Reconstruction of the anterior cruciate ligament in patients over 50 years.

The records of patients aged 50 years or over who underwent primary reconstruction of the anterior cruciate ligament between 1990 and 2002 were reviewed. There were 35 knees in 34 patients that met the inclusion criteria. The mean age of the patients was 57 years (50 to 66) and the mean clinical follow-up was for 72 months (25 to 173). A total of 23 knees were reconstructed with patellar tendon allograft, and 12 with patellar tendon autograft. The mean pre-operative knee extension was 1 degrees (-5 degrees to 10 degrees) and flexion was 129 degrees (125 degrees to 150 degrees) and at follow-up these values were 0 degrees (-5 degrees to 5 degrees) and 135 degrees (120 degrees to 150 degrees), respectively. Pre-operatively there were 31 knees (89%) with a Lachman grade 2+ or 3+. Post-operatively, 33 knees (94%) were Lachman grade 0 or 1+. The mean pre- and post-operative International Knee Documentation Committee scores were 39 (23 to 72) and 90 (33 to 100) respectively. The mean pre- and post-operative Lysholm scores were 50 (18 to 68) and 92 (28 to 100) respectively and the mean University of California Los Angeles activity scores were 8.5 before injury (4 to 10), 4.3 (3 to 6) after injury and 8.3 (4 to 10) post-operatively. There were three graft failures (8.6%) requiring revision. We conclude that reconstruction of the anterior cruciate ligament in carefully-selected patients aged 50 years or over can achieve similar results to those in younger patients, with no increased risk of complications.

Intraoral salivary duct carcinoma: case report with immunohistochemical observations.

Salivary duct carcinoma is an uncommon malignant salivary gland tumor that occurs predominantly in the parotid gland. Oral involvement is extremely rare, with few cases having been reported in the literature. The tumor is characterized by an aggressive behavior and has a poor prognosis. We describe a case of salivary duct carcinoma arising in the hard palate of a 63-year-old man. Immunohistochemical analysis revealed that tumor cells tested positive for cytokeratin, epithelial membrane antigen, proliferating cell nuclear antigen, Ki67, p53, laminin, and collagen IV. Despite radical surgical resection, bilateral neck dissection, and postoperative radiotherapy, liver metastases developed, and the patient subsequently died of his disease.

Long-term survivorship of cemented all-polyethylene acetabular components in patients > 75 years of age.

Between 1974 and 1982, 132 consecutive hips in 112 patients >75 years of age were treated with primary total hip arthroplasty for osteoarthritis using a cemented all-polyethylene T28 socket and cemented T28 or TR28 stem with a 28-mm head size. At the time of review, 94 patients (110 hips [83%]) had died and 18 patients (22 hips [17%]) were still living (mean age at follow-up, 93 years). Five hips (5 patients) were lost to follow-up. Clinical follow-up averaged 8.9 years for the entire group and 14.6 years for patients still living. Only 2 acetabular components have been revised (1 for recurrent dislocation, 1 for infection). No acetabular component has required revision for aseptic loosening. Survivorship free of acetabular revision for aseptic loosening at 10 years was 100%; free of symptomatic acetabular loosening, 97.4% (95% confidence interval, 91.8-100%); and free of acetabular loosening, 95.9% (95% confidence interval, 89.7-100%). The commonest complication was postoperative hip dislocation, which occurred in 11 hips (8.7%) and which required reoperation in 2 hips. Cemented acetabular components implanted in patients >75 years of age with a diagnosis of osteoarthritis showed a high rate of survivorship free of revision and free of symptomatic aseptic loosening.

Cemented all polyethylene tibial components in patients age 75 years and older.

