Art is our answer

[Palace]

Hello AN Friends,


Choose a medium and lose yourself in a craft, music or artwork.  Here is an amazing inspiration for all of us:  http://www.geekosystem.com/brain-art/


Google the above and you find it's worth your effort; post your reactions if you don't mind.


Today is the anniversary of my parents who committed suicide.  In their honor, please enjoy the artwork.  I can't take credit for the brain-art however, I do sell my own watercolours and have a show opening at the beginning of February next year.



HAPPY NEW YEAR TO ALL OF YOU,



Palace

[Palace]

Hello Holiday Survivors & Brain Tumor Patients:


Isn't that some beautiful art?  It just shows we can train and help distract ourselves from our symptoms.  How did you like that link?



Pal

[Jim Scott]

Hi, Palace ~

The 'brain pictures' were fascinating.  A bit idiosyncratic but, overall, interesting.  Thanks for the link - and the inspiration. 

Jim

[Crazycat]

Excellent post Palace! I'm beginning to wonder if brainwaves have something to do with the roaring tinnitus in my left ear. Dr. McKenna suggested the constant tinnitus in my deaf ear could be likened to the distortion you see when a television channel signs off the air.

In the way of sound, it's like something experimental and avant garde composers such as Stockhausen or John Cage would do ;. Or maybe Charles Ives with his Three Places in New England. In my case, I can tell you what the "three places" are: Mass General, Mass Eye & Ear and Spaulding Rehab. 

[Palace]

Hello Patient People:



Thanks guys for your thoughts on "art distractions to help train and direct our brain all over again."  There is only so much we can do however, there are ways of diverting reactions.

I'm dealing with the "slam-dunk-clunk" ear sounds right now and may have to go back to the ENT.  (on my AN side)  The full-feeling in my right ear has returned but, it's not nearly as severe as when I was diagnosed with the Acoustic Neuroma.

I'll use art to distract myself yet of course people, we must listen to our body as it's talking to us and telling us something isn't right and I must say in this thread, "Don't ignore the post-op symptoms---just make your way as best you can with within reason, then get help if you think you're needing it again."

Thank-you for your contributions on this thread. 

Interesting!



Palace

[Palace]

Using our brain and keeping it as healthy/active as possible is so important.  Perhaps the craft or art being the distraction, along with much reading can help in many ways.  I just came across this article regarding Alzheimer's disease.  (interesting, if nothing else)
______________________________________________________________________________________________________________



Testing brain pacemakers to zap Alzheimer's damage
By LAURAN NEERGAARD |

Google this article for image:
 

    FILE - This undated file image provided by Merck & Co., shows a cross section of a normal brain, right, and one of a brain damaged by advanced Alzheimer's disease. A dramatic shift is beginning in the disappointing struggle to find something to slow the damage of Alzheimer's disease: The first U.S. experiments with "brain pacemakers" for Alzheimer's are getting under way. Scientists are looking beyond drugs to implants in the hunt for much-needed new treatments. (AP Photo/Merck & Co., File)
    View Photo

    Associated Press/Merck & Co., File - FILE - This undated file image provided by Merck & Co., shows a cross section of a normal brain, right, and one of a brain damaged by advanced Alzheimer's disease. A dramatic …more

WASHINGTON (AP) — It has the makings of a science fiction movie: Zap someone's brain with mild jolts of electricity to try to stave off the creeping memory loss of Alzheimer's disease.

And it's not easy. Holes are drilled into the patient's skull so tiny wires can be implanted into just the right spot.

A dramatic shift is beginning in the disappointing struggle to find something to slow the damage of this epidemic: The first U.S. experiments with "brain pacemakers" for Alzheimer's are getting under way. Scientists are looking beyond drugs to implants in the hunt for much-needed new treatments.

The research is in its infancy. Only a few dozen people with early-stage Alzheimer's will be implanted in a handful of hospitals. No one knows if it might work, and if it does, how long the effects might last.

Kathy Sanford was among the first to sign up. The Ohio woman's early-stage Alzheimer's was gradually getting worse. She still lived independently, posting reminders to herself, but no longer could work. The usual medicines weren't helping.

Then doctors at Ohio State University explained the hope — that constant electrical stimulation of brain circuits involved in memory and thinking might keep those neural networks active for longer, essentially bypassing some of dementia's damage.

Sanford decided it was worth a shot.

"The reason I'm doing it is, it's really hard to not be able, sometimes, to remember," Sanford, 57, said from her Lancaster, Ohio, home.

Her father is blunter.

"What's our choice? To participate in a program or sit here and watch her slowly deteriorate?" asked Joe Jester, 78. He drives his daughter to follow-up testing, hoping to spot improvement.

A few months after the five-hour operation, the hair shaved for her brain surgery was growing back and Sanford said she felt good, with an occasional tingling that she attributes to the electrodes. A battery-powered generator near her collarbone powers them, sending the tiny shocks up her neck and into her brain.

It's too soon to know how she'll fare; scientists will track her for two years.

"This is an ongoing evaluation right now that we are optimistic about," is how Ohio State neurosurgeon Dr. Ali Rezai cautiously puts it.

