Role of antioxidant defense during different stages of preadult life cycle in European corn borer (Ostrinia nubilalis, Hubn.): Diapause and metamorphosis.

Antioxidant enzymes, total glutathione (GSH), and ascorbic acid (ASA) were determined in whole body homogenates of nondiapausing larvae, diapausing larvae during the diapausing period (October, December, and February), and in pupae emerged from both diapausing and nondiapausing larvae of the European corn borer (Ostrinia nubilalis, Hubn., Lepidoptera: Pyralidae). The activities of catalase, selenium nondependent glutathione peroxidase (GPx), and glutathione-S-transferase (GST), as well as the content of GSH and ASA, were found to vary throughout the larval diapause. Compared to diapausing larvae, nondiapausing larvae were higher in levels of catalase, GPx, GST, and dehydroascorbate reductase (DHAR) activity. GSH content was also increased. However, nondiapausing larvae contained less ASA than diapausing ones. Pupae had higher GPx and GST activity and an increased ASA content compared to larvae. The pupae emerged from nondiapausing larvae had higher GST, glutathione reductase (GR), and DHAR activities, but lower GPx activity and ASA content than those emerged from diapausing larvae. Correlation analysis revealed differences in the way the antioxidant level is equilibrated for a particular stage and developmental pattern. The results suggest that cellular antioxidants are involved in both the protection of cells and the regulation of redox levels during the pre-adult stages of Ostrinia nubilalis. Arch. Insect Biochem. Physiol. 55:79-89, 2004.

Correlation of age, acromial morphology, and rotator cuff tear pathology diagnosed by ultrasound in asymptomatic patients.

The importance of acromial morphology in the pathogenesis of rotator cuff tears remains controversial. Some surgeons place great emphasis on acromial morphology and others feel that acromial shape is a result of cuff tear pathology rather than the cause. The purpose of this study was to determine if there was an association between acromial morphology, age, and rotator cuff tears found by ultrasound in asymptomatic volunteer subjects with no past history of shoulder symptoms. One hundred eighteen outlet x-rays and ultrasound scans were performed in 59 asymptomatic patients in various age groups. Acromial morphology and the age of the patients were then correlated with the ultrasound findings. Older patients were noted to have a high incidence of type II and type III acromions (93% of those over 70). Full- and partial-thickness tears were more commonly seen in patients with type II or type III acromions compared with type I. Patients over 50 years had a high incidence of full-thickness tears (40%), but the incidence did not increase with increasing age past 50. These findings lend credence to the multifactorial etiology of rotator cuff tears. The patient's age (degeneration) and acromial morphology (impingement) are two of the factors involved in causing rotator cuff tears. The incidence of cuff tears and type III acromions was high in this group of entirely asymptomatic volunteer subjects. Surgeons should interpret radiologically hooked or curved acromions as well as rotator cuff tears diagnosed with ultrasound or other modalities with caution. It may well be that both of these findings should be regarded as part of the natural ageing process.

Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement.

s the surgical indications for total knee replacement (TKR) expand to include younger, heavier and more active patients, knowledge of the effect of these demographic variables on the outcome and survival of the implant is increasingly important. Between November 1986 and September 1990, 402 patients underwent 562 primary cemented cruciate-retaining TKRs carried out by a single surgical team. The overall results showed a survival of 96.8% at 14 years with 1.44% lost to follow-up. Evaluating the demographics of these patients showed that certain groups fared significantly less well. The best results were seen in non-obese women with osteoarthritis who were over 60 years of age in whom there was ten-year survival of 99.4%. The worst results were in obese men with osteoarthritis who were less than 60 years of age in whom there was a ten-year survival of 35.7%. Caution should be exercised when considering TKR on a patient with this combination of poor risk factors. By identifying demographic factors at the time of consultation the surgeon is better able to predict the survival of the TKR. This information is important when considering the best options for treatment of a patient and in providing accurate information during preoperative counselling.

Profiling cryopreservation protocols for Ribes ciliatum using differential scanning calorimetry.