Between 1976 and 1980, 81 knees in 59 patients 75 years of age or older, underwent primary total knee arthroplasty with a cemented, condylar femoral component and a cemented, moderately conforming, all polyethylene tibial component. All patients were followed up until death, revision surgery, or for a minimum of 10 years. Mean clinical followup was 8.1 years for the entire group and 14.6 years for those patients still alive. At final followup one patient (one knee) required revision surgery (for medial instability), and one patient (one knee) had marked pain but no radiographic evidence of loosening. No patients required revision surgery for aseptic loosening and no patients had symptomatic aseptic loosening at last followup. The mean Knee Society knee and function scores were 78 and 64 points, respectively at last followup. The mean postoperative range of motion was 101 degrees. The Kaplan-Meier survival of the index total knee arthroplasty at 14 years was 100% with symptomatic aseptic loosening as the end point; and 98% with revision for any cause as the end point. Cemented all polyethylene tibial components with a moderately conforming tibiofemoral articulation implanted in patients older than 75 years of age showed a high rate of survivorship without the need for revision surgery and without symptomatic loosening.

The role of phonology in the activation of word meanings during reading: evidence from proofreading and eye movements.

Six experiments explored the role of phonology in the activation of word meanings when words were embedded in meaningful texts. Specifically, the studies examined whether participants detected the substitution of a homophone mate for a contextually appropriate homophone. The frequency of the incorrect homophone, the frequency of the correct homophone, and the predictability of the correct homophone were manipulated. Also, the impact of reading skill was examined. When correct homophones were not predictable and participants had a range of reading abilities, the evidence indicated that phonology plays a role in activating the meanings of low-frequency words only. When the performance of good and poor readers was examined separately, the evidence indicated that good readers primarily activate the meanings of words using the direct route, whereas poor readers primarily activate the meanings of words using the phonological route.

Increased rat cardiac allograft survival by the glycosaminoglycan pentosan polysulfate.

BACKGROUND: Modulation of the inflammatory response has proven to be of benefit in salvaging cardiac allografts at risk of irreversible injury. Pentosan polysulfate (PPS), like heparin, is a negatively charged sulfated glycosaminoglycan (GAG) that possesses anti-inflammatory properties including the ability to inhibit activation of the complement system. This study was conducted to determine the potential of PPS to prolong allograft survival in an experimental model of cardiac transplantation. MATERIALS AND METHODS: A heterotopic cardiac transplant was performed by implanting the heart from fetal Brown Norway rats into the ear pinnae of adult Lewis rats. Vehicle (saline) or PPS (30 mg/kg) was administered subcutaneously immediately after transplantation and daily thereafter (n = 6 in each group). Another GAG, heparin, was also analyzed to determine the effect of anticoagulation on transplant survival (n = 6). RESULTS: Treatment with PPS significantly (P < 0. 05) increased allograft survival time as compared to vehicle-treated animals (8.0 +/- 0.3 days vs 5.5 +/- 0.5 days). The results noted with PPS were similar to those observed in cyclosporine (10 mg/kg; n = 6)-treated animals (8.25 +/- 0.25 days). Treatment with heparin (300 U/kg/day) did not significantly prolong cardiac graft survival time, suggesting that anticoagulation is not sufficient to prolong transplant survival. Analysis of tissue histology showed diminished transplant rejection as evidenced by decreased white blood cell infiltration and cellular necrosis. CONCLUSIONS: The results of this study indicate that PPS possesses the ability to prolong cardiac transplant viability in a heterotopic cardiac transplant model, independent of its anticoagulant actions.

Fast and slow namers: benefits of segmentation and whole word training.

Poor readers in Grade 2 (mean age 7 years 7 months) were categorized into fast and slow namer groups based on their performance on a Rapid Automatized Naming (RAN) task. The fast and slow groups were then trained to read words using 3 different training regimes: one that taught onset/rime segmentation, one that taught phonemic segmentation, and one that used whole word repetition. The main results were that the slow namers acquired the words more slowly across experiences than the fast namers, irrespective of training condition, but they were particularly disadvantaged when trained with word-level units. Unlike beginning nonreaders, poor Grade 2 readers showed poorer retention following onset/rime training compared with phoneme or word level training, even when final level of learning was controlled. Further, they showed the best generalization to reading new words and nonwords following phoneme training and the worst following whole word training, even when final level of acquisition was controlled. The data are related to the P. G. Bowers and M. Wolf (1993, Reading and Writing, 5, 69-85) double-deficit hypothesis and to the specific deficits associated with early reading failure.

