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There are few reports in the literature of fat embolism syndrome after cementless total hip arthroplasty (THA). Most reported cases have occurred after fracture or cemented THA. We report a case of a healthy 51-year-old woman who underwent THA for osteoarthritis under spinal anesthesia. A press-fit cup and extensively porous-coated diaphyseal locking stem were used and inserted without cement. In the recovery room, the patient became hypoxemic and hypotensive and developed cortical blindness. The next day, a petechial rash was evident. Gurd's criteria for fat embolism syndrome were fulfilled. Her symptoms resolved over a 2-week period. Patients undergoing cementless THA are at risk for fat embolism syndrome, and this must be considered in the differential diagnosis for postoperative hypoxemia and neurologic deficits.

A quantitative trait locus (QTL) genetic analysis of morphological and reproductive traits distinguishing the sibling species Drosophila simulans and D. sechellia was carried out in a backcross design, using 38 markers with an average spacing of 8.4 cM. The direction of QTL effects for the size of the posterior lobe was consistent across the identified QTL, indicating directional selection for this trait. Directional selection also appears to have acted on testis length, indicating that sexual selection may have influenced many reproductive traits, although other forms of directional selection cannot be ruled out. Sex comb tooth number exhibited high levels of variation both within and among isofemale lines and showed no evidence for directional selection and, therefore, may not have been involved in the early speciation process. A database search for genes associated with significant QTL revealed a set of candidate loci for posterior lobe shape and size, sex comb tooth number, testis length, tibia length, and hybrid male fertility. In particular, decapentaplegic (dpp), a gene known to influence the genital arch, was found to be associated with the largest LOD peak for posterior lobe shape and size.

We carried out the Bernese periacetabular osteotomy for the treatment of 13 dysplastic hips in 11 skeletally mature patients with an underlying neurological diagnosis. Seven hips had flaccid paralysis and six were spastic. The mean age at the time of surgery was 23 years and the mean length of follow-up was 6.4 years. Preoperatively, 11 hips had pain and two had progressive subluxation. Before operation the mean Tönnis angle was 33 degrees, the mean centre-edge angle was -10 degrees, and the mean extrusion index was 53%. Postoperatively, they were 8 degrees, 25 degrees and 15%, respectively. Pain was eliminated in 7 patients and reduced in four in those who had preoperative pain. One patient developed pain secondary to anterior impingement from excessive retroversion of the acetabulum. Four required a varus proximal femoral osteotomy at the time of the pelvic procedure and one a late varus proximal femoral osteotomy for progressive subluxation. Before operation no patient had arthritis. At the most recent follow-up one had early arthritis of the hip (Tönnis grade I) and one had advanced arthritis (Tönnis grade III). Our results suggest that the Bernese periacetabular osteotomy can be used successfully to treat neurogenic acetabular dysplasia in skeletally mature patients.

Thirteen laboratories within the United Kingdom participated in a collaborative study to determine ochratoxin A in wheat using an HPLC method incorporating immunoaffinity column clean-up. Mean recovery of ochratoxin A from wheat spiked at a level of 5 micrograms/kg was 91% for the method when using the OchraTest and 93% for the OCHRAPREP brands of column. Four samples naturally contaminated with ochratoxin A consisting of two blind duplicates containing concentrations of approximately 3 and 6 micrograms/kg of ochratoxin A were examined using a specified method. The relative standard deviations obtained within laboratories (repeatability) ranged between 9.7 and 12.5%, there being no significant difference between the two brands of immunoaffinity column. The relative standard deviations obtained between laboratories (reproducibility) were larger, ranging from 24.6 to 32.1% when using the OchraTest column and 14.0 and 19.6% for the OCHRAPREP column. When results were corrected for recovery, the apparent difference in reproducibility between the two columns was much reduced, 14.0-17.3% for OchraTest and 10.4-17.5% for OCHRAPREP. Horrat values for reproducibility were between 0.4 and 0.7 before correcting results for recovery and were between 0.3 and 0.6 after correction. The performance of the immunoaffinity column method tested compared very favourably with results of other published collaborative studies on mycotoxins.

The 5- to 13-year follow-up data on 297 cementless revision arthroplasties with extensively coated components (Anatomic Medullary Locking femoral component, DePuy, Warsaw, IN) are reported. A basic classification of the femoral defects was developed. All patients were evaluated clinically and radiographically at a minimum of 60 months. Clinically, the average Postel-d'Aubigné score improved from 4.8 before to a 10.2 after surgery. Definite radiographic instability was noted in seven hips. Five patients were symptomatic and were revised. The mechanical failure rate was 2.4%. The overall complication rate was 5.7%, with a 2.6% dislocation rate. In the presence of bone loss in the proximal metaphyseal region of the femur, fixation of the femoral component is best achieved in the diaphyseal region of the femur using an extensively coated femoral component.

