Developing a regional healthcare information network.

The Internet and associated technology is transforming the dissemination of healthcare information. As this occurs, means must be developed to manage and coordinate it effectively. One approach is through community healthcare information networks (CHINs), which benefit both information providers and consumers. This paper reports on a regional CHIN operational in Scotland.

Developing a health care information system for Scotland.

The rapid development and uptake of Internet technology has created opportunities for large-scale information networks to replace paper-based information sources. In order to obtain the maximum benefits for patients and medical practitioners it is important that health care providers work together to produce an integrated information service. However, the task of bringing together a large number of different information providers to create a huge structured pool of information covering a wide range of topics with appropriate quality assurance is non-trivial. This paper describes an approach being used to create healthcare information systems in a set of co-operative healthcare information networks in Europe, and specifically in Scotland.

Role of growth factors in scar contraction: an in vitro analysis.

Excessive scar contracture by wound fibroblasts can have devastating consequences, ranging from body disfigurement to joint immobility. The ability of fibroblasts isolated from lesions of hypertrophic scars, keloids, normal skin, or normal scars in contracting the provisional wound matrix (i.e., fibrin clot) was compared and analyzed. Hypertrophic scar fibroblasts showed a consistently higher basal level of fibrin matrix gel (FMG) contraction than other fibroblasts. This heightened basal level of contractility may be attributed partially to the autocrine effect of transforming growth factor-beta 1 (TGF-beta 1). Normal and keloid fibroblasts exhibited similar basal rates of FMG contraction, and both responded to platelet-derived growth factor (PDGF) and TGF-beta by increasing FMG contraction two- to threefold. However, 45% of the TGF-beta-induced increase in FMG contraction by keloid fibroblasts, but not normal fibroblasts, was mediated by the autocrine production of PDGF. Therefore, fibroblasts isolated from different scars exhibit varied degrees of FMG contraction. In addition, the mechanism underlying growth factor-mediated contraction differed vastly among fibroblasts of different scar origin. The significance of these differences in growth factor-mediated FMG contraction is discussed.

Results of knee replacement with the Walldius and geometric prostheses. A comparative study.

Sixty-two knees that were replaced with Walldius prostheses and twenty-five knees with geometric replacements were studied prospectively. The follow-up ranged from twenty-four to 162 months (average, seventy-four months) for the knees with the Walldius prostheses and from twenty-four to seventy-five months (average, forty-seven months) for those with the geometric prostheses. Using a 100-point clinical rating scale, the knees of patients who underwent Walldius replacement improved from their preoperative status by an average of 33 points (from 44 to 77 points) and those with geometric prostheses, an average of 24 points (from 54 to 78 points). Twelve patients with twenty Walldius prostheses were followed for more than 100 months (average, 127 months). The greater average improvement (36 points) in this group was due primarily to the absence of any major complications. Six patients underwent replacement of one knee with a Walldius prosthesis and one knee with a geometric implant. Although the ratings for the two knees were similar in each patient, four patients preferred the Walldius implant; one, the geometric replacement; and one had no preference. Significant technical errors or complications (defined as those affecting the end result) occurred in 8 per cent of the knees with Walldius implants and in 12 per cent of the knees in the geometric group. There were two late infections in each group. One Walldius prosthesis was removed and the knee was fused. The other three prostheses (one Walldius and two geometric) associated with infection were salvaged.

Results of knee replacement with the Walldius prosthesis: an interim report.

Fourty-two knees replaced with the Walldius prosthesis have been followed for an average of almost 6 years. The rating of the average knee on a 100 point clinical scale improved 29 points as a result of the procedure. Complications were carefully documented and were numerous, although relatively few affected the end result.

Fractures of the neural arch of the axis. A report of twenty-nine cases.

Twenty-nine patients with fractures of the neural arch of the axis (hangman's fracture) were followed for an average of six years. Hyperextension and longitudinal compression were probably the forces most frequently causing this injury. Serious neurological damage was uncommon; none of these patients had any neural deficit at follow-up. In addition to the six patients in this series who were treated by surgical fusion, the remaining twenty-three patients, treated by traction and immobilization, all regained a stable cervical spine. Because healing of the fracture of the neural arch or spontaneous interbody fusion between the axis and the third cervical vertebra invariably occurs, surgical treatment of this injury is seldom if ever necessary.