Isolation and partial purification of lipid-linked oligosaccharides from calf pancreas

International audienceLipid-linked oligosaccharides containing at least five mannose residues (0.7 nmol/g of tissue) were isolated from calf pancreas by chloroform-methanol-water extraction and purification on DEAE-cellulose and Sephadex LH-20, and affinity chromatography on concanavalin A-Sepharose in the presence of nonionic detergent. The addition, prior to the chromatographic steps, of 14C-labeled lipid-linked oligosaccharides (synthesized in vitro by calf pancreas microsomes in the presence of GDP-d-[14C]mannose and UDP-d-[14C]glucose, respectively) as internal standards, indicated a final yield ranging from 38 to 50%. Analysis of the oligosaccharide residues by liquid chromatography of the lipid-free preparation, monitored by u.v. absorbance and radioactivity measurement of the tritiated compounds, indicated a heterogeneous mixture of oligosaccharides. Its components, ranging from Man5(GlcNAc)2 to Glc3Man9(GlcNAc)2, cochromatographed with the 14C-labeled derivatives from in vitro synthesis. Calf pancreas contains lipid intermediates bearing at least six mannose residues, such as Man9(GlcNAc)2-P-P-lipid, in almost equal or even higher amounts than Glc3Man9(GlcNAc)2-P-P-dolichol

Infection after total knee replacement: diagnosis and treatment

Infection after total knee replacement (IATJ) is a rare complication. It is associated with increased morbidity and mortality increasing the final costs. Gram positive coccus and Staphylococcus coagulase-negative and Staphylococcus aureus are the most common isolated germs (>50% of the cases). Conditions related to the patient, to the surgical procedure and even to the post op have been identified as risk factors to IATJ. Many complementary methods together with clinical symptoms are useful to a proper diagnosis. Treatment for IATJ must be individualized but generally is a combination of systemic antibiotic therapy and surgical treatment. Prosthesis exchange in one or two stages is the first choice procedure. Debridement with prosthesis retention is an option in acute cases with stable implants and antibiotic sensible germs

Why Reintervention After Total Knee Arthroplasty Fails? A Consecutive Cohort of 1170 Surgeries

BACKGROUND: The aim of this study was to analyze why contemporary reintervention after total knee arthroplasty (RiTKA) fails. METHODS: Between January 2006 and December 2010, from a multicenter cohort of 1170 RiTKAs, we assessed all failures of RiTKA requiring additional surgery. All indications for the index reintervention were included. The minimum follow-up period was 3 years. RESULTS: A total of 192 (16.4%) patients required additional surgery after RiTKA (re-reintervention). The mean follow-up period was 7.7 years. Mean age was 69.2 years. The mean time to re-reintervention was 9.6 months with 90.1% of rTKA failure occurring within the first two years. Infection was the main cause of new surgery after RiTKA (47.9%; n= 92/192). Other causes included extensor mechanism pathology (14.6%), stiffness (13.5%), pain (6.8%), aseptic loosening (5.2%), laxity (5.2%), periprosthetic fracture (3.6%), and wound pathology (3.1%). In four groups, the main indication for re-reintervention was recurrence of the pathology leading to the first reintervention: RiTKA for infection (59/355, 16.6%, P < .05), stiffness (18/174, 10.3%, P < .05), extensor mechanism failure (9/167, 5.4%, P < .05), and RiTKA for pain (4/137, 2.9%, P= .003). Global survival curve analysis found 87.9% survivorship without re-reintervention at one year and 83% at eight years. CONCLUSION: Contemporary RiTKA failures mainly occur in the first two postoperative years. Infection is the main cause of failure in RiTKA. Recurrence of the initial pathology occurs in four groups of RiTKA and is the main indication for re-reintervention in these groups; infection (16.6%), stiffness (10.3%), extensor mechanism failure (5.4%), and pain (2.9%)

Excellent outcomes for lateral unicompartmental knee arthroplasty: Multicenter 268-case series at 5 to 23 years' follow-up

