Survival and reasons for revision of the uncemented Symax hip stem: A Dutch Arthroplasty Register study.

AIMS: Previous studies have already shown early proximal ingrowth, fast osseous integration, and a stable fit of the uncemented Symax hip stem, with excellent clinical and radiographic performance. Aims were to evaluate cumulative revision rates and reasons for revision of the Symax hip stem using Dutch Arthroplasty Register (LROI) data and to assess possible associations between patient characteristics and revision rate of the Symax hip stem. PATIENTS AND METHODS: All total hip arthroplasties with the uncemented Symax hip stem registered in the LROI between 2007 and 2017 were included (n = 5,013). Kaplan-Meier survival analysis was performed to assess the cumulative 1, 5 and 7-year revision percentages. Cox proportional hazard regression analysis was performed to assess the association between patient and procedural characteristics, and revision arthroplasty of the stem. RESULTS: Cumulative 1, 5, and 7-year revision rates (with 95% confidence interval (CI)) for revision of any component were 1.5% (CI 1.2%-1.8%), 3.2% (CI 2.7%-3.7%), and 3.8% (CI 3.1%-4.4%) respectively. Cumulative 1, 5, and 7-year stem revision rates of the Symax hip stem were 0.9% (CI 0.6%-1.1%), 1.5% (CI 1.1%-1.9%), and 1.7% (CI 1.3%-2.1%) respectively. Periprosthetic fractures (n = 35) and loosening of the stem (n = 30) were the most common reasons for revision of the stem. Revision of the stem was associated with acute fracture as primary diagnosis (Hazard Ratio (HR) 2.4 (CI 1.3-4.3)), or history of a previous surgery to the affected hip (HR 2.7 (CI 1.4-5.2)). CONCLUSION: This population-based registry study shows revision rates for the Symax hip stem comparable to those for best performing uncemented total hip arthroplasties in the Netherlands. Primary diagnosis of an acute fracture, and history of previous surgery on the affected hip, were significantly associated risk factors for revision of the Symax hip stem, and we discourage the use of the Symax hip stem in these patients.

Early stabilization of the uncemented Symax hip stem in a 2-year RSA study.

Background and purpose - The uncemented Symax hip stem has shown early proximal ingrowth as result of the BONIT-hydroxyapatite (HA) coating and the distal DOTIZE surface treatment. We evaluated 2-year postoperative radiostereometric analysis (RSA) migration of the Symax hip stem in THA patients. We also investigated the correlation between migration at 4 weeks and clinical outcomes after 2 years.Patients and methods - Patients in a 2-year clinical follow-up single-centre RSA randomized controlled trial were randomized to 2 different cup designs. All 45 patients received a Symax hip stem. RSA migration patterns of the Symax hip stem is presented here as a single cohort. RSA examinations were performed postoperatively, but before weight-bearing, and subsequently after 1, 3, 6, 12, and 24 months. Clinical outcomes and radiographic evaluations were assessed 3, 6, 12, and 24 months postoperatively.Results - During the first 4 weeks, the Symax hip stem subsided, rotated into retroversion, and translated posteriorly, after which the migration ceased and the prosthesis stabilized. All clinical outcomes improved from preoperatively to 2 years. There was no clinically or statistically significant correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years.Interpretation - RSA evaluation of the uncemented Symax hip stem confirms that the design principles and coating properties lead to early stabilization of the stem, as early as 4 weeks postoperatively. There was no correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years. Based on the predictive potential of the RSA technique, we anticipate excellent long-term survival of this hip stem.

How integrated are services for patients with chronic obstructive pulmonary disease? Perceptions of patients and health care providers.

Chronic obstructive pulmonary disease (COPD) is a common cause of hospital readmissions worldwide. Outcomes for COPD patients improve if care is more integrated. COPD patients and their health care providers at a district hospital and community health service were interviewed about their perceptions of integration of care. Patients were confused about provider roles, had little understanding of their disease, had difficulty accessing services and did not have COPD action plans. Health care providers espoused integration of COPD care. Care was reasonably well integrated in the hospital. Integration of care was compromised in the community because COPD patients went to the emergency department when symptoms became unmanageable, while only attending their GPs for routine booked appointments. Integration could be improved if health care providers spent more time with patients, promoting understanding of the disease, supporting self-management and liaising with other providers. Patients would benefit from an action plan and additional support. Potentially preventable COPD admissions will continue without action to improve integration of community services and patients' understanding of their condition.

