Purpose. To review records of 17 patients who sustained a tibial or femoral intra-operative fracture during primary cemented total knee arthroplasty (TKA) Methods. Records of 1346 primary cemented TKAs using the NexGen LPS fluted tibial component performed by a single surgeon were reviewed. 12 tibial and 5 femoral intra-operative fractures occurred in 5 men and 12 women aged 54 to 83 (mean, 71.6) years. No patient had any condition that may predispose to osteoporosis. Results. All 12 tibial fractures occurred during hammering down of the final tibial component. They were vertical crack fractures of the anterior cortex of the medial tibial plateau with minimal displacement and did not extend beyond the tip of the tibial stem. Four of the 5 femoral fractures were avulsion fractures in the coronal plane of the medial femoral condyles and occurred during removal of the intercondylar notch. The remaining femoral fracture involved the Intra-operative fracture in posterior-stabilised total knee arthroplasty
Self-rating scales currently in use for the detection of mood disturbance may not be suitable for use with neurological patients, or patients with substantial physical illness, because they employ items concerning activity and somatic or cognitive disorder and so are liable to produce a high level of false positive misclassifications. The development of a more suitable scale based purely on feelings, the Wimbledon Self-Report Scale (WSRS), is described. The WSRS provides a catalogue of the patient's adverse emotions for use in counselling and detects levels of mood disturbance that warrant further exploration. The classifications yielded by the scale are reliable and false positive and false negative rates are low. WSRS scores appear unaffected by sex or by age within the 18-80 year range.
Common variable immunodeficiency disorder (CVID) is the most frequent symptomatic primary immune deficiency disorder in adults. It probably comprises a spectrum of polygenic disorders, with hypogammaglobulinemia being the overarching feature. While the majority of patients with CVID can be identified with relative ease, a significant proportion can present with minimal symptoms in spite of profound laboratory abnormalities. Here we discuss three patients who were presented to the Auckland Hospital immunoglobulin treatment committee to determine if they qualified for immunoglobulin replacement. Two were asymptomatic with profound laboratory abnormalities while the third patient was severely ill with extensive bronchiectasis. The third patient had less severe laboratory abnormalities compared with the two asymptomatic patients. We have applied four sets of published diagnostic and treatment criteria to these patients to compare their clinical utility. We have chosen these patients from the broad phenotypic spectrum of CVID, as this often illustrates differences in diagnostic and treatment criteria.
This paper reports on the personality changes found in 261 patients after proven subarachnoid haemorrhage, and in particular on the association between these changes and the site and severity of damage to the brain. Psychiatric symptoms and details of intellectual impairment are not considered but will be reported elsewhere.
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