Bacteroides fragilis infection of a knee prosthesis after haemorrhoidectomy.
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Biomedical subjects
Publications and source records attributed to S E James.
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A method of treatment for a femoral shaft fracture in a patient with well-functioning ipsilateral total hip and knee arthroplasties is described. Total hip and knee arthroplasties are commonly performed, but ipsilateral femoral shaft fracture is an infrequent and troublesome complication. Management of these fractures is often difficult. Various operative treatments have been described in the literature with varying success.
Ninety-eight consecutive patients with Mason type 1 and 2 radial head fractures were randomized into three treatment groups to compare early mobilization with immobilization in flexion and extension. Eighty-one patients were reviewed on average 25 months following fracture and assessed for pain, disability and range of movement. Loss of full extension was the most frequent restriction of movement and was found in 17 patients. Two patients had restricted flexion without limited extension. Patients immobilized in a flexion cast had a significantly reduced range of movement compared with patients immobilized in extension (P = 0.02). Nineteen patients had residual pain and again the flexion group fared worse than the extension group (P = 0.06). Results from early mobilization in a sling were not significantly different from the other two groups. Treatment of radial head fractures in flexion casts should be avoided.
Three-dimensional computerized tomography provides a new approach to radiological imaging. Raw data from sequential two-dimensional scans have been reconstructed as a three-dimensional model of the carpal area using the Medical Graphics and Imaging Workstation. This study demonstrates the anatomical accuracy and potential diagnostic qualities of a reconstruction of the carpus using this system. The advantages, pitfalls and suggested applications of this technique of carpal imaging are discussed. Three-dimensional imaging is shown to provide a great deal of information which cannot be viewed on conventional radiographs or CT images.
A new method to reconstruct major acetabular floor defects is described. It relies on the placement of special nails into each of the three bones of the hemipelvis. Curved lugs attached to the nails are coalesced using bone cement forming a platform onto which a standard acetabular prosthesis is located. Forty-seven cases are reported with a mean follow-up of 4.4 years (1 to 8). No loosening of an acetabular cup or migration of the device has occurred.
A bi-articular prostheses was used to replace the femoral head in 323 patients over 7 years in an attempt to reduce the incidence of acetabular erosion, which has been reported by others who have used different types of prostheses. No erosion of the acetabulum has yet been found in our series, but from the point of view of cost, we consider that the use of this prosthesis should be restricted to active younger patients.
The rationale and clinical methods of percutaneous disc surgery have been modified during the past four years. Experience with a consecutive series of 48 patients suggests that the procedure now offers results comparable to open surgery and the advantages of reduced surgical trauma.
We have used the T-Lymphocyte cloning technique as a method of monitoring the human population for somatic cell mutant frequency. We present a statistical analysis of the experimental factors which may influence the observed mutant frequency. We have obtained consistently high plating efficiencies of T-cells from the mononuclear cell fraction from donor blood samples (mean of 56%, based on 123 observations from 70 individuals). Nevertheless, an inverse correlation of mutant frequency with plating efficiency was observed, and some experimental factors (serum and interleukin-2 batch, and worker) may have a significant effect on the observed mutant frequency. We discuss the difficulties that these possible effects present in establishment of a reference database and design of long-term studies. No significant effect of donor sex on mutant frequency was observed, but age (1.3% increase per year for normal adults) and smoking (56% increase over normal non-smokers) both significantly increased the mutant frequency. We discuss the utility of the assay for the monitoring of populations for heritable DNA damage, and we compare the results to those obtained with lymphocytes using other endpoints, e.g. chromosome aberrations, micronuclei and sister-chromatid exchange.
