Purpose: We report the clinical and functional outcome of limb salvage surgery and endoprosthetic... more Purpose: We report the clinical and functional outcome of limb salvage surgery and endoprosthetic reconstruction of the distal tibia and ankle joint in 5 patients. Introduction: The distal tibia is an uncommon site for primary malignant bone tumours and the treatment of choice for most patients is a below knee amputation. Patients who decline an amputation may be offered an endoprosthetic replacement. This is a technically challenging operation and may be associated with high morbidity. Methods and Results: Over 25 years at our centre, 5 patients underwent distal tibial replacements for bone or soft tissue sarcomas. Two had osteosarcoma, one had a recurrence of Ewing’s sarcoma, one had malignant fibrous histiocytoma, and one had an adamantinoma. The mean age was 37 years (13 to 69 years). There were no tumour recurrences. Four patients developed complications with wound infection. Two of these resulted in below knee amputations. Average follow-up was 31 months (19 to 55 months) with...
Background: Extra-compartmental limb soft tissue sarcomas are notoriously difficult to treat. The... more Background: Extra-compartmental limb soft tissue sarcomas are notoriously difficult to treat. These tumours can exhibit macro or microscopic spread beyond the confines of normal anatomical barriers and require radical resection, often necessitating excision of bone as well as soft tissue. This will inevitably affect the patient’s functional outcome. The primary operations for these aggressive sarcomas include wide local excision of soft tissue and adjacent involved bone, radical resection with endoprosthetic reconstruction and amputation. Methods: 85 patients who underwent such an operation between 1995 to 2000 were reviewed and categorised according to whether they received wide local excision, endoprosthesis reconstruction or amputation. Patient demographics, sarcoma details, recurrence and survival rates were identified and compared between the three groups. Functional outcomes in the 45 patients still alive were assessed using TESS and MSTS scores. Results: Mean age was 61 years...
Purpose: Autologous Chondrocyte Implantation (ACI) is being increasingly used in the treatment of... more Purpose: Autologous Chondrocyte Implantation (ACI) is being increasingly used in the treatment of osteochondral defects of the knee. We tested the hypothesis that ACI produces improvement in the Short Form (SF36) score comparable to those produced in total knee replacement (TKR). Methods and Materials: We prospectively used the SF-36 and
Purpose: Autologous Chondrocyte Implantation (ACI) is being increasingly used in the treatment of... more Purpose: Autologous Chondrocyte Implantation (ACI) is being increasingly used in the treatment of osteochondral defects of the knee. We tested the hypothesis that ACI produces improvement in the Short Form (SF36) score comparable to those produced in total knee replacement (TKR). Methods and Materials: We prospectively used the SF-36 and
The aim of work was to analyze clinical effectiveness of fresh bone marrow and periosteum versus ... more The aim of work was to analyze clinical effectiveness of fresh bone marrow and periosteum versus autologous chondrocytes in treatment of traumatic and degenerative cartilage defects. Methods and Materials: There were 30 patients involved into this study, with mean age of 37 years. Patients were randomly operated either with chondrocytes or fresh bone marrow. Bone marrow was aspirated from iliac crest and implanted under the periosteum sutured over the defect. Chondrocytes were isolated, cultured, than implanted under collagen membrane. Patients followed same rehabilitation protocol. At 12, 24 and 36 months postoperatively, patients were evaluated with analogue pain scale, Brittberg-Peterson VAS score, Lysholm and IKDC questionnaires. Patients were evaluated with MRI 3 and 