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PubMed1995

Go tell it on the mountain: Hilla Sheriff and public health in the South Carolina Piedmont, 1929 to 1940.

As director of the South Carolina units of the American Women's Hospitals and as the state's first female county health official, Hilla Sheriff combined elements of the Progressive Era's social gospel; the New Deal notion that concerned, public-spirited officials could make a difference; and a nascent feminism that led her into the controversial fields of family planning and nutrition. Sheriff's responses to endemic pellagra, innovative maternal and child health campaigns, and contraceptive research for the Milbank Memorial Fund attracted national attention and spawned programs based on her models throughout the South. Her ability to tailor programs to diverse communities--mothers who bore double burdens as textile workers, isolated farm families, mountaineers, and African Americans denied access to most health care facilities in the Jim Crow South--serves as a timeless example for those committed to community medicine.

Community Health Services↗
PubMed1996

The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty.

A method for measurement of the true acetabular region and the approximate femoral head center as well as a classification consisting of four zones for assessment of the acetabular position of the acetabular cup were used to analyze the results of primary total hip arthroplasty with cement in 117 patients (145 hips). All patients had Crowe type-II congenital dysplasia of the hip. The mean age at the time of the arthroplasty was fifty-one years (range, fifteen to seventy-six years), and the mean duration of follow-up was fourteen years (range, two to twenty-two years). The initial position of the acetabular cup outside of the true acetabular region and outside of zone 1 (inferior and medial) was associated with an increase in the rates of loosening (p < 0.05) and revision (p < 0.04) of the femoral components. Cups that initially were more than fifteen millimeters superior to the approximate femoral head center, without lateral displacement, were associated with an increased rate of loosening (p < 0.001) and of revision (p < 0.04) of the femoral components as well as with an increased rate of loosening (p < 0.002) and of revision (p < 0.01) of the acetabular components. These findings suggest that superior positioning of the acetabular component, even without lateral displacement, leads to increased rates of loosening of the femoral and acetabular components. An attempt should be made to position the acetabular component in or near the true acetabular region.

Acetabulum↗
PubMed1997

Total hip arthroplasty for congenital dysplasia or dislocation of the hip. Survivorship analysis and long-term results.

Two hundred and thirty-two total hip replacements with cement were performed between 1965 and 1987 in 190 patients who had osteoarthrosis secondary to acetabular dysplasia resulting from congenital dysplasia or dislocation of the hip. Forty-nine patients (fifty hips) who died or who did not have at least three years of clinical and radiographic follow-up were excluded; therefore, the study comprised 141 patients (182 hips), 125 of whom were women and sixteen of whom were men. The mean age at the time of the operation was 42.5 years (range, 19.5 to 76.5 years), and the mean duration of follow-up was 9.9 years (range, 3.1 to 22.8 years). A Charnley low-friction prosthesis with a 22.25-millimeter femoral head was used in all hips. A trochanteric osteotomy was performed in 164 hips. A direct lateral approach was used only when there was a limb-length discrepancy of less than two centimeters. Bulk autogenous graft was not used to augment the fixation of the acetabular component. The hips were divided into two groups on the basis of the degree of subluxation or dislocation according to the classification of Crowe et al. One hundred and thirty-six hips were grade I, II, or III (indicating subluxation) (Group S), and forty-six hips were grade IV (indicating dislocation) (Group D). At the most recent follow-up evaluation, 128 (94 per cent) of the 136 hips in Group S and forty-four (96 per cent) of the forty-six hips in Group D caused no or only slight pain (a score of 6 or 5 points, respectively, according to the system of Merle d'Aubigné and Postel). Nineteen cups (10 per cent) and five stems (3 per cent) failed and were revised. The rate of revision for loosening of the femoral component in Group D (2 per cent [one stem]) was similar to that in Group S (3 per cent [four stems]). In comparison, the rate of revision of the acetabular component in Group D (15 per cent [seven cups]) was almost twice that in Group S (9 per cent [twelve cups]). This study demonstrated satisfactory clinical results at a mean of nearly ten years. The fixation of the femoral components appeared to be satisfactory; however, the failure of the fixation of the acetabular components in Group D (the dislocated hips) is a cause for concern.

