Acute trunnion failure of a TMZF alloy stem with large diameter femoral heads.

INTRODUCTION: Femoral head-neck modularity in total hip arthroplasty (THA) is advantageous but taper corrosion at the trunnion can result in implant failure. We report two cases of acute catastrophic trunnion failure with a TMZF alloy cementless stem. METHODS: Demographic, clinical, radiographic and operative data including implant retrieval was recorded and is presented. RESULTS: Case 1: A 79 year old farmer presented with sudden onset of hip pain and an inability to weight bear. He underwent a cementless large diameter stemmed metal-on-metal system (MITCH acetabular component, 56mm cobalt chrome head 4.5 lateralised Accolade TMZF, Stryker) nine years previously. He denied symptoms prior to his presentation to the Emergency Department.Case 2: An 86 year old gentleman presented with sudden onset of hip pain and inability to weight bear. He underwent a cementless large diameter stemmed metal-on-poly THA (Trident acetabular component, X3 polyethylene insert, 44mm cobalt chrome head, 4.5 lateralised Accolade TMZF, Stryker)nine years previously. This man had been complaining of mild hip symptoms prior to presentation. CONCLUSION: Patients that have received TMZF alloy cementless stems coupled with CoCr alloy heads are at risk of catastrophic trunnion failure. Importantly, background trunnion corrosion may occur silently and present emergently irrespective of surveillance.

An isolated cuboid dislocation. A case report.

INTRODUCTION: Isolated cuboid dislocations are rare injuries Jacobson (1990). It is clinically significant and important in surgical education, as it is an injury and a source of lateral foot pain that can be misdiagnosed at the time of initial presentation and may be difficult to identify clinically or with imaging Drummond and Hastings (1969). PRESENTATION OF CASE: We present a case report in a 33year old rugby player, who was injured during a match after a tackle. The patient had ongoing concerns that he was not recovering following initial discharge, as he was unable to weight bear since his initial presentation to the Emergency Department (E.D.), and he had ongoing lateral foot pain. DISCUSSION: Important clinical findings include lateral foot pain, a palpable gap at the cuboid level and difficulty weight-bearing. Closed reduction is usually difficult as it can be blocked mechanically by the extensor digitorum brevis muscle or peroneus longus tendon Dobbs et al. (1969). Initial X-Rays may be inconclusive with this presentation. CT scanning is indicated if suspicion for pathology is high. Open reduction and internal fixation with Kirschner wires are usually necessary for isolated cuboid dislocations. CONCLUSION: Our take home message from this case report is that cuboid dislocations are rare injuries and are important to be aware of in reviewing X-rays in the E.D. Particularly in patients with inversion and plantar flexion type injuries to their foot and ankle joint, with an inability to weight bear and lateral midfoot pain following their injury.

Ras oncogene-independent activation of RALB signaling is a targetable mechanism of escape from NRAS(V12) oncogene addiction in acute myeloid leukemia.

Somatic mutations that lead to constitutive activation of NRAS and KRAS proto-oncogenes are among the most common in human cancer and frequently occur in acute myeloid leukemia (AML). An inducible NRAS(V12)-driven AML mouse model has established a critical role for continued NRAS(V12) expression in leukemia maintenance. In this model genetic suppression of NRAS(V12) expression results in rapid leukemia remission, but some mice undergo spontaneous relapse with NRAS(V12)-independent (NRI) AMLs providing an opportunity to identify mechanisms that bypass the requirement for Ras oncogene activity and drive leukemia relapse. We found that relapsed NRI AMLs are devoid of NRAS(V12) expression and signaling through the major oncogenic Ras effector pathways, phosphatidylinositol-3-kinase and mitogen-activated protein kinase, but express higher levels of an alternate Ras effector, Ralb, and exhibit NRI phosphorylation of the RALB effector TBK1, implicating RALB signaling in AML relapse. Functional studies confirmed that inhibiting CDK5-mediated RALB activation with a clinically relevant experimental drug, dinaciclib, led to potent RALB-dependent antileukemic effects in human AML cell lines, induced apoptosis in patient-derived AML samples in vitro and led to a 2-log reduction in the leukemic burden in patient-derived xenograft mice. Furthermore, dinaciclib potently suppressed the clonogenic potential of relapsed NRI AMLs in vitro and prevented the development of relapsed AML in vivo. Our findings demonstrate that Ras oncogene-independent activation of RALB signaling is a therapeutically targetable mechanism of escape from NRAS oncogene addiction in AML.

