in the treatment of congenital hip dislocation in children.

Results of surgical treatment of the congenital dislocation of the hip in 40 children (2-5 years) are presented. The mean observation period was 8 years. 80% of very good and good results were obtained in the included material. One-stage hip reposition -reconstruction with Dega's transiliacal osteotomy, applied to children of 2-3 years, gives positive results, adding to further development of the hip joint.

Social and psychological feeling of patients after total hip replacement by Mittelmeier method--reference to clinical results.

Social and psychological status of 40 female patients was studied, 1-3 years after total hip replacement by Mittelmeier method. The evaluation included standard tests of high reliability degree for medical purpose, like life goals ranking by Pleszewski and the semantic differential method by Osgood, Suci and Tannenbaum. Also a questionnaire was applied to analyse the situation and the subjective feelings of the patients after the surgery. The performed studies assure the positive aspect of operation and help in creating further life perspectives. The obtained output of the analysis was referred to the clinical results of the performed hip operation. Regarding the very good and good clinical results, the psychological and social feelings of the patients were connected and identified with psychological and environmental factors rather than with the very clinical result of the operation.

[Remarks on classification of Perthes disease]. / Uwagi dotyczace klasyfikacji choroby Perthesa.

The most commonly used classifications of Perthes disease are presented., their pros and cons discussed. The newest classification of Perthes disease proposed by Herring et al in 1992 is included. The ease of interpretation of the a-p hip radiographs, high reproducibility of the method and strict correlation between lateral pillar height and the final result of treatment make Herring's classification very useful. Its wide utilization may allow for uniform treatment of Perthes disease.

[An analysis of selected risk factors of aseptic loosening of hip endoprosthesis]. / Analiza wybranych czynników ryzyka aseptycznego obluzowania calkowitej endoprotezy stawu biodrowego.

An analysis of selected risk factors of aseptic loosening of hip endoprosthesis has been attempted on the ground of retrospective evaluation of 57 hips in 54 patients (41 females, 13 males) who underwent revision of the hip replacement. Age of the patients at primary surgery ranged from 18 to 73 years (mean 55.6 years). Follow-up ranged from 8 to 212 months (mean 83 months). Originally, in 45 cases cemented hip replacement was done and in 12 cementless endoprosthesis was implanted. In 34 cases both components were replaced, in 14 cases acetabular component, in 9 cases stem only and in 1 case the endoprosthesis was removed. Clinical evaluation was done according to Merle-d'Aubignea criteria, radiologic assessment was done according to DeLee and Charnley classification and the one of Gruen. Within 10 years after primary surgery all cementless hips were revised (all Parhofer-Mönch type within 5 years). Among Weller cemented replacements both components were replaced in 18 cases, acetabulum in 8, the stem in 5 and 1 endoprosthesis was removed. McKee-Farrar implants were replaced completely in all but 2 cases. Most of revisions among cemented hip replacements took place 10 years after primary operation. Angular migration of the acetabular component was found in 40 cases; in 8 cases no migration was observed. Forty-three hips with loosened stem have been analyzed: to small size of the stem was found in 6 cases, varus deviation was found in 14 cases and valgus deviation in 6. Special attention has been paid to the technical errors that are essential for long-term result of hip replacement.

[Prospects of using ultrasonic examination in Perthes disease]. / Mozoliwosci wykorzystania badania ultrasonograficznego w chorobie Perthesa.

The paper indicates benefits from ultrasound early diagnostics and management monitoring in Perthes disease. Fifty-two children with 56 hips (35 boys and 17 girls) aged 6-12 years treated because of aseptic of the femoral head to Orthopaedic Department Lódz were included in this study. Five MHz transducer was positioned anteriorly along the anterior margin of the femoral neck in external rotation of the limb, neutral and internal one as well as in perpendicular fashion to the long axis of the neck. These four images were compared with conventional a-p and Lauenstein radiographs. Ultrasound allowed for assessment of the synovial effusion, shape of the epiphysis, configuration of the physis and the shape of metaphysis. High correlation between ultrasound examination and radiography was found. Ultrasonography allowed for assigning a hip to one of Catterall's type. It has also served well for monitoring of the treatment and reduced the number of radiological exposures.

[Analysis of complications during lower extremity lengthening]. / Analiza powiklan wystepujacych podczas wydluzen konczyn.

Lengthening is generally accepted method of treatment for extremity length discrepancy. This attractive method carries the risk of many complications that may ruin primary treatment plan. The aim of this paper was to analyze complications and their management in own material consisting of 60 extremities in 58 patients aged 8-37 years. Limb length discrepancy was caused by congenital bony hypoplasia in 44 cases, trauma in 8 and infection in 8 cases. Initial shortening ranged from 4 to 15 cm (mean 6.5 cm). Ilizarov technique was used in 20 cases, Wagner method in 6 cases and DeBastiani in 34 cases. Expected elongation has been achieved in 60% cases; in remaining 40% complications occurred. New bone formation disturbances and axial malalignement were among most severe ones. An autogenic marrow injections were used to stimulate callus formation, osteogenon was administered. Axial malalignement was corrected by osteotomy. Percentage of complications decreased as number of elongations performed increased.

[The sensitivity and specificity of sonographic examination in detection of rotator cuff tear]. / Czulosc i swoistosc badania ultrasonograficznego w diagnostyce uszkodzenia pierscienia rotatorów.

Sonographic examination was performed in 72 patients (74 shoulders) suffering from different shoulder diseases. The results were correlated with findings obtained during subsequent surgery in 57 patients (58 shoulders) and arthrography in 15 cases (16 shoulders). Rotator cuff tear was proved during surgical procedure in 37 patients (38 shoulders). The sensitivity and specificity of ultrasonography in detection of cuff tear was 98.2% and 90% respectively. In case of partial cuff tear ultrasonography had lower sensitivity--50% while specificity was 96.3%. In detection of supraspinatus tendon tear the ultrasound sensitivity was 100% and specificity 95.6%, in case of infraspinatus tear sensitivity was 66.7% and specificity 94% while for subscapularis tear these values were equal 75% and 98.1%. The size of sonographically estimated cuff defect correlated properly with intrasurgical measurement in 76.3% of all cases.

[Surgical treatment of congenital clubfoot with constriction band syndrome]. / Leczenie operacyjne wrodzonej stopy konsko-szpotawej ze wspólistniejacymi przewezeniami amniotycznymi goleni.

Twelve feet in 11 patients with constriction band syndrome age ranging from 3 to 18 months (mean age 11 months) were evaluated in this study. The constriction band was located at the in the calf, at distal, media and proximal third levels. All these patients were treated surgically by a wide peritalar release using the Cincinnati incision, followed by a two-stage Z-skin plasty. Both clinical and radiological results were evaluated. In our material an excellent result was achieved in 1 case, good results in 3 cases, satisfactory in 4 cases and poor in the remaining four cases. Very good and good results were achieved in feet with shallow bands type II and III, while poor results were found in feet with deep constriction band type I. Early surgical treatment followed by serial casting leads to better functional results.