More than 5 million Americans have Alzheimer's or similar dementias, and that number is expected to rise rapidly as the baby boomers age. Today's drugs only temporarily help some symptoms. Attempts to attack Alzheimer's presumed cause, a brain-clogging gunk, so far haven't panned out.

"We're getting tired of not having other things work," said Ohio State neurologist Dr. Douglas Scharre.

The new approach is called deep brain stimulation, or DBS. While it won't attack Alzheimer's root cause either, "maybe we can make the brain work better," he said.

Implanting electrodes into the brain isn't new.

Between 85,000 and 100,000 people around the world have had DBS to block the tremors of Parkinson's disease and other movement disorders. The continuous jolts quiet overactive nerve cells, with few side effects. Scientists also are testing whether stimulating other parts of the brain might help lift depression or curb appetite among the obese.

It was in one of those experiments that Canadian researchers back in 2003 stumbled onto the Alzheimer's possibility. They switched on the electrical jolts in the brain of an obese man and unlocked a flood of old memories. Continuing his DBS also improved his ability to learn. He didn't have dementia, but the researchers wondered if they could spur memory-making networks in someone who did.

But wait a minute.

Alzheimer's doesn't just steal memories. It eventually robs sufferers of the ability to do the simplest of tasks. How could stimulating a brain so damaged do any good?

A healthy brain is a connected brain. One circuit signals another to switch on and retrieve the memories needed to, say, drive a car or cook a meal.

At least early in the disease, Alzheimer's kills only certain spots. But the disease's hallmark gunky plaques act as a roadblock, stopping the "on" switch so that healthy circuits farther away are deactivated, explained Dr. Andres Lozano, a neurosurgeon at Toronto Western Hospital whose research sparked the interest.

So the plan was to put the electrodes into hubs where brain pathways for memory, behavior, concentration and other cognitive functions converge, to see if the jolts reactivate those silenced circuits, added Ohio State's Rezai.

"It's like going through Grand Central Station and trying to affect all the trains going in and coming out," he said.

Lozano's team found the first clue that it's possible by implanting six Alzheimer's patients in Canada. After at least 12 months of continuous stimulation, brain scans showed a sign of more activity in areas targeted by Alzheimer's. Suddenly, the neurons there began using more glucose, the fuel for brain cells.

"It looked like a blackout before. We were able to turn the lights back on in those areas," Lozano said.

While most Alzheimer's patients show clear declines in function every year, one Canadian man who has had the implants for four years hasn't deteriorated, Lozano said, although he cautioned that there's no way to know whether that's due to the DBS.

The evidence is preliminary and will take years of study to prove, but "this is an exciting novel approach," said Dr. Laurie Ryan of the National Institutes of Health's aging division, which is funding a follow-up study.

Under way now:

—The Toronto researchers have teamed with four U.S. medical centers — Johns Hopkins University, the University of Pennsylvania, University of Florida and Arizona's Banner Health System — to try DBS in a part of the brain called the fornix, one of those memory hubs, in 40 patients. Half will have their electrodes turned on two weeks after the operation and the rest in a year, an attempt to spot any placebo effect from surgery.

—At Ohio State, Rezai is implanting the electrodes into a different spot, the frontal lobes, that his own DBS work suggests could tap into cognition and behavior pathways. That study will enroll 10 participants including Sanford.

Surgery back in October was Sanford's first step. Then it was time to fine-tune how the electrodes fire. She took problem-solving tests while neurologist Scharre adjusted the voltage and frequency and watched her reactions.

Sanford was cheered to see her test scores climb a bit during those adjustments. She said she knows there are no guarantees, but "if we can beat some of this stuff, or at least get a leading edge on it, I'm in for the whole deal."

 

   

[ppearl214]

Palace

Thank you for sharing this.  My father (known here over the years as PapaPearl) passed less than a year ago to Alzheimer's and I've also been doing a lot of fundraising and volunteering to the disease (as well as AN's).  Brain games and brain stimulation certainly help and in the Alz medical community, there is a great deal of frustration as noted in the article. Difficult journey for all.

We have talked here over the years regarding "brain games" and such to help with our focus, etc.  I remember the discussions of word searches, yarn work, Soduko puzzles, reading that seem to help.  I believe they may be noted in the "Cognitive/Emotional" forum but I'd have to do a "Search" to find it.

By keeping ourselves busy and focused, especially on things we are passionate (we had our book club here... is it still active?), it definately helps regardless of the ailment.  We had my dad, a very passionate reader, doing puzzles and such to try to help. I also try to keep brain games going to help me with my AN journey.  Little bit of brain stimulation never hurt anyone.

Thanks again for sharing this.
Phyl

[Palace]

Phyl & AN Group:


We lost another person now to Alzheimer's disease which was on the news today.  At least this educated brain made it to his ninties.

Former Brown University President Donald F. Hornig, who worked on the atomic bomb and was a scientific adviser to three U.S. presidents, has died, according to ABC News.

He was 92 and suffering from Alzheimer’s disease.

Hornig was the Ivy League university’s president from 1970 to 1976. He also taught at Princeton and Harvard.

Hornig was a Harvard-trained physical chemist and one of the youngest group leaders on the Manhattan Project that developed the atomic bomb during World War II.

