RESUMEN
BACKGROUND: Humans differ in the metabolism of the neurotoxicant methyl mercury (MeHg). This variation may be partially due to variation in genes encoding the transcription factor Nuclear factor E2-related factor 2 (NRF2) and its negative regulator Kelch-like ECH-Associated Protein 1 (KEAP1), which regulate glutathione and related transporter and antioxidant proteins that play a role in the metabolism and neurotoxicity of MeHg. AIM: To elucidate a potential risk from genetic variation in NFE2L2 (encoding NRF2) and KEAP1 toward prenatal mercury exposure and child neurodevelopmental outcomes at 20 months and 7 years of age in a population with variable prenatal exposure to MeHg from maternal fish consumption. MATERIAL AND METHODS: Nutrition Cohort 2 is a mother-child cohort in the Republic of Seychelles. Children were genotyped for NFE2L2 (rs2364723, rs13001694) and KEAP1 (rs8113472, rs9676881) polymorphisms (N = 1285 after removing siblings). Total mercury (Hg) was measured in cord blood as a biomarker for prenatal MeHg exposure. Child neurodevelopmental outcomes included the Bayley Scales of Infant Development II administered at 20 months of age, and outcomes across multiple neurodevelopmental domains from 14 tests administered in children and 3 instruments completed by parents when children were 7 years of age. RESULTS: The mean cord blood MeHg concentration was 34 (95% CI 11, 75) µg/L. None of the four polymorphisms had a significant association (p < 0.05) with either cord MeHg or neurodevelopmental test results at 20 months. There were no significant associations between either NFE2L2 polymorphism and any developmental test scores. At 7 years, children carrying KEAP1 rs8113472 CA showed significantly worse performance on psychomotor function than children with the CC variant (finger tapping, dominant hand: ß - 1.19, SE 0.34; finger tapping, non-dominant hand: ß - 0.92, SE 0.31) and worse social communication (SCQ Total: ß 0.65, SE 0.27). Children carrying rs8113472 AA, versus children with CC, showed significantly better performance on social communication (SRS Total: ß - 8.88, SE 3.60). Children carrying KEAP1 rs9676881 AG, versus children with GG, showed significantly worse performance on psychomotor function (trailmaking A time: ß 8.66, SE 3.37) and cognition (KBIT Matrices: ß - 0.96, SE 0.36). CONCLUSION: No associations between NFE2L2 and KEAP1 polymorphisms and MeHg concentration were identified. However, at 7 years, KEAP1 polymorphisms were associated with differences in neurodevelopmental outcomes in children from a population with high fish intake.
Asunto(s)
Proteína 1 Asociada A ECH Tipo Kelch , Mercurio , Compuestos de Metilmercurio , Efectos Tardíos de la Exposición Prenatal , Animales , Femenino , Humanos , Lactante , Embarazo , Desarrollo Infantil , Proteína 1 Asociada A ECH Tipo Kelch/genética , Mercurio/efectos adversos , Mercurio/toxicidad , Compuestos de Metilmercurio/efectos adversos , Compuestos de Metilmercurio/toxicidad , Factor 2 Relacionado con NF-E2/genética , Efectos Tardíos de la Exposición Prenatal/genética , SeychellesRESUMEN
PROBLEM: Markers of maternal inflammation may determine infant birth outcomes. METHOD OF STUDY: Maternal serum samples were collected at 28 weeks gestation (nâ¯=â¯1418) in the Seychelles Child Development Study Nutrition Cohort 2 and analyzed for immune markers by MSD multiplex assay, including cytokines from the Th1 (IFN-γ, IL-1ß, IL-2 and TNF-α) and Th2 (IL-4, IL-5, IL-10) subsets, with IL-6, MCP-1, TARC, sFlt-1 and VEGF-D. Associations of log-transformed immune markers with birthweight, length, head circumference and gestational age were assessed by multiple linear regression models, which were adjusted for maternal age, BMI, parity, child sex, gestational age and socioeconomic status. RESULTS: Neither total Th1, Th2 nor Th1:Th2 were significantly associated with any birth outcome. However, the angiogenesis marker VEGF-D was predictive of a lower birthweight, (ßâ¯=â¯-0.058, Pâ¯=â¯0.017) and birth length (ßâ¯=â¯-0.088, Pâ¯=â¯0.001) after adjusting for covariates. Higher concentrations of CRP were predictive of a lower birthweight (ßâ¯=â¯-0.057, Pâ¯=â¯0.023) and IL-2 (ßâ¯=â¯0.073, Pâ¯=â¯0.009) and the chemokine MCP-1 (ßâ¯=â¯0.067, Pâ¯=â¯0.016) were predictive of a longer gestational age. CONCLUSIONS: In our cohort of healthy pregnant women, we found no evidence for associations between the Th1 or Th2 inflammatory markers with birth outcomes. However, VEGF-D and CRP appear to predict lower birthweight and IL-2 and MCP-1 a longer gestation. Greater understanding is required of the variation in these immune markers at different gestational stages, as well as the factors which may regulate their balance in healthy pregnancy. nâ¯=â¯233.
