Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This study reports on ceramic-on-metal (CoM) bearings in total hip replacement. Whole blood metal ion levels were measured. The median increase in chromium and cobalt at 12 months was 0.08 microg/1 and 0.22 microg/1, respectively, in CoM bearings. Comparable values for metal-on-metal (MoM) were 0.48 microg/1 and 0.32 microg/1. The chromium levels were significantly lower in CoM than in MoM bearings (p = 0.02). The cobalt levels were lower, but the difference was not significant. Examination of two explanted ceramic heads revealed areas of thin metal transfer. CoM bearings (one explanted head and acetabular component, one explanted head and new acetabular component, and three new heads and acetabular components) were tested in a hip joint simulator. The explanted head and acetabular component had higher bedding-in. However, after one million cycles all the wear rates were the same and an order of magnitude less than that reported for MoM bearings. There were four outliers in each clinical group, primarily related to component malposition.

No abstract

Liver transplantation (LTx) in children currently offers long-term survival rates of more than 80%. Many causes for Tx failure have been identified. However, the incidence and impact of multi-organ system failure (MOSF) are, to date, unknown. Therefore, in this study the role of MOSF after LTx in children was investigated with regard to outcome. The data of 114 children (53 girls, 61 boys; median age 4.3 yr) after first LTx were evaluated retrospectively. The definition of MOSF, as used by Wilkinson et al. [Crit Care Med 1986: 14: 271-274], was modified with regard to age-adjusted values. The influence of MOSF on patient survival was investigated by Kaplan-Meier analysis and multivariate regression analysis. Thirty-one of 114 children with orthotopic LTx developed MOSF (involving two or more organs). In total, 18 children died (15.8%) during the hospitalization; 16 of these had MOSF. Mortality related to two-organ failure was 29.4% (n = 5), to three-organ failure 78% (n = 7), and to four-organ failure 80% (n = 4). The highest mortality rates were observed in children with central nervous system (CNS) and cardiovascular failure, leading to a decreased probability of survival of 0.40 (p < 0.0001). Multi-variate analysis showed that CNS and cardiovascular failure were the most important risk factors for survival (p < 0.0001 and 0.056, respectively). Respiratory and renal failure, in univariate analysis, were significant contributors to poor survival, but had no statistically significant influence on outcome in multivariate analysis. Bone marrow insufficiency was found to have no influence on survival in either analysis. In multivariate analysis, the risk of development of MOSF was significantly increased by high numbers of transfused units of fresh-frozen plasma (FFP), the absence of rejection episodes, or a high bilirubin level prior to Tx. Hence, MOSF is a major factor contributing to the death of children early after LTx. CNS and cardiovascular failure carried the highest risk for a poor outcome. Other risk factors associated with the development of MOSF were: numbers of transfused units of FFP, absence of rejection episodes, and a high pre-Tx bilirubin level.