Ovine genital actinobacillosis: a review.

Actinobacillus seminis infection in rams constitutes a spectrum of pathological changes in various genital organs, with a predilection for the cauda epididymis. There is a need to understand the disease, as it represents a significant factor contributing to infertility and sterility. Here, we aim to provide a comprehensive overview of the biological characteristics of A. seminis, modes of transmission, epidemiology and pathogenesis, clinical signs and pathological changes of the disease, the laboratory techniques that have been used in diagnosis, differential diagnosis, treatment and prevention, and the considerations that need to be taken into account for future research.

Early sequential findings in the genitalia of rams experimentally infected with Actinobacillus seminis.

AIM: To investigate and assess the sequential pathological changes in the epididymis and testis of young rams injected intra-epididymally with Actinobacillus seminis. METHODS: Twenty yearling Suffolk and Suffolk-cross rams were randomly divided into two groups comprising 16 test and four control animals. Each test ram received 2.3 x 109 cfu/ml of A. seminis injected intra-epididymally. Every 24 h post-inoculation (p.i.), two test rams were randomly selected, euthanised, and necropsied, until the end of the experiment at 192 h p.i. One control animal was euthanised at 24 h, 48 h, 96 h and 144 h p.i., respectively. The reproductive tract of each ram was carefully examined, lesions photographed, and tissues cultured. Thin sections of tissue samples were fixed and examined by light microscopy; additionally, epididymal tissues were examined by scanning electron microscopy (ScEM). RESULTS: Gross lesions were observed in the cauda epididymis of all test rams, and ranged from swelling at 24 h p.i. through enlargement and granuloma formation from 72 h p.i., to gradual enlargement and increasing firmness by 192 h p.i. Gross testicular atrophy was observed in three rams. Histologically, spermatic granulomas were evident in the epididymis and the tunica vaginalis of 10 and four rams, respectively. Cauda epididymitis was present in all rams, and caput and corpus epididymitis in eight and four rams, respectively. Interstitial orchitis was observed in seven, testicular degeneration in 14, and localised and diffuse tunica vaginalitis in 12 rams. Epididymal vasculitis and infiltration of eosinophils were observed as early as 24 h p.i. Moderate disruption of the epididymal duct from 72 h p.i., with subsequent release of spermatozoa into the interstitium, was revealed by ScEM. Actinobacillus seminis was cultured from the granuloma of six test rams from 72 h p.i. CONCLUSIONS: Actinobacillus seminis has the ability to persist in the genitalia of young rams following experimental infection. Suppurative epididymitis is observed as early as 24 h p.i., and spermatic granuloma within 72 h p.i. Infiltration of eosinophils appears to be an early host response to the bacterium, and may play a role in the pathogenesis of the epididymitis.

Epididymal and testicular lesions in rams following experimental infection with Actinobacillus seminis.

