Results of Primary Total Knee Arthroplasty in Jehovah's Witness Patients

Total knee arthroplasty can be challenging in Jehovah's Witnesses, as these patients do not accept blood transfusions. We reported our experiences with a special blood management protocol for these patients who underwent total knee arthroplasty. There were 124 self-reported Jehovah's Witnesses who had a mean age of 64 years and who underwent total knee arthroplasties between 1998 and 2009. Mean follow-up was 60 months (range, 24-120 months). Implant survivorship, with revision for aseptic component failure as an end point, was 98%. At the final follow-up, mean Knee Society objective and function score improved to 91and 81 points, respectively. The authors believe that this blood management protocol was responsible for performing safe and transfusion-free total knee arthroplasties that can ultimately lead to excellent outcomes.     

Excellent Results and Minimal Complications of Total Hip Arthroplasty in Sickle Cell Hemoglobinopathy at Mid-Term Follow-Up Using Cementless Prosthetic Components

The purpose of this study was to compare the outcomes of cementless primary total hip arthroplasty (THA) in sickle cell patients compared to the remaining cohort of osteonecrosis patients who did not have this disease. Thirty-two sickle cell patients (42 hips) who had a mean age of 37 years and mean follow-up of 7.5 years (range, 5–11 years) were compared to 87 non-sickle cell osteonecrosis patients (102 hips) who had mean age of 43 years and mean follow-up of 7 years (range, 3–10.5 years). Outcomes evaluated included implant survivorship, Harris hip scores, complication rates, radiographic outcomes, and Short Form-(SF-36) health questionnaire. There were no significant differences in aseptic implant survivorship (95 vs. 97%), Harris hip scores (87 vs. 88 points), SF-36 score, or radiographic findings between the two patient cohorts. In light of these findings, we believe that the outcomes of THA improved in sickle cell patients with optimized medical management and the use of cementless prosthetic devices.     

Urinary acidification in turtle bladder is due to a reversible proton-translocating ATPase.

Adverse proton electrochemical gradients (delta muH) applied across the turtle urinary bladder decrease active H+ transport in this epithelium. A delta muH of 180 mV abolishes both transport and its tightly coupled metabolic reaction. Larger gradients should, in theory, reverse the direction of H+ transport and the metabolic reaction leading to synthesis of ATP if the pump is an ATPase, or cause an increase in the oxidized state of a redox pair if it is a redox pump. To distinguish between these two possibilities, we measured ATP levels in epithelial cells that were poisoned to inhibit cellular mechanisms of ATP synthesis. At delta muH of 120 mV or less no ATP synthesis was found. At delta muH of greater than 120 mV there was a linear increase in ATP synthesis. Dinitrophenol, a H+ carrier, prevented synthesis at delta muH of 310 mV. Dicyclohexylcarbodiimide, an inhibitor of H+ transport that works at the cell surface, prevented ATP synthesis at delta muH of 310 mV. These results demonstrate that a reversible proton-translocating ATPase in the mucosal border of the bladder is the H+ pump responsible for urinary acidification.     

Transrectal ultrasonic volumetry of the prostate: In vivo comparison of different methods

In order to assess the accuracy of various volumetric methods for screening and follow-up of prostatic disease, total prostate volume and inner zone volume were measured by transrectal ultrasonography in a screening population of 716 men. Semiplanimetric and caliper formula methods were compared with step section planimetry as the gold standard. Planimetric volumetry of the prostate is regarded as the most reproducible method for individual follow-up of total gland and inner zone volume. The prolate spheroid formula is the most reproducible of caliper formula methods for both volumes. In this study the elliptical volume was, however, more accurate than the prolate spheroid volume of the total gland, as the correlation coefficient between total elliptical volume and planimetry was higher compared to the prolate spheroid volume (0.89 vs. 0.83), and the standard deviation of the mean volumetric difference smaller. The mean total prolate spheroid volume resembled the mean total planimetric volume better than the elliptical volume did, as the mean volumetric difference was smaller. For measurement of the inner zone volume the prolate spheroid volume was more accurate than the elliptical volume. The correlation coefficient between length and planimetric volume was similar to that of width and height, which accounted for more accuracy of the elliptical volume than of the prolate spheroid volume in larger prostates. The elliptical volume might be used for incidental volumetric measurements of the total gland, and for comparison of different individuals, e.g., in preoperative evaluation or screening studies. © 1996 Wiley-Liss, Inc.     

Prostatic expression of hensin, a protein implicated in epithelial terminal differentiation

OBJECTIVES: Hensin induces terminal differentiation in rabbit kidney collecting tubule cells. Rabbit hensin and human DMBT1 result from alternative splicing of the same gene. The human DMBT1 gene is located on chromosome 10q25-26, a region often deleted in prostate cancer. In this study we examined the potential role of this gene in terminal differentiation of prostate, as well as its role in prostatic carcinogenesis. METHODS: We searched for deletions of this gene in prostatic cells cultured from cancer and benign tissues using PCR and cDNA cloning. The expression of hensin/DMBT1 in cultured cells and during prostate development was characterized by immunochemistry. RESULTS: No deletions of hensin/DMBT1 similar to those found in glioblastomas, lung and esophageal cancers were observed in prostate cancer or BPH cells. Hensin/DMBT1 protein was localized in intracellular vesicles of epithelial cells in neonatal and 6-week-old mouse prostates. By 6 weeks, hensin/DMBT1 began to localize in the basal lamina of the prostate and vas deferens. In matured 6-month-old prostates, there was extensive deposition of hensin/DMBT1 in the basal lamina. CONCLUSIONS: There is no evidence that hensin/DMBT1 is implicated in prostatic carcinogenesis. The localization of hensin/DMBT1 during maturation raises the possibility that hensin/DMBT1 is involved in terminal differentiation of the prostate and vas deferens.