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AimsLong-term clinical outcomes for ceramic-on-ceramic (CoC) bearings are encouraging. However, there is a risk of squeaking. Guidelines for the orientation of the acetabular component are defined from static imaging, but the position of the pelvis and thus the acetabular component during activities associated with edge-loading are likely to be very different from those measured when the patient is supine. We assessed the functional orientation of the acetabular component.Patients and MethodsA total of 18 patients with reproducible squeaking in their CoC hips during deep flexion were investigated with a control group of 36 non-squeaking CoC hips. The two groups were matched for the type of implant, the orientation of the acetabular component when supine, the size of the femoral head, ligament laxity, maximum hip flexion and body mass index. ResultsThe mean functional anteversion of the acetabular component at the point when patients initiated rising from a seated position was significantly less in the squeaking group than in the control group, 8.1° (-10.5° to 36.0°) and 21.1° (-1.9° to 38.4°) respectively (p = 0.002). ConclusionThe functional orientation of the acetabular component during activities associated with posterior edge-loading are different from those measured when supine due to patient-specific pelvic kinematics. Individuals with a large anterior pelvic tilt during deep flexion might be more susceptible to posterior edge-loading and squeaking as a consequence of a significant decrease in the functional anteversion of the acetabular component. Cite this article: Bone Joint J2016;98-B:910–16.

Many different lengths of stem are available for use in primary total hip replacement, and the morphology of the proximal femur varies greatly. The more recently developed shortened stems provide a distribution of stress which closely mimics that of the native femur. Shortening the femoral component potentially comes at the cost of decreased initial stability. Clinical studies on the performance of shortened cemented and cementless stems are promising, although long-term follow-up studies are lacking. We provide an overview of the current literature on the anatomical features of the proximal femur and the biomechanical aspects and clinical outcomes associated with the length of the femoral component in primary hip replacement, and suggest a classification system for the length of femoral stems.Cite this article: Bone Joint J2014;96-B:442-8.

In forest ecosystems, organic solutes play prominent roles in pollutant and nutrient transport. This study, conducted in subalpine forested Humaquepts in Switzerland, investigated the influence of redox conditions and flow processes on dissolved organic carbon (DOC) and dissolved organic nitrogen (DON). In the mineral soil, concentrations of DOC were higher under reduced than under oxidized conditions. They averaged 1.2 mmol DOC L−1in the reduced mineral soil at a 100‐cm depth. A close correlation between DOC and dissolved Fe concentrations (r2= 0.83; p< 0.001) suggests that reductive dissolution of Fe‐oxides was the major reason for the low retention. However, during aerobic sampling of soil solution from the reduced mineral soil, DOC coprecipitated with Fe. This suggests that the DOC input from reduced mineral soils to aerobic stream water is lower than expected from the high DOC concentrations in the soil. Organic N was the major form of total dissolved N at all soil depths. In the reduced subsoil, dissolved N was completely organically bound. This was probably due to both an immobilization of inorganic N and a low retention of DON. During storms, DOC concentrations increased rapidly with increasing discharge in the subsurface flow. At peak flow, DOC concentrations were doubled, compared with base flow. The molar UV absorptivity of DOC in the subsurface flow corresponded closely to that of the topsoil. These findings suggest that DOC concentrations and properties are sensitive to flow velocities, and that DOC is preferentially transported to the subsoil at high discharge.

Sechs Patienten mit einer immunoblastischen Lymphadenopathie wurden beobachtet. Es wurden charakteristische morphologische und klinische Merkmale gefunden, die eine Abgrenzung von malignen lymphoproliferativen Erkrankungen einerseits und von benignen Pseudolymphomen andererseits gestatten. Zur klinischen Symptomatik gehören ausgeprägte subjektive Beschwerden, generalisierte Lymphknotenschwellungen, Hepatosplenomegalie, Hauterscheinungen, sowie der Nachweis von quantitativ und qualitativ pathologischen Reaktionen im B-Zell-Plasmazell-System wie Hypergammaglobulinämie, passageres Auftreten von Autoantikörpern und Erscheinen von Plasmazellen im peripheren Blut. Kriterien für eine maligne Neoplasie fehlen. Der Verlauf kann trotzdem rasch progredient zum Tode führen, wobei die Infektanfälligkeit als Todesursache im Vordergrund steht. Andererseits sind auch spontan remittierende Verläufe über viele Jahre zu beobachten. Zur Therapie sind vorwiegend supportive Maßnahmen zu empfehlen; Immunosuppressiva, vor allem Nebennierenrindensteroide, können vor allem bei immunologischen Komplikationen einen positiven Effekt haben.

Summary The influence of creatinine, urea and guanidine injection on the course of an artificially induced inflammatory reaction has been studied in rats. The formalin and bolus alba edema served as inflammatory models. It was shown that the inflammatory reaction was not significantly altered by urea. By creatinine, however, the inflammation was diminished. If urea and creatinine were given together the course of the inflammatory reaction was not altered significantly, suggesting an inhibitory interrelation between these two substances. Guanidines showed the strongest inhibiting effect on inflammation. It is discussed that guanidines influence energy availability by inhibition of oxydative phosphorylation.

Summary The influence of renal insufficiency upon the course of an experimentally induced inflammation was studied in rats. The formalin- and bolus alba edema served as models for an acute inflammatory reaction, the granuloma pouch technique as a subacute inflammary reaction. Acute renal insufficiency was produced by ligature of both ureters. Partial one side nephrectomy and ligature of one ureter caused a subchronic or chronic renal insufficiency. The results demonstrated that the response to an inflammatory stimulus only is influenced if uremic symptoms occured. The course of inflammation was not altered in animals which had not transpassed the borderline of uremia. If, however, the first clinical signs of toxicity had occured, the response to an inflammatory stimulus was reduced.

The development of a hematometra after radiotherapy for cervical carcinoma is often related to recurrent disease. We present two cases in which a hematometra developed during the use of estrogen replacement therapy. This development was related to regained endometrial activity in combination with fibrosis and obliteration of the upper vagina and/or cervix. In one patient a dilatation and curettage could be performed; in the other a hysterectomy was necessary in order to exclude recurrent disease. These two cases show once more that endometrium can regain its proliferative activity after radiotherapy for cervical cancer. Estrogen replacement therapy in these patients should include the use of a progestagen agent in order to avoid continuous unopposed endometrial stimulation. In the absence of progesterone withdrawal bleeding the uterine cavity should be routinely examined for the development of a hematometra.