Introduction: Isolated lateral compartment osteoarthritis of the knee (LCOA) is 10 times less frequent than medial compartment involvement. Long-term assessments of unicompartmental knee arthroplasty (UKA) in this indication are rare, with small series. Hypothesis Survival and functional outcome of lateral UKA in a large series are quite acceptable; the strategy is suited for isolated LCOA. Material and method A multicenter retrospective study in 6 French health establishments included all lateral UKAs performed between January 1988 and September 2014. Clinical data (range of motion, International Knee Society (IKS) knee and function scores, satisfaction), paraclinical data (radiologic angles) and complications were prospectively entered in medical files during follow-up and analyzed retrospectively at end of follow-up. Results During the study period, 311 lateral UKAs were performed in 295 patients, using 5 fixed-bearing implant models. Twenty-eight patients died within 5 years, and 15 (4.8%) were lost to follow-up. The series thus comprised 268 lateral UKAs in 63 male and 205 female patients, with a mean age of 68.8±10.5 years, including 7 cases of post-traumatic osteoarthritis and 4 of aseptic osteonecrosis. Mean follow-up was 9.1 years (range, 5-23 years), implant survivorship with failure defined as all-cause revision surgery was 85.4% at 10 years and 79.4% at 20 years. At last follow-up, IKS knee score was 87.0 and IKS function score 80.2. Maximal flexion was 125°. 94.3% of patients were satisfied or very satisfied. The main cause of revision surgery was osteoarthritis in another knee compartment (66,7%, n=26). Conclusion: Lateral UKA showed good survivorship, comparable to medial UKA, with good functional results and excellent long-term satisfaction. Level of evidence IV, retrospective cohort study

Diffuse pigmented villonodular synovitis in knee joint: diagnosis and treatment

ABSTRACT Pigmented villonodular synovitis is a rare proliferative condition of the synovium. Although the condition can present in any joint, the knee is the most commonly affected site. Despite being a benign condition, pigmented villonodular synovitis is often aggressive, with marked extra-articular extension in some cases. Monoarticular involvement occurs in two forms: localized and diffuse. The latter is more common, with a high recurrence rate. There is no standard method of management of this lesion. Open surgery is a classical and effective method for treatment. Arthroscopic synovectomy, however, has gained popularity, and has several advantages over the open technique particularly in exclusively articular cases. The combined approach is suggested in cases with extra-articular involvement. Synovectomy through any approach may prevent secondary osteoarthritis and subsequent joint arthroplasty. Internal irradiation or external beam radiation as an adjuvant treatment to surgical synovectomy appears to decrease the rate of local recurrence in diffuse cases. The authors observed a great heterogeneity in reporting of functional results, and specific conclusions should not be drawn. Each patient should be managed in accordance with his/her particular condition

Circumstances of death in hospitalized patients and nurses' perceptions: French multicenter Mort-a-l'Hôpital survey.

International audienceBACKGROUND: In developed countries at present, death mostly occurs in hospitals, but the circumstances and factors associated with the quality of organization and care surrounding death are not well described. METHODS: We designed a large multicenter cross-sectional study to analyze the setting and clinical course of each patient on the day of death. We included 2750 clinical departments of 294 hospitals. Of these, 1033 departments (37.6%) of 200 hospitals (68.0%) contributed to the Mort-a-l'Hôpital survey. Data were collected prospectively by the bedside nurse of each patient within 10 days of the occurrence of death. Main outcome measures included circumstances of death in hospitalized patients; secondary outcomes, nurses' perceptions of quality of end-of-life care. RESULTS: Of the 1033 participating departments, 420 recorded no deaths during the study period and 613 declared at least 1 death. In the 3793 patients who died and were included for assessment, only 925 (24.4%) had loved ones present at the time of death; 70.1% had respiratory distress during the period before death; and only 12.0% were in pain. Written protocols for end-of-life care were available in 12.2% of participating departments. Only 35.1% of nurses judged the quality of dying and death acceptable for themselves. Principal factors significantly associated with this perception were availability of a written protocol for end-of-life care, anticipation of death, informing the family, surrogate designation, adequate control of pain, presence of family or friends at the time of death, and staff meeting with the family after the death. CONCLUSIONS: This large prospective study identifies nonoptimal circumstances of death for hospitalized patients and a number of suggestions for improvement. A combination of factors reflected in the nurses' satisfaction may improve the quality of end-of-life care