Hemiarthroplasty in elderly, debilitated patients with an unstable femoral fracture in the trochanteric region.

The purpose of this study was to evaluate the results of patients with an unstable fracture in the trochanteric region who were treated by hemiarthroplasty. During a 10-year period, 154 of the 308 patients with a trochanteric fracture treated in our hospital had an unstable fracture. In patients with severe comminution and osteoporosis an endoprosthesis was inserted: 5 patients with a subtrochanteric and 17 with a pertrochanteric fracture. Ten patients suffered from central nervous system diseases, and in 10 patients cardiovascular or pulmonary disorders were diagnosed. Pre- and postoperative ambulation levels were classified. Seventeen patients (77%) achieved full weight-bearing mobilization. Five patients never walked again (23%): 2 patients died in the first month (9%). It is concluded that for elderly and debilitated patients with an unstable trochanteric fracture, hemiarthroplasty is an acceptable alternative to osteosynthesis.

Dietary influences on cell proliferation in bone marrow.

Oral dietary protein-calorie malnutrition was used in rats to study the influence of malnutrition on the distribution of the dividing cells in the bone marrow (stem cells) over the compartments of the cell cycle. A 5-day period of malnutrition induced an increase in the percentage of cells in the G0/G1 phase of the cell cycle while simultaneously inducing a statistically significant decrease in the percentage of cells in S phase. Similar results were obtained after a 14-day period of malnutrition. Nutritional replenishment after 5 and 14 days of dietary deprivation induced a rapid recovery of the percentage of S phase cells and a decrease in the percentage of cells in the G0/G1 phase of the cell cycle. Malnutrition and nutritional replenishment did not influence hemoglobin concentration and platelet numbers in the peripheral blood, but leucocyte numbers increased significantly after short-term replenishment. These results demonstrate a decrease in the percentage of proliferating bone marrow cells after short periods of deficiency and general malnutrition. The results also demonstrate that bone marrow cells recover quickly after nutritional replenishment. In malnourished cancer patients, suspected of bone marrow insufficiency and receiving therapy that potentially impairs bone marrow proliferation, a short period of nutritional replenishment preceding treatment could possibly be marrow-protective.

31P NMR study of the impact of dietary manipulation on tumor metabolism and response to methotrexate.

The effects of nutritional manipulation and subsequent chemotherapeutic treatment upon growth and metabolism of a transplanted rat rhabdomyosarcoma were investigated by in vivo 31P NMR spectroscopy. Nutritional manipulation was accomplished by administration of a protein deprived diet containing no protein and 75.5% glucose. After 5 days the protein deprived rats (PD rats) were nutritionally replenished with a normal protein diet containing 27% protein and 47.3% glucose. Twenty-four hours after nutritional replenishment the PD rats and continuously well-fed controls (NP rats) received methotrexate (MTX, 30 mg/kg, i.p.). 31P NMR spectroscopy of the tumors 24 h after MTX administration showed a decreased ratio of nucleoside triphosphates to inorganic phosphate (referred to as 'ATP/Pi ratio') in PD rats in contrast to an unchanged ATP/Pi ratio in the NP controls. At the time of MTX administration the PD rats had a significantly lower tumor pH than the NP group (6.75 +/- 0.03 [SEM] vs 6.95 +/- 0.04; p less than 0.02). Tumor response in the PD group was significantly (p less than 0.01) enhanced compared to the NP group. These findings indicate that a period of dietary protein deprivation combined with a high glucose load and followed by nutritional replenishment impairs tumor metabolism. The altered metabolic status is expressed by acidification of the tumor and distinct changes in ATP/Pi ratio and appears to relate to an enhanced susceptibility to MTX chemotherapy.

Alterations in serum levels, anti-tumor activity and toxicity of methotrexate in rats after a short period of nutritional depletion.

The alterations in serum levels, anti-tumor activity and host toxicity of methotrexate (MTX) were tested in tumor bearing rats following a period of dietary manipulation. A protein deprived (PD) diet or a diet containing a normal protein content (NP) was administered for 5 days and MTX injected intra-peritoneally (i.p.) at the end of the 5 day period. The MTX serum levels were significantly elevated in rats which received the PD diet, as compared to NP dietary rats. This elevation correlated with an enhanced tumor response to MTX administration. In addition, bone marrow toxicity and intestinal tract toxicity, measured with flow cytometry (FCM) of the bone marrow and morphometry of the jejunal mucosa respectively was increased in rats receiving the PD diet. These results indicate that the serum clearance of MTX is delayed in animals suffering from malnutrition, leading to both enhanced tumor response and increased host toxicity.

Ischemic damage to the spinal cord following surgery of the abdominal aorta.

Ischemic damage to the spinal cord after reconstructive procedures of the abdominal aorta is a rare complication. The literature up to and including 1980 records 46 of these cases. In this paper we present four additional cases and discuss the etiological factors and the practical measures available to minimize the risk of this unpredictable complication.