Search tips
Search criteria

Results 1-17 (17)

Clipboard (0)

Select a Filter Below

Year of Publication
more »
1.  Risk of cancer following primary total hip replacement or primary resurfacing arthroplasty of the hip: a retrospective cohort study in Scotland 
British Journal of Cancer  2013;108(9):1883-1890.
Release and dispersion of particles arising from corrosion and wear of total hip arthroplasty (THA) components has raised concerns about a possible increased risk of cancer. Concerns have been heightened by a recent revival in the use of metal-on-metal (MoM) hip prostheses.
From a linked database of hospital discharge, cancer registration, and mortality records, we selected a cohort of patients who underwent primary THA (1990–2009) or primary resurfacing arthroplasty (mainly 2000–2009) in Scotland, with follow-up to the end of 2010. Available operation codes did not enable us to distinguish MoM THAs. Indirectly standardised incidence ratios (SIRs) were calculated for selected cancers with standardisation for age, sex, deprivation, and calendar period.
The study cohort included 71 990 patients yielding 547 001 person-years at risk (PYAR) and 13 946 cancers diagnosed during follow-up. For the total period of observation combined, the risks of all cancers (SIR: 1.05; 95% CI: confidence interval 1.04–1.07), prostate cancer (SIR: 1.07; 95% CI: 1.01–1.14), and multiple myeloma (SIR: 1.22; 95% CI: 1.06–1.41) were increased. These modest increases in risk emerged in the context of effectively multiple tests of statistical significance, and may reflect inadequate adjustment for confounding factors. For 1317 patients undergoing primary resurfacing arthroplasty between 2000 and 2009 (PYAR=5698), the SIR for all cancers (n=39) was 1.23 (95% CI: 0.87–1.68).
In the context of previous research, these results do not suggest a major cause for concern. However, the duration of follow-up of patients receiving recently introduced, new-generation MoM prostheses is too short to rule out a genuinely increased risk of cancer entirely.
PMCID: PMC3658512  PMID: 23549038
arthroplasty; cohort studies; hip prosthesis; medical record linkage; neoplasms; risk
2.  Clinically relevant doses of lidocaine and bupivacaine do not impair cutaneous wound healing in mice† 
BJA: British Journal of Anaesthesia  2010;104(6):768-773.
Lidocaine and bupivacaine are commonly infiltrated into surgical cutaneous wounds to provide local anaesthesia after surgical procedures. However, very little is known about their effects on cutaneous wound healing. If an inhibitory effect is demonstrated, then the balance between the benefits of postoperative local anaesthesia and the negatives of impaired cutaneous wound healing may affect the decision to use local anaesthesia or not. Furthermore, if a difference in the rate of healing of lidocaine- and bupivacaine-treated cutaneous wounds is revealed, or if an inhibitory effect is found to be dose-dependent, then this may well influence the choice of agent and its concentration for clinical use.
Immediately before incisional wounding, we administered lidocaine and bupivacaine intradermally to adult female mice, some of which had been ovariectomized to act as a model of post-menopausal women (like post-menopausal women, ovariectomized mice heal wounds poorly, with increased proteolysis and inflammation). Day 3 wound tissue was analysed histologically and tested for expression of inflammatory and proteolytic factors.
On day 3 post-wounding, wound areas and extent of re-epithelialization were comparable between the control and local anaesthetic-treated animals, in both intact and ovariectomized groups. Both tested drugs significantly increased wound activity of the degradative enzyme matrix metalloproteinase-2 relative to controls, while lidocaine also increased wound neutrophil numbers.
Although lidocaine and bupivacaine influenced local inflammatory and proteolytic factors, they did not impair the rate of healing in either of two well-established models (mimicking normal human wound healing and impaired age-related healing).
PMCID: PMC2867659  PMID: 20418532
anaesthetics local, bupivacaine; anaesthetics local, lidocaine; mouse
3.  An unusual case of finger swelling: A case report 
Cases Journal  2009;2:155.
A 66 year old man initially presented with haemoptysis and subsequently required a pneumonectomy for a lung mass, following this he had a finger swelling which was found to be a rare leiomyosarcoma and this was a metastatic deposit. This pattern of metastasis for this type of tumour has not been described before.
PMCID: PMC2783111  PMID: 19946526
4.  Peri-acetabular radiolucent lines: inter- and intra-observer agreement on post-operative radiographs 
International Orthopaedics  2005;29(3):152-155.
Peri-acetabular radiolucent lines (RLLs) seen on “early” post-operative radiographs have been identified as a potential predictor of long-term implant performance. This study examines the inter- and intra-observer variation encountered when assessing such radiographs. Four consultant orthopaedic surgeons assessed the presence, extent and width of RLLs in 220 radiographs performed on 50 patients taken one to two weeks, six weeks, six months and one year following surgery. Inter-observer agreement was fair at 7–14 days but improved to moderate to good in films at six and 12 months. Intra-observer agreement was moderate to good at 7–10 days but again improved to good at 6 and 12 months. When only the presence or absence of RLLs was considered, both inter-observer and intra-observer agreement improved for both the six-month and one-year radiographs. This experiment shows that caution must be used for the interpretation of RLLs on hip radiographs taken during the very early post-operative period. We recommend that films taken at least six weeks to six months following surgery should be used for assessment to reduce observer variation. For optimum results, a single experienced observer should do the assessment with a simple classification.