He designed the firing unit that triggered the simultaneous implosion of the bomb’s plutonium device.

Hornig advised presidents Eisenhower, Kennedy and Johnson, then became president at Brown, where he restored the university to financial health.

He then joined Harvard’s School of Public Health. Harvard honored him last year for being a “visionary scientist and educator.”



Pal

[Palace]

Here is another reason to stay out of the public during flu season and do your craft or art which calls you:


Emelie Olsson falls asleep as he watches television in her apartment in Stockholm, January 17, 2013. Emelie is one of around 800 children in Sweden and elsewhere in Europe who developed narcolepsy, an incurable sleep disorder, after being immunised in 2009 with the Pandemrix H1N1 swine flu vaccine made by British drugmaker GlaxoSmithKline. Picture taken January 17, 2013. REUTERS/Ints Kalnins
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STOCKHOLM (Reuters) - Emelie is plagued by hallucinations and nightmares. When she wakes up, she's often paralyzed, unable to breathe properly or call for help. During the day she can barely stay awake, and often misses school or having fun with friends. She is only 14, but at times she has wondered if her life is worth living.

Emelie is one of around 800 children in Sweden and elsewhere in Europe who developed narcolepsy, an incurable sleep disorder, after being immunized with the Pandemrix H1N1 swine flu vaccine made by British drugmaker GlaxoSmithKline in 2009.

Finland, Norway, Ireland and France have seen spikes in narcolepsy cases, too, and people familiar with the results of a soon-to-be-published study in Britain have told Reuters it will show a similar pattern in children there.

Their fate, coping with an illness that all but destroys normal life, is developing into what the health official who coordinated Sweden's vaccination campaign calls a "medical tragedy" that will demand rising scientific and medical attention.

Europe's drugs regulator has ruled Pandemrix should no longer be used in people aged under 20. The chief medical officer at GSK's vaccines division, Norman Begg, says his firm views the issue extremely seriously and is "absolutely committed to getting to the bottom of this", but adds there is not yet enough data or evidence to suggest a causal link.

Others - including Emmanuel Mignot, one of the world's leading experts on narcolepsy, who is being funded by GSK to investigate further - agree more research is needed but say the evidence is already clearly pointing in one direction.

"There's no doubt in my mind whatsoever that Pandemrix increased the occurrence of narcolepsy onset in children in some countries - and probably in most countries," says Mignot, a specialist in the sleep disorder at Stanford University in the United States.

30 MILLION RECEIVED PANDEMRIX

In total, the GSK shot was given to more than 30 million people in 47 countries during the 2009-2010 H1N1 swine flu pandemic. Because it contains an adjuvant, or booster, it was not used in the United States because drug regulators there are wary of adjuvanted vaccines.

GSK says 795 people across Europe have reported developing narcolepsy since the vaccine's use began in 2009.

Questions about how the narcolepsy cases are linked to Pandemrix, what the triggers and biological mechanisms might have been, and whether there might be a genetic susceptibility are currently the subject of deep scientific investigation.

But experts on all sides are wary. Rare adverse reactions can swiftly develop into "vaccine scares" that spiral out of proportion and cast what one of Europe's top flu experts calls a "long shadow" over public confidence in vaccines that control potential killers like measles and polio.

"No-one wants to be the next Wakefield," said Mignot, referring to the now discredited British doctor Andrew Wakefield who sparked a decades-long backlash against the measles, mumps and rubella (MMR) shot with false claims of links to autism.

With the narcolepsy studies, there is no suggestion that the findings are the work of one rogue doctor.

Independent teams of scientists have published peer-reviewed studies from Sweden, Finland and Ireland showing the risk of developing narcolepsy after the 2009-2010 immunization campaign was between seven and 13 times higher for children who had Pandemrix than for their unvaccinated peers.

"We really do want to get to the bottom of this. It's not in anyone's interests if there is a safety issue that needs to be addressed," said GSK's Begg.

LIFE CHANGED

Emelie's parents, Charles and Marie Olsson, say she was a top student who loved playing the piano, taking tennis lessons, creating art and having fun with friends. But her life started to change in early 2010, a few months after she had Pandemrix. In the spring of 2010, they noticed she was often tired, needing to sleep when she came home from school.

But it wasn't until May, when she began collapsing at school, that it became clear something serious was happening.

As well as the life-limiting bouts of daytime sleepiness, narcolepsy brings nightmares, hallucinations, sleep paralysis and episodes of cataplexy - when strong emotions trigger a sudden and dramatic loss of muscle strength.

In Emelie's case, having fun is the emotional trigger. "I can't laugh or joke about with my friends anymore, because when I do I get cataplexies and collapse," she said in an interview at her home in the Swedish capital.

Narcolepsy is estimated to affect between 200 and 500 people per million and is a lifelong condition. It has no known cure and scientists don't really know what causes it. But they do know patients have a deficit of a brain neurotransmitter called orexin, also known as hypocretin, which regulates wakefulness.

Research has found that some people are born with a variant in a gene known as HLA that means they have low hypocretin, making them more susceptible to narcolepsy. Around 25 percent of Europeans are thought to have this genetic vulnerability.