Adult↗
PubMed1998

Total hip arthroplasty with use of an acetabular reinforcement ring in patients who have congenital dysplasia of the hip. Results at five to fifteen years.

The purpose of our study was to examine the clinical and technical problems associated with reconstruction of the hip in patients who had congenital dysplasia and to offer recommendations for their solution. We reviewed the records on 123 consecutive total hip arthroplasties that had been performed by one of us (M. E. M.), between 1981 and 1986, for the treatment of coxarthrosis due to congenital dysplasia of the hip. A minimum of five years of follow-up was required for inclusion in the study. The study group consisted of seventy patients who had had a total of eighty-seven reconstructions. According to the classification of Crowe et al., eleven hips had type-IV acetabular dysplasia; sixty-five, type-II; and eleven, type-II. Acetabular reconstruction was performed with use of the Müller acetabular roof-reinforcement ring and a polyethylene cup, which was inserted with cement. Autologous graft from the femoral head was used in forty-two hips. Femoral reconstruction was performed with use of the Müller straight-stem component for congenital dysplasia of the hip in eighty hips and with use of a standard Müller straight-stem component in seven hips. At an average of 9.4 years (range, five to fifteen years) postoperatively, the result was described as excellent for sixty hips (69 per cent), as good for twenty-three (26 per cent), as fair for two (2 per cent), and as poor for two. Nine (10 per cent) of the hips had been revised. One revision had been performed because of aseptic loosening of the acetabular component; one, because of aseptic loosening of the femoral component; one, because of aseptic loosening of both components; and six, because of infection. Of the unrevised hips, three had had superior migration of the acetabular component of less than five millimeters, and mild protrusion had developed in one. Two hips had a continuous radiolucent line around the acetabular construct. Two hips had had subsidence of the femoral stem of less than three millimeters; one had a complete, non-progressive radiolucent line at the bone-cement interface; and four had a radiolucent line at the proximal part of the bone-cement interface. Six hips had evidence of endosteal osteolysis. Six hips had grade-III or IV heterotopic ossification according to the system of Brooker et al. These results compare favorably with others in the literature. We recommend restoration of the anatomical hip center with the use of an acetabular roof-reinforcement ring and a polyethylene cup inserted with cement for the reconstruction of a deficient acetabulum. The acetabular reinforcement ring prevents resorption of bone graft and migration of the cup, which are major causes of failure of the cup in patients who have had a reconstruction of a deficient acetabulum. Bone graft should be used medially and superiorly as needed to augment bone stock notably. Cement should not be used to fill acetabular defects as we believe that it contributes to aseptic loosening.

Arthroplasty, Replacement, Hip↗
PubMed1999

Medial protrusio technique for placement of a porous-coated, hemispherical acetabular component without cement in a total hip arthroplasty in patients who have acetabular dysplasia.

