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The cementless Bicontact stem series in particular formed the subject of continuous follow-up work [30–32] discount decadron 0.5mg amex. The latest follow-up of this series with 250 implantations was recently published by Eingartner et al cheap decadron 0.5mg with amex. Special aspects of the proximal load transfer could be found in cases where screw-type sockets implanted in the first Bicontact series of 1987–1989 had loosened generic 1mg decadron mastercard. Even where there was severe polyethylene wear and acetabular osteolysis, the proxi- mally coated Bicontact stem was somehow sealed against polyethylene wear particles. This remarkable feature of the titanium plasmaspray coating is the subject of further investigations. Primary and secondary Bicontact implant stability was analysed by Eingartner et al. Periprosthetic bone remodeling in the proximal coated Bicontact stem area was investigated by dual-energy X-ray absorptiometry (DEXA). The relative values of the proximal bone mineral density declined by 20% at 6 months but did not change in the subsequent follow-up periods. Bicontact was introduced into Japan in 1994 and into Korea in 1996 with specific hip stem types designed for the special requirements of the smaller femoral canal dimensions. For this reason, the Bicontact standard stem range was extended with an SD series for dysplastic femoral canal conditions and the Bicontact N series for narrow femoral canal conditions in secondary osteoarthritis. Conclusion European hip stem design concepts have influenced the successful development of total hip arthroplasty in the cemented and cementless techniques. Straight tapered hip stems offer reliable biomechanical concepts for cementless fixation. Even if Current Trends in THA in Europe and Experiences with Bicontact 209 different biomechanical concepts can lead to successful implant designs, we use the favourable characteristics of the proximal bone preservation hip implant concept in our institution. Not all current trends in hip arthroplasty are based on experience and sufficient clinical data. Implantation for hip arthroplasties in younger patients should not lead us to an uncritical use of less-experienced methods and implants. However, innova- tion in medicine must also be studied with new technologies that seem to be promis- ing for the benefit of our patients. Wroblewski BM, Fleming PA, Siney PD (1999) Charnley low-frictional torque arthro- plasty of the hip. Bettin D, Greitemann B, Polster J, et al (1995) Long term results of uncemented Judet hip endoprostheses. Keisu KS, Mathiesen EB, Lindgren JU (2001) The uncemented fully textured Lord hip prosthesis: a 10- to 15-year followup study. Swanson TV (2005) The tapered press fit total hip arthroplasty: a European alternative. Weller S, Rupf G, Ungethum M, et al (1988) The Bicontact Hip System (in German). Malchau H, Garellick G, Eisler T, et al (2005) Presidential guest address. The Swedish Hip Registry: increasing the sensitivity by patient outcome data. Espehaug B, Furnes O, Havelin LI, et al (2006) Registration completeness in the Norwegian Arthroplasty Register. Eskelinen A, Remes V, Helenius I, et al (2006) Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid- to long-term follow-up study from the Finnish Arthroplasty Register. Pedersen AB, Johnsen SP, Overgaard S, et al (2006) Total hip arthroplasty in Denmark: incidence of primary operations and revisions during 1996–2002 and estimated future demands. Mittelmeier H, Heisel J (1992) Sixteen-years’ experience with ceramic hip prostheses. Willmann G (1998) Ceramics for total hip replacement: what a surgeon should know. Engh CA Jr, Young AM, Engh CA Sr, et al (2003) Clinical consequences of stress shielding after porous-coated total hip arthroplasty. D’Antonio JA, Capello WN, Manley MT, et al (2001) Hydroxyapatite femoral stems for total hip arthroplasty: 10- to 13-year followup. Kawamura H, Dunbar MJ, Murray P, et al (2001) The porous coated anatomic total hip replacement.