When results of Emelie's hypocretin test came back in November last year, it showed she had 15 percent of the normal amount, typical of heavy narcolepsy with cataplexy.

The seriousness of her strange new illness has forced her to contemplate life far more than many other young teens: "In the beginning I didn't really want to live any more, but now I have learned to handle things better," she said.

TRIGGERS?

Scientists investigating these cases are looking in detail at Pandemrix's adjuvant, called AS03, for clues.

Some suggest AS03, or maybe its boosting effect, or even the H1N1 flu itself, may have triggered the onset of narcolepsy in those who have the susceptible HLA gene variant.

Angus Nicoll, a flu expert at the European Centre for Disease Prevention and Control (ECDC), says genes may well play a part, but don't tell the whole story.

"Yes, there's a genetic predisposition to this condition, but that alone cannot explain these cases," he said. "There was also something to do with receiving this specific vaccination. Whether it was the vaccine plus the genetic disposition alone or a third factor as well - like another infection - we simply do not know yet."

GSK is funding a study in Canada, where its adjuvanted vaccine Arepanrix, similar to Pandemrix, was used during the 2009-2010 pandemic. The study won't be completed until 2014, and some experts fear it may not shed much light since the vaccines were similar but not precisely the same.

It all leaves this investigation with far more questions than answers, and a lot more research ahead.

WAS IT WORTH IT?

In his glass-topped office building overlooking the Maria Magdalena church in Stockholm, Goran Stiernstedt, a doctor turned public health official, has spent many difficult hours going over what happened in his country during the swine flu pandemic, wondering if things should have been different.

"The big question is was it worth it? And retrospectively I have to say it was not," he told Reuters in an interview.

Being a wealthy country, Sweden was at the front of the queue for pandemic vaccines. It got Pandemrix from GSK almost as soon as it was available, and a nationwide campaign got uptake of the vaccine to 59 percent, meaning around 5 million people got the shot.

Stiernstedt, director for health and social care at the Swedish Association of Local Authorities and Regions, helped coordinate the vaccination campaign across Sweden's 21 regions.

The World Health Organization (WHO) says the 2009-2010 pandemic killed 18,500 people, although a study last year said that total might be up to 15 times higher.

While estimates vary, Stiernstedt says Sweden's mass vaccination saved between 30 and 60 people from swine flu death. Yet since the pandemic ended, more than 200 cases of narcolepsy have been reported in Sweden.

With hindsight, this risk-benefit balance is unacceptable. "This is a medical tragedy," he said. "Hundreds of young people have had their lives almost destroyed."

PANDEMICS ARE EMERGENCIES

Yet the problem with risk-benefit analyses is that they often look radically different when the world is facing a pandemic with the potential to wipe out millions than they do when it has emerged relatively unscathed from one, like H1N1, which turned out to be much milder than first feared.

David Salisbury, the British government's director of immunization, says "therein lies the risk, and the difficulty, of working in public health" when a viral emergency hits.

"In the event of a severe pandemic, the risk of death is far higher than the risk of narcolepsy," he told Reuters. "If we spent longer developing and testing the vaccine on very large numbers of people and waited to see whether any of them developed narcolepsy, much of the population might be dead."

Pandemrix was authorized by European drug regulators using a so-called "mock-up procedure" that allows a vaccine to be authorized ahead of a possible pandemic using another flu strain. In Pandemrix's case, the substitute was H5N1 bird flu.

When the WHO declared a pandemic, GSK replaced the mock-up's strain with the pandemic-causing H1N1 strain to form Pandemrix.

GSK says the final H1N1 version was tested in trials involving around 3,600 patients, including children, adolescents, adults and the elderly, before it was rolled out.

The ECDC's Nicoll says early warning systems that give a more accurate analysis of a flu strain's threat are the best way to minimize risks of this kind of tragedy happening in future.

Salisbury agrees, and says progress towards a universal flu vaccine - one that wouldn't need last-minute changes made when a new strain emerged - would cuts risks further.

"Ideally, we would have a better vaccine that would work against all strains of influenza and we wouldn't need to worry about this ever again," he said. "But that's a long way off."

With scientists facing years of investigation and research, Emelie just wants to make the best of her life.

She reluctantly accepts that to do so, she needs a cocktail of drugs to try to control the narcolepsy symptoms. The stimulant Ritalin and the sleeping pill Sobril are prescribed for Emelie's daytime sleepiness and night terrors. Then there's Prozac to try to stabilize her and limit her cataplexies.

"That's one of the things that makes me feel most uncomfortable," she explains. "Before I got this condition I didn't take any pills, and now I have to take lots - maybe for the rest of my life. It's not good to take so many medicines, especially when you know they have side effects."

(Reporting by Kate Kelland; Editing by Will Waterman)


Palace

[Palace]

Not to stray from the topic however, here is a "quick-read" as the book-exchange has gone mostly to E-books.  I find certain types of metals interesting when used in the body!


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Total Hip Replacement
Hip Implants
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Cemented Total Hip Replacement
Cementless Total Hip Replacement
Hybrid Total Hip Replacement
Partial Hip Replacements
Hip Resurfacing
Longevity and Outcomes

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Total hip joint replacement is an orthopaedic success story, enabling hundreds of thousands of people to live fuller, more active lives.

