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A retrospective study was done on a consecutive series of patients who had revision of a femoral hip prosthesis using a titanium-alloy implant with proximal fibermesh pads. Of 28 patients who had revision using a Harris-Galante (Zimmer, Warsaw, IN) femoral prosthesis between 1985 and 1989, 25 of them (25 hip arthroplasties) were followed for an average of 5.5 years (range, 4-8 years); the other 3 had died. There were 12 men and 13 women whose age averaged 55 years. Thirty-two percent of the patients had moderate or severe femoral bone stock deficiency before surgery and 72% had intramedullary femoral bone-grafting. All of the patients had revision of the acetabular component using a cementless Harris-Galante prosthesis. Five (20%) of the 25 patients have undergone repeat femoral revision, 4 for aseptic loosening and 1 for persistent thigh pain. Of the 20 hips that have not been revised, 9 (45%) of the femoral prostheses have subsided 5 mm or more. Femoral endosteal lysis was present in 36% of all the hips. Only 8 (32%) of the 25 patients had radiologic signs of bone ingrowth fixation of the femoral component. The average Harris hip score rose from 46 before surgery for all 25 patients to 82 (range, 55-100) at last follow-up examination for the 20 patients not rerevised. Because of the poor clinical results (36% of patients with a poor Harris hip score [4 patients] or rerevised [5 patients]) and radiologic results (48% subsidence) of femoral reconstruction with this proximally porous-coated femoral prosthesis, its use for revision hip surgery is not recommended.

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Scleredema of Buschke is a rare disorder characterized by the development of areas of skin induration which usually resolve spontaneously. It is occasionally associated with a benign gammopathy, and rarely with myelomatosis. We describe a 60-year-old woman with extensive skin changes, who developed IgA myeloma. Unusually, her skin disease did not respond to conventional myeloma therapy. Death occurred as a consequence of the progressive skin disease.

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Intercarpal coalitions are well-known but poorly documented entities, resulting from incomplete cavitation of a common embryologic carpal precursor during the fourth to eighth weeks of intrauterine life. At our institution we have collected a series of 36 cases of carpal coalition in 24 persons. We found the condition to be much more common in American blacks than whites. The patients reported no symptoms or wrist dysfunction relative to the condition. The coalitions were incidental findings on radiographs taken for other reasons (usually trauma). This is the largest series in the English-language literature.

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The radioactive microsphere technique was used to investigate the distribution of blood flow during halothane anesthesia when either sodium nitroprusside (SNP) or saralasin, a competitive inhibitor of angiotensin II, was infused. Seventeen fasted male Wistar rats were anesthetized with halothane and received either saralasin (n = 6) or SNP (n = 11) to decrease mean arterial pressure 20 torr. Cardiac output was unchanged with SNP, but blood flow decreased 23 per cent to the brain, and 25 per cent to the kidney, while splanchnic flow increased 19 per cent (P less than .05). There were 37 per cent less microspheres present in the lung after drug treatment. Saralasin did not alter cardiac output or flow to other organs but did cause a 49 per cent decrease in the number of microspheres found in the lung after drug treatment. An additional group of rats first received SNP, and then saralasin. This combination was not well tolerated, resulting in lethal hypotension and a mortality of 60 per cent. In the thirteen animals which were able to complete the protocol, increases in blood flow to the heart, kidney and splanchnic circulation were seen while brain flow decreased (P less than .05). The number of microspheres in the lung also decreased after combined therapy. These studies demonstrate the differential effects of SNP and saralasin in lowering blood pressure. The use of combined drug treatment, when tolerated, may improve organ perfusion.

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There have been encouraging reports of symptomatic improvement in patients with low back pain following injection of a mixture of a local anesthetic and a corticosteroid into the lumbar epidural space. However, there is a lack of animal or human studies which examined possible long-term effects of this combination on the exposed neural tissues. This study evaluated by both light and electron microscopy the effect of triamcinolone diacetate in vehicle and of the vehicle itself (both in 2% lidocaine) in 48 cats after percutaneous epidural injections were done at the lumbosacral space. When the animals were killed at 30 or 120 days, specimens of the spinal root, the root exit zone, and the meninges at the level of injection and level above and below were obtained. Because all of the histologic findings were found to be mild, it is concluded that local anesthetic-steroid combinations do not cause significant damage to neural tissues.

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The role of the renin--angiotensin system in the maintenance of blood pressure during halothane anesthesia and sodium nitroprusside (SNP)-induced hypotension was evaluated. Control rats received halothane anesthesia (1 MAC) for one hour, followed by SNP infusion, 40 microgram/kg/min, for 30 min, followed by a 30-min recovery period. A second group of rats was treated identically and, in addition, received an infusion of saralasin (a competitive inhibitor of angiotensin II) throughout the experimental period. In each group, SNP infusion resulted in an initial decrease in blood pressure from 86 torr and 83 torr, respectively, to 48 torr. During the SNP infusion the control animals demonstrated a progressive increase in blood pressure to 61 torr, whereas the saralasin-treated animals showed no change. Following discontinuation of SNP, blood pressure in the control animals rebounded to 94 torr, as compared with 78 torr in the saralasin-treated rats. This study indicates that with stable halothane anesthesia, the partial recovery of blood pressure during SNP infusion and the post-SNP rebound of blood pressure can be completely blocked by saralasin. This demonstrates the participation of the renin--angiotensin system in antagonizing the combined hypotensive effects of halothane and SNP.

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