Twenty-four hip replacements were performed with use of a medial protrusio technique to stabilize the fit of a hemispherical metal shell in the acetabulum in nineteen patients who had dysplasia of the hip. All of the hips were followed for a minimum of five years (average, seven years; range, five to thirteen years). Six of the hips were type I, seven were type II, eight were type III, and three were type IV according to the criteria of Crowe et al. The acetabular cup was implanted with the medial aspect of its dome beyond the Kohler line (drawn from the ischium along the ilioischial line) in all hips. An autogenous graft sculpted from the femoral head was used to cover 15 to 30 percent of the superolateral portion of the cup in one type-I hip, four type-III hips, and one type-IV hip. The need for these six bone grafts could have been avoided by reaming two to three millimeters more medially or by allowing 20 percent of the superolateral portion of the cup to be uncovered. Sixty to 84 percent of each bone graft was resorbed, effectively leaving the superolateral portion of the cup uncovered. The amount of the surface of the cup that was beyond the Kohler line averaged 41 percent for the six type-I hips, 43 percent for the seven type-II hips, 41 percent for six of the type-III hips, and 44 percent for one of the type-IV hips. Crossing of the ilioischial and iliopubic lines was noted on the radiographs of two type-III and two type-IV hips. Radiographs of two type-I hips and one type-II hip showed 7 to 17 percent of the surface of the dome of the cup through the internal pelvic wall (beyond the iliopubic line). None of the twenty-four metal shells were revised. A reoperation was performed on two hips to exchange a worn polyethylene insert, and three femoral components that had been fixed without cement were revised because of mechanical loosening. Wear averaged 0.26 millimeter per year in the fourteen hips that had a titanium femoral head and 0.09 millimeter per year in the nine hips that had a cobalt-chromium femoral head. The remaining hip had a ceramic femoral head, and the wear rate was 0.09 millimeter per year. The medial protrusio technique is a predictable, reproducible method for obtaining fixation of a porous-coated, hemispherical acetabular component in a dysplastic acetabulum. The technique permits the use of a porous-coated (bone-ingrowth) component; avoids the use of support bone graft and thereby reduces the operative time; facilitates rehabilitation by permitting earlier weight-bearing of the hip; and permits the use of a modular bearing surface, which may allow future exchange of only this surface rather than revision of the entire acetabular component because of excessive wear.

Acetabulum↗
PubMed2003

Total hip arthroplasty with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip.

BACKGROUND: The long-term results of total hip arthroplasty performed with cement and use of a bulk autograft for acetabular reconstruction in patients with developmental dysplasia of the hip have varied considerably. We evaluated the results of total hip arthroplasties performed with acetabular bulk autograft to identify the factors that influence the results of this procedure. METHODS: Acetabular roof defects secondary to developmental dysplasia of the hip were reconstructed with a bulk femoral head autograft at the time of total hip arthroplasties performed with use of the Charnley technique and prosthesis. Thirty-seven hips in thirty patients (mean age at the time of the operation, fifty-seven years) were followed for ten to twenty-six years (mean, nineteen years). The Crowe classification of hip subluxation or dislocation was Group II for sixteen hips, Group III for seventeen, and Group IV for four. RESULTS: Coverage of the socket by the graft ranged from 5% to 49% (mean, 33%). Twenty-nine sockets were located within the true acetabulum, and eight were placed more proximally. At the time of the latest follow-up, all of the patients had an excellent clinical result, all of the grafts had united, and no hip had radiographic evidence of failure of the fixation. CONCLUSIONS: We found that total hip arthroplasty performed with cement and use of a bulk autograft to reconstruct an acetabulum with severe bone deficiency secondary to developmental dysplasia of the hip can provide long-term success in patients forty-eight years of age and older when coverage of the socket by the graft does not exceed 50%. When it is not possible to achieve >50% coverage of the socket by the ilium at the level of the true acetabulum, more proximal placement of the socket to obtain adequate coverage is recommended.

Acetabulum↗
PubMed2004

Total hip arthroplasty with bulk femoral head autograft for acetabular reconstruction in DDH. Surgical technique.

BACKGROUND: The long-term results of total hip arthroplasty performed with cement and use of a bulk autograft for acetabular reconstruction in patients with developmental dysplasia of the hip have varied considerably. We evaluated the results of total hip arthroplasties performed with acetabular bulk autograft to identify the factors that influence the results of this procedure. METHODS: Acetabular roof defects secondary to developmental dysplasia of the hip were reconstructed with a bulk femoral head autograft at the time of total hip arthroplasties performed with use of the Charnley technique and prosthesis. Thirty-seven hips in thirty patients (mean age at the time of the operation, fifty-seven years) were followed for ten to twenty-six years (mean, nineteen years). The Crowe classification of hip subluxation or dislocation was Group II for sixteen hips, Group III for seventeen, and Group IV for four. RESULTS: Coverage of the socket by the graft ranged from 5% to 49% (mean, 33%). Twenty-nine sockets were located within the true acetabulum, and eight were placed more proximally. At the time of the latest follow-up, all of the patients had an excellent clinical result, all of the grafts had united, and no hip had radiographic evidence of failure of the fixation. CONCLUSIONS: We found that total hip arthroplasty performed with cement and use of a bulk autograft to reconstruct an acetabulum with severe bone deficiency secondary to developmental dysplasia of the hip can provide long-term success in patients forty-eight years of age and older when coverage of the socket by the graft does not exceed 50%. When it is not possible to achieve >50% coverage of the socket by the ilium at the level of the true acetabulum, more proximal placement of the socket to obtain adequate coverage is recommended.