We judged weight using the body mass index (BMI): (body weight in kilo- grams)/(height in meters)2 order decadron 1 mg without prescription. Another condition that cuts across the four causal categories is pressure ulcers (decubitus ulcers) purchase 1 mg decadron overnight delivery, which occur where bony structures press into sur- rounding tissues of people who are immobilized buy cheap decadron 0.5mg on-line, seated, or bedridden for long periods. Pressure ulcers can become profoundly debilitating and life-threaten- ing, particularly among institutionalized persons with severely impaired mo- bility. But among people living in the community, less than 4 percent of those with major mobility problems report pressure ulcers, as do 0. For people with amputations above the knee, the prosthesis must include not only a foot-ankle complex but also a knee joint, allowing persons to sit, climb stairs, walk up and down inclines. Complicated biomechanics make this prosthesis more difficult and expensive to devise, and it requires more training to use than below-the-knee prostheses. Sophisticated prostheses can substan- tially restore mobility, even permitting performance in rigorous competitive sports among athletes with high amputations. The NHIS-D asked about sensory and other physical functions (Table 3) but did not indicate whether mobility difficulty caused or resulted from prob- lems. These data on use of cigarettes, snuff, and chewing tobacco come from the 1994 Healthy People 2000 supplemental questionnaire administered along with the 1994 NHIS-D. Exact percentages are 28 for minor, 30 for moderate, and 29 for persons with major mobility difficulties. Be- fore broad-spectrum antibiotics became available, urinary tract infections killed many people with spinal cord injuries, who generally must use catheters or other instrumentation to evacuate their bladders. Today, these infections re- main the leading reason for medical services, with more than half of people with spinal cord injuries developing urinary tract infections each year (Berkowitz et al. I write this revision just over a year after the 11 September 2001 terror- ist attacks on the United States. What future airport security will entail is still evolving, as it becomes a federal responsibility. I resumed traveling by air about a month after the attacks and found that little had actually changed for 300 / Notes to Pages 54–55 me when passing through airport security, although the request to remove my shoes is physically difficult and seems perhaps excessive. Anecdotal reports suggest that airlines’ performance was mixed when it came to accommodating passengers using wheelchairs even before 11 September. Williams, decided 8 January 2002, a unanimous court ruled against Ella Williams, who had argued that her carpal tunnel syn- drome prevented her from performing her job at a Toyota manufacturing plant. Williams was not “disabled” because she could still perform routine tasks at home, such as brushing her teeth and gar- dening—in other words, that her condition did not limit “major life activities” (thus implicitly viewing employment as outside “major life activities,” the standard used by the ADA to describe disabling conditions). Another impor- tant case was Board of Trustees of the University of Alabama et al. In this case, two employees of Alabama sued the state for money damages under Title I of the ADA. Patricia Garrett, a registered nurse, had been employed as a director of nursing at the University of Alabama in Birmingham Hospital when she de- veloped breast cancer. During treatment for her cancer, she took extensive leave from work, and when she returned, her supervisor told Garrett that she had been transferred to a lower-paying job as a nurse manager. In a separate suit, Milton Ash had worked as a security officer for the Alabama Department of Youth Services. Because of asthma and at his physician’s recommendation, Ash requested that his employer limit his exposure to cigarette smoke and car- bon monoxide; Ash later developed sleep apnea and requested reassignment to daytime shifts. The Supreme Court ruled that individuals cannot bring lawsuits for money damages against states under the ADA. Rehnquist as- serted that, in passing the ADA, Congress had failed to show a convincing pat- tern of discrimination by states against people with disabilities, as would be re- quired for these persons to meet the “equal protection” assurances of the Fourteenth Amendment. Rehnquist continued,“Thus, the Fourteenth Amend- ment does not require States to make special accommodations for the disabled, so long as their actions toward such individuals are rational. They could quite hardheadedly—and perhaps hardheartedly—hold to job-qualification require- ments which do not make allowance for the disabled.