Labial talon cusps: a South American archaeological case in the deciduous dentition and review of a rare trait.

Talon cusps are rarely reported developmental anomalies of the anterior dentition. They occur most commonly on the lingual aspect of the tooth but may also affect the labial aspect, and double (lingual and labial) talon cusps have also been reported. This study presents the first case of a labial talon cusp affecting the maxillary deciduous central incisor to be described in the literature. It was identified in a child skeleton from the archaeological site of Borgatta, north-west Argentina. The aetiology of talon cusps remains uncertain, with a combination of both genetic and environmental factors hypothesised to be involved. As a number of cases of labial talon cusps have now been published, this study presents a survey of cases in the literature to characterise the expression of this trait, and compares it with that of lingual talon cusps. The aim is to offer further insight into the relationship between lingual and labial talon cusps and their aetiologies. Differences between these traits in sex distribution, frequency of maxillary and mandibular cases, and the most commonly affected teeth are demonstrated.

Assessment of the impact of flares in ankylosing spondylitis disease activity using the Flare Illustration.

OBJECTIVES: Many AS patients report periods of perceived higher disease activity (flares). This pilot study aims to document disease activity patterns reported by AS patients and examine associations with disease-specific health status measures. METHODS: Consecutive AS patients (n = 114) were asked whether they experience flares, and if they experience symptoms of AS between flares. They were shown the Flare Illustration of disease patterns over time and asked to select the pattern that best described their disease (i) since symptom onset and (ii) in the past year. Associations between reported disease pattern and disease activity (Bath AS Disease Activity Index, BASDAI); functional impairment (Bath AS Functional Index, BASFI); AS Quality of Life (ASQoL); Back Pain (Nocturnal and Overall) and demographic features were assessed in a subsample (n = 83) (statistical significance defined at P 70% of patients) and patterns with constant symptoms since onset (vs intermittent symptoms) were associated with worse health status (ASQoL: P = 0.007; BASDAI: P = 0.029; BASFI: P = 0.013, overall back pain: P = 0.025). CONCLUSIONS: Almost all AS patients report flares in disease activity: 70-80% report constant symptoms with single/repeated flares, while 20-30% report flares with no intermittent symptoms. The former is associated with a significantly poorer health status. These findings will be validated in a prospective study.

Strengthening Social Security.

Social Security's core protections must be maintained, according to this author. He believes that by creating universal savings accounts and investing a small portion of the Social Security trust fund in equities, it is possible to secure the long-term future of Social Security without subjecting workers to the risks of individual, private accounts.

The impact of anticipatory grief on caregivers of persons with Alzheimer's disease.

Caregivers of persons with Alzheimer's disease (AD) and other dementias are known to experience many physical and emotional problems. However, research has consistently shown that the relationship between the demands of caregiving and the effects on the caregiver is not strong. Despite considerable research, a full understanding of how the demands of caregiving uniquely impact the individual has not been established. The present study examines anticipatory grief, an emotion that has not been studied to date for its possible impact on the current functioning of caregivers. Structured interviews, consisting primarily on standardized measures, were conducted with 100 caregivers. Results of the study show that physical and emotional problems and the expectation to place the patient out of the home were more likely to occur among those caregivers who expressed the most intense grief and those feelings of remorse and anger characteristic of the anger and guilt stages of grief.

Depression or grief? The experience of caregivers of people with dementia.

The exploratory study discussed in this article attempted to shed some light on the nature of the depression and grief experienced by caregivers of people with dementia. The findings suggest that the depression so frequently described in the literature may not be as severe or clinically significant as previously thought and that it may be more precisely described as anticipatory grief. Viewing caregivers apparent depression as being the result of grief over the losses they are experiencing may assist practitioners in planning and evaluating the effectiveness of clinical interventions specifically designed for this growing group of clients.