Acetabulum↗
PubMed2005

Strategies of adaptation: interpopulation selection differentials.

Spatial and temporal variation of selection intensities has been analyzed using published data on Crow's indices in 278 human populations, representing various anthropological types, religions, cultures and a wide spectrum of environmental conditions. Statistical analysis has shown that populations with different types of economy have different adaptive strategies. In tribal populations both components of selection-differential fertility and differential mortality-have equal contributions, vary according to ecological factors and show no decline with time. Urban populations of the industrially developed countries show dramatic selection relaxation; the second component becomes negligible due to a sharp decrease in childhood mortality; fertility and its variance are reducing due to cultural factors (family planning).

Adaptation, Biological↗
PubMed1993

Prevalence of diagnosed diabetes and selected related conditions of six reservations in Montana and Wyoming.

OBJECTIVE: To describe the prevalence of diabetes and related complications in Plains Indians. RESEARCH DESIGN AND METHODS: The medical records of individuals with diagnosed diabetes seen in IHS facilities before 1 January 1987 were reviewed. Records were obtained from primary care clinics and hospitals accessible to the following six reservation communities in Montana and Wyoming: Blackfeet, Crow, Fort Belknap, Fort Peck, Northern Cheyenne, and Wind River. Medical records were reviewed to ascertain accuracy of diagnosis and associated complications. RESULTS: Age-adjusted prevalence rate of diagnosed diabetes was 119/1000 adults > or = 15 yr of age. CONCLUSIONS: Diabetes rates in Plains Indians are higher than rates described for the general U.S. population.

Amputation, Surgical↗
PubMed1987

Impoverished written responses and negative features of schizophrenia.

Repetition in the written language of schizophrenics and its possible relationships to other aspects of schizophrenic disorders are not well understood. We investigated repetitiousness in written utterances, finding schizophrenic subjects to be more repetitive than affective controls and normal controls. Over-all, written repetitiousness was more strongly correlated with psychopathologic features than oral repetitiousness. As in previous work, thought-disordered schizophrenic subjects produced the most repetitive responses. Poverty of content and illogical thinking were correlated with scores for written repetition. Measures of other negative features, disturbed mental functioning and motor behavior were also associated with repetitiousness in both written and oral modes. That these negative features are linked (namely, linguistic repetitiousness, negative formal thought disorder, voluntary motor abnormalities, and deficient mental functioning) is consistent with Crow's concept of a defect syndrome (Type 2) in schizophrenia.

Humans↗
PubMed1993

Aggressive behavior in schizophrenia: relationship to age of onset and cortical atrophy.

Aggressive behavior is a common feature of schizophrenia and is associated with the presence of 'soft' neurological signs. Since early age of onset of schizophrenia has been found to be associated with the negative syndrome, which according to Crow (1982) is related to structural brain abnormalities, I predicted that early age of onset may be a biological risk factor for aggressive behavior in the disease. To test this hypothesis, I investigated in 52 chronic institutionalized schizophrenic patients (mean age = 32.8 years; SD = 8.0), the association between age of onset of the disease and the severity of belligerent behavior. The age of onset was judged from the patient's histories as the age at which florid symptoms first emerged. Patients with early onset schizophrenia had a significantly higher belligerent score compared to those with later-onset schizophrenia (p < .05). These findings support the hypothesis of an association between early age of onset of schizophrenia and the risk of aggressive behavior and suggest, furthermore, that schizophrenic symptoms which emerge early may predict a higher risk of aggressive behavior. Furthermore, this study suggest that the neurochemical mechanisms which underlie the early emergence of symptoms may also predispose to aggressive behavior in schizophrenia. Specifically, since aggressive behavior has been linked to impairment of serotonergic (5-HT) functions, I propose that the timing of onset of schizophrenia may be partly associated with dysregulation of the 5-HT system. In a second study, I investigated whether schizophrenic patients with aggressive (suicide) behavior are characterized by more extensive brain damage and hence greater degree of cerebral atrophy on CT scan. The study, which involved 26 schizophrenic patients (mean age: 31.3 years; SD = 6.8), revealed that patients with aggressive behavior had a significantly greater degree of parieto-occipital atrophy on CT scan (p < .05). In contrast, ventricular size and prefrontal cortical atrophy did not distinguish aggressive from nonaggressive patients. These findings suggest that cortical atrophy may be a neuroradiological marker of aggressive behavior in schizophrenia.