12 and 24 months postoperatively. In 3 patients of each group tissue samples were obtained for histological assessment. Results: After 36 months, 12 patients treated with bone marrow were as normal. In both groups MRI revealed surface with correct contour and continuity, without changes in subchondral bone in all but one patient treated with bone marrow. All histology samples revealed good cartilage-like regeneration. Conclusions: In our opinion, there is need for introduction of biological therapies that avoid manipulations outside the surgical study clinical results of bone marrow and periosteum combination in treatment of symptomatic, full thickness cartilage defects were compared with autologous chondrocytes implantation, without 5.8 7 Year sequential clinical outcome improvement following autologous chondrocyte implantation
Purpose: Recently, a medical device (Arthro-BST™, Bio Syntech Canada Inc.) was developed to asses... more Purpose: Recently, a medical device (Arthro-BST™, Bio Syntech Canada Inc.) was developed to assess the electromechanical properties of articular cartilage during arthroscopy by measuring streaming potentials. The purpose of this study was to evaluate the reliability of this device and to correlate Arthro-BST™ measurements to biochemical, biomechanical and geometrical properties of human articular cartilage. Methods and Materials: Streaming potentials were mapped using the Arthro-BST™ in vitro at 102 positions on the articular surfaces of one human cadaver knee. Five different users performed 3 consecutive mappings on each surface. 27 cartilage disks were isolated and collagen, mature (hydroxylysyl-pyridinoline) and immature (divalent keto-imine) collagen crosslinks. The reliability of the Arthro-BST measurements among different users was evaluated using the
Journal of Bone and Joint Surgery - British Volume, 2008
We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with ... more We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with failed total hip replacement and severe proximal femoral bone loss by revision using a distal fix/proximal wrap prosthesis. The mean follow-up was for 55.3 months (25 to 126). The mean number of previous operations was 2.2 (1 to 4). The mean Oxford hip score decreased from 46.2 (38 to 60) to 28.5 (17 to 42) (paired t-test, p < 0.001) and the mean Harris Hip score increased from 30.4 (3 to 57.7) to 71.7 (44 to 99.7) (paired t-test, p < 0.001). There were two dislocations, and in three patients we failed to eradicate previous infection. None required revision of the femoral stem. This technique allows instant distal fixation while promoting biological integration and restoration of bone stock. In the short term, the functional outcome is encouraging and the complication rates acceptable in this difficult group of patients.
Journal of Bone and Joint Surgery-british Volume, 2014
Introduction: Endoprosthetic replacement of the proximal femur is common in the management of bon... more Introduction: Endoprosthetic replacement of the proximal femur is common in the management of bone tumours and failed revision arthroplasty. This study seeks to compare those patients undergoing acetabular resurfacing at the time of femoral replacement with those patients where the native acetabulum was preserved. Methods: All proximal femoral replacements from 2004 to 2009 with a five year follow up were included. Case files were interrogated to identify those that had either revision surgery or dislocation of the hip. Results: 87 patients met the inclusion criteria with an average age of 53 years. 25 operations were for failed revision arthroplasty, 61 for tumours and 1 for osteomyelitis. In 60 patients the acetabulum was resurfaced at surgery, and in 27 patients the acetabulum was preserved. 36 of 60 patients (60%) undergoing immediate resurfacing of the acetabulum had tumours. In patients who did not undergo acetabular resurfacing at surgery 4 sustained dislocations; 1 had surge...
