Failure of the Femoral Component in a Cemented Total Knee Replacement: A Case Report.

CASE: The usual mechanism of failure of a total knee arthroplasty is aseptic loosening of the tibial component. We present a case of an atraumatic late failure by fracture of the femoral component in an active 83-year-old and review the very small number of similar cases within the literature. CONCLUSION: Although it is difficult to draw firm conclusions on such a rare presentation, it appears the heavy-set, active man may be at risk of a femoral component fracture in the long-term. This case also raises an important question about diligence in cementing techniques for the femoral component.

Talar Neck Fracture after United Tibiotalar Fusion.

Tibiotalar arthrodesis is a well-established treatment for tibiotalar arthritis, for example, in younger high demand patients. Talar neck fractures are less common though well-recognised sequelae of foot ankle trauma. Here we present the clinical case of a 69-year-old male who presented to our institution with a nonunion of a talar neck fracture, having undergone a left tibiotalar fusion 24 years previously. To the authors' knowledge, this injury has only been described once previously in the literature. However, the original case described a fracture sustained in the very early postoperative period following tibiotalar fusion, postulated to be secondary to postimmobilisation osteopaenia or stress risers from metalwork. The aetiology in this case is likely due to axial compression transmitted to the talar neck via the calcaneus. The predisposing factors for nonunion are discussed, highlighting the importance of vigilance for this injury in any patient with concomitant tibiotalar fusion and foot trauma. The management of this patient is discussed.

Nurse-aid management of neurological emergencies.

People with altered levels of consciousness cannot be responsible for themselves. This article highlights the steps a nurse aider must take at the scene of an accident and discusses the importance of the environment in the neurological emergency.

Nurse-aid management of hypovolaemic shock.

Shock is a potentially life-threatening situation and the nurse aider must therefore be able to recognize its development and take immediate action. This article describes the actions that a nurse aider must take at the scene of an accident.

Behaviour at the scene of an accident.

Remember that your behaviour at the scene of an accident will directly influence the actions of the other people present. Be aware of your own safety at all times. Double-check that vehicles, machinery and smokers involved in the accident pose no further threat. Be mindful of spinal injuries. Do not move injured patients unless their lives are in immediate danger. Never leave an unconscious patient's airway unsupervised. If a motor cyclist's helmet is removed, it must be done slowly and smoothly.

The first powerful steps in strategic development.

In an ever-changing business climate, the need for strategically oriented management increases, for the organization that is insensitive and unresponsive to its environment will not survive. The authors of this "Action Plan" examine the challenges facing the health industry and outline a series of actions for initiating strategic-driven management.

The Ommaya reservoir: newly recognized complications and recommendations for insertion and use.

Two of 27 patients treated with intraventricular chemotherapy via an Ommaya reservoir developed unusual life-threatening complications attributable to the reservoir. In one patient treated for meningeal Burkitt's lymphoma, the cause of death was a large mass of tumor cells growing around the cannula. Also the tip of the cannula was found in the contralateral cerebral peduncle. In the other patient, the tip of the cannula apparently perforated the ventricular wall postoperatively and migrated into the contralateral thalamus. In both cases evidence for methotrexate-associated leukoencephalopathy was present at autopsy. Based on the experience with these two patients, we offer specific recommendations for reservoir insertion and use.

Leiomyosarcoma of the scrotum: a case report with electron microscopy.

A case of leiomyosarcoma of the scrotum is presented. The tumor measured 3 X 2.5 X 2 cm and had been present as a slowly enlarging mass in the right scrotum for three months prior to excision. Light microscopy demonstrated the typical interlacing fasicles of neoplastic cells with eccentric cigar-shaped nuclei and electron microscopy confirmed the neoplastic cells to be of smooth muscle origin. A review of the world's literature revealed this to be the fifth reported case of leimyosarcoma confined to the scrotal wall.

Early demonstration of experimental aludrin-induced myocardial damage by the stain according to Lie et al. (HBFP).

Catecholamine-induced alterations of the myocardium were studied in 48 rats following a single subcutaneous injection of 40 mg Aludrin/kg body weight after different intervals following the injection by means of the HBFP stain described by LIE et al. (1971). As early as 5 minutes following application of Aludrin extensive areas with ischemic fuchsinorrhagic cells could be demonstrated. Six hours post injection a decrease in the extent of the alterations could be observed. Five weeks following the injection only small feathery strands of scar tissue could be found in the experimental animals as sequela of the effect of Aludrin. The stain according to LIE et al. (1971) employed by us allows earliest demonstration of (catecholamine-induced) ischemic alterations in the myocardium.

The effects of cosmic particle radiation on pocket mice aboard Apollo XVII: VI. launch, flight, and recovery.

The final phase to fly five pocket mice in the Apollo XVII command module was carried out at the NASA Kennedy Space Center. Upon completion of the 13-d space flight, the package was removed from the spacecraft and, after having been purged with an oxygen-helium gas mixture, was flown to American Samo. Four of the five mice were recovered alive from the package. Analysis of the mouse that died during the flight revealed several factors that could have contributed to its death, the chief of which was massive hemorrhage in its middle ear cavities.

The effects of cosmic particle radiation on pocket mice aboard Apollo XVII: X. Results of ear examination.

In the five pocket mice flown on Apollo XVII, no evidence was found that the inner ear had been damaged, though poor fixation precluded detailed study. On the other hand, the middle ear cavity was involved in all the mice, hemorrhage having occurrred in response to excursions in pressure within the canister that housed the mice during their flight. The same occurred in flight control mice which had been subjected to pressure excursions of much the same magnitude. A greater degree of exudation into air cells and greater leukotaxis were noted in the flight animals than in the control animals. There was no increase in leukocyte population along the paths of the 23 cosmic ray particles registered in the subscalp dosimeters that traversed the middle ear cavities of the flight mice. The increased exudation and the greater response by leukocytes in the flight mice may have been causally related to the lesions found in their olfactory mucosa but there were no data in support of this possibility.