Adult↗
PubMed1982

Inhibition of tissue aryl hydrocarbon (benzo[a]pyrene) hydroxylase by 7,8-benzoflavone in birds.

1. Addition of 7,8-benzoflavone (7,8-BF) inhibited both hepatic and renal constitutive activity of aryl hydrocarbon (benzo[a]pyrene) hydroxylase in vitro for a number of avian species. Inhibition of hepatic benzo[a]pyrene hydroxylase was 70-94% in wild pigeon; 46-88% in homing pigeon; 85-93% in house crow; 18-53% in common kite; 56-86% in cattle egret; and for the renal enzyme was 43-84, 52-88, 18-73 and 13-48% respectively. 2. 3-Methylcholanthrene treatment of homing pigeons resulted in the induction of liver and kidney benzo[a]pyrene hydroxylase activity. Induced enzyme activity was also significantly inhibited by 7,8-BF.

Animals↗
PubMed1994

Mixed connective tissue disease associated with multicentric Castleman's disease.

We describe a 60-year-old woman who developed mixed connective tissue disease (MCTD) associated with multicentric Castleman's disease (MCD) and Crow-Fukase syndrome (CFS). She showed HLA DR-4 antigen and an abnormal X chromosome (47,XXX). The serum interleukin-6 (IL-6) level was markedly increased and IL-6 mRNA was detected in enlarged lymph node cells. After prednisolone was administered, her IL-6 level decreased and the symptoms of MCTD, MCD, and CFS all improved. Thus, IL-6 may be involved in the modification of the pathologic condition in this patient.

Castleman Disease↗
PubMed1991

Slowly adapting cutaneous mechanoreceptor afferent units associated with Merkel cells in frogs and effects of direct currents.

In the bullfrog, two types of slowly adapting (SA) cutaneous mechanoreceptor afferent units have been identified physiologically: irregularly discharging frog type I (Ft I) units in both warty and nonwarty skin, and regularly discharging frog type II (Ft II) units in the nonwarty skin. In the present study, mechanosensitive spots of Ft I units were located around the skin warts in the warty skin. The quinacrine technique (Crowe and Whitear, 1978) revealed that quinacrine-accumulating Merkel cells were present around the skin warts and near the orifice of skin glands that also surrounded the skin warts. Thus, a significant correlation was found between the location of Merkel cells and the receptive fields (RFs) of Ft I units in the warty skin. Direct current (DC) stimulation was applied for 1 sec to the skin inside and outside the mechanical RFs of the two types of SA units. RFs for DC stimulation were located on those for mechanical stimulation in both types of SA units. The current threshold required to produce a single spike was lower in cathodal than in anodal pulses in both types of SA units. Greater current intensity elicited an increased number of spikes, but the effective polarity of currents was anodal for Ft I units and cathodal for Ft II units. The optimal current intensity for producing prolonged discharges ranged from +60 to +100 microA in Ft I units and - from -50 to -80 microA in Ft II units. The sequence of impulses evoked was irregular in Ft I units and regular in Ft II units, as seen in mechanical responses.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2000

Plasma cell dyscrasia with polyneuropathy--POEMS syndrome presenting with vasculitic skin lesions and responding to combination chemotherapy.