AIM: To investigate and assess the epididymal and testicular lesions in rams up to 44 days after inoculation with Actinobacillus seminis via various routes. METHODS: Forty-four young (18-24 months old) rams were randomly divided into nine test and two control groups (n=4 per group). The test rams were infected by installation, drenching or injection of A. seminis organisms cultured for 24 h in a brain-heart infusion (BHI) broth containing 2.3 x 10(9) cells/ml, via the following nine routes: intra-epididymal (1 ml), intravenous (3 ml), intra-urethral (3 ml), intra-preputial (3 ml), vas deferens (1 ml), intramuscular (3 ml), oral (10 ml), intranasal (3 ml), and intra-conjunctival (3 drops). All test rams were necropsied 9-44 days post-inoculation (p.i.). Control rams were subdivided into in-contact and non-contact groups and necropsied at 45 and 46 days p.i., respectively. Thin tissue sections were examined for histopathology. RESULTS: Gross lesions were evident only in rams inoculated intra-epididymally. Epididymides on the inoculated side were two to three times larger than those on the un-inoculated side, and the testes attached to the inoculated epididymides were also enlarged. Fibrinopurulent periorchitis and tunica vaginalitis were seen in three rams and atrophy in one. Microscopically, epididymitis was present in 17 (47%) rams, the highest incidence being in the cauda, followed by the caput and the corpus epididymis. Seminiferous tubular degeneration with areas of lymphocytic infiltration were seen in four rams: three inoculated via the cauda epididymis and one via the urethra. No epididymal and/or testicular lesions were seen in rams inoculated via the nasal and conjunctival routes. CONCLUSIONS: Injection of A. seminis in young rams by all routes except intra-conjunctival and intranasal resulted in epididymitis, predominantly in the cauda epididymis. Development of lesions in the reproductive tract following non-genital routes of inoculation supports earlier suggestions that non-venereal transmission of genital actinobacillosis occurs. This study confirmed the predilection of A. seminis for the epididymis, especially the cauda.

Experimental transmission of Actinobacillus seminis infection to rams.

Nine groups of four 18- to 24-month-old rams were inoculated with Actinobacillus seminis by the following routes: intraconjunctival, intranasal, oral, intravenous, intramuscular, intraepididymal, vas deferens, intraurethral or intrapreputial. Eight similar rams were left uninoculated as controls. Systemic clinical signs were minimal and were confined primarily to the inoculation sites and the scrotal contents. Mild to severe epididymitis resulted from all the routes of inoculation except intraconjunctival and intranasal. Direct inoculation into the genital tract, especially into the cauda epididymis, was more effective. Intrapreputial and intraurethral inoculation led to ascending urethral infection, and inoculation into the vas deferens resulted primarily in descending infection of the accessory sex glands. A seminis was isolated from 11 of the 36 test rams (30.6 per cent); 26 of the 36 rams, some from each of the test groups except those inoculated intravenously, reacted serologically.

Increase in daytime symptoms is a sensitive and specific criterion for predicting corticosteroid-treated exacerbations in a clinical asthma trial.

BACKGROUND: To determine which diary card variables are the most predictive for administration of additional courses of corticosteroids using the TRUST (The Regular Use of Salbutamol Trial) data set. METHODS: Logistic regression models were used to identify the extent to which a change in diary card variable affected the odds ratio (OR) for administering a course of oral or increased inhaled corticosteroids. The complete TRUST diary card data were used with over 200,000 days of diary card observations from 983 mild to moderate asthmatic subjects. RESULTS: An increase in daytime symptoms of 1-5 U over baseline was associated with an increase in the OR for starting all types of corticosteroids from two- to 60-fold. CONCLUSIONS: These results indicate that an increase in daytime symptoms of two or more over baseline strongly predicts the administration of additional corticosteroids. The results have significant implications for both clinical practice and design of clinical trials in asthma.

The dissemination of the British Guideline on the Management of Asthma 2003.

The BTS/SIGN British Guideline on the Management of Asthma was published in February 2003 (4). If health outcomes are to be influenced successfully, dissemination of the guideline and implementation of recommendations is essential. We report the dissemination activities undertaken during the 18 weeks following the guideline launch. To facilitate implementation a range of educational materials were produced reflecting the key messages from the guideline. In addition to postal mailing of the guideline to appropriate healthcare professionals, both educational materials and the guidelines were made freely available from the BTS and SIGN websites. In total, 135,710 copies of the guideline and 90,198 copies of the Quick Reference Guide were downloaded in the first 18 weeks, representing a considerable increase over the number of copies of the 1997 guidelines disseminated by mailing alone. Large quantities of educational materials were downloaded with many used for teaching purposes. An on-line survey suggested that most respondents rated the materials as useful or very useful. Using websites to disseminate guidelines is a cost-effective method of informing health professionals of their content and is a more active process than the passive receipt of mailed copies. The availability of interactive educational materials for use in teaching appears to have been popular.