PMCID: PMC3456885  PMID: 15806358
5.  Removal of the subchondral plate in acetabular preparation 
International Orthopaedics  2000;24(1):19-22.
Retention of the subchondral plate during acetabular preparation in total hip replacement is believed to be an important part of modern cementing techniques. We have constructed a two-dimensional finite element analysis to assess the effect of retention and removal of this relatively stiff structure. The finite element analysis demonstrates increased stiffness and stress concentrations at the bone-cement interface that may have an adverse effect. Although further study is required, it may be that subchondral bone retention is not advantageous.
PMCID: PMC3619851  PMID: 10774856
6.  Abductor weakness and stresses around acetabular components of total hip arthroplasty: a finite element analysis 
International Orthopaedics  1999;23(5):275-278.
Abductor weakness, and the resulting Trendelenburg gait, after total hip arthroplasty is believed to be associated with a poor long-term outcome. We have constructed a two-dimensional finite element analysis using load cases to mimic this abductor weakness. The finite element analysis demonstrates slightly increased stresses, particularly at the bone-cement interface in the DeLee-Charnley zone I, which does not seem sufficient to explain the adverse effect of abductor weakness.
PMCID: PMC3619762  PMID: 10653293
7.  Rothmund-Thomson syndrome: two case reports show heterogeneous cutaneous abnormalities, an association with genetically programmed ageing changes, and increased chromosomal radiosensitivity. 
Journal of Medical Genetics  1996;33(11):928-934.
Rothmund-Thomson syndrome is a rare, autosomal recessive disorder associated with characteristic cutaneous changes, sparse hair, juvenile cataracts, short stature, skeletal defects, dystrophic teeth and nails, and hypogonadism. Mental retardation is unusual. An increased incidence of certain malignancies has been reported. Clonal or mosaic chromosome abnormalities and abnormalities in DNA repair mechanisms have been reported in some cases. We report two cases of Rothmund-Thomson syndrome, both with intellectual handicap, associated in one with a previously undescribed histological appearance of involved skin, suggesting that the spectrum of abnormalities is even more heterogeneous than previously presumed. Both cases exhibited chromosomal radiosensitivity of lymphocytes which may be an indication of a DNA repair defect. This is the first report of an association between Rothmund-Thomson syndrome and unique, intrinsic, age related skin changes.
PMCID: PMC1050787  PMID: 8950673
8.  Role of doctors in the prevention of suicide: the final consultation. 
BACKGROUND. It is generally assumed that people committing suicide see their doctor shortly before their death, and consequently that enhancing doctors' psychiatric knowledge and interview skills might help prevent some suicides. AIM. A study was undertaken to determine the nature and timing of final contacts with medical practitioners by people committing suicide. METHOD. Adults dying by suicide in Scotland during 1988-89 were identified by the General Register Office for Scotland and their primary care case notes studied. RESULTS. Within this national sample, medical contact near to the time of the suicidal act was rare, except for those individuals who had a previous psychiatric history. CONCLUSION. These data suggest that medical practitioners, particularly those working in primary care, are not failing to detect and intervene in significant numbers of preventable suicides. Consequently, the likelihood of implementing successful suicide prevention strategies based within primary care is open to question. Greater awareness of the risk of eventual suicide in those with a previous history of psychiatric disorder may contribute to any future reduction in suicide rates.
PMCID: PMC1238949  PMID: 8068391
10.  Relation between cognitive impairment and early death in the elderly. 
BMJ : British Medical Journal  1990;300(6719):239-240.
STUDY OBJECTIVE--To study the association between cognitive impairment and early death in elderly patients living in the community. DESIGN--Case-control study of 410 patients assessed by the mental status questionnaire and followed up after three years. SETTING--A general practice in Inverurie, Aberdeenshire, with 14,000 patients. PATIENTS--205 Patients aged greater than or equal to 65 with cognitive impairment according to the mental status questionnaire (score less than or equal to 8) and 205 patients scoring greater than 8 on the questionnaire matched for age and sex. MAIN OUTCOME MEASURE--Death. RESULTS--The relative risk of death in the cognitively impaired patients overall was 3.5. Those patients who scored less than or equal to 7 on the mental status questionnaire were five times more likely to die than their controls. There was no difference in risk of death between those with severe or moderate cognitive impairment. CONCLUSIONS--Cognitive impairment is associated with early death.
PMCID: PMC1662050  PMID: 2106935
11.  Cognitive evaluation following NMR imaging of the brain. 
Nuclear magnetic resonance imaging of the brain will soon be a standard neuroradiological investigation. Previous work has indicated that this is a safe procedure. Tests which measure various aspects of cognition were performed on volunteer subjects before and after (medium and short term) NMR brain imaging and indicate that deterioration did not occur.
PMCID: PMC1027735  PMID: 6707682
13.  Psychological medicine. Management of depression. 
British Medical Journal  1975;2(5967):372-376.
PMCID: PMC1673177  PMID: 1131607
15.  Amine Metabolism in Brain 
Proceedings of the Royal Society of Medicine  1969;62(11 Pt 1):1099-1101.
PMCID: PMC1810640  PMID: 5356862
16.  Recognition of Amphetamine Addicts 
British Medical Journal  1965;1(5426):57.
PMCID: PMC2167908  PMID: 14213112

Results 1-17 (17)