We report a 61-year-old male patient who presented with severe sensorimotor neuropathy, leg edema and skin lesions with M-paraprotein and 50% plasma cells in the bone marrow. The POEMS (Crow-Fukase) syndrome was diagnosed and the skin lesions were compatible with vasculitis according to the histopathology. The patient was treated with aggressive combined chemotherapy, which induced improvement in both the clinical and laboratory parameters of his disease. To the best of our knowledge this is the first report of a vasculitic process underlying the skin changes in the POEMS syndrome. Our findings may shed light on the unknown pathogenesis of this syndrome and the successful results of treatment support the adoption of an aggressive therapeutic approach in symptomatic patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

Mosquito surveillance for West Nile virus in southeastern Wisconsin--2002.

In 2001, West Nile virus (WNV) was identified among dead American crows and bluejays in five counties in southeastern Wisconsin. In response to the introduction of WNV, a pilot mosquito surveillance program was initiated in these five southeastern Wisconsin counties during the summer of 2002. Forty sites were selected for surveillance one night each week during a 17-week period. Mosquitoes were collected in carbon dioxide-baited light traps and gravid traps. During the study period 31,419 mosquitoes were collected, identified to species level and pooled into groups of up to 50 mosquitoes of like species from each collection site. Twenty-five different mosquito species were identified with the common pest mosquitoes, Aedes vexans and Ochlerotatus trivittatus, being the most abundant. Seventeen of the 25 mosquito species found in southeastern Wisconsin have previously been shown to be carriers of WNV in other parts of the U.S. Only 2/1,592 (0.126%) mosquito pools from Wisconsin were positive for WNV by cell culture and reverse transcription polymerase chain reaction (RT-PCR). Active mosquito surveillance is useful for identifying potential mosquito vectors of arboviruses in defined geographic areas, and to monitor population densities of those vectors. This information coupled with infection rate data can help guide public health policies related to vector control, and may help reduce the impact on human, veterinary and bird mortality.

Animals↗
PubMedDate not supplied

Mosquito surveillance for West Nile virus in Connecticut, 2000: isolation from Culex pipiens, Cx. restuans, Cx. salinarius, and Culiseta melanura.

Fourteen isolations of West Nile (WN) virus were obtained from four mosquito species (Culex pipiens [5], Cx. restuans [4], Cx. salinarius [2], and Culiseta melanura [3]) in statewide surveillance conducted from June through October 2000. Most isolates were obtained from mosquitoes collected in densely populated residential locales in Fairfield and New Haven counties, where the highest rates of dead crow sightings were reported and where WN virus was detected in 1999. Minimum field infection rates per 1,000 mosquitoes ranged from 0.5 to 1.8 (county based) and from 1.3 to 76.9 (site specific). Cx. restuans appears to be important in initiating WN virus transmission among birds in early summer; Cx. pipiens appears to play a greater role in amplifying virus later in the season. Cs. melanura could be important in the circulation of WN virus among birds in sylvan environments; Cx. salinarius is a suspected vector of WN virus to humans and horses.

Animals↗
PubMed2002

Experimental infection of horses with West Nile virus.

A total of 12 horses of different breeds and ages were infected with West Nile virus (WNV) via the bites of infected Aedes albopictus mosquitoes. Half the horses were infected with a viral isolate from the brain of a horse (BC787), and half were infected with an isolate from crow brain (NY99-6625); both were NY99 isolates. Postinfection, uninfected female Ae. albopictus fed on eight of the infected horses. In the first trial, Nt antibody titers reached >1:320, 1:20, 1:160, and 1:80 for horses 1 to 4, respectively. In the second trial, the seven horses with subclinical infections developed Nt antibody titers >1:10 between days 7 and 11 post infection. The highest viremia level in horses fed upon by the recipient mosquitoes was approximately 460 Vero cell PFU/mL. All mosquitoes that fed upon viremic horses were negative for the virus. Horses infected with the NY99 strain of WNV develop low viremia levels of short duration; therefore, infected horses are unlikely to serve as important amplifying hosts for WNV in nature.

Aedes↗