Fluent and nonfluent forms of transfer in reading: words and their message.

In two experiments, we examined transfer to the reading of a normal text from a prior reading of that intact text or from a prior reading of a scrambled word version of the passage. In Experiment 1, we studied good and poor readers in Grade 4; in Experiment 2, high- and low-ability undergraduate readers. Good readers at both ages showed rereading benefits only when the prior reading was of the intact text, with no reliable benefit from experience with words only. The poorer readers showed reliable rereading benefits even when only the words, in a scrambled order, were read on the first encounter. The results are discussed in terms of two forms of transfer nonfluent reading transfer when attention must be focused on word recognition, and fluent rereading transfer when word recognition is skilled so that attention can be focused on text processing.

Transfer effects across contextual and linguistic boundaries: evidence from poor readers.

We report two experiments that are consistent with two hypotheses about poor, nonfluent readers: (1) fluency gains in text reading skill transfer across contextual and linguistic boundaries and (2) these fluency gains enable higher-order comprehension operations to function in the processing of text. We conclude that unlike the fluent reader, the nonfluent reader does not completely integrate the surface characteristics (words) of the text and the message of the text. Word-level representations remain free to support transfer across various processing episodes. Thus, a variety of reading experiences aimed at promoting word recognition fluency will provide benefits to the developing reader.

Carbon dioxide laser for de-epithelialization of periodontal flaps.

Regeneration of mineralized and soft connective tissue components of the attachment apparatus is the main goal in the treatment of periodontal diseases. Often, apical migration of epithelium (long junctional epithelium) effectively prevents the formation of bone and connective tissue attachment after periodontal surgery. The purpose of the present study was to compare conventional periodontal surgery combined with carbon dioxide laser and conventional periodontal surgery alone with respect to epithelial elimination and degree of necrosis of mucoperiosteal flaps. After signing a consent form, five patients with at least two comparable bilateral periodontal defects needing pocket elimination surgery participated in this study. The investigators randomly divided each side into test and control sites. Each patient received oral hygiene instruction and initial therapy prior to surgery. At surgery, the test site received a sulcular incision and carbon dioxide laser de-epithelialization of the outer and inner aspects of the flap. The control group received reverse bevel incision only. The surgeon performed open flap debridement on all teeth. At the time of surgery, the surgeon did a biopsy of each site and submitted specimens for histologic evaluation. A matched pairs t-test was used to analyze the data. The results show significant differences between the carbon dioxide laser and reverse bevel incision with respect to sulcular (P < or = 0.025) and gingival (external) (P < or = 0.01) flap surface epithelial elimination and tissue necrosis (P < or = 0.005). These results should be replicated with a larger number of subjects. The carbon dioxide laser eliminated sulcular and gingival (external) epithelium without disturbing underlying connective tissue. This finding supports the concept that the carbon dioxide wavelength has little or no effect on tissues beyond the target. However, neither laser nor blade eliminated all the epithelium. Researchers observed chronic inflammation in the control and test sites, with a predominance of plasma cells. Lining the sulcular and gingival (external) lased areas, investigators found coagulation necrosis covered by fibrin and coagulated blood. The laser appears to effectively remove epithelium at the time of surgery; however, future long-term, well-controlled quantitative histologic studies are needed to evaluate the effect of repeated carbon dioxide laser de-epithelialization of the gingival (external) surface of mucoperiosteal flaps at intervals during the healing period.

Computer expert system for the histopathologic diagnosis of salivary gland neoplasms.