Regular inhaled salbutamol and asthma control: the TRUST randomised trial. Therapy Working Group of the National Asthma Task Force and the MRC General Practice Research Framework.

BACKGROUND: Previous work has suggested that the long-term regular use of inhaled beta2-agonist bronchodilators might lead to a deterioration in asthma control. The aim of TRUST (The Regular Use of Salbutamol Trial) was to study the effects of regular use of inhaled salbutamol, the most widely prescribed bronchodilator in the UK, on the control of asthma. METHODS: A randomised, double-blind, placebo-controlled trial was undertaken in 983 patients with asthma being treated at least twice a week with short-acting beta2-agonist, alone or in combination with inhaled steroids (2 mg or less) daily. Patients were aged 18 years and over and were recruited from 115 general practices in the UK. 90% (881) of the patients used inhaled corticosteroid therapy, and all patients continued to use their usual inhaled beta2-agonist for symptomatic relief. Patients were randomised to receive 400 microg salbutamol or matched placebo via a Diskhaler four times per day for 12 months. The primary outcome measure was rate of exacerbations of asthma, with criteria based on data from diary cards completed daily by each patient, treatment with additional corticosteroids, or both. FINDINGS: There were no differences in the annual rate, timing, or duration of exacerbations between the two groups. The mean morning peak expiratory flow was similar for the two groups. The mean evening peak expiratory flow (p<0.001) and the diurnal variation (p<0.001) were greater, and the use of rescue bronchodilator was less (p<0.001), in the group receiving regular salbutamol. INTERPRETATION: There was no evidence that regular use of inhaled salbutamol 400 microg four times daily for a year increased the exacerbation rate of asthma in the population studied.

Congenital duplication.

Almost all types of congenital duplication described in humans have been observed in food animals, and a number are illustrated in this article. Congenital duplications, especially conjoined symmetric twins, are relatively common defects in cattle. The incidence is less in sheep and in hogs, and they appear to be rare in goats. In cattle, cranial duplication is predominant; this is in contrast to caudal duplication in sheep and hogs. These differences among species are interesting and may explain why congenital duplications appear more frequently in cattle than in other domestic animals. Based on the number of eyes and ears, classification criteria for cranial duplications are proposed. The cause of congenital duplications is not known.

Congenital defects of sheep.

With increasing incrimination of viruses, plants, and drugs as causes of ovine congenital defects, concerted efforts are required to identify environmental teratogens. Expanding knowledge of congenital defects requires studying as many defective lambs as possible; recording and documenting; detailed diagnostic examinations; genetic analyses and chromosomal examinations, whenever possible; and field investigations. Adopting standardized classification, terminology, and diagnostic procedures should improve descriptions, diagnoses, and interdisciplinary exchange of information. That, in turn, should improve our knowledge of and diagnosis of congenital defects of sheep in the future. Finally, veterinary clinicians and diagnosticians are encouraged to take an interest in congenital defects and teratology.

Congenital defects of the bovine musculoskeletal system and joints.

A variety of structural and functional congenital defects affecting the central nervous system of cattle have been identified. This article discusses specific defects of the central nervous system. Spastic and paralytic, metabolic, and storage diseases are reviewed.

Congenital defects of the bovine central nervous system.

What should you do if you observe a defective calf in a herd? Our suggestion is to seek qualified help to examine and diagnose the condition. Parentage should be verified by blood typing. But, most important, you can keep cattle genetically clean by having your clients report all defects in calves to their breed association and artificial insemination centers.

Brachygnathia superior and degenerative joint disease: a new lethal syndrome in Angus calves.