Using metal alloys, high-grade plastics, and polymeric materials, orthopaedic surgeons can replace a painful, dysfunctional joint with a highly functional, long-lasting prosthesis.

Over the past half-century, there have been many advances in the design, construction, and implantation of artificial hip joints, resulting in a high percentage of successful long-term outcomes.
Implant Design

The hip joint is called a ball-and-socket joint because the spherical head of the thighbone (femur) moves inside the cup-shaped hollow socket (acetabulum) of the pelvis.

To duplicate this action, a total hip replacement implant has three parts: the stem, which fits into the femur; the ball, which replaces the spherical head of the femur; and the cup, which replaces the worn out hip socket. Each part comes in various sizes to accommodate various body sizes and types.

In some designs, the stem and ball are one piece; other designs are modular, allowing for additional customization in fit.

Several manufacturers make hip implants. The brand used by your doctor or hospital depends on many factors, including your needs (based on your age, weight, bone quality, activity level, and health), the doctor's experience and familiarity with the device, and the cost and performance record of the implant. These are issues you may wish to discuss with your doctor.
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Implant Construction

Many people credit Sir John Charnley, a British orthopaedist, with performing the first modern total hip replacement. His innovations included combining a metal stem and ball with a plastic shell and using a methacrylate cement to hold the devices in place.

Today, the stem portions of most hip implants are made of titanium- or cobalt/chromium-based alloys. They come in different shapes and some have porous surfaces to allow for bone ingrowth.

Cobalt/chromium-based alloys or ceramic materials (aluminum oxide or zirconium oxide) are used in making the ball portions, which are polished smooth to allow easy rotation within the prosthetic socket.

The acetabular socket can be made of metal, ultra-high molecular-weight polyethylene, or a combination of polyethylene backed by metal.

All together, these components weigh between 14 and 18 ounces, depending on the size needed.

All the materials used in a total hip replacement have four characteristics in common:

    They are biocompatible. They can function in the body without creating either a local or a systemic rejection response.
    They are resistant to corrosion, degradation, and wear. Therefore, they will retain their strength and shape for a long time. Resistance to wear is particularly significant in maintaining proper joint function and preventing the further destruction of bone caused by particulate debris generated as the implant parts move against each other.
    They have mechanical properties that duplicate the structures they are intended to replace. For example, they are strong enough to withstand weight-bearing loads, flexible enough to bear stress without breaking, and able to move smoothly against each other as required.
    They meet the highest standards. These high standards extend to fabrication and quality control at a reasonable cost.

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Implant Insertion

During a total hip replacement surgery, the orthopaedic surgeon will take a number of measurements to ensure proper prosthesis selection, limb length, and hip rotation. After making the incision, the surgeon works between the large hip muscles to gain access to the joint.

The femur is pushed out of the socket, exposing the joint cavity. The deteriorated femoral head is removed.

The acetabulum is prepared by cleaning and enlarging it with circular reamers of gradually increasing size. The new acetabular shell is implanted securely within the prepared hemispherical socket. The plastic inner portion of the implant is placed within the metal shell and fixed into place.

Next, the femur is prepared to receive the stem. The hollow center portion of the bone is cleaned and enlarged, creating a cavity that matches the shape of the implant stem. The top end of the femur is planed and smoothed so the stem can be inserted flush with the bone surface. If the ball is a separate piece, the proper size is selected and attached. Finally, the ball is seated within the cup so the joint is properly aligned and the incision is closed.

Hip replacements may be cemented, cementless, or hybrid (a combination of cemented and cementless components), depending on the type of fixation used to hold the implant in place. Although there are certain general guidelines, your surgeon will evaluate your particular situation carefully before making any decisions. Do not hesitate to ask which type of implant will be used in your situation and why that choice is appropriate for you.
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Cemented Total Hip Replacement

Over the past 40 years, there have been many improvements in both the materials and the methods used to hold the femoral and acetabular components in place. Today, the most commonly used bone cement is an acrylic polymer called polymethylmethacrylate (PMMA).

A patient with a cemented total hip replacement can put full weight on the limb and walk without support almost immediately after surgery, resulting in a faster rehabilitation. Although cemented implants have a long and distinguished track record of success, they are not ideal for everyone.

Cemented fixation relies on a stable interface between the prosthesis and the cement and a solid mechanical bond between the cement and the bone. Today's metal alloy stems rarely break, but they can occasionally loosen. Two processes, one mechanical and one biological, can contribute to loosening.

    In the femoral component, cracks (fatigue fractures) in the cement that occur over time can cause the prosthetic stem to loosen and become unstable. This occurs more often with patients who are very active or very heavy. The action of the metal ball against the polyethylene cup of the acetabular component creates polyethylene wear debris. The cement or polyethylene debris particles generated can then trigger a biologic response that further contributes to loosening of the implant and sometime to loss of bone around the implant.
    The microscopic debris particles are absorbed by cells around the joint and initiate an inflammatory response from the body, which tries to remove them. This inflammatory response can also cause cells to remove bits of bone around the implant, a condition called osteolysis. As the bone weakens, the instability increases. Bone loss can occur around both the acetabulum and the femur, progressing from the edges of the implant.

