The Furlong hydroxyapatite-coated total hip replacement in patients under age 51. A 6-year follow-up study.

Forty-five Furlong hydroxyapatite-coated total hip replacements were reviewed at an average of 71 months (46-89) after surgery. Patient's average age at surgery was 46 years (31-50). The average Harris hip score at the time of final review was 89, and 38 hips (84%) had no pain (28) or only slight pain (10). Three hips were revised, none for aseptic loosening. Two cups were loose. The remainder of the cups and all the stems were radiographically stable with positive evidence of bone ingrowth and no signs of impending failure. One cup showed definite wear of the polyethylene liner. Focal progressive osteolytic lesions occurred in the calcar region in 3 stable hips (7%). To date the Furlong hydroxyapatite-coated implant has produced encouraging results in this group of young patients, although longer follow-up is needed to determine its durability.

The Furlong hydroxyapatite-coated femoral prosthesis. A 4- to 7-year follow-up study.

We report the clinical and radiograph outcome of 77 Furlong hydroxyapatite fully coated femoral prosthesis in 71 patients undergoing primary total hip replacement, with mean follow-up of 65 months (range 48-82 months). The patients' average age at surgery was 55 years. The clinical results, as determined by Harris hip score, were excellent or good for 84% of the hips. Thigh pain which was not disturbing was present in 9% of the hips. No femoral component had been revised for aseptic loosening, and none were considered loose radiographically at the time of final follow-up evaluation. Serial radiographs revealed an excellent quality of bone around the prostheses, with positive evidence of bone ingrowth and no signs of impending failure.

Asymmetric bilateral traumatic hip dislocation.

A case of a patient with traumatic, simultaneous right posterior and left anterior hip dislocations without associated fractures is reported. Simultaneous asymmetric bilateral hip dislocation is very rare. The mechanism of this injury is discussed.

The health status of women in Oaxaca: determinants and consequences.

Survey data from a sample of 575 women from the city of Oaxaca de Juárez, Mexico, are analyzed to ascertain the effect of the receipt of job-related benefits, including health benefits, on the self-reported health status of women, their rating of the health of the members of their household, and their satisfaction with the health of the members of their household. Health status depends on the woman's age, her socioeconomic status, and the number of children she has borne. Her rating of the health of the members of her household is related to her age, her socioeconomic status, and her rating of her own health. Satisfaction with the physical health of the members of the household is a function her health, her rating of the health of her household, her age, her socioeconomic status and the number of children she has borne. The overall conclusion is that, in this study, it is socioeconomic and demographic factors that are important in determining the woman's health status, rather than the receipt of job-related benefits. That she reports good health is an important factor in her view of her family's health and her satisfaction with her own health and that of her family.

Migrants to and in Oaxaca City.

"This paper examines migration to Oaxaca City, an intermediate city in southern Mexico, and describes the differences between migrants and non-migrants. The data show that migrants to Oaxaca City tend to come from district capitals rather than more rural municipios. Once in Oaxaca, migrants are not as different from non-migrants as is commonly asserted in the literature."

Proximity as a mediating influence on the perceived aging parent-adult child relationship.

This research examines whether proximity has a mediating influence on the quality of the relationship between aging parents and adult children. Results of LOGIST regressions indicate no difference in quality of relationships between groups of parents whose children live near them and whose children live more than 60 miles away. Significant predictors of the relationships for the proximate group were personal sense of control and education, and for the distant group, sex of the child, and number of living children. Our findings support the contention that the modified extended family can maintain psychological closeness regardless of physical distance.

Assessment of the outcome of low back surgery.

We aimed to develop a better understanding and method of rating the success or failure of low back surgery by studying 185 patients prospectively. Identical pre-operative and postoperative assessment by an independent observer included pain, disability, physical impairment, psychological distress and illness behaviour. Outcome was assessed by the patient, by the observer and by return to work. There was 96% follow-up at two years. Correlation co-efficients varied considerably between the various measures of outcome, both patient and observer appearing to base their assessment mainly on postoperative status rather than on any change produced by surgery. The observer was influenced most by postoperative pain, disability and physical impairment. Patients were influenced most by residual physical impairment, type of surgery and proportional change in disability. Return to work was moderately influenced by postoperative disability and to a larger extent by social and work-related factors. We developed a simple formula to judge overall success or failure which accurately reproduced the combined assessment of patient and observer. If surgical audit is to be meaningful it must be based on an improved understanding of how the outcome of surgery should be assessed.

A concept of illness tested as an improved basis for surgical decisions in low-back disorders.