Asunto(s)
Peso al Nacer/inmunología , Edad Gestacional , Inflamación/diagnóstico , Segundo Trimestre del Embarazo/inmunología , Adulto , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Proteína C-Reactiva/inmunología , Recuento de Linfocito CD4 , Quimiocina CCL2/sangre , Quimiocina CCL2/inmunología , Femenino , Humanos , Recién Nacido , Inflamación/sangre , Inflamación/inmunología , Interleucina-2/sangre , Interleucina-2/inmunología , Masculino , Edad Materna , Embarazo , Segundo Trimestre del Embarazo/sangre , Seychelles , Células TH1/inmunología , Células Th2/inmunología , Factor D de Crecimiento Endotelial Vascular/sangre , Factor D de Crecimiento Endotelial Vascular/inmunología , Adulto JovenRESUMEN
We are pleased to introduce this special issue of Neurotoxicology. It reproduces Volume 7, Number 1 of the Seychelles Medical and Dental Journal (SMDJ), initially published in November 2004. Publication of the SMDJ was discontinued in 2005 and the manuscripts it published are no longer accessible to the scientific community. The papers in this special issue lay the background for the Seychelles Child Development Study (SCDS) and provide valuable data on the MeHg exposures that occurred at Niigata, Japan. They are relevant to the ongoing debate over whether the consumption of fish and consequently low-level exposure to methylmercury (MeHg) is a risk to human health.
Asunto(s)
Desarrollo Infantil/efectos de los fármacos , Exposición a Riesgos Ambientales/efectos adversos , Compuestos de Metilmercurio/toxicidad , Animales , Niño , Femenino , Peces , Contaminación de Alimentos , Humanos , Embarazo , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , SeychellesRESUMEN
BACKGROUND: Fish contains methylmercury (MeHg) which can cause oxidative stress and neurodevelopmental toxicity at sufficiently high doses. Fish also contains polyunsaturated fatty acids (PUFA) which have both antioxidant (n-3) and oxidant (n-6) properties. Mitochondrial DNA (mtDNA) is sensitive to oxidative stress but has not been previously studied in relation to MeHg exposure or PUFA status. OBJECTIVE: To investigate the associations between MeHg exposure and PUFA status during pregnancy with relative mitochondrial DNA copy number (RmtDNAcn) in mothers and their newborns. METHODS: In total, 1488 mother-child pairs from the Seychelles Child Development Study Nutrition Cohort 2 were included in this study. Total Hg was measured in maternal blood collected at 28â¯weeks' gestation, maternal hair at delivery, and in fetal cord blood. PUFA (n-3 and n-6) were measured only in maternal blood. RmtDNAcn was measured by qPCR in both maternal and cord blood. RESULTS: Increasing maternal blood Hg (ßâ¯=â¯0.001, 95%CI: 0.000, 0.002) and n-3 PUFA concentrations (ßâ¯=â¯0.183, 95%CI: 0.048, 0.317) were associated with higher maternal RmtDNAcn. Increasing maternal n-6 PUFA (ßâ¯=â¯-0.103, 95%CI: -0.145, -0.062) and n-6/n-3 ratio (ßâ¯=â¯-0.011, 95%CI: -0.017, -0.004) were associated with lower maternal RmtDNAcn. Increasing fetal cord blood Hg was associated with lower fetal RmtDNAcn (ßâ¯=â¯-0.002, 95%CI: -0.004, -0.000). Neither maternal blood Hg nor PUFA status was associated with fetal RmtDNAcn. CONCLUSIONS: Our findings suggest that MeHg and PUFA may influence mitochondrial homeostasis although the magnitude of these associations are small. Future studies should confirm the findings and explore the underlying mechanisms.