Despite these recognized failure mechanisms, the bond between cement and bone is generally very durable and reliable. Cemented total hip replacement is more commonly recommended for older patients, for patients with conditions such as rheumatoid arthritis, and for younger patients with compromised health or poor bone quality and density. These patients are less likely to put stresses on the cement that could lead to fatigue fractures.
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Cementless Total Hip Replacement

In the 1980s, new implant designs were introduced to attach directly to bone without the use of cement. In general, these designs are larger and longer than those used with cement.

They also have a surface topography that is conducive to attracting new bone growth. Most are textured or have a surface coating around much of the implant so that the new bone actually grows into the surface of the implant. Because they depend on new bone growth for stability, cementless implants require a longer healing time than cemented replacements.

The orthopaedic surgeon must be very precise in preparing the femur for a cementless impact. The implant channel must match the shape of the implant itself very closely. New bone growth cannot bridge gaps larger than 1 mm to 2 mm.

Your surgeon may recommend a period of protected weight-bearing (using crutches or a walker) to give the bone time to attach itself to the implant. This protected weight bearing helps to ensure there is no movement between the implant and bone so a durable connection can be established.

Cementless femoral components tend to be much larger at the top, with more of a wedge shape. This design enables the strong surface (cortex) of the bone and the dense, hard spongy (cancellous) bone just below it to provide support.

The acetabular component of a cementless total hip replacement also has a coated or textured surface to encourage bone growth into the surface. Depending on the design, these components may also use screws through the cup or spikes, pegs, or fins around the rim to help hold the implant in place until the new bone forms. Usually these components have a metal outer shell and a polyethylene liner.

The pelvis is prepared for a cementless acetabular component using a process similar to that used in a cemented total hip replacement procedure. The intimate contact between the component and bone is crucial to permit bone ingrowth.

Initially, it was hoped that cementless total hip replacement would eliminate the problem of bone resorption or stem loosening caused by cement failure. Although certain cementless stem designs have excellent long-term outcomes, cementless stems can loosen if a strong bond between bone and stem is not achieved.

Patients with large cementless stems may also experience a higher incidence of mild thigh pain. Likewise, polyethylene wear, particulate debris, and the resulting osteolysis (dissolution of bone) remain problems in both cemented and uncemented designs. Improvements in the wear characteristics of newer polyethylene, and research into newer bearing surfaces may help resolve some of these problems in the future.

Although some orthopaedic surgeons are now using cementless devices for all patients, cementless total hip replacement is most often recommended for younger, more active patients and patients with good bone quality where bone ingrowth into the components can be predictably achieved. Individuals with juvenile inflammatory arthritis may also be candidates, even though the disease may restrict their activities.
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Hybrid Total Hip Replacement

A hybrid total hip replacement has one component, usually the acetabular socket, inserted without cement, and the other component, usually the femoral stem, inserted with cement. This technique was introduced in the early 1980s, so long-term results are just now being measured. A hybrid hip takes advantage of the excellent track records of cementless hip sockets and cemented stems.
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Partial Hip Replacements

If only one part of the joint is damaged or diseased, a partial hip replacement may be recommended. In most instances, the acetabulum is left intact and the head of the femur is replaced, using components similar to those used in a total hip replacement. The most common form of partial hip replacement is called a bipolar prosthesis.
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Hip Resurfacing

A newer technique for hip replacement that has recently emerged is called hip resurfacing. In this procedure, the socket is replaced similar to a total hip replacement. The femur, however, is covered or "resurfaced" with a hemispherical component. This fits over the head of the femur and spares the bone of the femoral head and the femoral neck. It is fixed to the femur with cement around the femoral head and has a short stem that passes into the femoral neck.

Hip resurfacing is an emerging procedure, most commonly performed in younger patients. It is too early to assess the long-term success of this procedure.
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Longevity and Outcomes

Hip replacement operations are highly successful in relieving pain and restoring movement. However, the ongoing problems with wear and particulate debris may eventually necessitate further surgery, including replacing the prosthesis (revision surgery). Men and patients who weigh more than 165 lb have higher rates of failure. The chance of a hip replacement lasting 20 years is approximately 80%.



Palace

[Palace]

Patient Safety:
Contrast Materials

    What are contrast materials and how do they work?
    Which imaging exams use contrast materials?
    How safe are contrast materials?
    How should I prepare for my imaging procedure with contrast material?
    Side effects and adverse and allergic reactions
    What will I experience before and after receiving contrast material?
    Pregnancy and contrast materials

What are contrast materials and how do they work?

Contrast materials, also called contrast agents or contrast media, are used to improve pictures of the inside of the body produced by x-rays, computed tomography (CT), magnetic resonance (MR) imaging, and ultrasound. Often, contrast materials allow the radiologist to distinguish normal from abnormal conditions.

Contrast materials are not dyes that permanently discolor internal organs. They are substances that temporarily change the way x-rays or other imaging tools interact with the body.

