Objectives To prospectively compare compliance with treatment in patients with hypertension responsive to treatment versus patients with treatment resistant hypertension. Design Prospective case-control study. Setting Outpatient department in a large city hospital in Switzerland, providing primary, secondary, and tertiary care. Participants 110 consecutive medical outpatients with hypertension and taking stable treatment with at least two antihypertensive drugs for at least four weeks. Main outcome measures Treatment compliance assessed with MEMS devices; blood pressure determined by 12 hour daytime ambulatory monitoring (pressure < 135/85 mm Hg in patients aged <60 years and < 155/90 mm Hg in patients aged > 60 indicated hypertension responsive to treatment). Results Complete data were available for 103 patients, of whom 86 took >80% of their prescribed doses ("compliant") and 17 took < 80% ("non-compliant"). Of the 49 patients with treatment resistant hypertension, 40 (82%) were compliant, while 46 (85%) of the 54 patients responsive to treatment were compliant. Conclusion Non-compliance with treatment was not more prevalent in patients with treatment resistant hypertension than in treatment responsive patients.

Osteoarthritis (OA) secondary to dislocation and dysplasia is a common problem in patients with cerebral palsy. The purpose of this study was to evaluate the results of total hip replacement (THR) in ambulatory patients with cerebral palsy. Eighteen total hip arthroplasties were performed in 16 ambulatory patients with cerebral palsy. The patient's mean age at surgery was 42±8 years (range 32-58 years), and the mean follow-up was 10±6 years (range 2-18 years). Data were obtained by a standardised telephone interview. There was a significant postoperative reduction in pain on the NAS (narrative analogue scale) from 8.4 preoperatively to 1.1 postoperatively (p= 0.002). At follow-up no stem had been revised. Three cups were revised for aseptic loosening at two and six years, and one cup was revised for recurrent dislocation of the hip. One hip was revised for infection 12 years after the index surgery. One hip dislocated (three months postoperatively) and was treated by closed reduction. In ambulatory patients with cerebral palsy and secondary osteoarthritis of the hip THR can provide long-term pain relief and improved function. The rate of long term complications was moderate in this series; however, the dislocation rate was higher than in standard OA cases.

The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections represents a significant healthcare burden. Vancomycin and linezolid exhibit potent clinical and microbiological activity in MRSA infections. Our purpose was to investigate the efficacy of linezolid versus vancomycin in experimental implant infections and the influence on implant stability in a rabbit model. Thirty-six female New Zealand White rabbits received surgical insertion of titanium implants into their distal femurs and were randomly assigned to six groups (A: infected, no treatment; B: infected, vancomycin; C: infected, linezolid; D: no infection, no treatment; E/F: no infection, vancomycin or linezolid, respectively). Antibiotics were administered, and plasma levels determined.Bone-implant specimens were tested for mechanical stability of fixation. Quantitative histomorphometry of bone and soft tissue was performed using computerized image analysis. Plasma levels of linezolid and vancomycin were within the respective therapeutic ranges. Microbiological analysis of specimens from infected rabbits showed MRSA tissue colonization in all untreated animals, in two of six vancomycin-treated animals, and in none of the linezolid-treated animals. Antibiotic treatment improved mechanical stability significantly (p ¼ 0.004) with both vancomycin and linezolid. Mechanical testing correlated with histomorphometry results. A significant negative correlation was found between displacement of the implant and the percentage of calcified tissue around the implant, and a significant positive correlation was found between displacement of the implant and the amount of noncalcified tissue. Our data indicate that both treatment regimens improved implant stability. ß

The usage of autologous iliac crest transplants for reconstruction of metacarpal or phalanx defects which include one partner of the MCP joint can be advised after tumour resection, especially because of rare functional alternatives. Bone defects including one part of the PIP joint might also be replaced by iliac crest transplants. However, the functional outcome seems to be less attractive than in MCP reconstruction. In cases of development of osteoarthritis after iliac crest transplantation, arthroplasty with silicone spacers might be a salvage procedure to maintain joint movement.

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