A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over.

The aim of this study was to analyse the functional outcome after a displaced intracapsular fracture of the femoral neck in active patients aged over 70 years without osteoarthritis or rheumatoid arthritis of the hip, randomised to receive either a hemiarthroplasty or a total hip replacement (THR). We studied 252 patients of whom 47 (19%) were men, with a mean age of 81.1 years (70.2 to 95.6). They were randomly allocated to be treated with either a cemented hemiarthroplasty (137 patients) or cemented THR (115 patients). At one- and five-year follow-up no differences were observed in the modified Harris hip score, revision rate of the prosthesis, local and general complications, or mortality. The intra-operative blood loss was lower in the hemiarthroplasty group (7% > 500 ml), THR group (26% > 500 ml) and the duration of surgery was longer in the THR group (28% > 1.5 hours versus 12% > 1.5 hours). There were no dislocations of any bipolar hemiarthroplasty than in the eight dislocations of a THR during follow-up. Because of a higher intra-operative blood loss (p < 0.001), an increased duration of the operation (p < 0.001) and a higher number of early and late dislocations (p = 0.002), we do not recommend THR as the treatment of choice in patients aged ≥ 70 years with a fracture of the femoral neck in the absence of advanced radiological osteoarthritis or rheumatoid arthritis of the hip.

Effects of different durations of total warm ischemia of the gut on rat mesenteric microcirculation.

BACKGROUND: Gut injury due to ischemia and reperfusion (I/R) plays a pivotal role in many clinical conditions, such as small bowel transplantation, heart or aortic surgery in adults, and necrotizing enterocolitis in neonates. The influence of ischemic events on microcirculatory mechanisms is not well understood. Therefore, we studied, in vivo, local perfusion and leukocyte-vessel wall interactions before and after different periods of total warm ischemia of the whole gut and subsequent reperfusion in mesenteric microvessels. MATERIALS AND METHODS: Groups of pentobarbital-anaesthetized Lewis rats were subjected to 15 (n = 9), 30 (n = 12), or 60 min (n = 5) of total warm gut ischemia and 2 h reperfusion. As control a sham group (n = 10) was included. After ligating the inferior mesenteric artery, total warm ischemia was induced by clamping the superior mesenteric artery. Before and at different time periods after start of reperfusion intravital video microscopic measurements were performed. RESULTS: Rats subjected to 60 min ischemia died during the early reperfusion phase. Fifteen, 30, and 60 min ischemia induced in venules a significant decrease in blood flow, while diameter changes were not observed. This flow decrease was severe in the 15- and 30-min ischemia groups, dropping to 40 and 25% of control, respectively. Following 60 min ischemia blood flow did not exceed 10% of control. The total number of interacting leukocytes, a parameter which includes both leukocyte rolling and adhesion in venules, increased up to 5 or 10 times its control value following 15 or 30 min ischemia, respectively. Leukocyte-vessel wall interactions could not be studied in the 60-min ischemia group, due to the low blood flow. CONCLUSIONS: Even short periods of total warm ischemia of the whole gut induce severe attenuation of venular blood flow with an increase in leukocyte-vessel wall interactions. These changes increase with prolongation of the ischemic period. A 60-min period of total warm ischemia is fatal during the early reperfusion phase.

Ischemia/reperfusion injury in rat mesenteric venules: red blood cell velocity and leukocyte rolling.

The authors determined the effects of 15 (n = 9) and 30 (n = 12) minutes of warm ischemia on the rat mesentery and compared the results with those of a sham-operated group (n = 10). Red blood cell velocity and number of rolling leukocytes were assessed before ischemia as well as 10, 20, 30, 60, 90, and 120 minutes after the start of reperfusion. Leukocyte rolling is considered to be an early step of the inflammatory process. Leukocytes roll along the vessel wall at a velocity that is clearly lower than that of the other blood cells. The preischemic values of red blood cell velocity and number of rolling leukocytes in the 15- and 30-minute ischemia groups did not differ from those of the sham group. In the sham group, no significant changes in red blood cell velocity and number of rolling leukocytes were observed over time. Compared with the sham group, the red blood cell velocity of the 15-minute ischemia group was significantly lower at 30, 60, 90, and 120 minutes after the start of reperfusion the number of rolling leukocytes did not differ significantly. For the 30-minute ischemia group, red blood cell velocity also was significantly lower at 20, 30, 60, 90, and 120 minutes after the start of reperfusion, and the number of rolling leukocytes was higher at 10, 20, and 30 minutes after the start of reperfusion. The results of this study indicate that short periods of total warm ischemia of the rat small bowel and subsequent reperfusion result in a significantly impaired microcirculatory blood flow in the mesentery. However, a prolonged period of ischemia is required to increase leukocyte-vessel wall interactions. In the future, this model will enable us to study the effect of pharmacological interventions during an early stage of the inflammatory response to ischemia/reperfusion in the gut.

Electrophysiologic effects of ORG 30701 (dopropidil) on rabbit ventricular myocardium.

The electrophysiologic effects of ORG 30701 (1-8 x 10(-6) M) were tested in a thin, two-dimensional sheet of ventricular myocardium. Special attention was paid to a possible promotion of reentrant excitation. The drug did not increase the degree of inhomogeneity of conduction and because of the marked effect on refractoriness prevent fast rates (either spontaneously or driven). If the extracellular potassium concentration was lowered (from 5.6 to 2.0 mM), the enhancement of refractoriness by the drug was more marked. The changes in refractoriness do not appear to be based on lengthening of the repolarization of the action potential, but rather on post-repolarization refractoriness; therefore, the occurrence of triggered activity (early afterdepolarizations) is not anticipated. ORG 30701 is a cardioactive drug that because of its calcium antagonistic action acts as an antianginal drug and, in addition, exhibits antiarrhythmic properties.

[Comparative psychodiagnostic test study in acute and chronic asthma patients]. / Vergleichende psychodiagnostische Testuntersuchung bei akuten und chronisch Asthmakranken.

The psychic characteristics of patients suffering from asthma bronchiale have mostly been investigated without considering the duration of the illness. So the question was if and in which way the duration of the disease influences the patient's psychic state. 61 asthmatics were examined by the FPI and by a structured interview. Two parallel groups with a duration of illness of less than two years respectively more than five years were compared with each other. Obviously frankness and self-criticism were to be found more frequently in the chronic group than among the patients of the short continuance of the disease. The lower frankness and willingness to self-criticism of this group of patients is also symptomatic of the first reaction to the sudden onset of the illness. The patients' first reactions are denial and repression, especially concerning the psychic parts in the multifactorial pathogenesis of the disease and its social consequences. In the course of the illness self-criticism and the capability of perceiving psychosocial factors increase. These results lead to the conclusion that the chronification of asthma bronchiale is a stimulus for confrontation with conflicts in the own biography and thus with the illness itself. It seems important to use different forms of psychotherapy depending on the duration of the illness.