Aim: The aim of this study was to correlate the histology of cartilage repair site with long term... more Aim: The aim of this study was to correlate the histology of cartilage repair site with long term clinical function. Materials and methods: We have analyzed the clinical results of a cohort of patients who had collagen-covered autologous chondrocyte implantations performed since 1998. Our hypothesis was that the hyaline cartilage repair does influence the clinical outcome. The modified Cincinnati scores (MCRS) of eighty-six patients were evaluated prospectively at one year and at the latest follow-up following ACI-C (mean follow-up= 4.7 years. Range= 4 to 7 years). All these patients underwent biopsies of their cartilage repair site performed at variable periods between six months and five years following ACI-C (mean=22.2 months). The neo-cartilage was graded as hyaline (n=32), mixed fibrohyaline (n=19), fibrocartilagenous (n=35) and fibrous (n=0). Results: The clinical results showed that at one year, the percentage of patients with excellent and good results was 84.4, 89.5 and 74.3 respectively for those with hyaline, mixed fibro-hyaline and fibro-cartilagenous histology respectively. Their mean MCRS were 70.8, 72.4 and 66.2 respectively. This difference was not statistically significant (p=0.34). However, their clinical scores at the latest follow-up demonstrated a significantly superior result for those with hyaline repair tissue when compared to those with mixed fibro-hyaline and fibro-cartilagenous repair tissue (p=0.05). The percentage of patients with excellent and good results for those with hyaline, mixed fibro-hyaline and fibro-cartilagenous repair was 75, 42 and 68.6 respectively. Their mean MCRS were 70.6, 56.8 and 63.9 respectively. Conclusion: This study demonstrates that any form of cartilage repair would give good clinical outcome at one year. At four years and beyond, it appears that patients with hyaline repair tissue tend to show a more favourable clinical outcome whereas those who demonstrated mixed fibrohyaline and fibrocartilagenous repair would show less favourable clinical results.
Purpose: Recently, a medical device (Arthro-BST™, Bio Syntech Canada Inc.) was developed to asses... more Purpose: Recently, a medical device (Arthro-BST™, Bio Syntech Canada Inc.) was developed to assess the electromechanical properties of articular cartilage during arthroscopy by measuring streaming potentials. The purpose of this study was to evaluate the reliability of this device and to correlate Arthro-BST™ measurements to biochemical, biomechanical and geometrical properties of human articular cartilage. Methods and Materials: Streaming potentials were mapped using the Arthro-BST™ in vitro at 102 positions on the articular surfaces of one human cadaver knee. Five different users performed 3 consecutive mappings on each surface. 27 cartilage disks were isolated and collagen, mature (hydroxylysyl-pyridinoline) and immature (divalent keto-imine) collagen crosslinks. The reliability of the Arthro-BST measurements among different users was evaluated using the Results: The high value of the computed ICC (0.87) from streaming potentials demonstrated the important ability of the Arthro-BST to provide user independent cartilage electromechanical properties. moduli and cartilage thickness in a manner similar to a previous parameter correlated positively with the collagen content and the ratio of mature to immature crosslinks. Conclusions: Streaming potentials from the Arthro-BST™ provided a reliable indicator of composition and biomechanical properties of human articular cartilage. This instrument could be used to assess cartilage quality during clinical arthroscopic procedures.
Purpose: Autologous Chondrocyte Implantation (ACI) is being increasingly used in the treatment of... more Purpose: Autologous Chondrocyte Implantation (ACI) is being increasingly used in the treatment of osteochondral defects of the knee. We tested the hypothesis that ACI produces improvement in the Short Form (SF36) score comparable to those produced in total knee replacement (TKR).
D. The descriptive epidemiology of warts in British schoolchildren. Br J Dermatol 1993;128:504-11... more D. The descriptive epidemiology of warts in British schoolchildren. Br J Dermatol 1993;128:504-11. 13 Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneous warts: systematic review. BMJ 2002;325:461. 14 Resnick S. Staphylococcal and streptococcal skin infections: pyodermas and toxin-mediated syndromes. In: Harper JO, A. Prose N, eds. Textbook of pediatric dermatology. Oxford: Blackwell, 2000:369-77. 15 Dagan R. Impetigo in childhood: changing epidemiology and new treatments. Ped Annals 1993;22:235-40. 16 Bruijnzeels MA, van Suijlekom-Smit LWA, van der Velden J, van der Wouden JC. The child in general practice. Dutch national survey of morbidity and interventions in general practice. Rotterdam: Erasmus University Rotterdam, 1993. 17 Hlady WG, Middaugh JP. An epidemic of bullous impetigo in a newborn nursery due to Staphylococcus aureus: epidemiology and control measures.
