The tourniquet's effects on skeletal muscle during total knee arthroplasty.

This study investigates the impact of perioperative tourniquet on skeletal muscle cells during total knee arthroplasty (TKA) and its effects on the gene expression of apoptotic, inflammatory, and angiogenic pathways. The randomized controlled trial included 44 patients undergoing TKA. The patients were randomized to undergo surgery with (n = 23) or without (n = 21) tourniquet. The tourniquet was inflated before skin incision and deflated before wound closure in the tourniquet group. Biopsies from the lateral vastus muscle were obtained from both groups before wound closure and 8 weeks after surgery. The messenger ribonucleic acid (mRNA) expression and protein levels of angiopoietin-like 4 (ANGPTL4), Hypoxia-inducible Factor 1α, and Vascular Endothelial Growth Factor Alpha (VEGF-A) in the biopsies were examined by reverse transcription-quantitative polymerase chain reaction and tissue microarray, respectively. Differences in mean values (ΔCt for mRNA expression and staining positivity for protein expression) were compared with t-tests. The apoptotic marker BID and the angiogenic marker VEGF-A were significantly lower in the tourniquet group compared to the control group (p = 0.03, p = 0.047). However, there was a significant upregulation of VEGF-A 8 weeks after surgery in the tourniquet group compared to perioperative biopsies (p = 0.002), indicating persistent changes. A significant upregulation in protein expression of the angiogenic marker ANGPTL4 was found perioperatively in the tourniquet group (p = 0.02). Our results demonstrate that the angiogenic gene expression is significantly altered by the tourniquet, the effects of which might contribute to postoperative interstitial edema, increased pain, and decreased muscle strength. These effects could lead to delayed rehabilitation and ultimately reduced patient satisfaction after TKA.

[Acute abdominal pain as cause of hospitalisation]. / Akutte buksmerter som årsak til innleggelse.

BACKGROUND: Our aim was to investigate the extent, management and use of resources in patients admitted for acute abdominal pain. MATERIAL AND METHODS: A prospective analysis of patients admitted as emergencies with acute abdominal pain of less than seven days duration was performed during two 3-month periods in 2000 and 2001. RESULTS: 483 patients, 262 women and 221 men with median age 50 years were registered. Median duration of pre-hospital symptoms was 16.5 hours. At discharge, non-specific abdominal pain was the most frequent diagnosis (26%), followed by acute appendicitis (12%), acute biliary disease (12%), ileus and ureterolithiasis (both 6%) and diverticulitis (5%). 31% of the patients presented during normal working hours, whereas 69% were admitted during nighttime and/or weekends. Only 23% of the patients needed an acute operation. The overall mortality was 0.4%. The median stay in hospital was two days (0-165 days). 43% of the patients were discharged in less than one day, and 48% had no need for any medical treatment. The patient group occupied 17% of the beds and resources in our surgical department. INTERPRETATION: Patients with acute abdominal pain is a heterogenous group that occupies a great deal of a surgical department's resources. It might be cost-effective to examine these patients in an observational unit supervised by well-trained surgeons.