DSC analysis was performed at three points in the cryopreservation process on encapsulated-dehydrated meristems of Ribes ciliatum. Meristems were excised from shoots pre-treated with either sucrose or glucose, encapsulated in alginate beads, dehydrated in sucrose solutions, air dried, and plunged in liquid nitrogen. Thermal analysis revealed glass transitions during cooling of air-desiccated meristems, however, on rewarming a small endothermic event was detected suggesting glass destabilization can occur. Interestingly, this did not occur in alginate beads or meristems when these components were cooled and rewarmed separately. The possibility exists that thermal and moisture gradients may arise within the alginate bead/tissue complex and we propose that the heterogeneous composition of the meristems and the surrounding alginate may promote ice nucleation on rewarming. The significance of this regarding the stabilization of glasses formed in alginate beads and their encapsulated meristems is discussed. This study also reports an approach to Ribes cryopreservation in which the pregrowth of shoots in 0.75M sucrose for 1 week can be used as a substitute for cold acclimation.

Bipolar shoulder arthroplasty in patients with osteoarthritis: short-term clinical results and evaluation of birotational head motion.

To determine the clinical outcome and evaluate the biomechanical properties (persisting birotational head motion) of the bipolar shoulder system in patients with primary osteoarthritis, a prospective study of 48 shoulders in 43 patients was undertaken. Patients were monitored for a mean of 3. 1 years (range 2 to 6 years). Pain relief was achieved in 92% of cases. Forty-one (96%) patients were satisfied with the result of the surgery, and satisfactory results were obtained in 92% of shoulders (with The University of California at Los Angeles rating system). Prosthetic birotational motion (head-shell and shell-glenoid motion) persisted in all shoulders. Bipolar shoulder arthroplasty is a low-friction device with persisting birotational head motion that offers excellent pain relief, eliminates glenoid component loosening concerns, and represents an adequate alternative to shoulder arthroplasty. Early results have been promising.

Repair of massive rotator cuff tears in patients older than 70 years.

Major ruptures of the rotator cuff are common in elderly patients, and their management has been a challenge for orthopaedic surgeons. This study was undertaken to evaluate the results obtained in patients older than 70 years who were treated with open surgical repair for massive ruptures of the rotator cuff tendons and to correlate the functional outcomes with the quality of the repairs. Between January 1991 and November 1994, 69 patients older than 70 years of age underwent rotator cuff repairs of massive tears with a minimum follow-up of 2 years (mean of 3 years). These patients were evaluated before and after surgery with the University of California at Los Angeles score. The mean age was 75 years (range 70 to 90 years), and female sex and right shoulder were predominant. A good bone-tendon repair was achieved in 55 patients, a fair bone-tendon repair in 5 patients, a poor bone tendon-repair in 8 patients, and 1 patient had no repair. The mean University of California at Los Angeles rating score before surgery was 9.4 points, and the mean postoperative score at final follow-up was 30.9 points, with an average improvement of 21.5 points (P = .0001). Satisfactory results were achieved in 78.2% of the patients (University of California at Los Angeles score equal or over 28). The patients' clinical results and postoperative arthrograms are evaluated with regard to the quality of cuff repair. Painful massive rotator cuff tears can be repaired in patients older than 70 years with satisfactory results.

Non-Hodgkin's lymphoma as an unexpected diagnosis in a shoulder arthroplasty.

Shoulder arthroplasty (SA) is commonly performed in patients with rheumatoid arthritis (RA) who have been treated with long-term immunosuppressive medication. RA is associated with an increased risk of neoplasms of the immune system. A case of non-Hodgkin's lymphoma as an unexpected diagnosis after the routine pathologic examination of the soft tissues after SA was detected in a 54-year-old woman with long-standing RA and prolonged immunosuppressive therapy. Although this case does not support the cost-effectiveness of routine specimen evaluation during SA, we suggest that histological analysis of the surgical tissues is appropriate and should be performed in all patients who have been treated with prolonged immunosuppressive medication, especially RA patients as well as patients who have suspicious surgical findings.

Periprosthetic humeral fractures: management and classification.

Six patients (67 to 94 years of age) sustained a periprosthetic humeral fracture at an average of 43 months after shoulder arthroplasty (range 13 to 85 months). These fractures were classified depending on fracture anatomy and implant stability. Type A fractures occur about the tuberosities. Type B fractures occur about the stem and are subclassified by fracture anatomy and implant stability: B1 fractures are spiral fractures with a stable implant, B2 fractures are transverse or short oblique fractures about the tip of the stem with a stable implant, and B3 fractures are those fractures about the stem with an unstable implant. Type C fractures occur well distal to the tip of the stem. Five of the 6 fractures required surgery, 4 with revision to a long-stemmed component. All fractures united with restoration of range of motion and function. Satisfactory results may be anticipated if these fractures are managed in an appropriate fashion.

