Faculty Bibliography

The authors report an unusual complication of total hip arthroplasty. A patient developed significant swelling and discomfort in the left lower extremity 4 1/2 years following a left total hip arthroplasty. Magnetic resonance imaging and venography demonstrated a large intrapelvic mass compressing the external iliac vein. An arthrogram revealed a cystic cavity consistent with an iliopsoas bursa in communication with the hip pseudocapsule. Two aspirations of the bursa led to resolution of the cystic enlargement and symptoms. An enlarged iliopsoas bursa should be considered in the differential diagnosis of hip pain or extremity swelling after total hip arthroplasty

To assess the early and late valve-related events, 340 consecutive patients undergoing mitral valve repair from 1969 to 1988 were evaluated. Follow-up was complete, with a mean of 7.5% years and range from 2 to 22 years (cumulative 2456 patient-years). There were 221 (65%) female patients. Rheumatic valvular disease was present in 246 (68%) patients. The remaining patients had ischemic or congenital valve disease, floppy valve or infective endocarditis. At surgery, 47% of the patients had pure mitral incompetence, 43% had mixed mitral stenosis and incompetence and 10% had predominant mitral stenosis. Seventy-three percent of the patients were in functional class III or IV. Twelve percent had had prior heart surgery. Concomitant valve procedures including coronary revascularization were performed in 62.3%. There were 23 hospital deaths (6.8%) but only 3 of these (0.8%) were valve-related in patients who died at reoperation for valve repair failure. There were 4 other early repair failures who survived early reoperation. Of the 317 hospital survivors, there were 127 late deaths, and an actuarial survival of 44 +/- 3.7% (70% CL) at 14 years. Of these, 13 were valve-related or 0.5% patient-year. Late events included thromboembolism (TE) 1% patient-year, anticoagulant bleeding 0.4% patient-year, infective endocarditis (IE) 0.2% patient-year and late reoperation for mitral valve repair failure in 63 patients or 2.8% patient-year. At the late follow-up, 88% of the hospital survivors were in functional class I or II.(ABSTRACT TRUNCATED AT 250 WORDS)

It has been suggested that immature hearts are less well protected by conventional cardioplegic solutions than are adult hearts. In an attempt to develop an improved cardioplegic solution for use in the immature ischemic heart the authors investigated whether the addition of various concentrations of glucose or mannitol to St Thomas' Hospital cardioplegic solution can improve its protective ability. Hearts from immature (three- to five-day-old) rats were perfused as Langendorff preparations with an indwelling left ventricular balloon. Contractile function (left ventricular developed pressure, maximum rate of development of pressure, heart rate, rate-pressure product and coronary flow) was recorded before and after a period of normothermic global ischemia with preischemic infusion (2 mins) of St Thomas' Hospital cardioplegic solution. In preliminary experiments the post ischemic recovery of contractile function was related to the duration of ischemia. With 60, 75, 90 and 120 mins of ischemia the post ischemic recovery of developed pressure was 47.6 +/- 3.9%, 17.4 +/- 5.5%, 15.0 +/- 5.4% and 13.8 +/- 4.8%, respectively, of its preischemic control. Comparable results were obtained with the other indices of cardiac function. The effect on the post ischemic recovery of function and tissue water content of the addition of mannitol or glucose (10, 20, 40, 60 or 80 mmol/L) to the cardioplegic solution was examined after 60 mins of ischemia. The mannitol groups tended to show consistently better recoveries at all concentrations studied but the improvement was small and rarely achieved a degree of statistical significance. In contrast glucose gave a U-shaped dose response profile with a significant deleterious effect at 10, 20 and 40 mmol/L.(ABSTRACT TRUNCATED AT 250 WORDS)

This article embraces legal and legislative concerns about treatability of dangerous sex offenders; the disease concept of chronic offenders; treatment modalities; an evaluation of treatment; a consideration of treatability. The shortcomings of clinical methods must be borne in mind when evaluating and redesigning sexually dangerous offender statutes

It has previously been demonstrated in the rat heart, in vivo and in vitro, with regional ischemia, that an asymmetric bell-shaped curve defines the relationship between the vulnerability to reperfusion-induced arrhythmias and the duration of the preceding period of ischemia. The present study sought to establish whether a similar relationship occurred with global ischemia and reperfusion. Using rats from three different sources (two British, one North American) it was observed that, when an appropriate duration of ischemia was selected, reperfusion was capable of eliciting a very high incidence (up to 100%) of ventricular fibrillation and ventricular tachycardia. In the first series of studies an asymmetric bell-shaped relationship was observed such that with reperfusion after 5, 10, 20, 25, 28, 30, 33, 37 and 45 mins 0, 8, 8, 8, 50, 58, 83, 33, 33 and 25% of hearts fibrillated, respectively (12 hearts per group). However, upon repeating the studies with groups of rats from other suppliers or different batches from the same supplier, different results were obtained. Thus, in some study groups a very high incidence of arrhythmia was observed with reperfusion after very short (7.5 mins) durations of ischemia and low incidences were sometimes obtained with reperfusion after 30 mins, a time which, in some study groups, elicited a very high (100%) incidence of severe arrhythmias. These results contrast strikingly with those obtained with regional ischemia where a highly reproducible profile for the incidence of arrhythmias is consistently observed.(ABSTRACT TRUNCATED AT 250 WORDS)

This study sought to determine where drugs that are known to alter sensorimotor reactivity measured with the acoustic startle reflex ultimately act within the acoustic startle pathway. To do this, startle was elicited either acoustically or electrically within various nuclei believed to comprise the acoustic startle pathway. Direct infusion of serotonin into the subarachnoid space of the lumbar spinal cord increased acoustic startle and startle elicited electrically through the ventral cochlear nucleus (VCN) to a comparable degree. Subconvulsant doses of strychnine increased startle elicited acoustically or electrically through either the VCN or the nucleus reticularis pontis caudalis (RPC), pointing to a spinal locus of action of strychnine after systemic administration. In marked contrast, the dopamine agonists d-amphetamine and apomorphine consistently increased acoustic startle but actually depressed startle elicited electrically through the VCN or the RPC. These later results suggest that dopamine agonists increase sensorimotor reactivity measured with acoustic startle by acting on sensory rather than motor parts of the reflex arc