Randomized controlled trial comparing esophageal dilation to no dilation among adults with esophageal eosinophilia and dysphagia.

The role of esophageal dilation in patients with esophageal eosinophilia with dysphagia remains unknown. The practice of dilation is currently based on center preferences and expert opinion. The aim of this study is to determine if, and to what extent, dysphagia improves in response to initial esophageal dilation followed by standard medical therapies. We conducted a randomized, blinded, controlled trial evaluating adult patients with dysphagia and newly diagnosed esophageal eosinophilia from 2008 to 2013. Patients were randomized to dilation or no dilation at time of endoscopy and blinded to dilation status. Endoscopic features were graded as major and minor. Subsequent to randomization and endoscopy, all patients received fluticasone and dexlansoprazole for 2 months. The primary study outcome was reduction in overall dysphagia score, assessed at 30 and 60 days post-intervention. Patients with severe strictures (less than 7-mm esophageal diameter) were excluded from the study. Thirty-one patients were randomized and completed the protocol: 17 randomized to dilation and 14 to no dilation. Both groups were similar with regard to gender, age, eosinophil density, endoscopic score, and baseline dysphagia score. The population exhibited moderate to severe dysphagia and moderate esophageal stricturing at baseline. Overall, there was a significant (P < 0.001) but similar reduction in mean dysphagia score at 30 and 60 days post-randomization compared with baseline in both groups. No significant difference in dysphagia scores between treatment groups after 30 (P = 0.93) or 60 (P = 0.21) days post-intervention was observed. Esophageal dilation did not result in additional improvement in dysphagia score compared with treatment with proton pump inhibitor and fluticasone alone. In patients with symptomatic esophageal eosinophilia without severe stricture, dilation does not appear to be a necessary initial treatment strategy.

Antibiotic prophylaxis for the prevention of late infections of prosthetic joints.

Late infection of prosthetic joints as a result of the haematogenous spread of an organism from a remote site with the seeding of that organism on the bone-implanted prosthesis interface is a well-documented but rare complication of prosthetic joint surgery. However, the use of antibiotic prophylaxis is such cases is controversial. The details of 67 previously reported cases of late infection have been reviewed in conjunction with the details of a series of 43 patients, and observations and recommendations regarding antibiotic prophylaxis are made upon the basis of these accumulated data.

The fate of femoral windows in revision joint arthroplasty.

We retrospectively reviewed the radiographs of twenty patients in whom a window in the femoral cortex had been created to facilitate revision of a failed total hip replacement with a non-cemented prosthesis, to determine if the window had healed and, if so, how long it had taken. All but three windows showed clear evidence of healing three months postoperatively. At six months, only two windows remained radiographically visible, and at eight months, all of the windows had healed. We concluded that when the section of cortical bone that is removed to create the window is replaced with an uncemented femoral component, the window heals by bone within three to eight months.

Reduction of blood loss in knee arthroplasty.

The purpose of this study was to investigate ways of reducing and controlling blood loss and postoperative anaemia in total condylar knee arthroplasty performed under tourniquet. The study covers a two year period to December 1982. Reduction of blood loss was successfully achieved by being aware of the very rich blood supply to the knee and utilizing diathermy for potential bleeders before and after the release of the tourniquet and employing various haemostatic measures. All these patients need blood transfusion, as well as the measures to reduce blood loss, so that they do not become anaemic postoperatively.