Home continuous passive motion machine versus professional physical therapy following total knee replacement.

A vigorous rehabilitation program following discharge from the hospital is necessary for patients having a total knee arthroplasty to maintain and improve range of motion and function. To compare the effectiveness of the continuous passive motion (CPM) machine as a home therapy program versus professional physical therapy, a prospective, comparative, randomized clinical study of 103 consecutive primary total knee arthroplasties in 80 patients (23 bilateral) was performed. The CPM group consisted of 37 patients (49 knees), and the physical therapy group consisted of 43 patients (54 knees). At 2 weeks, knee flexion was similar in the two groups, but a flexion contracture was noted in the CPM group (4.2 degrees). This difference is felt by the authors to be clinically insignificant. At 6 months, there were no differences in knee scores, knee flexion, presence of flexion contracture, or extensor lag between the two groups. The cost for the CPM machine group was $10,582 ($286 per patient), and the cost for professional therapy was $23,994 ($558 per patient). We conclude that the CPM machine after the hospital discharge of patients having total knee replacement is an adequate rehabilitation alternative with lower cost and with no difference in results compared with professional therapy.

Bipolar shoulder arthroplasty for painful conditions of the shoulder.

Between April 1991 and March 1997, 182 bipolar shoulder replacements were implanted in 174 patients (8 bilateral) for painful conditions of the shoulder. The study group comprises 108 patients who were followed for an average of 2.9 years (range, 2-6 years). Diagnoses included osteoarthritis (51), rotator cuff arthropathy (27), avascular necrosis (3), revisions (8), rheumatoid arthritis (2), and fractures--both old and recent (17). A satisfactory rating (University of California at Los Angeles shoulder rating score greater than or equal to 28 points of 35) was achieved by 72% of the patients (including rotator cuff arthropathy patients). Patients with osteoarthritis obtained 90.2% of satisfactory results (46 of 51). The overall pain score after surgery was 8.8 points (of 10), meaning that none or occasional pain was present. Five patients required prosthetic revision, and 102 (94.4%) were satisfied with the surgical procedure.

Tumescent abdominoplasty: full abdominoplasty under local anesthesia with i.v. sedation in an ambulatory surgical facility.

The tumescent technique makes it possible for the surgeon to perform a full abdominoplasty with suction-assisted lipoplasty (SAL) contouring without the necessity for general anesthesia. Benefits include minimal blood loss, less postoperative pain, and limited postoperative bruising. In mid-1996, the co-author performed his first full abdominoplasty under local anesthesia with i.v. sedation in his office operating facility. Since then this technique has been used routinely. Patient satisfaction and rapid return to activities of daily living are remarkable.

Scintigraphic evaluation in total knee failure secondary to severe metallosis.

The scintigraphic findings are described for a patient with severe metallosis in a failed noninfected total knee arthroplasty secondary to metal-metal friction between the femoral and tibial components as a result of polyethylene wear. Technetium-99m phosphate and gallium-67 citrate scans were positive in incongruent uptake areas. This uptake is classically associated with septic loosening. The recommendation is made that metallosis be suspected before surgery as a possible cause of a false positive scan where sequential technetium-gallium scans are employed.

Nonunion after a tibial shaft fracture complicating tibial tubercule osteotomy.

Tibial shaft fracture after tibial tubercle osteotomy in total knee replacement is a rare complication. We report on a 67-year-old man who had a knee revision arthroplasty in which a long tubercle osteotomy was performed to facilitate exposure. Three weeks after surgery, he presented with a transverse shaft fracture, which became a nonunion requiring surgical management. This shaft nonunion and its solution after tibial tubercle osteotomy is discussed as well as relevant literature.

Midterm results in metal-backed patella revisions for metallosis.

Nine patients underwent isolated patellar revisions and synovectomies for metallosis secondary to the mechanical failure of metal-backed patellar components. These patients were followed for an average of 5 years (range, 2 to 8 years). In all cases, the femoral and tibial components were left in place, and in one patient the patellar bone was deemed too thin to resurface. Two patients (22%) developed deep infection. One infection (enterococcal) required arthrodesis, and the other (staphylococcal) was successfully managed with a two-staged reimplantation. A third patient sustained an inferior patella pole fracture that was treated conservatively. The remaining six patients are functioning satisfactorily. Metallosis is a serious complication in knee arthroplasty, and these patients merit close follow-up.