Total knee replacements using rotating hinge implants in polio patients: clinical and functional outcomes

Little evidences are available in the literature concerning the outcomes of total knee replacement (TKR) in poliomyelitis patients with severe knee deformities or degeneration. Encouraging results have been reported concerning the use of constrained implants, i.e., rotating hinge knee prosthesis (RHK), compared to less constrained ones. The purpose of this paper is to report our experience with rotating hinge total knee replacement, using only RHK prosthesis, to determine functional results, complications, and survival of TKR in poliomyelitis patients. We performed a retrospective chart review of 14 patients with a history of knee osteoarthritis following poliomyelitis that underwent primary TKR, for a total of 15 surgical procedure (one bilateral case). Preoperative and postoperative clinical measurements have been conducted for all patients using the Knee Society Score (KSS). Hip-knee angle, recurvatum knee angle, and Insall-Salvati index were evaluated with full weight-bearing panoramic view X-ray preoperatively and postoperatively. The 2-year postoperative clinical KSS significantly improved from the preoperative scores. The average clinical KSS improved from 32,9 (range 3-48) preoperatively to 77,4 (range 60-88) postoperatively (P value < 0.005). The average functional KSS improved from 32,5 (range 10-60) preoperatively to 59,4 (range 30-95) postoperatively (P value < 0.005). TKR is a successful treatment in improving knee function and patient's quality of life. Using constrained implants, especially rotating hinge implants in polio patients with a quadriceps muscle weakness, could be a good alternative to maintain a physiological kinematics and reducing the revision rate due to knee instability

A Simple Mathematical Approach to Calculate Blood Loss in Radical Prostatectomy

Introduction: The aim of this study was to apply a simple mathematical approach to calculate blood loss in 126 patients undergoing radical retropubic prostatectomy (RRP). Materials and Methods: Perioperative red blood cell loss (RBCL) was estimated by adding the difference in circulating red blood cells from before to after surgery to the allogeneic red blood cells transfused in the same period. Results: Mean preoperative hematocrit was 45 \ub1 4% and mean perioperative RBCL was 574 \ub1 297 ml, corresponding to a mean equivalent whole blood loss (WBL) of 1,479 \ub1 831 ml. Twenty of 126 patients (15.9%) received 42 units of allogeneic packed red blood cells (PRBC), for a mean of 2.1 \ub1 1.2 U/patient. The transfusion rate was higher in patients with a preoperative hematocrit of 40% or less (45 vs. 13%, p = 0.014). Conclusions: Anatomical RRP is still associated with appreciable operative blood loss. Owing to the high preoperative hematocrit values, the allogeneic blood transfusion rate is low and the transfusion requirement of the majority of patients is limited to about 2 units of PRBC. Preoperative autologous blood augmentation strategies may not be routinely needed for patients with a basal hematocrit of >40%

Politics, corruption and democracy The 1995 Stein Rokkan Lecture*

First published: September 199

Understanding corruption in different contexts

In their contribution entitled Understanding Corruption in Different Contexts, the authors Richard Rose and Caryn Peiffer discuss the meaning and standards of corruption by looking at countries in the Global North and Global South. They refer to fuzzy and broad definitions of corruption in circulation worldwide and emphasize the demand for an integrated explanation of corruption by following an interdisciplinary approach. The chapter offers a review of social scientists theories about causes and consequences of corruption followed by new findings and evidence from a comparison of 122 countries around the globe assessed by the Global Corruption Barometer and 176 countries compared by the Corruption Perception Index of Transparency International. Rose and Peiffer find that generalizations about corruption in countries grouped according to geography and culture are misleading. Variations in national context within continents are greater than differences between mean ratings of continents. A superficial comparison of the degree of corruption across continents and countries of the Global South and North is misleading. The authors suggest nine principles for reducing retail corruption with high practical value. In particular, they emphasize that reducing direct contact between public servants and citizens by delivering services electronically can result in more efficient public services at the grass roots and simultaneously lower the possibilities for corrupt behavior