C. B. D. Lavy

The fate of allogeneic and xenogeneic neuronal tissue transplanted into the third ventricle of rodents.

Neural grafts from day 17-19 fetal rats or mice survived well when transplanted into syngeneic, or immunodeficient hosts, thus demonstrating that there are no non-immunological barriers to cross-species transplantation of neuronal tissue in rats and mice. However, intraventricular grafts from rat to mouse, or vice versa, in immunocompetent animals were rejected in less than 30 days. By this time all graft tissue had been destroyed and scavenged, presumably by the macrophages seen infiltrating the grafts within 10 days of grafting. Rat allografts from major histocompatibility complex disparate donors disparate donors survived well as did grafts between rats differing only at minor histocompatibility loci. However, allografts from donors that differed from recipients at both major and minor histocompatibility complex loci had a variable survival time. When neural tissue was grafted into immunologically primed recipients, it was rejected as was similar tissue grafted beneath the kidney capsule of an allogeneic host. Concomitant grafting of allogeneic tissue under the kidney capsule and into the third ventricle was followed by rejection in both sites. A striking observation in these studies was the induction of Class I major histocompatibility complex antigens on grafted neuronal tissue. High levels of antigen expression were correlated with a vigorous host response and poor graft survival but lower levels were not indicative of impending graft destruction. Whilst the brain can be regarded as an immunologically privileged site, the privilege is not absolute and caution needs to be exercised in the interpretation of results from allogeneic or xenogeneic grafts.

Surgery in Malawi – A National Survey of Activity in Rural and Urban Hospitals

INTRODUCTIONnMalawi is a poor country with few doctors. It has 21 district hospitals all of which have operating theatres but none of which has a permanent surgeon. It also has 4 central hospitals, each with one or more surgeons. Most district hospitals are manned by a single doctor and two or more paramedical clinical officers.nnnPATIENTS AND METHODSnAll district and central hospitals were visited, and theatre logbooks analysed. All cases performed in 2003 were recorded.nnnRESULTSnIn 2003, a total of 48,696 surgical operations were recorded, of which 25,053 were performed in 21 district hospitals and 23,643 in 4 central hospitals. Caesarean section is the commonest major surgical procedure in district hospitals and is performed in approximately 2.8% of all births, compared to 22% in the UK. Very few major general surgical or orthopaedic procedures are carried out in district hospitals.nnnCONCLUSIONnThis study underlines Malawis need for more surgeons to be trained and retained.

Orthopaedic Clinical Officer Program in Malawi: A Model for Providing Orthopaedic Care

Malawi has a population of about 13xa0million people, 85% of whom live in rural areas. The gross national income per capita is US

Septic arthritis of the shoulder in children in Malawi: A RANDOMISED, PROSPECTIVE STUDY OF ASPIRATION VERSUS ARTHROTOMY AND WASHOUT

620, with 42% of the people living on less than US

Racial and gender variations in adult hip morphology

1 per day. The government per capita expenditure on health is US

Clinical features and microbiology in 204 cases of septic arthritis in Malawian children

5. Malawi has 266 doctors, of whom only nine are orthopaedic surgeons. To address the severe shortage of doctors, Malawi relies heavily on paramedical officers to provide the bulk of healthcare. Specialized orthopaedic clinical officers have been trained since 1985 and are deployed primarily in rural district hospitals to manage 80% to 90% of the orthopaedic workload in Malawi. They are trained in conservative management of most common traumatic and nontraumatic musculoskeletal conditions. Since the program began, 117 orthopaedic clinical officers have been trained, of whom 82 are in clinical practice. In 2002, Malawi began a local orthopaedic postgraduate program with an intake of one to two candidates per year. However, orthopaedic clinical officers will continue to be needed for the foreseeable future. Orthopaedic clinical officer training is a cost-effective way of providing trained healthcare workers to meet the orthopaedic needs of a country with very few doctors and even fewer orthopaedic surgeons.

One-year follow-up of orthopaedic implants in HIV-positive patients

We undertook a prospective study of 61 children in Malawi with septic arthritis of the shoulder. They were randomised into two groups, treated by aspiration (group 1, 31 patients) or arthrotomy (group 2, 30 patients). Both received antibiotics for six weeks. We studied the results of blood tests, microbiology, and the clinical and radiological outcome one year after diagnosis. Only one patient was sickle-cell positive and three were HIV-positive. Non-typhoidal Salmonella species accounted for 86% (19/22) of the positive joint cultures in group 1 and 73% (16/22) in group 2. Of the 33 radiographs available for review at follow-up at six months, 23 (70%) showed evidence of glenohumeral damage. There was no statistical difference in radiological outcome for the two groups. We devised and validated a scoring system, the Blantyre Septic Joint Score, for the assessment of joints based upon swelling, tenderness, function and range of movement. Despite the radiological changes only one of the 24 joints examined at one year had any deficit in these parameters. There was no statistical difference in the clinical outcome for the two treatment groups at any stage during the period of follow-up.

