Influence of omega-6/omega-3 rich dietary oils on lipid profile and antioxidant enzymes in normal and stressed rats.

To evaluate the influence of omega-6/omega-3 poly unsaturated fatty acid (PUFA) containing oils on lipid profile and endogenous antioxidant enzymes in normal and stressed (immobilization) rats, 28 day old male Wistar rats were fed for 45 days with fat enriched special diet (10% fat) prepared with sunflower oil (SO)--omega-6 rich, mustard oil (MO)--omega-3 rich and groundnut oil--control respectively. SO treated normal rats have significantly reduced total cholesterol, high density lipoprotein-cholesterol (HDL-C) and catalase thereby significantly increased the atherogenic index (AI) and lipid peroxidation (LPO). However, treatment with MO increased superoxide dismutase; decreased LPO significantly. Under stress conditions AI and LPO were significantly high with SO and significantly less with MO. In addition, SO decreased HDL-C whereas MO decreased non-HDL-C significantly. Results suggest a protective role against AI and LPO in normal and stress conditions in MO. The quantity of omega-3 fatty acids in dietary oil may play a crucial role in the body against atherogenicity. The findings signify that not just PUFA, but type of PUFA present in dietary oil used is important.

Is there a place for shelf acetabuloplasty in the management of adult acetabular dysplasia? A survivorship study.

We followed up 76 consecutive hips with symptomatic acetabular dysplasia treated by acetabular shelf augmentation for a mean period of 11 years. Survival analysis using conversion to hip replacement as an end-point was 86% at five years and 46% at ten years. Forty-four hips with slight or no narrowing of the joint space pre-operatively had a survival of 97% at five and 75% at ten years. This was significantly higher (p = 0.0007) than that of the 32 hips with moderate or severe narrowing of the joint-space, which was 76% at five and 22% at ten years. There was no significant relationship between survival and age (p = 0.37) or the pre- and post-operative centre-edge (p = 0.39) and acetabular angles (p = 0.85). Shelf acetabuloplasty is a reliable, safe procedure offering medium-term symptomatic relief for adults with acetabular dysplasia. The best results were achieved in patients with mild and moderate dysplasia of the hip with little arthritis.

Surgical treatment of late developmental displacement of the hip. Results after 33 years.

The outcome of displaced hips treated by Somerville and Scott's method was assessed after more than 25 years. A total of 147 patients (191 displaced hips) was reviewed which represented an overall follow-up of 65.6%. The median age at the index operation was two years. During the first five years, 25 (13%) hips showed signs of avascular change. The late development of valgus angulation of the neck, after ten years, was seen in 69 (36%) hips. Further operations were frequently necessary. Moderate to severe osteoarthritis developed at a young age in 40% of the hips. Total hip replacement or arthrodesis was necessary in 27 (14%) hips at a mean age of 36.5 years. Risk factors identified were high dislocation, open reduction, and age at the original operation. Two groups of patients were compared according to outcome. All the radiographic indices were different between the two groups after ten years, but most were similar before. It takes a generation to establish the prognosis, although some early indicators may help to predict outcome.

The false profile arthrogram in developmental dysplasia of the hip.

Arthrography is useful in the evaluation and treatment of developmental dysplasia of the hip. The authors describe the additional diagnostic value obtained from a "false profile" arthrogram. The "false profile" arthrogram allows assessment of anterior acetabulum cover, femoral neck anteversion and hip joint subluxation (instability), which may not be apparent on other views. (Hip International 2005; 15: 177-81).

Dynamic foot movement in children treated for congenital talipes equinovarus.

The aim of this study was to define objectively gait function in children with treated congenital talipes equinovarus (CTEV) and a good clinical result. The study also attempted an analysis of movement within the foot during gait. We compared 20 children with treated CTEV with 15 control subjects. Clinical assessment demonstrated good results from treatment. Three-dimensional gait analysis provided kinematic and kinetic data describing movement and moments at the joints of the lower limb during gait. A new method was used to study movement within the foot during gait. The data on gait showed significantly increased internal rotation of the foot during walking which was partially compensated for by external rotation at the hip. A mild foot drop and reduced plantar flexor power were also observed. Dorsiflexion at the midfoot was significantly increased, which probably compensated for reduced mobility at the hindfoot. Patients treated for CTEV with a good clinical result should be expected to have nearly normal gait and dynamic foot movement, but there may be residual intoeing, mild foot drop, loss of plantar flexor power with compensatory increased midfoot dorsiflexion and external hip rotation.