D. The descriptive epidemiology of warts in British schoolchildren. Br J Dermatol 1993;128:504-11... more D. The descriptive epidemiology of warts in British schoolchildren. Br J Dermatol 1993;128:504-11. 13 Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneous warts: systematic review. BMJ 2002;325:461. 14 Resnick S. Staphylococcal and streptococcal skin infections: pyodermas and toxin-mediated syndromes. In: Harper JO, A. Prose N, eds. Textbook of pediatric dermatology. Oxford: Blackwell, 2000:369-77. 15 Dagan R. Impetigo in childhood: changing epidemiology and new treatments. Ped Annals 1993;22:235-40. 16 Bruijnzeels MA, van Suijlekom-Smit LWA, van der Velden J, van der Wouden JC. The child in general practice. Dutch national survey of morbidity and interventions in general practice. Rotterdam: Erasmus University Rotterdam, 1993. 17 Hlady WG, Middaugh JP. An epidemic of bullous impetigo in a newborn nursery due to Staphylococcus aureus: epidemiology and control measures.
Journal of Bone and Joint Surgery - British Volume, 2008
We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with ... more We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with failed total hip replacement and severe proximal femoral bone loss by revision using a distal fix/proximal wrap prosthesis. The mean follow-up was for 55.3 months (25 to 126). The mean number of previous operations was 2.2 (1 to 4). The mean Oxford hip score decreased from 46.2 (38 to 60) to 28.5 (17 to 42) (paired t-test, p &amp;amp;amp;amp;lt; 0.001) and the mean Harris Hip score increased from 30.4 (3 to 57.7) to 71.7 (44 to 99.7) (paired t-test, p &amp;amp;amp;amp;lt; 0.001). There were two dislocations, and in three patients we failed to eradicate previous infection. None required revision of the femoral stem. This technique allows instant distal fixation while promoting biological integration and restoration of bone stock. In the short term, the functional outcome is encouraging and the complication rates acceptable in this difficult group of patients.
Purpose: We report the clinical and functional outcome of limb salvage surgery and endoprosthetic... more Purpose: We report the clinical and functional outcome of limb salvage surgery and endoprosthetic reconstruction of the distal tibia and ankle joint in 5 patients. Introduction: The distal tibia is an uncommon site for primary malignant bone tumours and the treatment of choice for most patients is a below knee amputation. Patients who decline an amputation may be offered an endoprosthetic replacement. This is a technically challenging operation and may be associated with high morbidity. Methods and Results: Over 25 years at our centre, 5 patients underwent distal tibial replacements for bone or soft tissue sarcomas. Two had osteosarcoma, one had a recurrence of Ewing’s sarcoma, one had malignant fibrous histiocytoma, and one had an adamantinoma. The mean age was 37 years (13 to 69 years). There were no tumour recurrences. Four patients developed complications with wound infection. Two of these resulted in below knee amputations. Average follow-up was 31 months (19 to 55 months) with...
Background: Extra-compartmental limb soft tissue sarcomas are notoriously difficult to treat. The... more Background: Extra-compartmental limb soft tissue sarcomas are notoriously difficult to treat. These tumours can exhibit macro or microscopic spread beyond the confines of normal anatomical barriers and require radical resection, often necessitating excision of bone as well as soft tissue. This will inevitably affect the patient’s functional outcome. The primary operations for these aggressive sarcomas include wide local excision of soft tissue and adjacent involved bone, radical resection with endoprosthetic reconstruction and amputation. Methods: 85 patients who underwent such an operation between 1995 to 2000 were reviewed and categorised according to whether they received wide local excision, endoprosthesis reconstruction or amputation. Patient demographics, sarcoma details, recurrence and survival rates were identified and compared between the three groups. Functional outcomes in the 45 patients still alive were assessed using TESS and MSTS scores. Results: Mean age was 61 years...