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Desarrollo Infantil , ADN Mitocondrial/efectos de los fármacos , Ácidos Grasos Omega-3/sangre , Compuestos de Metilmercurio/sangre , Adulto , Animales , Estudios de Cohortes , Femenino , Sangre Fetal , Peces , Humanos , Recién Nacido , Masculino , Madres , Estado Nutricional , Embarazo , Alimentos Marinos/análisis , SeychellesRESUMEN
INTRODUCTION: Glutathione (GSH) pathways play a key role the metabolism and elimination of the neurotoxicant methylmercury (MeHg). We hypothesized that maternal genetic variation linked to GSH pathways could influence MeHg concentrations in pregnant mothers and children and thereby also affect early life development. METHODS: The GCLM (rs41303970, C/T), GCLC (rs761142, T/G) and GSTP1 (rs1695, A/G) polymorphisms were genotyped in 1449 mothers in a prospective study of the Seychellois population with a diet rich in fish. Genotypes were analyzed in association with maternal hair and blood Hg, fetal blood Hg (cord blood Hg), as well as children's mental (MDI) and motor development (PDI; MDI and PDI assessed by Bayley Scales of Infant Development at 20â¯months). We also examined whether genotypes modified the association between Hg exposure and developmental outcomes. RESULTS: GCLC rs761142 TT homozygotes showed statistically higher mean maternal hair Hg (4.12â¯ppm) than G carriers (AG 3.73 and GG 3.52â¯ppm) (pâ¯=â¯0.037). For the combination of GCLC rs761142 and GCLM rs41303970, double homozygotes TTâ¯+â¯CC showed higher hair Hg (4.40â¯ppm) than Gâ¯+â¯T carriers (3.44â¯ppm; pâ¯=â¯0.018). No associations were observed between GSTP1 rs1695 and maternal hair Hg or between any genotypes and maternal blood Hg or cord blood Hg. The maternal GSTP1 rs1695 rare allele (G) was associated with a lower MDI among children (ßâ¯=â¯-1.48, pâ¯=â¯0.048). We also observed some interactions: increasing Hg in maternal and cord blood was associated with lower PDI among GCLC rs761142 TT carriers; and increasing Hg in hair was associated with lower MDI among GSTP1 rs1695 GG carriers. CONCLUSIONS: Maternal genetic variation in genes involved in GSH synthesis is statistically associated with Hg concentrations in maternal hair, but not in maternal or fetal blood. We observed interactions that suggest maternal GSH genetics may modify associations between MeHg exposure and neurodevelopmental outcomes.
Asunto(s)
Desarrollo Infantil , Glutatión/genética , Exposición Materna/estadística & datos numéricos , Mercurio/sangre , Compuestos de Metilmercurio/toxicidad , Alimentos Marinos/análisis , Animales , Niño , Femenino , Peces , Glutatión/metabolismo , Humanos , Polimorfismo Genético/genéticaRESUMEN
BACKGROUND: ATP-binding cassette (ABC) transporters have been associated with methylmercury (MeHg) toxicity in experimental animal models. AIMS: To evaluate the association of single nucleotide polymorphisms (SNPs) in maternal ABC transporter genes with 1) maternal hair MeHg concentrations during pregnancy and 2) child neurodevelopmental outcomes. MATERIALS AND METHODS: Nutrition Cohort 2 (NC2) is an observational mother-child cohort recruited in the Republic of Seychelles from 2008-2011. Total mercury (Hg) was measured in maternal hair growing during pregnancy as a biomarker for prenatal MeHg exposure (N=1313) (mean 3.9ppm). Infants completed developmental assessments by Bayley Scales of Infant Development II (BSID-II) at 20months of age (N=1331). Genotyping for fifteen SNPs in ABCC1, ABCC2 and ABCB1 was performed for the mothers. RESULTS: Seven of fifteen ABC SNPs (ABCC1 rs11075290, rs212093, and rs215088; ABCC2 rs717620; ABCB1 rs10276499, rs1202169, and rs2032582) were associated with concentrations of maternal hair Hg (p<0.001 to 0.013). One SNP (ABCC1 rs11075290) was also significantly associated with neurodevelopment; children born to mothers with rs11075290 CC genotype (mean hair Hg 3.6ppm) scored on average 2 points lower on the Mental Development Index (MDI) and 3 points lower on the Psychomotor Development Index (PDI) than children born to mothers with TT genotype (mean hair Hg 4.7ppm) while children with the CT genotype (mean hair Hg 4.0ppm) had intermediate BSID scores. DISCUSSION: Genetic variation in ABC transporter genes was associated with maternal hair Hg concentrations. The implications for MeHg dose in the developing child and neurodevelopmental outcomes need to be further investigated.