We have measured clonal survival following gamma-irradiation of unstimulated (G0) T-lymphocytes from 35 donors, of 11 T-lymphocyte cell lines, of six lymphoblastoid cell lines, and of nine primary fibroblast strains for which we have G0 T-lymphocyte material from the same donor. Amongst the G0 lymphocytes we have results from nine normal donors, from eight cord bloods, from seven ataxia-telangiectasia (A-T) patients and from nine A-T heterozygotes. Although there is some variation between samples, G0 T-lymphocytes from normal donors appear to be slightly more radioresistant than T-lymphocyte lines, with a more shouldered survival curve. From our limited sample, lymphoblastoid cell lines appear to be slightly more radiosensitive than T-lymphocytes. The overall radiosensitivity of primary fibroblasts appears to be broadly similar to that of G0 T-lymphocytes. In nine instances, five A-Ts and four A-T heterozygotes, both G0 T-lymphocytes and primary fibroblasts from the same donor were tested. In five cases there was closely similar radiosensitivity in the two cell types, but in four cases there was some discrepancy. Further work, especially with normal donors, will be required in order to establish how reliably radiosensitivity in other cell types can be predicted from that of G0 T-lymphocytes. In all cell types the hypersensitivity of A-T cells was confirmed. Furthermore, the marginally greater sensitivity of A-T heterozygotes, when compared as a group with normals, was confirmed with G0 T-lymphocytes. Our results also suggest a slightly increased radiosensitivity in G0 T-lymphocytes from some, but not all, cord blood samples.
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Autologous blood transfusion is one of the most effective ways of avoiding the need for homologous transfusion and all its associated complications. Since the beginning of 1985, autotransfusions have been used in 48 patients undergoing total joint replacement, without significant complications. Their average haemoglobin level two weeks postoperatively was 11.3 mg/dl. We believe that this is a safe, effective and economical procedure which benefits both patients and medical staff, and its use should be more widespread.
A method of detecting 6-thioguanine-resistant lymphocytes by the cloning of T-lymphocytes in microtitre wells is evaluated for its usefulness in population monitoring. Factors shown to affect the cloning efficiency of lymphocytes include the strain and irradiation level of the lymphoblastoid feeder cells and the use of a pre-incubation period in bulk culture without mitogenic stimulus before plating at limiting dilutions. Cord blood samples have markedly lower mutant frequencies than adult blood samples. The adult range was 8.0 X 10(-7) to 1.8 X 10(-5). Seven males and seven females aged between 23 and 47 years were sampled. No effect of sex or age was found. Individual samples which were divided at collection and treated separately did not vary from each other, but repeat samples taken at different times showed up to a 2-fold variation. The application of this method in population monitoring is discussed.
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A preliminary study was undertaken to determine if the carbon dioxide laser was a suitable technique for the removal of tattoos. Twenty-eight patients with 47 tattoos had their tattoos removed by the carbon dioxide laser. The results were assessed by an independent observer 1 year after completion of treatment. The most satisfactory results were obtained in patients with discrete linear tattoos of amateur origin. In those with polychromatic blocked-in tattoos of professional origin, hypertrophic scars occurred and the overall result was unsatisfactory.
A patient with rheumatic mitral stenosis and previous cerebral embolism had a myocardial infarction during cardiac catheterisation. She later developed severe mitral regurgitation one year after open valvotomy and at valve replacement was found to have a papillary tumour of the mitral valve. Unexplained low cardiac output occurred four days after operation. Postmortem examination showed thrombotic occlusion of the xenograft prosthesis, a complication not previously seen with tissue valves. Both of these rare events were suggested by the patient's clinical course and could have been diagnosed with cross sectional echocardiography.
There were one hundred and ninety seven patients who presented with back pain to an Athletes Clinic over four years. Their mode of presentation, investigations, diagnoses and treatments are analysed. The majority of patients were male and below 30 years of age. The average duration of symptoms prior to presentation, despite an easy access policy, was 42 weeks. Injury was usually related to six popular sports. Radiological examination was a rewarding investigation in these patients and included an A-P view of the pelvis. The diagnostic label of prolapsed intervertebral disc appears to have been used too frequently. Physiotherapy was the most useful treatment modality regardless of age, mode of onset and duration of symptoms.
A method is described for determining the radiation sensitivity of dividing human T-lymphocytes in long-term culture. The results are fitted to a single-hit multi-target model. For cobalt-60 gamma radiation Do values of cells from five normal individuals range from 0.99 to 1.37 Gy with an overall Do of 1.09 Gy, and the extrapolation numbers range from 1.20 to 1.71 with an overall extrapolation number of 1.42.