The Bernese periacetabular osteotomy was developed for precise spatial reorientation of the adult dyplastic acetabulum and improvement of the femoral head coverage. The osteotomy has a large correction potential (average decrease of acetabular index: 22 degrees) but is technically demanding. With appropriate patient selection, the results obtained are promising. Therefore, the technique described should be considered in the treatment plan for the acetabular dysplasia of the young adult.

The effectiveness of an intra-articular injection of bupivacaine, administered before the incision or after closure of the wound, was studied in an effort to decrease the need for postoperative narcotics and to improve analgesia for patients who have elective knee replacement. Eighty-two patients received two intra-articular injections in a random, double blind fashion. Twenty-eight of them received thirty milliliters of 0.5 percent bupivacaine and 1:200,000 epinephrine in saline solution before the incision and an injection of thirty milliliters of plain saline solution after closure of the wound (Group 1). Twenty-seven patients received an injection of thirty milliliters of plain saline solution before the incision and thirty milliliters of 0.5 percent bupivacaine and 1:200,000 epinephrine in saline solution after closure of the wound (Group 2). Twenty-seven patients were given thirty milliliters of plain saline solution (a placebo) for both injections (Group 3). The patients who had received bupivacaine after closure of the wound (Group 2) used less morphine from the patient-controlled analgesia pumps than the patients who had received bupivacaine before the incision (Group 1) and the patients who had received the placebo (Group 3). In the first twenty-four hours after the operation, the administration of morphine (mean and standard deviation) was 59 +/- 27 milligrams for Group 2 compared with 68 +/- 30 milligrams for Group 1 (p = 0.26) and 81 +/- 30 milligrams for Group 3 (p = 0.006). At the time of discharge from the hospital, the patients in Group 2 also had a significantly greater mean range of motion (85.2 +/- 8.0 degrees) compared with that of the patients in Groups 1 (80.6 +/- 6.8 degrees, p = 0.02) and 3 (80.1 +/- 6.2 degrees, p = 0.009). However, there was no difference among the groups with respect to the effectiveness of the analgesia, as measured with use of either the visual-analog or the verbal pain-rating scale, or in the prevalence of side effects, including somnolence, urinary retention, nausea and vomiting, or pruritus. Serum concentrations of bupivacaine were well below toxic levels. It was our conclusion that that and intra-articular injection of thirty milliliters of 0.5 percent bupivacaine and 1:200,000 epinephrine in saline solution after closure of the wound decreases the need for narcotics and increases the range of motion after an elective knee replacement. The clinical importance of the amount of increased motion is questionable and needs long-term monitoring.

The commentary review similarities between the American and the European perspective of the HIV spread, with particular emphasis on the British mode of transmission among women. Social perceptions of the female role are seen as contributing to the difficulties experienced by British women who are HIV positive. Although there are numerous ongoing programs to assist and support HIV-infected women, the projection of an increased incidence in the spread of HIV among the heterosexual population is one that needs to be addressed. This is recognized as an issue that will reveal the needs of this new infected population and will in turn decide the necessary revisions of all existing programs that offer help and assistance to women. The commentary acknowledges the value of the American-designed peer counseling and leadership training and suggests that international (PCLT) program implementation might be considered.

In order to address the problem of amino acid auxotroph scarcities in photosynthetic organisms, an attempt was made to recover methionine auxotrophs in a unicellular green alga, Chlamydomonas reinhardtii. Evidence of methionine permeation into the algal cells was provided by the successful competition of the amino acid with its antimetabolite, methionine sulfoximine. No methionine auxotrophs were isolated despite the frequent recovery of both nicotinamide and arginine auxotrophs, selected as controls, and of methionine sensitive mutants. The use of either N-methyl-N'-nitro-N-nitrosoguanidine or ultraviolet light as mutagens appeared not to alter the mutation spectrum. Medium containing methionine was shown to be inhibitory to the growth of cells in culture under fluorescent light and this toxicity was further stimulated in the presence of riboflavin. In view of our results, and the observations of other studies, the non-recoverability of methionine auxotrophs is discussed as a function of the photodynamic action of methionine.