Purpose: Autologous Chondrocyte Implantation (ACI) is being increasingly used in the treatment of... more Purpose: Autologous Chondrocyte Implantation (ACI) is being increasingly used in the treatment of osteochondral defects of the knee. We tested the hypothesis that ACI produces improvement in the Short Form (SF36) score comparable to those produced in total knee replacement (TKR). Methods and Materials: We prospectively used the SF-36 and
Purpose: Autologous Chondrocyte Implantation (ACI) is being increasingly used in the treatment of... more Purpose: Autologous Chondrocyte Implantation (ACI) is being increasingly used in the treatment of osteochondral defects of the knee. We tested the hypothesis that ACI produces improvement in the Short Form (SF36) score comparable to those produced in total knee replacement (TKR). Methods and Materials: We prospectively used the SF-36 and
The aim of work was to analyze clinical effectiveness of fresh bone marrow and periosteum versus ... more The aim of work was to analyze clinical effectiveness of fresh bone marrow and periosteum versus autologous chondrocytes in treatment of traumatic and degenerative cartilage defects. Methods and Materials: There were 30 patients involved into this study, with mean age of 37 years. Patients were randomly operated either with chondrocytes or fresh bone marrow. Bone marrow was aspirated from iliac crest and implanted under the periosteum sutured over the defect. Chondrocytes were isolated, cultured, than implanted under collagen membrane. Patients followed same rehabilitation protocol. At 12, 24 and 36 months postoperatively, patients were evaluated with analogue pain scale, Brittberg-Peterson VAS score, Lysholm and IKDC questionnaires. Patients were evaluated with MRI 3 and 12 and 24 months postoperatively. In 3 patients of each group tissue samples were obtained for histological assessment. Results: After 36 months, 12 patients treated with bone marrow were as normal. In both groups MRI revealed surface with correct contour and continuity, without changes in subchondral bone in all but one patient treated with bone marrow. All histology samples revealed good cartilage-like regeneration. Conclusions: In our opinion, there is need for introduction of biological therapies that avoid manipulations outside the surgical study clinical results of bone marrow and periosteum combination in treatment of symptomatic, full thickness cartilage defects were compared with autologous chondrocytes implantation, without 5.8 7 Year sequential clinical outcome improvement following autologous chondrocyte implantation
Purpose: Recently, a medical device (Arthro-BST™, Bio Syntech Canada Inc.) was developed to asses... more Purpose: Recently, a medical device (Arthro-BST™, Bio Syntech Canada Inc.) was developed to assess the electromechanical properties of articular cartilage during arthroscopy by measuring streaming potentials. The purpose of this study was to evaluate the reliability of this device and to correlate Arthro-BST™ measurements to biochemical, biomechanical and geometrical properties of human articular cartilage. Methods and Materials: Streaming potentials were mapped using the Arthro-BST™ in vitro at 102 positions on the articular surfaces of one human cadaver knee. Five different users performed 3 consecutive mappings on each surface. 27 cartilage disks were isolated and collagen, mature (hydroxylysyl-pyridinoline) and immature (divalent keto-imine) collagen crosslinks. The reliability of the Arthro-BST measurements among different users was evaluated using the
Journal of Bone and Joint Surgery - British Volume, 2008
We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with ... more We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with failed total hip replacement and severe proximal femoral bone loss by revision using a distal fix/proximal wrap prosthesis. The mean follow-up was for 55.3 months (25 to 126). The mean number of previous operations was 2.2 (1 to 4). The mean Oxford hip score decreased from 46.2 (38 to 60) to 28.5 (17 to 42) (paired t-test, p < 0.001) and the mean Harris Hip score increased from 30.4 (3 to 57.7) to 71.7 (44 to 99.7) (paired t-test, p < 0.001). There were two dislocations, and in three patients we failed to eradicate previous infection. None required revision of the femoral stem. This technique allows instant distal fixation while promoting biological integration and restoration of bone stock. In the short term, the functional outcome is encouraging and the complication rates acceptable in this difficult group of patients.
