Middle-term results of a cementless threaded self-tapping acetabular cup.

Various designs of acetabular cup are available for cementless fixation in patients undergoing total hip arthroplasty. Conflicting results have been reported in the literature about the middle to long-term outcomes with the use of these cups. We present our experience of a design of self-tapping threaded acetabular cup with metal backing (the ACSYS acetabular cup). This is a study of 41 hips with average follow up of 6.43 years. Functional grading of the hips was very satisfactory and none of the patients needed revision for aseptic loosening. No case of significant cup migration or osteolysis was noted. The paper also reviews the literature.

The materiality of gender.

SUMMARY Lesbian and transgender histories often recuperate the same historical figures; however, many lesbian spaces (like the Michigan Womyn's Music Festival) have excluded lesbian-identified male-to-female transsexuals. Through an analysis of historical inclusion and socio-political exclusion, this essay examines the relationship between "birth bodies," gender and sexuality. It argues that the lesbian body appears in history through the naturalization of "birth-bodies" and the recuperation of cross-gender behavior. In this way, the body becomes a template for lesbian historical recuperation and an organizing principle for contemporary lesbian communities.

Diagnosis and carrier detection of chronic granulomatous disease in five families by flow cytometry.

BACKGROUND: The application of flow cytometric assays, for determination of phagocyte respiratory burst (ROB) activity, to the investigation of chronic granulomatous disease (CGD) may lead to improved laboratory detection of patients and carriers and indicate the nature of the molecular defect. To evaluate the diagnostic capability of flow cytometry an investigation of 5 CGD families was undertaken. METHODS: Phorbol myristate acetate (PMA)-induced neutrophil ROB was determined using dihydrorhodamine 123 (DHR) and flow cytometric analysis in 26 members of 5 CGD families (2: X-CGD; 3: autosomal recessive CGD). RESULTS: Neutrophils from X-CGD patients displayed absence of reactivity. Female carriers demonstrated dual fluorescence peaks of high and low intensity indicative of normal and abnormal populations, respectively. Normal ROB activity was observed in a boy whose X-CGD was successfully treated by bone marrow transplantion. Reduced ROB activity was observed in 3 patients with autosomal-recessive CGD compared with their parents and siblings. The patterns of flow cytometric reactivity correlated with the different molecular defects identified. Absence of the p22phox membrane component of the NADPH oxidase complex resulted in a significantly reduced level of respiratory burst activity which was comparable to that observed in X-CGD, whereas reduced but detectable levels of respiratory burst activity were observed in a patient with diminished levels of p22phox and in a patient with deficiency of the cytosolic p47phox component. CONCLUSIONS: The DHR flow cytometric assay offers a sensitive diagnostic screening test for CGD and furthermore may provide an indication of the likely underlying molecular defect.

Quantitation of vitronectin in serum: evaluation of its usefulness in routine clinical practice.

AIMS: To make a preliminary assessment of the clinical relevance of serum vitronectin concentrations in various disease groups, using a recently available commercial radial immunodiffusion kit. METHODS: Serum vitronectin concentrations were measured in 80 control subjects and 144 patients with various diseases. The following characteristics were used to evaluate the test procedures: linearity of method, inter- and intrabatch precision, effect of storage, temperature and in vitro activation of the classical and alternative complement pathways on vitronectin concentrations. RESULTS: Significantly reduced serum vitronectin concentrations were found in patients with liver disease, renal disease, and systemic lupus erythematosus (SLE) (normal C3 and C4 concentrations, when compared with normal subjects. This particular method was suitable for measuring vitronectin concentrations in serum samples provided they were stored at -20 degrees C. CONCLUSIONS: The clinical value of measuring serum vitronectin seems to be limited, but a larger study may be justified to ascertain the clinical importance of reduced serum vitronectin concentrations in liver diseases, and the possible role of vitronectin in other disease processes.

CD4 lymphocyte subset abnormalities associated with impaired delayed cutaneous hypersensitivity reactions in patients with X-linked agammaglobulinaemia.

Circulating CD4 lymphocyte subset (CD45RA; CD45RO; CD29; Leu8) levels were determined in nine patients with X-linked agammaglobulinaemia (XLA), nine patients with common variable immunodeficiency (CVI) and in 18 age- and sex-matched controls. CD4CD45RO and CD4CD29 cells were significantly lower (P less than 0.01) in the XLA patient group (CD45RO, 15.7 +/- 10.2%; CD4CD29, 32.1 +/- 14.6%) compared with CVI patients (61.8 +/- 25.4%; 60.1 +/- 11.2%) and normal controls (43.7 +/- 22.3%, 54.5 +/- 22.0%). The levels of CD4CD45RA and CD4Leu8 cells were not abnormal in the XLA patient group. No selective reduction in CD4 subsets was observed in the CVI patient group. Delayed cutaneous hypersensitivity testing of five XLA and five CVI patients revealed a significantly reduced response to recall antigens in patients with XLA. This may relate to the deficiency of circulating memory T cells observed in these patients.

A new fluorescent mitochondrial antibody: disease association.

The case notes of 34 patients whose sera contained an antibody giving an unusual immunofluorescent staining pattern were reviewed. This antibody designated M2(1) gave a slightly different pattern of staining on composite sections of rat liver, kidney and stomach from the primary biliary cirrhosis associated M2 antimitochondrial antibody. Anaemia was present in 10 patients, endocrine disease in 7 patients and autoimmune liver disease in 6 patients. We did not find the presence of M2(1) antibody to be of specific diagnostic significance. Although the M2(1) antibody is rare, caution is required in order to avoid confusion between this antibody and the M2 antimitochondrial antibody of primary biliary cirrhosis.

The natural history and management of congenital short tibia with dysplasia or absence of the fibula.

Forty-three patients with unilateral congenital short tibia with partial or complete absence of the fibula are reviewed. The factors influencing the degree of leg shortening at maturity are considered. Serial radiographic measurements of leg length in fourteen patients covering an average observation period of 9-3 years support the hypothesis that the relative difference in growth between the two limbs remains remarkably constant. By estimating the percentage difference between the normal and abnormal leg lengths on the first measurable radiograph it is therefore possible to predict the likely shortening at maturity. This method of prediction allows the surgeon to make the decision to proceed to Syme's amputation or to the use of an extension prosthesis at about one year of age when the child starts to walk.

A military surgical team in Belfast.

This paper details the experiences of a military surgical team in Belfast from 1972 to early 1974. The overall picture of the problem is given and the current management of 'war' injuries discussed. Up to February 1974 over 1000 servicemen have been injured in Northern Ireland as a result of the vivil disturbance. Over 200 have died. Because of the close proximity of the hospital to many battle areas, casualties may arrive with massive injuries, requiring major resuscitation. Limb wounds have predominated. There is no short cut to adequate wound debridement, especially in the surgery of high-velocity missile injury. Missile wounds of the large bowel require a colostomy. Formal thoracotomy is increasingly used for the through-and-through gunshot wounds of the chest. Controlled ventilation is playing an increasingly important role in the management of some missile wounds of the head. Mine and bomb explosions frequently cause multiple injuries, requiring extensive surgery on any one patient.

British surgical aid to Jordan.

The surgical commitment of No. 2 Field Hospital, R.A.M.C., during its stay in Jordan is presented. The majority of patients that were admitted had sustained war wounds, many of which were infected due to the delay in treatment. The difficulties encountered in their subsequent management are discussed. Special reference is made to the use of ketamine (Ketalar) and mafenide acetate (Sulphamylon) in the treatment of those burns cases under our care. It is the first time for many years that a British field hospital has been employed in an active rôle.