For how long should antibiotics be given in acute paediatric septic arthritis? A prospective audit of 96 cases

Pelvic X-rays of 99 adult patients (198 hips) were analysed in 58 men and 41 women to determine the morphology of the adult hip in Malawians. For each hip the centre edge angle of Wiberg, the acetabular angle of Sharp and the acetabular head index were measured. For each parameter, women were more dysplastic than men, and for the acetabular angle of Sharp there was a significant gender difference (p<0.05, t test). Our figures were compared to those of Fujii et al. who had measured the same parameters in Japanese and British hips. His results taken with ours showed that within a racial group, women were more dysplastic that men and that Japanese hips were more dysplastic than British hips, which were in turn more dysplastic than Malawian hips.RésuméLes radiographies pelviennes de 99 malades adultes (198 hanches) ont été analysées chez 58 hommes et 41 femmes pour déterminer la morphologie de la hanche adulte au Malawi. Pour chaque hanche, langle de Wiberg, langle acétabulaire de Sharp, et lIndex Tête /Acétabulum ont été mesurés. Pour chaque paramètre les femmes étaient plus dysplasiques que les hommes et pour langle acétabulaire de Sharp il y avait une différence significative selon le sexe (p <0.05, t-test). Nos chiffres ont été comparés à ceux de Fujii et coll. qui avaient mesuré les mêmes paramètres sur des hanches japonais et britanniques. Ses résultats, considérés avec les nôtres, ont montré que dans un groupe racial les femmes étaient plus dysplasiques que les hommes, et les hanches japonaises étaient plus dysplasiques que les hanches britanniques elles-même plus dysplasiques que les hanches du Malawi.

Septic arthritis of the shoulder in children in Malawi

We examined 204 children (137 boys and 67 girls) aged 12 years and under with septic arthritis. Their mean age was 31.1 months (1 to 144; SD 41.6). The most common joints affected were the knees and shoulders. Joints in the upper limb were affected more often in younger children and in the lower limb in those who were older. The mean age for an infection was 12 months in the shoulder and 73 months in the hip. The most common organisms cultured were species of Salmonella.

Clubfoot in Malawi: treatment-seeking behaviour

We followed prospectively 38 orthopaedic implants in 36 HIV-positive patients. X-rays and clinical examination were used to assess union, and observation was made for early and late wound sepsis for 12 months from the time of surgery. Two patients died of causes unrelated to the implantation, two patients had implants removed for reasons other than infection and eight cases were lost to follow-up. Of the 26 cases that were reviewed at 1 year, no late sepsis was identified. All of the fractures, non-unions, osteotomies and arthrodeses united. The literature indicates that late sepsis following arthroplasty occurs more frequently in haemophiliacs who are HIV positive than their HIV-negative counterparts. It is still not certain whether or not such a risk also applies to HIV-positive patients who are not haemophiliacs and have undergone internal fixation of fractures or non-unions. This study increases the confidence that fixation in immune-compromised patients with intact skin is safe, at least for the time period that the implant is required. Further studies are required to know whether or not fixation implants should be removed.RésuméNous avons suivi de façon prospective 38 implants orthopédiques chez 36 malades HIV-Positifs. La radiographie et l’examen clinique ont été utilisés pour étudier l’évolution et ont été recherchées les infections précoces et tardives survenant dans l’année suivant la chirurgie. Deux malades sont morts de causes sans rapport avec l’implantation, deux malades avaient des implants retirés pour des raisons autre qu’une infection, et huit cas ont été perdus de vue. Des 26 cas qui ont été examinés à une année, aucune infection tardive n’a été identifiée. Toutes les fractures, pseudarthroses, osteotomies et arthrodèses ont fusionnées. La littérature indique que les infections tardives après arthroplastie surviennent plus fréquemment chez les hémophiles séro-positifs que chez ceux qui sont séro-négatifs. Il n’est pas encore certain qu’un tel risque s’applique aussi à malades séropositifs qui ne sont pas des haemophiles. Cette étude augmente la confiance dans le fait que l’utilisation d’implants orthopédiques chez des patients immuno déprimés avec une peau intacte est sûre, au moins pour la période ou l’implant est nécessaire. Des études supplémentaires sont nécessaires pour savoir si les implants de fixation devraient être enlevés ou non.