In previous studies a model of illness based on analysis of the relationship between the different elements of illness at one pont in time was developed. This study prospectively tested this model and a number of associated hypotheses in 185 patients who had various types of surgery for low-back disorders: 49 had chemonucleolysis; 91, first-time disc operations; 20, fusions; and 25, repeat operations. Identical pre- and postoperative evaluations were performed with 96% of patients independently reviewed at an average of 26 months after surgery. The authors analyzed how physical and psychologic factors interacted to affect the outcome of surgery and attempted to explain other conflicting reports of how either physical or psychologic factors determined surgical outcome. It was found that physical outcome was almost entirely determined by physical factors, ie, accuracy of diagnosis of a surgically treatable lesion, operative findings, surgical procedure, and avoidance of complications. The most important psychologic disturbances were distress and abnormal illness behavior that could affect surgical outcome indirectly if inappropriate illness behavior led to inappropriate surgery and also directly affected subjective judgments of pain or disability--by patient or observer. Return to work was strongly influenced by additional occupational factors. All the main hypotheses were confirmed and this model or concept of illness is proposed as the basis for a fundamental reconsideration of clinical management and surgical decisions in low-back disorders.

Diagnosis and decision making in lumbar disc prolapse and nerve entrapment.

This prospective study of 185 patients undergoing first-time lumbar surgery compared how accurately clinical criteria and water-soluble myelography predicted the operative findings. Clinical diagnostic criteria of nerve root pain, root irritation signs, and neurologic signs of root compression supplemented by myelography were shown to be much more accurate than myelography alone, both in predicting the presence or absence of nerve root involvement and in distinguishing disc prolapse from bony entrapment. Provided the clinical criteria were clearly defined, patients with three or more of the four criteria were usually found to have a disc prolapse while bony entrapment could frequently be identified with one or two criteria. It is concluded that although lumbar disc prolapse is well-recognized, in practice clinical assessment and diagnostic criteria need to be defined more clearly to match increasingly sophisticated radiology.

Chronic low-back pain, psychologic distress, and illness behavior.

The authors have calculated the mathematic relationship between measured elements of illness behavior in chronic low-back pain. Objective physical impairment accounts for about one-half the total disability that also is affected by psychologic reactions. The most important psychologic disturbance in low-back pain is emotional distress, measured on questionnaires as increased bodily awareness and depression and presenting clinically as inappropriate descriptions of symptoms and inappropriate responses to physical examination. Simple methods for the assessment of distress and illness behavior in chronic low-back pain are developed and described.

Normality and reliability in the clinical assessment of backache.

Backache is common yet its routine medical assessment is imprecise, unreliable, and poorly interpreted. Reproducibility studies on 475 patients improved the reliability of clinical interview and examination in backache, while studies of 335 normal subjects defined the limits of normality. Assessment of nerve function was found to be reliable but assessment of the back itself had to be considerably modified and examination improved by incorporating actual measurements. The validity and clinical utility of the information were analysed to determine the minimum amount of information which should be collected to permit clear diagnosis and management.

Combined force injury of the elbow joint--the mechanism clarified.

An unusual elbow injury occurring as a result of a poorly executed breakfall in judo is recorded. The treatment, possible mechanism and outcome are described. The poor prognosis of severe lesions is emphasised with reference to current literature.

Autoparathyroidectomy: a case report.

This report describes a patient with primary hyperparathyroidism who became spontaneously normocalcaemic preoperatively. This was due to infarction in a parathyroid adenoma. Plasma parathormone (PTH) levels were monitored pre- and postoperatively.

Prevention of karate injuries--a progress report.

Methods of preventing karate injuries are discussed. These fall into three groups:--1. Prevention by control. 2. Prevention by using protective clothing. 3. Pre-fight medical examination. The results of the above methods in reducing the incidence of injury in karate competitions are described. After a follow up one year (1102 fights) it is concluded that the incidence and severity of karate injuries has been reduced significantly thus making the sport safer.

Observations on the source of embryonic myocardioblasts.

The light and electron microscopic appearance of mesenchymal and myoblastic tissue in the embryonic heart is described. The similarity in the morphological appearance of all mesenchymal cells is pointed out, whether they occur in atrioventricular cushion tissue, the ridge tissue of the bulbus, cordis, sub-epicardial tissue or in mesenchyme elsewhere in the embryo. Cells intermediate in their ultrastructure between mesenchymal cells and myoblasts are found. The significance of such cells is discussed and the suggestion made that their appearance is consistent with their representing stages in the differentiation of mesenchymal cells into myoblasts.