When introduced into the body prior to an imaging exam, contrast materials make certain structures or tissues in the body appear different on the images than they would if no contrast material had been administered. Contrast materials help distinguish or “contrast” selected areas of the body from surrounding tissue. By improving the visibility of specific organs, blood vessels or tissues, contrast materials help physicians diagnose medical conditions.

Contrast materials enter the body in one of three ways. They can be:

    swallowed (taken by mouth or orally)
    administered by enema (given rectally)
    injected into a blood vessel (vein or artery; also called given intravenously or intra-arterially)

Following an imaging exam with contrast material, the material is absorbed by the body or eliminated through urine or bowel movements.

There are several types of contrast materials:

    Iodine-based and barium-sulfate compounds are used in x-ray and computed tomography (CT) imaging exams.

Contrast materials can have a chemical structure that includes iodine, a naturally occurring chemical element. These contrast materials can be injected into veins or arteries, within the disks or the fluid spaces of the spine, and into other body cavities.

Barium-sulfate is the most common contrast material taken by mouth, or orally. It is also used rectally and is available in several forms, including:

    powder, which is mixed with water before administration
    liquid
    paste
    tablet

When iodine-based and barium-sulfate contrast materials are present in a specific area of the body, they block or limit the ability of x-rays to pass through. As a result, blood vessels, organs and other body tissue that temporarily contain iodine-based or barium compounds change their appearance on x-ray or CT images.

    Gadolinium is the key component of the contrast material most often used in magnetic resonance (MR) exams. When this substance is present in the body, it alters the magnetic properties of nearby water molecules, which enhances the quality of MR images.
    Saline (salt water) and air are also used as contrast materials in imaging exams. Microbubbles and microspheres have been administered for ultrasound imaging exams, particularly exams of the heart.

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Which imaging exams use contrast materials?
Oral Contrast Materials

Barium-sulfate contrast materials that are swallowed or administered by mouth (orally) are used to enhance x-ray and CT images of the gastrointestinal (GI) tract, including:

    pharynx
    esophagus
    stomach
    the small intestine
    the large intestine (colon)

In some situations, iodine-based contrast materials are substituted for barium-sulfate contrast materials for oral administration.
Rectal Contrast Materials

Barium-sulfate contrast materials that are administered by enema (rectally) are used to enhance x-ray and CT images of the lower gastrointestinal (GI) tract (colon and rectum).

In some situations, iodine-based contrast materials are substituted for barium-sulfate contrast materials for rectal administration.
Intravenous Contrast Materials
Iodine-based and Gadolinium-based

Iodine-based contrast materials injected into a vein (intravenously) are used to enhance x-ray and CT images. Gadolinium injected into a vein (intravenously) is used to enhance MR images. Typically they are used to enhance the:

    internal organs, including the heart, lungs, liver, adrenal glands, kidneys, pancreas, gallbladder, spleen, uterus, and bladder
    gastrointestinal tract, including the stomach, small intestine and large intestine
    arteries and veins of the body, including vessels in the brain, neck, chest, abdomen, pelvis and legs
    soft tissues of the body, including the muscles, fat and skin
    brain
    breast

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How safe are contrast materials?

Contrast materials are safe drugs; adverse reactions ranging from mild to severe do occur but severe reactions are very uncommon. While serious allergic or other reactions to contrast materials are rare, radiology departments are well-equipped to deal with them.

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How should I prepare for my imaging procedure with contrast material?

Because contrast materials carry a slight risk of causing an allergic reaction or adverse reaction, you should tell your doctor about:

    allergies to contrast materials, food, drugs, dyes, preservatives, or animals
    medications you are taking, including herbal supplements
    recent illnesses, surgeries, or other medical conditions
    history of asthma and hay fever
    history of heart disease, diabetes, kidney disease, thyroid problems or sickle cell anemia

You will be given specific instructions on how to prepare for your exam.

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Side effects and adverse and allergic reactions
Barium Sulfate Contrast Materials

You should tell your doctor if these mild side effects of barium-sulfate contrast materials become severe or do not go away:

    stomach cramps
    diarrhea
    nausea
    vomiting
    constipation

Tell your doctor immediately about any of these symptoms:

    hives
    itching
    red skin
    swelling of the throat
    difficulty breathing or swallowing
    hoarseness
    agitation
    confusion
    fast heartbeat
    bluish skin color

You are at greater risk of an adverse reaction to barium-sulfate contrast materials if:

    you have a history of asthma, hay fever, or other allergies, which will increase your risk of an allergic reaction to the additives in the barium-sulfate agent.
    you have cystic fibrosis, which will increase the risk of blockage in the small bowel.
    you are severely dehydrated, which may cause severe constipation.
    you have an intestinal blockage or perforation that could made worse by a barium-sulfate agent.