Asunto(s)
Transportadoras de Casetes de Unión a ATP/genética , Desarrollo Infantil , Contaminantes Ambientales/análisis , Mercurio/análisis , Compuestos de Metilmercurio/metabolismo , Adulto , Estudios de Cohortes , Femenino , Genotipo , Cabello/química , Humanos , Lactante , Masculino , Exposición Materna , Intercambio Materno-Fetal , Madres , Proteína 2 Asociada a Resistencia a Múltiples Medicamentos , Polimorfismo de Nucleótido Simple , Embarazo , Seychelles , Adulto JovenRESUMEN
Long-chain n-6 and n-3 PUFA (LC-PUFA), arachidonic acid (AA) (20:4n-6) and DHA (22:6n-3), are critical for optimal brain development. These fatty acids can be consumed directly from the diet, or synthesized endogenously from precursor PUFA by Δ-5 (encoded by FADS1) and Δ-6 desaturases (encoded by FADS2). The aim of this study was to determine the potential importance of maternal genetic variability in FADS1 and FADS2 genes to maternal LC-PUFA status and infant neurodevelopment in populations with high fish intakes. The Nutrition Cohorts 1 (NC1) and 2 (NC2) are longitudinal observational mother-child cohorts in the Republic of Seychelles. Maternal serum LC-PUFA was measured at 28 weeks gestation and genotyping for rs174537 (FADS1), rs174561 (FADS1), rs3834458 (FADS1-FADS2) and rs174575 (FADS2) was performed in both cohorts. The children completed the Bayley Scales of Infant Development II (BSID-II) at 30 months in NC1 and at 20 months in NC2. Complete data were available for 221 and 1310 mothers from NC1 and NC2 respectively. With increasing number of rs3834458 minor alleles, maternal concentrations of AA were significantly decreased (NC1 p=0.004; NC2 p<0.001) and precursor:product ratios for linoleic acid (LA) (18:2n-6)-to-AA (NC1 p<0.001; NC2 p<0.001) and α-linolenic acid (ALA) (18:3n-3)-to-DHA were increased (NC2 p=0.028). There were no significant associations between maternal FADS genotype and BSID-II scores in either cohort. A trend for improved PDI was found among infants born to mothers with the minor rs3834458 allele.In these high fish-eating cohorts, genetic variability in FADS genes was associated with maternal AA status measured in serum and a subtle association of the FADS genotype was found with neurodevelopment.
Asunto(s)
Enfermedades Carenciales/genética , Ácido Graso Desaturasas/genética , Desarrollo Fetal , Fenómenos Fisiologicos Nutricionales Maternos , Polimorfismo de Nucleótido Simple , Complicaciones del Embarazo/genética , Animales , Ácidos Araquidónicos/sangre , Ácidos Araquidónicos/deficiencia , Trastornos del Conocimiento/genética , Trastornos del Conocimiento/metabolismo , Enfermedades Carenciales/sangre , Enfermedades Carenciales/metabolismo , delta-5 Desaturasa de Ácido Graso , Ácido Graso Desaturasas/metabolismo , Femenino , Peces , Estudios de Asociación Genética , Humanos , Recién Nacido , Masculino , Neurogénesis , Nutrigenómica/métodos , Estado Nutricional , Estudios Observacionales como Asunto , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/metabolismo , Alimentos Marinos , SeychellesRESUMEN
BACKGROUND: Fish are important sources of protein and contain a variety of nutrients, such as n-3 long-chain polyunsaturated fatty acids (PUFA), essential for normal brain development. Nevertheless, all fish also contain methyl mercury (MeHg), a known neurotoxicant in adequate dosage. Our studies of the Seychelles Child Development Study (SCDS) Main Cohort enrolled in 1989-1990 (n=779) have found no consistent pattern of adverse MeHg effects at exposures achieved by daily fish consumption. Rather, we have observed evidence of improved performance on some cognitive endpoints as prenatal MeHg exposure increases in the range studied. These