Pattern of diabetic neuropathic arthropathy associated with the peripheral bone mineral density.

The relationship between the bone mineral density (BMD) and Charcot arthropathy is unclear. Prospectively, 55 consecutive diabetic patients presenting with a Charcot arthropathy of the foot or ankle were classified as having a fracture, dislocation, or a combination fracture-dislocation pattern of initial destruction. In these groups we used dual-energy x-ray absorptiometry to compare the peripheral bone of the affected and unaffected limbs. The clinical data relating to diabetes and related major comorbidities and the site of the arthropathy (ankle, hindfoot, midfoot, forefoot) were also compared. There were 23 patients with a fracture pattern, 23 with a dislocation pattern, and nine with a combination. The age-adjusted odds ratio for developing a Charcot joint with a fracture pattern as opposed to a dislocation pattern in patients with osteopenia was 9.5 (95% confidence interval 2.4 to 37.4; p = 0.0014). Groups also differed as to the site of the arthropathy. Fracture patterns predominated at the ankle and forefoot whereas dislocations did so in the midfoot. Diabetic Charcot arthropathy of the foot and ankle differs according to the pattern of the initial destruction. The fracture pattern is associated with peripheral deficiency of BMD. The dislocation pattern is associated with a normal BMD.

Emerging food-borne zoonoses.

Diarrhoeal diseases, almost all of which are caused by food-borne or waterborne microbial pathogens, are leading causes of illness and death in less developed countries, killing an estimated 1.9 million people annually at the global level. Even in developed countries, it is estimated that up to one third of the population are affected by microbiological food-borne diseases each year. The majority of the pathogens causing this significant disease burden are now considered to be zoonotic. The occurrence of some of these zoonotic pathogens seems to have increased significantly over recent years. The factors involved in such increases have not been well studied, but they are generally agreed to include changes in animal production systems and in the food production chain. Both types of changes can cause corresponding changes in patterns of exposure to the pathogens and the susceptibility pattern of the human population. This paper will not attempt a more in-depth analysis of such factors. The authors briefly describe five of the most important emerging food-borne zoonotic pathogens: Salmonella spp., Campylobacter spp., enterohaemorrhagic Escherichia coli, Toxoplasma gondii and Cryptosporidium parvum. The paper does not include a full description of all important emerging food-borne pathogens but instead provides a description of the present situation, as regards these globally more important pathogens. In addition, the authors describe each pathogen according to the new framework of a Food and Agriculture Organization (FAO)/World Health Organization (WHO) microbiological risk assessment, which consists of hazard identification and characterisation, exposure assessment and risk characterisation. Moreover, the authors provide a brief account of attempts at risk mitigation, as well as suggestions for risk management for some of these pathogens, based on thorough international FAO/WHO risk assessments. The authors emphasise the importance of science-based programmes for the continued reduction of pathogens at relevant points of the 'farm-to-fork' food production chain, as this is the only sustainable basis for further reducing risks to human health in the area of preventable food-borne diseases.

Radiographic analysis of a cemented titanium alloy femoral component.

Proximal femoral cortical bone remodeling was evaluated radiographically about a 1 piece cemented titanium alloy femoral prosthesis implanted with modern cement techniques and was compared with one described previously in which early cement techniques and a stainless steel stem were used. Two hundred twenty-six total hip replacements (196 patients) were observed for an average of 6.3 years (range, 5-10 years). Analysis of all hips revealed that the ratio of cortical thickness to that of the overall femoral bone diameter did not change significantly about the periprosthetic bone throughout the length of the study. Cortical hypertrophy and atrophy occurred at rates similar to those seen with the early cement techniques. Distal fusiform cortical hypertrophy and the formation of osteosclerotic (reactive) lines at the bone cement interface occurred at approximately half the rate using modern cement techniques. In addition, cortical atrophy was associated with the formation of these reactive lines, the occurrence of osteolytic lesions, and progressive bone cement interface radiolucencies. Although periprosthetic cortical atrophy occurred at rates similar to those reported previously, important differences were noted between the findings of this study and the earlier study; these differences most likely were a result of cement technique or the prosthesis.

Patellofemoral complications following total knee arthroplasty. Effect of a lateral release and sacrifice of the superior lateral geniculate artery.

Between 1987 and 1989, 1,205 Anatomic Graduated Component (AGC, Biomet, Warsaw, IN) total knee arthroplasties were performed by three surgeons using the same prosthesis and same technique. Four hundred twenty-eight total knee arthroplasties (35%) had lateral releases; in 107 (75%) of these, the superior lateral geniculate artery was saved. Lateral release had no effect on patellar subluxation, dislocation, or loosening, but was associated with significantly more patellar fractures. Conversely, patellar radiolucency was more common in knees without a lateral release. Furthermore, saving the superior lateral geniculate artery during a lateral release had no effect on patellar dislocation, radiolucency, loosening, or fracture.