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Nourse discount 0.5 mg decadron with mastercard, who had been prevented from coming sooner quality decadron 1mg, fortunately entered the drawing of the skeletal injuries responsible for it order decadron 1mg otc. After examining the limb, he conceived there His ascription is quite impersonal and he makes was a possibility of preserving it: an attempt to save it no mention of the fracture that he himself was acquiesced in, and succeeded. In consequence there has been some 275 Who’s Who in Orthopedics misapprehension as to the nature of Pott’s acci- vertebrae. His classical description of the ankle frac- origin elsewhere in the body: the disease was ture–dislocation, and his reticence about his own scrophula, and was capable of revealing itself in fracture of the tibia at a higher level, have misled a variety of organs. To give it a modern termi- many to believe that in describing the ankle injury nology, tuberculosis is an infective disease with he was speaking of something within his own inti- local manifestations. This misconception has helped The treatment of spinal disease had been to fasten his name to the fracture–dislocation. This was a new departure Palsy of the Lower Limbs which is frequently in treatment and was the first sign of understand- found to accompany a Curvature of the Spine and ing of the natural process of cure by osseous is supposed to be caused by it. But he was per- in 1779 and was translated into French and Dutch; suaded, partly by the inspiration of Hippocratic the disease that it described became known on the teaching, to form an artificial sinus by applying continent as “La maladie du Pott. He seemed confirmed in his view patients with their symptoms and signs with so by the frequent relief of paralysis in patients sub- sure a touch that we can add nothing to the mitted to this operation. He differentiated between flaccid and the object of draining an abscess, and indeed there spastic paralysis and noted that spasticity was the seldom is any superficial abscess in Pott’s para- invariable rule of spinal cord pressure in spinal plegia. The artificial sinus imposed recumbency, and in consequence of prolonged rest the paraly- The disease of which I mean to speak, is generally sis disappeared. Pott, like many of his successors, called a palsy, as it consists in a total or partial aboli- failed to realize the decisive importance of rest. It tion of the power of using, and sometimes of even was not until nearly a century later that the value moving the lower limbs, in consequence, as is gener- of rest in joint tuberculosis was formulated by ally supposed, of a curvature of some part of the spine. Until the curvature of the spine has been dis- covered, it generally passes for a nervous complaint.... I have in compliance with custom called the Pott’s Puffy Tumour disease a palsy... In common nervous palsy: the legs and thighs are ren- 1760 he published a monograph entitled “Obser- dered unfit for all the purposes of locomotion and do vations on the Nature and Consequences of also lose much of their sensibility, but they have neither Wounds and Contusions of the Head, Fractures of the flabby feel, which a truly paralytick limb has, nor the Skull, Concussions of the Brain, etc. His publications included abundant case which Pott dealt mainly with the morbid anatomy histories, which are interesting apart from their of disease of the spine, accompanied by engrav- main purpose; his delightful narrative touches ings illustrating the changes that occurred in the upon the occupations, social habits and customs 276 Who’s Who in Orthopedics of ordinary people in the eighteenth century. The with this degrading custom, but a centenarian still particular scalp swelling or puffy tumor that he lives who at the age of 12 worked 15 hours a day, described is referred to in this paragraph: climbed the insides of chimneys, and swept down soot with a hand brush. If the symptoms of pressure, such as stupidity, loss of The humane disposition of Percivall Pott was sense, voluntary motion, etc. Before he joined the staff after the head has suffered injury from external mis- of St. Bartholomew’s, extensive use was made of chief, they do most probably imply an effusion of a escharotics and the actual cautery, but Pott con- fluid somewhere; this effusion may be in the substance demned the practice and ultimately succeeded in of the brain, in its ventricles, between its membranes, abolishing it. Furthermore, he contrived to render or on the surface of the dura mater; and which of these surgical treatment as mild as possible, consistent is the real situation of such extravasation is a matter of with efficiency; and this principle was reflected in great uncertainty; none of them being attended with any his use at operations of a reduced number of peculiar mark, or sign that can be depended upon, as pointing it out precisely; but the inflammation of the instruments of simple design. These reforms were dura mater, and the formation of matter between it and greeted with some contempt by his colleagues the skull, in consequence of contusion, is generally who were accustomed to elaboration of technique indicated and preceded by one which I have hardly ever but Abernethy, a warm admirer, testified to Pott’s known to fail; I mean a puffy, circumscribed, indolent consideration for the ease and comfort of his tumour of the scalp, and a spontaneous separation of patients. He also had a kindly heart toward his dressers, These appearances therefore following a smart blow on some of whom he took into his own home. He the head, and attended with languor, pain, restlessness, took a leading part in improving the instruction of watching, quick pulse, headache, and slight irregular students. His lectures were open to all on payment shiverings, do almost infallibly indicate an inflamed dura mater, and pus, either forming or formed between of a small fee and they were well attended. His monograph on palsy of the lower injuries did much to establish him as one of the leading surgeons of his day. One instance is Judging by portraits of Pott, he had a pleasing chimney-sweep’s cancer, which he was the first to appearance, and dressed according to the fashion describe; he was the first to point out the car- of the period, visiting the hospital in his powdered cinogenic properties of soot on man. In the words of mental verification of Pott’s observations on the Earle he was “elegant, lower than middle size. He was a devoted the misery of the chimney-boys, he drew the son, and made a home for his mother until her attention of profession and public to the evil death in 1746, after which he married the daugh- nature of their occupation: ter of Robert Cruttenden, by whom he had five sons and four daughters. In 1769 he bought a The fate of these people seems singularly hard; in house near Lincoln’s Inn Fields and resided in it their early infancy, they are most frequently treated with great brutality and almost starved with cold and for 7 years, when he moved to Prince’s Street, hunger; they are thrust up narrow and sometimes hot Hanover Square.