observations cannot be related to MeHg and may reflect the role of unmeasured covariates such as essential nutrients present in fish. To determine if these associations persist into young adulthood, we examined the relationship between prenatal MeHg exposure, recent PUFA exposure and subjects' neurodevelopment and behavior at 19 years of age. METHODS: We examined 533 participants using the following test battery: the Profile of Mood States-Bipolar (POMS-Bi); Finger Tapping; Kaufman Brief Intelligence Test (K-BIT); measures of Fine Motor Control and Complex Perceptual Motor Control; and Visual Spatial Contrast Sensitivity. We collected the following covariates: maternal IQ, family life course stressors, socioeconomic status, and subjects' recent postnatal MeHg, sex, and computer use. Primary analyses (based on N=392-475) examined covariate-adjusted associations in multiple linear regression models with prenatal MeHg as the primary exposure measure. Secondary analyses additionally adjusted for total n-6 and fish-related n-3 PUFA measured in the subjects' serum at the 19-year examination. RESULTS: Study participants had a mean prenatal MeHg exposure of 6.9 ppm, and a mean recent postnatal exposure of 10.3 ppm. There were no adverse associations between prenatal MeHg and any of the measured endpoints. For recent postnatal MeHg exposure, however, adverse associations were observed for Finger Tapping (non-dominant hand) among women and for the K-BIT Matrices for both sexes, with or without adjustment for PUFA. CONCLUSION: Our findings continue to provide no evidence for an adverse effect of prenatal MeHg exposure on development in a cohort that consumes fish daily. Observations for postnatal MeHg exposure will need to be confirmed using more comprehensive exposure measures.
Asunto(s)
Desarrollo del Adolescente/efectos de los fármacos , Compuestos de Metilmercurio/toxicidad , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Efectos Tardíos de la Exposición Prenatal/psicología , Adolescente , Ácidos Grasos Omega-3/sangre , Ácidos Grasos Omega-6/sangre , Femenino , Contaminación de Alimentos , Humanos , Masculino , Pruebas Neuropsicológicas , Embarazo , Efectos Tardíos de la Exposición Prenatal/sangre , Seychelles , Adulto JovenRESUMEN
Serum uric acid (SUA) concentration is independently associated with blood pressure (BP) in adults. We examined this association in young adults at an age where anti-hypertension treatment, other potential confounding factors and co-morbidity are unlikely to occur. We assessed BP, anthropometric variables including weight, height, waist circumference (WC), body fat percent (using bioimpedance), lifestyle behaviors, SUA and blood lipids in 549 participants aged 19-20 years from a population-based cohort study (Seychelles Child Development Study). Mean (s.d.) SUA was higher in males than females, 0.33 (0.08) and 0.24 (0.07) mmol l(-1), respectively. Body mass index (BMI) was higher in females than males but BP was markedly higher in males than in females. SUA was associated with both systolic and diastolic BP. However, the magnitude of the linear regression coefficients relating BP and SUA decreased by up to 50% upon adjustment for BMI, WC or body fat percent. The association between SUA and BP was not altered upon further adjustment for alcohol intake, smoking, triglycerides or renal function. In fully adjusted models, SUA remained associated with BP (P<0.05) in females. In conclusion, adiposity substantially decreased the association between SUA and BP in young adults, and BP was independently associated with SUA in females. These findings suggest a role of adiposity in the link between hyperuricemia and hypertension.