Journal of Bone and Joint Surgery-british Volume, 2014
Introduction: Endoprosthetic replacement of the proximal femur is common in the management of bon... more Introduction: Endoprosthetic replacement of the proximal femur is common in the management of bone tumours and failed revision arthroplasty. This study seeks to compare those patients undergoing acetabular resurfacing at the time of femoral replacement with those patients where the native acetabulum was preserved. Methods: All proximal femoral replacements from 2004 to 2009 with a five year follow up were included. Case files were interrogated to identify those that had either revision surgery or dislocation of the hip. Results: 87 patients met the inclusion criteria with an average age of 53 years. 25 operations were for failed revision arthroplasty, 61 for tumours and 1 for osteomyelitis. In 60 patients the acetabulum was resurfaced at surgery, and in 27 patients the acetabulum was preserved. 36 of 60 patients (60%) undergoing immediate resurfacing of the acetabulum had tumours. In patients who did not undergo acetabular resurfacing at surgery 4 sustained dislocations; 1 had surge...
Aim: The aim of this study was to correlate the histology of cartilage repair site with long term... more Aim: The aim of this study was to correlate the histology of cartilage repair site with long term clinical function. Materials and methods: We have analyzed the clinical results of a cohort of patients who had collagen-covered autologous chondrocyte implantations performed since 1998. Our hypothesis was that the hyaline cartilage repair does influence the clinical outcome. The modified Cincinnati scores (MCRS) of eighty-six patients were evaluated prospectively at one year and at the latest follow-up following ACI-C (mean follow-up= 4.7 years. Range= 4 to 7 years). All these patients underwent biopsies of their cartilage repair site performed at variable periods between six months and five years following ACI-C (mean=22.2 months). The neo-cartilage was graded as hyaline (n=32), mixed fibrohyaline (n=19), fibrocartilagenous (n=35) and fibrous (n=0). Results: The clinical results showed that at one year, the percentage of patients with excellent and good results was 84.4, 89.5 and 74.3 respectively for those with hyaline, mixed fibro-hyaline and fibro-cartilagenous histology respectively. Their mean MCRS were 70.8, 72.4 and 66.2 respectively. This difference was not statistically significant (p=0.34). However, their clinical scores at the latest follow-up demonstrated a significantly superior result for those with hyaline repair tissue when compared to those with mixed fibro-hyaline and fibro-cartilagenous repair tissue (p=0.05). The percentage of patients with excellent and good results for those with hyaline, mixed fibro-hyaline and fibro-cartilagenous repair was 75, 42 and 68.6 respectively. Their mean MCRS were 70.6, 56.8 and 63.9 respectively. Conclusion: This study demonstrates that any form of cartilage repair would give good clinical outcome at one year. At four years and beyond, it appears that patients with hyaline repair tissue tend to show a more favourable clinical outcome whereas those who demonstrated mixed fibrohyaline and fibrocartilagenous repair would show less favourable clinical results.
Purpose: Recently, a medical device (Arthro-BST™, Bio Syntech Canada Inc.) was developed to asses... more Purpose: Recently, a medical device (Arthro-BST™, Bio Syntech Canada Inc.) was developed to assess the electromechanical properties of articular cartilage during arthroscopy by measuring streaming potentials. The purpose of this study was to evaluate the reliability of this device and to correlate Arthro-BST™ measurements to biochemical, biomechanical and geometrical properties of human articular cartilage. Methods and Materials: Streaming potentials were mapped using the Arthro-BST™ in vitro at 102 positions on the articular surfaces of one human cadaver knee. Five different users performed 3 consecutive mappings on each surface. 27 cartilage disks were isolated and collagen, mature (hydroxylysyl-pyridinoline) and immature (divalent keto-imine) collagen crosslinks. The reliability of the Arthro-BST measurements among different users was evaluated using the Results: The high value of the computed ICC (0.87) from streaming potentials demonstrated the important ability of the Arthro-BST to provide user independent cartilage electromechanical properties. moduli and cartilage thickness in a manner similar to a previous parameter correlated positively with the collagen content and the ratio of mature to immature crosslinks. Conclusions: Streaming potentials from the Arthro-BST™ provided a reliable indicator of composition and biomechanical properties of human articular cartilage. This instrument could be used to assess cartilage quality during clinical arthroscopic procedures.