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Her antiserum for rhinitis discount decadron 1mg line, hay fever cheap decadron 0.5 mg overnight delivery, a term used since the 1830s effective 1 mg decadron, is inaccu- reduced the death rate by almost 80%. Further research led to rate because the condition is not caused by fever and its symp- the use of sulfa drugs and other antibiotics in the treatment of toms do not include fever. Her discovery prompted 46 million allergy sufferers in the United States, about 25 mil- research that has led to effective treatments for croup. While the mite itself is too large to be inhaled, its feces are about the size of pollen grains and can lead to allergic rhinitis. Other types of allergy can be traced to the fur of animals and pets, food, drugs, insect bites, and skin contact with chemical substances or odors. In the United States, there are about 12 million people who are allergic to a variety of chemicals. In some cases an allergic reaction to an insect sting or a drug reaction can cause sudden death. Serious asthma attacks are sometimes associated with seasonal rhinitis and other allergies. Some people are allergic to a wide range of allergens, while others are allergic to only a few or none. The reasons for these differences can be found in the makeup of an individ- ual’s immune system. The immune system is the body’s defense against substances that it recognizes as dangerous to the body. Lymphocytes, a type of white blood cell, fight Hayfever allergy triggered by oilseed rape plants. When an allergen first enters the body, the lymphocytes pro- duce an antibody called immunoglobulin E (IgE). This knowledge makes it possible to develop med- antibodies attach to mast cells, large cells that are found in icines that will be more effective in reducing the symptoms of connective tissue and contain histamines along with a number various allergies. Corticosteroids are sometimes prescribed to allergy Studies show that allergy sufferers produce an excessive sufferers as anti-inflammatories. Decongestants can also bring amount of IgE, indicating a hereditary factor for their allergic relief, but these can be used for a short time only, since their responses. How individuals adjust over time to allergens in continued use can set up a rebound effect and intensify the their environments also determines their degree of susceptibil- allergic reaction. The second time any given allergen enters the body, it See also Antibody and antigen; Antibody-antigen, biochemi- becomes attached to the newly formed Y-shaped IgE antibod- cal and molecular reactions; Antibody formation and kinetics; ies. These antibodies, in turn, stimulate the mast cells to dis- Antigenic mimicry; Immunology charge its histamines and other anti-allergen substances. H1 histamines travel to receptor sites located in the nasal passages, respiratory system, Amebic dysenteryAMEBIC DYSENTERY and skin, dilating smaller blood vessels and constricting air- ways. The H2 histamines, which constrict the larger blood ves- Amebic (or amoebic) dysentery, which is also referred to as sels, travel to the receptor sites found in the salivary and tear amebiasis or amoebiasis, is an inflammation of the intestine glands and in the stomach’s mucosal lining. The severe form play a role in stimulating the release of stomach acid, thus of the malady is characterized by the formation of localized contributing to a seasonal stomach ulcer condition. In such by vomiting, severe diarrhea with fluid loss leading to dehy- cases, desensitization to the allergen is sometimes attempted dration, and abdominal pain. The other is Antihistamines, which are now prescribed and sold over infection with bacteria of the Shigella group. Amebiasis is contracted mainly by ingesting the para- There are a number of different antihistamines, and they either site in contaminated food or water. Person–to–person trans- inhibit the production of histamine or block them at receptor mission is less likely, but can occur. After the administration of antihistamines, IgE receptor common where sanitation is poor, in the developing world. Run–off from fields can allergens are still there, but the body’s “protective” actions are contaminate wells contaminating the drinking water.

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