Asunto(s)
Adiposidad/fisiología , Presión Sanguínea/fisiología , Ácido Úrico/sangre , Índice de Masa Corporal , Estudios de Cohortes , Impedancia Eléctrica , Femenino , Humanos , Hipertensión/sangre , Hipertensión/fisiopatología , Masculino , Modelos Biológicos , Factores Sexuales , Seychelles , Circunferencia de la Cintura/fisiología , Adulto JovenRESUMEN
The aim of this study was to compare the component positioning of Birmingham Hip Resurfacings implanted through a posterolateral approach with those inserted via a direct lateral approach. Sixty-four hip resurfacings for osteoarthritis were carried out by a single surgeon: 23 through a direct lateral approach and 41 through a posterolateral approach. No significant differences in implant survival, Oxford Hip Scores or complications were found. The mean abduction angle for the acetabular component was lower (p < 0.007) with a posterior approach (mean: 37.5 degrees ; range 26-50 degrees ) than the lateral approach (mean: 43 degrees ; range 30-56 degrees ). There was no significant difference in stem orientation, either in flexion/extension or varus/valgus, between the two groups. This study demonstrates that components can be implanted in an acceptable orientation through either approach but that the posterior approach results in greater closure of the acetabular component.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera , Osteoartritis de la Cadera/cirugía , Adulto , Anciano , Femenino , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiología , Articulación de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Ajuste de Prótesis , Radiografía , Rango del Movimiento Articular/fisiología , Estudios RetrospectivosRESUMEN
Information on the status of long-chain polyunsaturated fatty acids (LCPUFAs) in pregnancy and breast milk in very high fish-eating populations is limited. The aim of this study was to examine dietary intake and changes in fatty acid status in a population of pregnant women in the Republic of Seychelles. Serum docosahexaenoic acid (DHA) decreased significantly between 28-week gestation and delivery (n=196). DHA status did not correlate significantly with length of gestation and was not associated with self-reported fish intake, which was high at 527 g/week. In breast milk, the ratio of DHA to arachidonic acid (AA) was consistent with those observed in other high fish-eating populations. Overall the data suggest that high exposure to LCPUFAs from habitual fish consumption does not prevent the documented decrease in LCPUFA status in pregnancy that occurs as a result of foetal accretion in the third trimester of pregnancy.
Asunto(s)
Ingestión de Energía/fisiología , Ácidos Grasos Insaturados/metabolismo , Peces , Alimentos Marinos/análisis , Adulto , Animales , Desarrollo Infantil/fisiología , Dieta , Ácidos Docosahexaenoicos/análisis , Ácidos Docosahexaenoicos/sangre , Ácidos Eicosanoicos/análisis , Ácidos Eicosanoicos/sangre , Ácidos Grasos Insaturados/análisis , Ácidos Grasos Insaturados/sangre , Femenino , Edad Gestacional , Humanos , Recién Nacido , Leche Humana/química , Leche Humana/metabolismo , Fenómenos Fisiológicos de la Nutrición , Periodo Posparto/sangre , Periodo Posparto/metabolismo , Embarazo , Tercer Trimestre del Embarazo/sangre , Tercer Trimestre del Embarazo/metabolismo , SeychellesRESUMEN
We reviewed 131 consecutive primary total hip replacements implanted into 127 patients between 1995 and 1997. Surgery was performed through a Hardinge approach using the Exeter universal stem in combination with the Ogee Elite acetabular component.Five of 131 hips have required revision. The ten year survival analysis demonstrates: 95.3% survival with revision for any cause as the end point; 98.9% with revision for aseptic loosening of the stem as the endpoint, 98.1% revision for aseptic loosening of the acetabular component as the endpoint. There were no cases of dislocation.Our findings show that the Exeter universal stem in combination with the Ogee Elite acetabular component can be inserted through a Hardinge approach in a district general setting with results comparable to surgery performed in a specialist unit and through a posterior approach.
Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera , Osteoartritis de la Cadera/cirugía , Diseño de Prótesis , Acetábulo/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , Reoperación , Estudios RetrospectivosRESUMEN
Pathological fractures due to metastasis with destruction of the acetabulum and central dislocation of the hip present a difficult surgical challenge. We describe a series using a single technique in which a stable and long-lasting reconstruction was obtained using standard primary hip replacement implants augmented by strong, fully-threaded steel rods with cement and steel mesh, where required. Between 1997 and 2006, 19 patients with a mean age of 66 years (48 to 83) were treated using a modified Harrington technique. Acetabular destruction was graded as Harrington class II in six cases and class III in 13. Reconstruction was achieved using three 6.5 mm rods inserted through a separate incision in the iliac crest followed by augmentation with cement and a conventional cemented Charnley or Exeter primary hip replacement. There were no peri-operative deaths. At the final follow-up (mean 25 months (5 to 110)) one rod had fractured and one construct required revision. Of the 18 patients who did not require revision, 13 had died. The mean time to death was 16 months (5 to 55). The mean follow-up of the five survivors was 31 months (18 to 47). There were no cases of dislocation, deep infection or injury to a nerve, the blood vessels or the bladder.