Brachygnathia superior and generalized diarthrodial degenerative joint disease were seen in 17 related, purebred Angus calves ranging in age from 2 days to 4 months. Craniometrical studies revealed decreased maxillary and palatine bone lengths and increased cranial, skull, and facial indices. Radiological evaluation of major appendicular joints demonstrated lipping of the joint margins with osteophyte formation, sclerosis of subchondral bone, and narrowing of joint spaces. Synovial fluid evaluation indicated joint degeneration but no etiologic agent. Rheumatoid factor analysis of plasma was negative. Grossly, all major appendicular joints were defective including the atlanto-occipital articulation. Lesions ranged from loss of surface luster to erosions and deep ulcers with eburnation of the subchondral bone and secondary proliferative synovitis. Histological changes were degeneration of the articular cartilage matrix, chondrocyte necrosis, flaking and fibrillation, chondrone formation, erosions and ulcers of the articular cartilage with subchondral bone sclerosis, vascular invasion with fibrosis, and chronic, nonsuppurative, proliferative synovitis. Growth plates had defective chondrocyte proliferation and hypertrophy with aberrant ossification of calcified cartilaginous matrix. Histochemical analysis of cartilage and bone failed to incriminate which component was defective, glycosaminoglycan or collagen, but indicated different distribution or absence of one or the other. Genealogic studies revealed a genetic basis for the new defect.

Congenital defects of the bovine central nervous system.

Congenital brain defects in cattle are usually obvious at birth, but detection may depend on the nature and extent of the defect. The cause may be genetic or environmental, or the cause may be unknown. Many central nervous system defects are inherited as a simple autosomal recessive trait and may have a significant economic impact on purebred and commercial cattle operations. A common structural defect of genetic nature is internal hydrocephalus. A functional defect of simple autosomal recessive inheritance is bovine progressive degenerative myeloencephalopathy. The most significant teratogenic agents causing central nervous system defects are prenatal viral infections such as bovine virus diarrhea and bluetongue viruses. Many other defects of the central nervous system are reviewed.

Effect of lasalocid, monensin and thiopeptin on rumen protozoa.

The effects of lasalocid, monensin and thiopeptin on the total number and the generic composition of rumen protozoa were determined in vivo and in vitro. Feeding lasalocid or monensin to cattle on either high grain or high roughage diets reduced total protozoal counts. Addition of lasalocid or monensin (6 to 48 micrograms ml-1) to the in vitro rumen fermentation resulted in marked reduction in protozoal numbers. The inhibition was dose dependent. Thiopeptin had no effect on rumen protozoa either in vivo or in vitro. Among the protozoal types, holotrichs (Dasytricha, Isotricha and Charonina) were unaffected by either lasalocid or monensin. Among the entodiniomorphs, Entodinium, Diplodinium and Ophryoscolex were more sensitive than the other types. Ophryoscolex purkynei was more sensitive to monensin than to lasalocid. Protozoal inhibition by lasalocid and monensin was transient because prolonged antibiotic feeding resulted in the selection of a resistant population in the rumen of cattle.

Congenital cardiac defects in calves.

In a 14-year study of calves with cardiac defects, 36 had 78 congenital cardiac defects: ectopia cordia cervicalis (n = 10 defects), common aortic trunk (n = 3 defects), dextraposed aorta (n = 8 defects), duplicated major trunks (n = 1 defect), hypoplastic aorta (n = 2 defects), interventricular septal defect (n = 11), interatrial septal defect (n = 2), left ventricular hypoplasia (n = 10), patent ductus arteriosus (n = 5), patent foramen ovale (n = 5), right ventricular hypoplasia (n = 10), cor triloculare biatriatum (n = 1), endocardial fibroelastosis with calcification (n = 3), and valvular hematomas (n = 7). All septal defects were high in location and ranged from 5 to 35 mm in diameter. One calf with a septal defect also had bilateral microphthalmia.

Pathology of acute experimental Actinobacillus seminis mastitis in ewes.

Sequential pathological changes were studied for 9 days after inoculating Actinobacillus seminis in the mammary gland of sheep. The inoculated mammary glands became enlarged (2 to 4 times normal), turgid or consolidated and contained creamy or greenish-yellow viscid contents. A seminis was isolated from all inoculated udders at necropsy. Microscopically, the reaction in the udder to A. seminis may be divided into 4 overlapping phases; acute purulent, subacute purulent, necrotising, and proliferative. It was concluded that A. seminis was pathogenic for the ovine mammary gland, the clinical and pathological findings were nonspecific, and that A. seminis could survive within ovine mammary tissue for at least 9 days after inoculation.