The design, development, and testing of a prototype interactive histopathologic expert system capable of diagnosing 15 types of primary salivary gland neoplasms is described. The system incorporates a multiple subprogram modular design and makes use of multiple reasoning methods including: data-driven and goal-directed rule-based reasoning, linear pattern recognition, and Bayesian classification. Its user interface incorporates both a "hypertext" context-sensitive information assistance facility and the video display of stored and digitized photomicrographic images. The system can report a differential diagnosis of its findings with assessment of its confidence in its diagnosis. The system's performance was evaluated in a series of tests. The results of a weighted kappa analysis of the system's diagnoses versus those of four oral pathologists for 20 salivary gland neoplasms indicated no statistical difference in diagnostic performance between the system and the human experts and each of the experts in relationship to the others (Wilcoxon rank sums test). A modified version of Turing's test of artificial intelligence demonstrated no statistically significant difference in the system's diagnoses versus the diagnosis of four human expert pathologists (Fisher's exact test). The knowledge and experience gained in the development and testing of the expert system described in this study have demonstrated the validity of histopathologic diagnostic expert systems in a selected area of oral pathology.

How text difficulty and reader skill interact to produce differential reliance on word and content overlap in reading transfer.

Four experiments examined the factors that influence across-text transfer for children. Transfer was indicated by increases in the reading speed and accuracy of a second text following reading of different first texts. The first texts were related to the second by overlap in words only, in content only, in words and content, or in neither words nor content. Results indicated that the extent to which readers benefited from word or content overlap depended on the interaction of reader skill with text difficulty. Children who read texts that were easy for them showed transfer only when a pair of stories shared content. However, when children read stories that were difficult for them, they also showed transfer when words alone were shared by a pair of stories. The results are discussed in terms of how easy and difficult texts are represented in memory and retrieved to produce transfer.

Increasing the naming speed of poor readers: representations formed across repetitions.

In three experiments we examined the effect of repetition practice on the acquisition, retention, and generalization of children's skill in rapidly naming visually presented words. Experiment 1 showed that naming times decrease rapidly with practice. Retention of this newly acquired skill in rapid naming was a function of the degree of learning during training. "Overlearning" was necessary to prevent forgetting of the skill. Experiment 2 indicated that the rate at which the naming gains were acquired, and the amount of forgetting, was unrelated to the specific orthographic to phonological correspondences among the trained words. Experiment 3 suggested that even when the spelling/sound regularities were used to facilitate learning, there was no generalization of the naming time skill to new words that share the same spelling/sound relations. The results were discussed in terms of the nature of the representation that underlies rapid naming.

Gingival overgrowth induced by diltiazem. A case report.

Gingival overgrowth induced by diphenylhydantoin (Dilantin) has been well documented in the literature. Recently, there have been other medications with side effects causing Dilantin-like gingival overgrowth. This article presents a case in which diltiazem (Cardizem), a calcium-channel blocker, induced gingival overgrowth. A discussion of the clinical and histologic features and possible pathogenesis of the disorder is presented.

Intraoral Masson's vegetant intravascular hemangioendothelioma.

Two cases of Masson's vegetant intravascular hemangioendothelioma are described. The intraoral appearance of these reported lesions are rare. Due to histologic similarities to angiosarcoma and the benign progression of vegetant intravascular hemangioendothelioma, a thorough discussion of these diseases is presented.

Processing changes across reading encounters.

Five experiments examined changes in the processing of a text across reading encounters. Experiment 1 showed that reading speed increased systematically across encounters, with no loss in the extensiveness of analyses of the printed text, as indicated by the ability to detect nonword errors embedded within that passage. Experiment 2 replicated this improved reading fluency with experience and showed that it occurred even with typescript changes across trials, thus indicating that a primed visual operations explanation cannot account for the effect. The third and fourth experiments then extended the study of the familiarity effect to higher level processing, as indicated by the detection of word errors. Familiarity facilitated the detection of these violations at the syntactic-semantic levels. Finally, Experiment 5 showed that these higher level violations continued to be well detected over a series of reading encounters with the same text. The results indicate that prior experience improves reading speed, with no attenuation of analysis of the printed words or of the passage's message.