Effect of Tobacco Use on Radiolucent Lines in Modern Cementless Total Knee Arthroplasty Tibial Components

Background

The link between tobacco consumption and wound complications following total knee arthroplasty (TKA) is well established. However, the effect of tobacco use on biologic fixation in cementless TKA remains unknown. This study evaluated the influence of tobacco use on the presence of radiolucent lines of tibial components in cementless TKA.

Methods

A total of 293 consecutive cementless TKAs of 2 contemporary designs were retrospectively reviewed. Tibial radiolucent lines and component alignment were measured using an established measurement protocol. Patients with any history of tobacco use or active tobacco use (tobacco users) were compared to those with no history of tobacco use (tobacco nonusers). No significant differences which influenced outcomes were detected between the tobacco user and tobacco nonuser groups (P ≥ .071).

Results

Radiolucent lines decreased from 1-month to latest follow-up (mean 2.5 years) in all 10 radiographic zones regardless of tobacco use (P ≤ .084). However, evaluating intrapatient change in radiolucent line width, the tobacco nonuser group had more radiolucent lines resolve by the latest follow-up in nearly all radiographic zones, although most differences did not reach statistical significance, except for anteroposterior zone 1 (-31% vs -19%, P = .022). No tibial components were revised for aseptic loosening.

Conclusions

Results from this study suggest that any tobacco use prior to cementless TKA has the potential to hinder biologic fixation of tibial components. While no tibial components were revised for aseptic loosening, follow-up was relatively short at 2.5 years and therefore warrants further study to discern the effect of persistent radiolucent lines on long-term fixation.

A Salter-Harris II Distal Radius Fracture Irreducible by Closed Methods

CASE

A 10-year-old boy presented with a Salter-Harris II distal radius fracture that was irreducible by closed methods. An open reduction was performed in the operating room where a sleeve of periosteum was found interposed between the fracture fragments. Successful reduction was performed without difficulty after the periosteum was removed from the fracture.

CONCLUSION

Soft-tissue interposition must be kept in mind when having difficulty performing closed reductions of pediatric distal radius physeal fractures to avoid excessive reduction attempts.

Occurrence of nonceliac gluten sensitivity in patients with allergic disease

BACKGROUND

The aim of this study was to determine the occurrence of gluten sensitivity (GS) in a group of allergic patients and to assess the efficacy of a gluten-free diet (GFD) on the improvement of the symptomatology in those who were diagnosed with GS.

METHODS

262 unrelated allergic patients with gastrointestinal symptoms of obscure origin were tested for GS condition by biopsy. All patients were also genotyped for the typical celiac DQ2 and DQ8 molecules and investigated for several hematological parameters such as antigliadin and antiendomysial antibodies. Patients displaying mucosal lesions were invited to follow a GFD.

RESULTS

Seventy-seven of the 262 allergic patients were positive to mucosal lesions, but negative to the antiAGA, antiEMA and to DQ2 and DQ8 molecules. We found, instead, a prevalence of the DQA1*05 allele, whereas anemia of inflammatory origin represented the predominant complaint in our subjects. The positive patients, who, after the GS diagnosis, followed a GFD, exhibited control of symptoms as well as stabilization of the hematological parameters even if allergic manifestations were not abated.

CONCLUSIONS

A nonceliac gluten-sensitive enteropathy (NCGSE) commonly occurs in allergic patients. Based on the high prevalence of NCGSE in allergy, it is recommended that biopsy should be part of the routine investigation of allergic disease to offer the benefits of treatment with a GFD to the patients.

Prevalence and incidence of hepatitis C virus (HCV) in hemodialysis patients: study of risk factors

The prevalence of antibodies against hepatitis C virus (HCV) was assessed in 246 hemodialysis patients who attended a dialysis unit in Bari, using a recombinant enzyme immunoassay test (Abbot Lab.). Fifty-six (22.8%) sera were reactive to anti-HCV. The reactivity was confirmed in 46 specimens (18.7%) using the Abbott EIA HCV neutralization test. The anti-HCV prevalence was higher in males than in females and increased with age, duration of dialysis and number of transfusions. Moreover, a correlation between the presence of anti-HCV and the persistent increase of ALT was noted. The HCV-infection attack rate was calculated using the frozen sera collected from 1984 to 1990: the incidence of infection in the first year was 6.1%, and in following years 4.6%, 4.9%, 3.1%, 2.1% and 2.2%, respectively.

Hepatitis C virus in hemodialysis patients

Anti-HCV prevalence in 284 hemodialysis patients was assessed using the Abbott HCV-EIA test. Anti-HCV positivity was found in 19.4% of patients, was higher in males than in females and progressively increased with age. A correlation between time of dialysis treatment, transfusions and ALT course was found. These data suggest that HCV infection is a very important risk in dialysis units.

[Behavior of theophylline-sensitive T lymphocytes in viral A, B, non-A, non-B hepatitis. I. Methodological aspects]

To evaluate the behaviour of the Theophylline-sensitive T lymphocytes subpopulation some modifications of the standard procedure are proposed. Lymphoprep purified lymphocytes were counted in a Neubauer hemocytometer after Acridine Orange stain, viability was evaluated by Ethidium Bromide counterstain and monocytes contamination was evaluated by the peroxidase stain. Sheep red blood cells were treated with AET, Theophylline was used at 3 mM (final concentration) and the results compared with untreated lymphocytes; the enumeration of the rosetting lymphocytes was facilitated by adding Acridine Orange prior to the resuspension. The modifications described were able to increase the % of rosetting T lymphocytes, to eliminate differences depending by different lots of sheep red blood cells and to decrease differences depending by subjective evaluation of the rosetting T lymphocytes.

[Behavior of theophylline-sensitive T lymphocytes in viral A, B, non-A, non-B hepatitis. II. Application aspects]

The pathogenesis of the hepatic damage in hepatitis is not well understood but an imbalance in immunoregulatory T lymphocytes is probable. We tested the Theophylline-sensitive T lymphocytes in acute and protracted cases of hepatitis A, in hepatitis B and non-A, non-B. A delayed increment of such cells was demonstrated in hepatitis B suggesting a positive role in the recovery from the disease. The results were indicative for a direct action of the HAV and nAnB on the lymphocytes. Theophylline-sensitive lymphocytes were increased in the course of protracted hepatitis A whereas were progressively decreasing in nAnB hepatitis. This behaviour of suppressor cells in nAnB hepatitis may explain the high frequency of evolution in chronic liver disease.