Purpose: Autologous Chondrocyte Implantation (ACI) is being increasingly used in the treatment of... more Purpose: Autologous Chondrocyte Implantation (ACI) is being increasingly used in the treatment of osteochondral defects of the knee. We tested the hypothesis that ACI produces improvement in the Short Form (SF36) score comparable to those produced in total knee replacement (TKR).
D. The descriptive epidemiology of warts in British schoolchildren. Br J Dermatol 1993;128:504-11... more D. The descriptive epidemiology of warts in British schoolchildren. Br J Dermatol 1993;128:504-11. 13 Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneous warts: systematic review. BMJ 2002;325:461. 14 Resnick S. Staphylococcal and streptococcal skin infections: pyodermas and toxin-mediated syndromes. In: Harper JO, A. Prose N, eds. Textbook of pediatric dermatology. Oxford: Blackwell, 2000:369-77. 15 Dagan R. Impetigo in childhood: changing epidemiology and new treatments. Ped Annals 1993;22:235-40. 16 Bruijnzeels MA, van Suijlekom-Smit LWA, van der Velden J, van der Wouden JC. The child in general practice. Dutch national survey of morbidity and interventions in general practice. Rotterdam: Erasmus University Rotterdam, 1993. 17 Hlady WG, Middaugh JP. An epidemic of bullous impetigo in a newborn nursery due to Staphylococcus aureus: epidemiology and control measures.
D. The descriptive epidemiology of warts in British schoolchildren. Br J Dermatol 1993;128:504-11... more D. The descriptive epidemiology of warts in British schoolchildren. Br J Dermatol 1993;128:504-11. 13 Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneous warts: systematic review. BMJ 2002;325:461. 14 Resnick S. Staphylococcal and streptococcal skin infections: pyodermas and toxin-mediated syndromes. In: Harper JO, A. Prose N, eds. Textbook of pediatric dermatology. Oxford: Blackwell, 2000:369-77. 15 Dagan R. Impetigo in childhood: changing epidemiology and new treatments. Ped Annals 1993;22:235-40. 16 Bruijnzeels MA, van Suijlekom-Smit LWA, van der Velden J, van der Wouden JC. The child in general practice. Dutch national survey of morbidity and interventions in general practice. Rotterdam: Erasmus University Rotterdam, 1993. 17 Hlady WG, Middaugh JP. An epidemic of bullous impetigo in a newborn nursery due to Staphylococcus aureus: epidemiology and control measures.
Journal of Bone and Joint Surgery - British Volume, 2008
We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with ... more We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with failed total hip replacement and severe proximal femoral bone loss by revision using a distal fix/proximal wrap prosthesis. The mean follow-up was for 55.3 months (25 to 126). The mean number of previous operations was 2.2 (1 to 4). The mean Oxford hip score decreased from 46.2 (38 to 60) to 28.5 (17 to 42) (paired t-test, p &amp;amp;amp;amp;lt; 0.001) and the mean Harris Hip score increased from 30.4 (3 to 57.7) to 71.7 (44 to 99.7) (paired t-test, p &amp;amp;amp;amp;lt; 0.001). There were two dislocations, and in three patients we failed to eradicate previous infection. None required revision of the femoral stem. This technique allows instant distal fixation while promoting biological integration and restoration of bone stock. In the short term, the functional outcome is encouraging and the complication rates acceptable in this difficult group of patients.
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