A psychoeducational group intervention for family members of persons with HIV/AIDS.

We describe a psychoeducational group intervention for family members of persons living with AIDS. The 33 family members were compared with 13 waiting-list controls in order to evaluate the effectiveness of the intervention. We focus on the practice aspects of the intervention, its development and implementation, and our belief that it is an apparently effective approach for helping family members work through the social and emotional aspects of the devastating impact of HIV/AIDS.

Anticipatory grief and AIDS: strategies for intervening with caregivers.

Anticipatory grief may have beneficial effects for caregivers of people with HIV infection or AIDS. However, the duration of the illness and the stigmatization and multiple losses associated with the disease may impede the caregiver's ability to effectively engage in the grief process. This article discusses the impact of these aspects of the disease on the anticipatory grief process and mourning tasks for caregivers at each stage of the illness. Intervention strategies developed to help the caregiver remain actively involved with the patient and simultaneously grieve losses and prepare for death are specified.

Compact Disc Interactive (CD-i) multimedia project.

In 1993, the National Library of Medicine (NLM), in collaboration with the National Cancer Institute (NCI), developed a Compact Disc Interactive (CD-i) program: "Cervical Cancer: Screening For Life." This was NLM's first experience in developing for an all-digital interactive medium, containing motion video, graphic images, and text. In 1994, the original CD-i was expanded to include a telecommunications capability that allowed the user to obtain the NCI's most recent screening and treatment information related to cervical cancer.

Health reform: setting the agenda for long term care.

The White House Task Force on National Health Care Reform, headed by First Lady Hillary Rodham Clinton, is expected to release its prescription for health care reform this month. From the outset, Clinton's mandate was clear: to provide universal coverage while reining in costs for delivering quality health care. Before President Clinton was even sworn into office, he had outlined the major principles that would shape the health reform debate. Global budgeting would establish limits on all health care expenditures, thereby containing health costs. Under a system of managed competition, employers would form health alliances for consumers to negotiate for cost-effective health care at the community level. So far, a basic approach to health care reform has emerged. A key element is universal coverage--with an emphasis on acute, preventive, and mental health care. Other likely pieces are employer-employee contributions to health care plans, laws that guarantee continued coverage if an individual changes jobs or becomes ill, and health insurance alliances that would help assure individual access to low-cost health care. What still is not clear is the extent to which long term care will be included in the basic benefits package. A confidential report circulated by the task force last month includes four options for long term care: incremental Medicaid reform; a new federal/state program to replace Medicaid; a social insurance program for home and community-based services; or full social insurance for long term care. Some work group members have identified an additional option: prefunded long term care insurance.(ABSTRACT TRUNCATED AT 250 WORDS)

Interpersonal judgements of schizophrenics: a golden section study.

Normal subjects typically categorize acquaintances on bipolar dimensions consisting of pairs of contrasting descriptive adjectives by using positive adjectives in the golden section ratio, i.e. 62 percent cent of the time. This study compared the performance of thought-disordered and non-thought-disordered schizophrenics on a similar task, using acquaintances and inanimate objects. Subjects generated six evaluatively positive figures (three acquaintances and three objects) and six negative figures (three acquaintances and three objects) and categorized them and themselves using either pole of 12 pairs of contrasting descriptive adjectives. Positive adjectives were assigned to objects 59.2 per cent and to acquaintances 62.8 per cent of the time. Overall, positive adjectives were assigned 61.0 per cent of the time. There were no differences between TD and NTD subjects. Subjects rated acquaintances positively (62.0 per cent) significantly more often than objects (P less than 0.05). Results supported the fundamental nature of the GS in interpersonal relations and the idea that schizophrenics identify with and differentiate themselves from others in the same way as normals.

A cross-cultural format for national mental health program analysis.

With the growing interest in community mental health programs outside of the United States on the part of American mental health professionals, a cross-cultural format has been developed to assist in making a comprehensive analysis of any national mental health program. The format itself, together with initial experiences with its utilization in the study of six different mental health programs, is presented. While continued revisions of the format can be expected, it has already proved useful in comparative analyses of a variety of mental health program components.