Prophylaxis against infection in total joint arthroplasty. One day of cefuroxime compared with three days of cefazolin.

The efficacy of cefuroxime was compared with the efficacy of cefazolin for prophylaxis against postoperative wound infection in a prospective, double-blind, multicenter study of 1354 patients who had had elective primary or revision total hip or knee arthroplasty. The patients were randomly assigned to receive either 1.5 grams of cefuroxime followed by 750 milligrams eight and sixteen hours later (for a total of one day of antibiotic treatment), or one gram of cefazolin every eight hours for nine doses (for a total of three days of antibiotic treatment). The first dose of each drug was administered fifteen to sixty minutes before the operative incision was made (for a primary operation) or after tissue samples had been obtained for culture (for a revision procedure). After the operation, the patients were assessed daily while hospitalized and then at two to three months and one year after the operation. Demographic characteristics and risk factors were similar in the two groups. For the patients who had had a primary hip arthroplasty, the rate of deep wound infection was 0.5 per cent (one of 187) for those who had received cefuroxime and 1.2 per cent (two of 168) for those who had received cefazolin. For the patients who had had a primary knee arthroplasty, the rate of deep wound infection was 0.6 per cent (one of 178) for those who had received cefuroxime and 1.4 per cent (three of 207) for those who had received cefazolin.(ABSTRACT TRUNCATED AT 250 WORDS)

Structural bone-grafting for early atraumatic avascular necrosis of the femoral head.

Between 1970 and 1987, nineteen patients, thirty-one to fifty-five years old, had twenty core-decompression procedures with corticocancellous bone-grafting for Stage-I or II atraumatic avascular necrosis of the femoral head. A tibial autogenous graft was used in three hips; a fibular autogenous graft, in seven hips; and a fibular allograft, in ten hips. Treatment was considered to have failed when there was clinical or roentgenographic evidence of progression of the necrosis. Eighteen patients who had a minimum follow-up of two years (average, eight years; range, two to nineteen years) were asymptomatic, with no evidence of progression of the necrosis or collapse of the affected segment. In two hips, the necrotic segment of the femoral head collapsed within one year after the operation, and a replacement arthroplasty was carried out.

Inhibition of human lymphocyte responses by methylmethacrylate.

The in vitro response of normal stimulated human peripheral blood lymphocytes to methylmethacrylate (MMA) was a dose related inhibition. Fifty per cent inhibition occurred at concentrations of 0.078-0.125%. MMA affected not only responses to soluble phytomitogens but also responses to specific antigens and allogeneic lymphocytes. Numbers of viable cells in cultures with and without mitogens and MMA were comparable at the beginning and end of experiments, excluding methacrylate-related cytotoxicity as the primary mechanism of inhibition of lymphocyte responses. Inhibition did not result from alteration of kinetics of lymphocyte responses. Inhibition was greatest when MMA was added during early phases of cellular activation. It also reduced the ability of T-lymphocytes to rosette with sheep erythrocytes. These data indicate that MMA causes noncytotoxic, incompletely reversible inhibition of nonspecific, specific, soluble, and insoluble stimulated lymphocyte responses and rosette formation in vitro.

Identification of a nonlysozymal bactericidal factor (beta lysin) in human tears and aqueous humor.

An antibacterial factor, identical with or closely related to beta lysin, was measured in human tears, in human aqueous humor, and in fractions of each fluid after an absorption step involving cellulose-asbestos filters. Antibeta lysin was used to help distinguish whether bactericidal activity was due to lysozyme or beta lysin. Beta lysin activity was found in both human tears and aqueous humor in higher amounts than were present in serum; appreciable amounts of lysozyme were found in human tears but not in aqueous humor. Beta lysin is a normal constituent of human tears and aqueous humor and its role in these fluids is that of an antibacterial agent that may also act in concert with lysozyme to destroy bacteria in tears.