Iodine-based Contrast Materials

Mild reactions include:

    nausea and vomiting
    headache
    itching
    flushing
    mild skin rash or hives

Moderate reactions include:

    severe skin rash or hives
    wheezing
    abnormal heart rhythms
    high or low blood pressure
    shortness of breath or difficulty breathing

Severe reactions include:

    difficulty breathing
    cardiac arrest
    swelling of the throat or other parts of the body
    convulsions
    profound low blood pressure

A very small percentage of patients may develop a delayed reaction with a rash which can occur hours to days after an imaging exam with an iodine-based contrast material. Most are mild, but severe rashes may require medication after discussion with your physician.
Contrast-Induced Nephropathy

Patients with impaired kidney (renal) function should be given special consideration before receiving iodine-based contrast materials by vein or artery. Such patients are at risk for developing contrast-induced nephropathy, in which the pre-existing kidney damage is worsened.
At-Risk Patients

Some conditions increase the risk of an allergic or adverse reaction to iodine-based contrast materials. These include:

    previous adverse reactions to iodine-based contrast materials
    history of asthma
    history of allergy
    heart disease
    dehydration
    sickle cell anemia, polycythemia and myeloma
    renal disease
    the use of medications such as Beta blockers, NSAIDs, interleukin 2
    having received a large amount of contrast material within the past 24 hours

Being at increased risk for an allergic or adverse reaction to contrast material does not necessarily mean a patient cannot undergo an imaging exam with contrast materials. Medications are sometimes given before the contrast material is administered to lessen the risk of an allergic reaction in susceptible patients.
MR-Gadolinium

The contrast material used in MR called gadolinium is less likely to produce an allergic reaction than the iodine-based materials used for x-rays and CT scanning. Very rarely, patients are allergic to gadolinium-based contrast materials and experience hives and itchy eyes. Reactions usually are mild and easily controlled by medication. Severe reactions are rare.

Nephrogenic systemic fibrosis (NSF), a thickening of the skin, organs and other tissues, is a rare complication in patients with kidney disease that undergo an MR with contrast material. Gadolinium-based contrast material may be withheld in some patients with severe kidney disease.

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What will I experience before and after receiving contrast material?
Barium-Sulfate Oral and Rectal Contrast Material

If a barium-sulfate contrast material (given orally or rectally) will be used during your exam, you will be asked not to eat for several hours before your exam begins. If the contrast material will be given rectally, you may also be asked to cleanse your colon with a special diet and medication (possibly including an enema) before your exam.

If you swallow the contrast material, you may find the taste mildly unpleasant; however, most patients can easily tolerate it.

If your contrast material is given by enema, you can expect to experience a sense of abdominal fullness and an increasing need to expel the liquid. The mild discomfort will not last long.

It is a good idea to increase your fluid intake after an imaging exam involving a barium-based contrast material to help remove the contrast material from your body.

Barium-sulfate contrast materials are expelled from the body with feces. You can expect bowel movements to be white for a few days. Some patients may experience changes in their normal bowel movement patterns for the first 12 to 24 hours.
Iodine-based Contrast Material

When an iodine-based contrast material is injected into your bloodstream, you may have a warm, flushed sensation and a metallic taste in your mouth that lasts for a few minutes.

The needle may cause you some discomfort when it is inserted. Once it is removed, you may experience some bruising.

It is a good idea to increase your fluid intake after an imaging exam involving an iodine-based contrast material to help remove the contrast material from your body.
Gadolinium-based Contrast Material

When the gadolinium is injected, it is normal to feel coolness at the site of injection, usually the arm for a minute or two.

The needle may cause you some discomfort when it is inserted. Once it is removed, you may experience some bruising.
For all of the above administrations of contrast material (barium sulfate, iodine-based, and gadolinium-based):

If you have not been sedated, no recovery period is necessary. You may resume your usual activities and normal diet immediately after the exam. Increased fluid intake will help eliminate the contrast material from your body.

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Pregnancy and contrast materials

Prior to any imaging exam, women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. Many imaging tests and contrast material administrations are avoided during pregnancy to minimize risk to the baby.

For CT imaging, if a pregnant woman must undergo imaging with an iodine-based contrast material, the patient should have a discussion with her referring physician and radiologist to understand the potential risks and benefits of the contrast-enhanced scan.

For MR imaging, gadolinium contrast material administration is usually avoided due to unknown risk to the baby, but may be used when critical information must be obtained that is only available with the use of gadolinium-based contrast material.
Intravenous Contrast Material (Iodine and Gadolinium) and Breast-feeding:

Manufacturers of intravenous contrast indicate mothers should not breast-feed their babies for 24 to 48 hours after contrast medium is given. However, both the American College of Radiology (ACR) and the European Society of Urogenital Radiology note that the available data suggest that it is safe to continue breast-feeding after receiving intravenous contrast. The Manual on Contrast Media from the ACR states:

"Review of the literature shows no evidence to suggest that oral ingestion by an infant of the tiny amount of gadolinium contrast medium excreted into breast milk would cause toxic effects. We believe, therefore, that the available data suggest that it is safe for the mother and infant to continue breast-feeding after receiving such an agent.

If the mother remains concerned about any potential ill effects, she should be given the opportunity to make an informed decision as to whether to continue or temporarily abstain from breast-feeding after receiving a gadolinium contrast medium. If the mother so desires, she may abstain from breast-feeding for 24 hours with active expression and discarding of breast milk from both breasts during that period. In anticipation of this, she may wish to use a breast pump to obtain milk before the contrast study to feed the infant during the 24-hour period following the examination."

For further information please consult the ACR Manual on Contrast Media and its references. You may find it here on the ACR website.