Outcome of the contralateral hip following total hip arthroplasty for osteoarthritis.

One thousand one hundred and sixteen patients who underwent unilateral total hip arthroplasty osteoarthritis between 1970 and 1980 were examined for development, progression, and total hip arthroplasty in the contralateral joint. At the time of the original surgery, 452 patients were diagnosed with bilateral osteoarthritis and 664 had a normal contralateral hip. The probability of osteoarthritis progressing in the contralateral joint is 78.6% at 10 years, with the chance of arthroplasty being 53.8%. The probability of a hip diagnosed as normal developing osteoarthritis is 36.5% at 10 years, with an 8.3% chance of requiring total hip arthroplasty.

Web-based delivery and open-architecture database support in the ITreS Counselor Information System.

ITreS is a prototype information system for substance abuse counselors and clinicians. ITreS integrates client records, on-line screening and assessment instruments, and knowledge bases into a single integrated system. This paper discusses two aspects of the development of ITres: the use of the World Wide Web as a development and delivery environment and the use of an attributed translation-based data model to integrate data from various sources into a single client record.

Long-term survival analysis of a posterior cruciate-retaining total condylar total knee arthroplasty.

From 1975 to 1983, 278 patients received 418 posterior cruciate ligament-retaining Total Condylar knee arthroplasties. Twenty-four patients were excluded, 15 for lack of followup data, 6 for infection during followup, and 3 for revision surgeries for previous infections. The 394 remaining knees were observed from 1 to 18 years (mean, 8.08 years). Kaplan-Meier and crude survival estimates at 12 years were 96.8% and 98.1%, respectively. Various survival analyses by other authors have yielded similar successful results.

Radiolucency at the bone-cement interface in total knee replacement. The effects of bone-surface preparation and cement technique.

Three hundred and sixty-three knees (221 patients) that had been treated with total arthroplasty between 1975 and 1985 were divided into three groups on the basis of the preparation of the surface of the bone and the technique of the cement application. Group 1 (155 knees) was treated with irrigation of the bone surfaces with a syringe and manual packing of the bone cement. Group 2 (sixty-one knees) had high-volume, high-pressure lavage of the bone surfaces and manual packing of the cement. Group 3 (147 knees) had high-volume, high-pressure lavage and pressure injection of low-viscosity methylmethacrylate cement. Radiolucency was evaluated at each follow-up interval, and the findings were subjected to chi-square analysis and Kaplan-Meier survival analysis. Chi-square analysis of the data at one and three years indicated a significantly higher frequency of lines at the bone-cement interface in the femur and tibia in Group-1 knees compared with those in Groups 2 and 3. The survival curves showed increasing rates of radiolucency adjacent to the tibial components of the knees that had been prepared with lavage that was not high-volume and high-pressure and that had been prepared with finger-packing of cement (Group 1). This may partially explain the clinical problem of loosening of tibial components despite acceptable alignment. This study demonstrates that proper preparation of the cancellous bone and pressurization of the cement reduce the initial occurrence of a radiolucent line, which may have a positive effect on the ultimate failure of at least the tibial component.

The effect of preoperative knee deformity on the initial results of cruciate-retaining total knee arthroplasty.

Between November 1985 and June 1987, 751 posterior cruciate-sparing total knee arthroplasties were performed on 523 patients who exhibited fixed varus or valgus deformities. Patients excluded from this study included the following: those with a postoperative follow-up period of less than 2 years (including patients who had died), patients who became infected, and patients with previous failed total knee arthroplasty in the same knee. A total of 473 knees left for evaluation. All arthroplasties were measured using anatomic axis for alignment measurement. The Hospital for Special Surgery scoring system was used to determine the clinical scores prior to the end of each follow-up examination. All ligament releases were performed sequentially, including balancing of the posterior cruciate ligament. All arthroplasties were divided into six separate groups depending upon the degree of varus or valgus deformity. Kaplan-Meier curves were constructed using three methods of failure definition. Curves were then compared between groups. The mean Hospital for Special Surgery score was no different between any of the groups, except for the group of 6 degrees-10 degrees varus, which was significantly higher than the mean score of the 11 degrees and higher valgus group. All other groups were the same statistically. It is concluded that severe varus and valgus deformities may be satisfactorily corrected with the use of a cruciate-retaining type of total knee arthroplasty.

Survival analysis of total condylar-type prostheses.

Between 1975 and 1983, 280 patients received 422 posterior cruciate ligament-retaining total condylar knee arthroplasties. Fifty-nine were excluded for one of the following reasons: previous total knee replacement, follow-up less than 1 year, or infection at any time during the life of the prosthesis. The 363 remaining knees were observed from 1 to 13 years (mean, 6.86). Kaplan-Meier and "crude" survival estimates at 12 years were 94.7% and 96.6%, respectively. Results of various survival analyses by other authors yield similar successful results.