Reliability of the Severin classification in the assessment of developmental dysplasia of the hip.

This study was undertaken to investigate the reliability of Severin's classification at various ages, and to determine whether the reliability is improved by careful measurement rather than subjective assessment. The radiographs taken at ages 6, 10 and 16 years of 20 randomly selected patients treated for developmental dysplasia of the hip were graded by six observers on two separate occasions using parameters measured according to Severin's criteria. In addition, four of these observers regraded the same radiographs using subjective assessment without measurements being made on two other separate occasions. Agreements between and within observers were evaluated using the weighted Cohen's kappa statistic for each age group. Intraobserver reliability was good, there being a close association between the measured and the subjectively observed ratings. This accords with the subjective nature of this classification. The interobserver reliability was found to be poor although it improved when direct measurements were made. Overall agreement between observers improves as patient age increases. It is concluded that comparisons between different observers using the Severin classification system are not reliable. However, a single investigator comparing treatment modalities in the same study allowing for individual bias in assessing deformity and subluxation would produce reliable results.

The hip in hereditary multiple exostoses.

We defined the characteristics of dysplasia and coxa valga in hereditary multiple exostoses (HME) by radiological analysis of 24 hips in 12 patients. The degree and effect of the 'osteochondroma load' around the hip were quantified. We investigated the pathology of the labrum and the incidence of osteoarthritis and of malignant change in these patients. Coxa valga and dysplasia were common with a median neck-shaft angle of 156 degrees, a median centre-edge angle of 23 degrees and Sharp's acetabular angle of 44 degrees. There was overgrowth of the femoral neck with a significantly greater ratio of the neck/shaft diameter in HME than in the control hips (p < 0.05), as well as correlations between the proximal femoral and pelvic osteochondroma load (p < 0.05) and between the proximal femoral osteochondroma load and coxa valga (p < 0.01). Periacetabular osteochondromas are related to Sharp's angle as an index of dysplasia (p < 0.05), but not coxa valga. No correlation was found between dysplasia and coxa valga. These data suggest that HME may cause anomalies of the hip as a reflection of a generalised inherited defect, but also support the theory that osteochondromas may themselves precipitate some of the characteristic features of HME around the hip.

Microanatomy of the acetabular cavity and its relation to growth.

The anatomy and development of the growing acetabulum are not clearly understood. We dissected and studied histologically two acetabula from the pelvis of a three-month-old infant. Relative rates of growth at the different growth plates were assessed by comparing the height of the proliferative layer with that of the hypertrophic layer. The three bones which form the acetabulum are surrounded by growth plates on all sides except medially. These face towards the centre of the triradiate cartilage, the limbs of the triradiate cartilage and the articular surface and each may be divided into four distinct areas according to the orientation of its cell columns which reflect the direction of growth. Growth was particularly rapid at the ischial growth plates directed towards the centre and the articular cartilage, add on both sides of the anterior limb of the triradiate cartilage. These findings may explain the mechanism by which the acetabulum changes orientation and inclination with growth.

Does early treatment by abduction splintage improve the development of dysplastic but stable neonatal hips?

A prospective trial was carried out to assess the outcome of children aged from 2 to 6 weeks with stable but dysplastic hips, treated with abduction splintage or by observation. Forty-four patients with 63 dysplastic hips were entered into the study and allocated into the two treatment groups at random. The ultrasound measured percentage acetabular cover in the splinted group improved in the first 3 months from an average of 32.8 to 54.3%. In the unsplinted group, the increase in cover was from 36.7 to 48.6%. The changes in cover for the splinted group were significantly more than those for the unsplinted group (p < 0.003) There was, however, no significant difference between the two groups in acetabular angle measurements on plain radiographs taken at 3 months. At 24 months, similarly, there was no significant difference in the acetabular angles of the two groups. These results support the view that stable dysplastic hips will correct with growth and that there is no sustained benefit from early splintage.

Xanthoma disseminatum with respiratory tract involvement and fatal outcome.

