Prognostic determinants in lupus nephritis: a long-term clinicopathologic study.

Over the past 50 years, survival has improved in patients with systemic lupus erythematosus and associated nephritis. Yet, there are few long-term outcome studies in patients with well-defined nephropathy. We examined the outcome of 439 patients with lupus nephritis who were seen at the Mayo Clinic between 1964 and 1986 in whom renal biopsies were assessed using the World Health Organization (WHO) classification. There were 341 women and 98 men (mean +/- s.d., age 33.5 +/- 14 years); 200 (46%) patients were hypertensive and 249 (57%) had impaired renal function at renal biopsy. All WHO morphologic classes were represented and 339 (77%) patients had class III, IV and V (the more severe forms of nephritis). Follow-up averaged 10.2 years per patient. At last contact, 286 (65%) patients were alive and 153 (35%) were dead. Overall patient survival was 80%, 69% and 53% at 5, 10 and 20 years after biopsy that was significantly worse than expected survival (P < 0.001). Ten-year cumulative patient survival improved comparing earlier to more recent time spans: 64% in 231 patients seen during 1964-75; 76% in 2089 patients studied during 1976-86 (P = 0.03). Survival free of renal failure was 83%, 74% and 64% at 5, 10 and 20 years, and survival was unfavorably influenced by progressive WHO class, hypertension, impaired renal function, nephrotic range proteinuria, hypoalbuminemia and anemia. Multivariate analysis found impaired renal function, increased urine protein, anemia and younger age to be independent predictors of renal failure. WHO class was not a significant predictor when adjusted for these four factors. Cardiovascular events accounted for 48% of the known deaths and were equally distributed across all WHO classes, followed by infections, renal failure, malignancy, respiratory failure and gastrointestinal bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)

Deep infection after total hip replacement.

Sixty-eight patients suffering deep infection from a consecutive series of 1746 total hip replacement operations are reviewed. The infection rate has been reduced considerably by improved technique and multiple antibiotic prophylaxis without the use of a special operation enclosure. Factors affecting deep infection are analysed and discussed.

The operative management of the difficult supracondylar fracture of the humerus in the child.

A series of supracondylar fractures of the humerus in children is presented. The majority was reduced by closed manipulation. The difficult fractures were defined as those in which adequate reduction either could not be achieved by manipulation or was not maintained, or those in which neurological or vascular complications occurred. Such cases were treated by open reduction and internal fixation. The results were assessed with regard to loss of elbow movement, deformity and symptoms. The results of the operative series were comparable with those achieved by closed manipulation in the easier cases. No secondary corrective procedures were necessary. It is concluded that closed manipulation should be used routinely as the method of treatment for supracondylar fractures of the humerus in children, except in the difficult case, for which operative treatment should be undertaken. Stiffness or deformity does not follow open reduction and internal fixation.

A comparison of the treatment of trochanteric fractures of the femur by internal fixation with a nail plate and the Ender technique.

In our experience, trochanteric fractures fixed with Ender nails achieved a degree of success similar to those treated by nail plating, but the risk of wound infection was much less with the former method. The results of 78 trochanteric fractures of the femur internally fixed with Ender nails have been analysed and compared with the results in 100 similar patients treated by nail plate fixation. The Ender method has advantages over existing operative methods, in that in our series the infection rate was zero and we found that the operation produced less shock. We consider that this method, although technically more difficult, can be used for most intertrochanteric fractures and merits further trial.