Asunto(s)
Acetábulo , Neoplasias Óseas/cirugía , Fracturas Óseas/cirugía , Fracturas Espontáneas/cirugía , Procedimientos Ortopédicos/métodos , Procedimientos de Cirugía Plástica/métodos , Acetábulo/lesiones , Acetábulo/cirugía , Neoplasias de las Glándulas Suprarrenales/patología , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/secundario , Neoplasias de la Mama/patología , Carcinoma/secundario , Cementación , Femenino , Fracturas Óseas/etiología , Fracturas Espontáneas/etiología , Luxación de la Cadera/etiología , Luxación de la Cadera/cirugía , Prótesis de Cadera , Humanos , Ilion/cirugía , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Mieloma Múltiple/secundario , Diseño de Prótesis , Falla de Prótesis , Neoplasias de la Tiroides/patología , Resultado del TratamientoRESUMEN
We have investigated whether improvements in design have altered the outcome for patients undergoing endoprosthetic replacement of the proximal tibia following resection of a tumour. Survival of the implant and 'servicing' procedures have been documented using a prospective database. A total of 194 patients underwent a proximal tibial replacement, with 95 having a fixed-hinge design and 99 a rotating-hinge with a hydroxyapatite collar; their median age was 21.5 years (10 to 74). At a mean follow-up of 14.7 years (5 to 29), 115 patients remain alive. The risk of revision for any reason in the fixed-hinge group was 32% at five years, 61% at ten years and 75% at 15 and 20 years, and in the rotating-hinge group 12% at five years, 25% at ten years and 30% at 15 years. Aseptic loosening was the most common reason for revision in the fixed-hinge knees, fracture of the implant in the early design of rotating hinges and infection in the current version. The risk of revision for aseptic loosening in the fixed-hinge knees was 46% at ten years. This was reduced to 3% in the rotating-hinge knee with a hydroxyapatite collar. The cemented, rotating hinge design currently offers the best chance of long-term survival of the prosthesis.
Asunto(s)
Neoplasias Óseas/cirugía , Prótesis de la Rodilla , Recuperación del Miembro/métodos , Tibia/cirugía , Adolescente , Adulto , Distribución por Edad , Anciano , Amputación Quirúrgica , Niño , Humanos , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , Infecciones Relacionadas con Prótesis , Reoperación , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
We investigated whether improvements in design have altered the outcome for patients undergoing endoprosthetic replacement of the distal femur after resection of a tumour. Survival of the implant and 'servicing' procedures have been documented using a prospective database, review of the design of the implant and case records. In total, 335 patients underwent a distal femoral replacement, 162 having a fixed-hinge design and 173 a rotating-hinge. The median age of the patients was 24 years (interquartile range 17 to 48). A total of 192 patients remained alive with a mean follow-up of 12 years (5 to 30). The risk of revision for any reason was 17% at five years, 33% at ten years and 58% at 20 years. Aseptic loosening was the main reason for revision of the fixed-hinge knees while infection and fracture of the stem were the most common for the rotating-hinge implant. The risk of revision for aseptic loosening was 35% at ten years with the fixed-hinge knee, which has, however, been replaced by the rotating-hinge knee with a hydroxyapatite collar. The overall risk of revision for any reason fell by 52% when the rotating-hinge implant was used. Improvements in the design of distal femoral endoprostheses have significantly decreased the need for revision operations, but infection remains a serious problem. We believe that a cemented, rotating-hinge prosthesis with a hydroxyapatite collar offers the best chance of long-term survival of the prosthesis.
Asunto(s)
Neoplasias Femorales/cirugía , Prótesis e Implantes , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Recuperación del Miembro/métodos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/cirugía , Reoperación , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Several biological media have been used as indicators of the fetal body burden of methylmercury and the levels in the primary target tissue, the developing brain. These media include maternal hair and blood. The relative merits of these media will be considered both with regard to current knowledge of the physiology of mercury disposition in the body and also the practicality of field application with respect to sample, collection, transport, storage and processing.
Asunto(s)
Monitoreo del Ambiente , Compuestos de Metilmercurio/análisis , Adulto , Femenino , Cabello/química , Humanos , Indicadores y Reactivos , Compuestos de Metilmercurio/sangre , Compuestos de Metilmercurio/farmacocinética , EmbarazoRESUMEN
We identified 25 children (10 girls and 15 boys) who had been treated with single bone intramedullary fixation for diaphyseal fractures of both forearm bones. Their mean age was 10.75 years (4.6 to 15.9). All had a good functional outcome. We conclude that in selected children, single bone intramedullary nailing is a suitable method of treatment for diaphyseal fractures of both bones of the forearm.