Xanthoma disseminatum (XD) is a rare mucocutaneous xanthomatosis classified as a benign form of non-Langerhans' cell histiocytosis. The case history is presented of a 61 year old woman with XD who developed dyspnoea and spirometric features of airflow obstruction. Bronchoscopy and computed tomography confirmed involvement of the large and medium sized bronchi and she subsequently died from acute respiratory failure. The post-mortem findings and the importance of respiratory tract disease in this unusual condition are discussed.

Acetabular dysplasia and failure of development of the ischiopubic synchondrosis: a report of three related cases.

Three cases of acetabular dysplasia associated with failed ossification of the ischiopubic synchondrosis are presented. The patients are second-degree relatives and all skeletally mature with no evidence of other pathological process to delay ossification. A summary of the development of the inferior pubic ramus is presented and the literature of this unusual condition is reviewed.

Fatal complication of an expandable metallic bronchial stent.

A case of massive fatal haemoptysis secondary to erosion of a Gianturco expandable wire bronchial stent is described. The stent had been inserted for a benign bronchial stenosis. CT demonstrated erosion of the stent through the oesophagus and a false aneurysm of the descending thoracic aorta. The CT and plain radiographic appearances are presented. The potential for progressive migration and local damage should limit the use of this type of stent in benign bronchial stenoses.

MRI after operative reduction for developmental dysplasia of the hip.

We performed MRI on 13 infants after operative reduction for developmental dysplasia of the hip (DDH). Using an axial gradient-echo sequence, MRI accurately depicted the acetabular anatomy and confirmed adequate reduction in 12 patients. The one patient with redislocation after surgery was correctly identified. MRI can be carried out quickly, inexpensively and without risk of radiation and is the investigation of choice to confirm adequate reduction in DDH.

The reliability of measurements of pelvic radiographs in infants.

We have evaluated the reliability of the measurement of radiological indicators in developmental dysplasia of the hip. Three observers each independently assessed 60 pelvic radiographs from infants aged from 3 to 36 months. Errors from the true value of a single measurement made by a single observer (E1), of the average of two measurements by a single observer (E2), and of the average of two single measurements by two different observers (E3) were established for the acetabular index of Hilgenreiner, for the assessment of superior and lateral femoral displacement and for indicators of pelvic alignment. The errors for the assessment of the acetabular index were E1 +/- 5 degrees, E2 +/- 5 degrees, and E3 +/- 3.5 degrees. There was a significant correlation between the presence of an acetabular notch on the radiograph and an increased error in measurement (p = 0.01). Yamamuro's measurement of lateral femoral displacement was more reliable than the Hilgenreiner distance. The errors of indicators of pelvic alignment showed a correlation with the age of the infant; the quotient of pelvic rotation was more reliable after seven months of age (p < 0.0001). The errors of the measurement of the symphysis os-ischium angle tended to increase with age and those of the measurement of the index of pelvic tilt decreased with skeletal maturation (p = 0.002).

Acute colonic pseudo-obstruction after total hip replacement.

Acute colonic pseudo-obstruction is a poorly recognised and potentially fatal complication of hip surgery. Between 1991 and 1994 six patients were observed who required laparotomy after failure of medical management. In three the indication was signs of peritonism, while in the other three exploration was required to exclude segmental ischaemia and to decompress the bowel. In all, there was no evidence of mechanical obstruction. Patients having total hip replacement are at risk of developing pseudo-obstruction due to their age, comorbidity, high doses of analgesics and the nature of the operation. If postoperative ileus persists for more than 48 hours acute colonic pseudo-obstruction should be suspected and confirmed by plain radiography. Prompt recognition and treatment with early referral to a colorectal unit are indicated. Laparotomy appears to carry less risk than that for patients with idiopathic pseudo-obstruction, but should be performed only if colonic ischaemia is suspected.

Acetabular notch.

Ultrasound images of dysplastic and/or unstable hips often display an indentation or notch at the superolateral part of the acetabulum where the iliac wing joins the acetabular roof. We reviewed the ultrasound and subsequent radiographic examinations of 295 babies examined in our hip screening clinic. Of the hips with a notch demonstrable at the first ultrasound, 97% had a persistent notch at the second ultrasound and in 79% the notch was apparent on the 3-month radiograph. When the notch persists, we believe that it represents damage to the lateral acetabular ring epiphysis and delayed maturation of the lateral acetabulum.