Subcutaneous low-dose epoetin beta for the avoidance of transfusion in patients scheduled for elective surgery not eligible for autologous blood donation.

This randomized, multicentre, parallel-group study assessed the efficacy of epoetin beta in reducing the transfusion frequency in patients ineligible for autologous blood donation prior to surgery. The patients (n = 194) received either epoetin beta (125 or 250 IU/kg, once weekly) or no therapy for 3-4 weeks before surgery. The pre-operation haemoglobin levels were markedly increased in the epoetin beta groups (125 IU/kg: +1.1 g/dl; 250 IU/kg: +1.6 g/dl), but not in the control group. The transfusion frequency was significantly reduced in both epoetin groups as compared with the control group (p = 0.046). Epoetin beta was well tolerated, and no serious adverse events were observed. Low-dose administration of epoetin beta before elective surgery reduces the transfusion frequencies in patients not eligible for autologous blood donation.

Prophylaxis with systematic antibiotics versus gentamicin bone cement in total hip arthroplasty. A ten-year survey of 1,688 hips.

In 1976, nine Swedish orthopedic departments started a prospective, randomized, and controlled study in which the prophylactic effect of systematic antibiotics (SAs) was compared with gentamicin bone cement (GBC) in 1,688 consecutive total hip arthroplasties (THAs). After ten years, 13 deep infections had occurred in the SA group and nine in the GBC group. The earlier reported significant difference at two and five years in favor of GBC no longer existed. No allergic or toxic reactions have been reported in the GBC group.

Low- vs high-viscosity cement in hip arthroplasty. No radiographic difference in 226 arthrosis cases followed for 5 years.

In 1984 and 1985, 352 hips were randomly assigned to total hip arthroplasty with either low- or high-viscosity cement at 5 Swedish orthopedic departments. Of the 267 hips finally included in the study, 226 were examined clinically and radiographically after 54-77 months. Radiographically, 21 definite stem loosenings and 1 probable stem loosening were observed (10 percent) and 4 additional stems had been exchanged before the 5-year examination. In the survivorship analysis, 261 stem prostheses were included and using this method, 7 percent were radiographically loose after 5 years. There were 4 definitely loose and 8 probably loose acetabular cups. No difference was found between cement of high and low viscosity with regard to prosthetic fixation.

Characteristics of young female smokers in a Swedish primary health care area.

OBJECTIVE: To analyse the correlation between smoking, socioeconomic characteristics, and sexual and contraceptive patterns in young women. DESIGN: Cross-sectional population study, smokers compared with non-smokers. SETTING: Nättraby-Hasslö, a rural area in southern Sweden. PARTICIPANTS: All women between 15-34 years of age (n = 541). RESULTS: 26% smoked daily. Smokers on average had less schooling, lower 9th grade results, less satisfaction in school, and more unskilled professions than non-smokers. Apart from a higher parental divorce rate among smokers, no correlation between parental factors and smoking was found. Smokers on average reported an earlier sexual debut, more unprotected first intercourse, more life-time sexual partners, and more legal abortions. CONCLUSION: Smoking is associated with sexual habits, which may reflect a higher tendency to take personal risks among smokers.

Prevalence of genital Chlamydia trachomatis infection among women in a Swedish primary health care area.

The objective of this study was to estimate the prevalence of genital chlamydial infection in an unselected population of young women by offering a screening investigation to all women between the ages of 15 and 34 in a primary health care area. Specimens were taken from both the urethra and the cervix in all participating women, and data regarding the participants' symptoms, sexual habits, contraceptive use and socioeconomic factors were also collected. The specimens were analyzed with a primary enzyme immunoassay (Syva MikroTrak) and a confirmatory direct immunofluorescence test (Syva MikroTrak). A total of 543 women were invited to the study and 374 women (68.9%) participated. 10/374 women (2.7%) were chlamydia positive and only 2 of these 10 chlamydia infected women were less than 25 years of age. The chlamydia infected women had positive tests either from the urethra (4 women) or from the cervix (6 women), and in no case the tests were positive from both locations. No statistically significant differences between the chlamydia positive and negative women were found concerning any clinical or anamnestic factor.

Contraception and sexuality in an area-specific group of Swedish women 15-34 years of age.

In a community-based study in a Swedish suburban/rural area, all women aged 15-34 years (n = 671) were invited to the local health centre to be examined for chlamydia infection and for an interview. The attenders were asked about contraceptive history, age at first intercourse, number of life-time sexual partners and socioeconomic background. The net attendance was 69%, and contraceptive information on an additional 20% could be gathered through medical records. The average age at first intercourse was around 16 years, and the average number of sexual partners in the age-groups 20-24, 25-30 and 31-34 years was 4.0, 5.6 and 6.1, respectively. Of all women, around 75% had used contraception at first intercourse, and there was no tendency to a changing pattern during the past 20 years studies through the interviews. Combined estrogen-progestagen pills were by far the most used contraceptive method, presently being used by 42% of the contracepting women, followed by condom (23%), IUD (19%) and other hormonal methods (10%). It is concluded that sexual life in Sweden starts earlier than it did 30 years ago, that the number of sexual partners is higher, that most women in the studied group were efficient contraceptors, and that hormonal contraception was by far the most common method.

Hip arthroplasty infection. Current concepts.

Due to systemic or local antibiotic treatment and other preventive procedures, the incidence of deep hip-prosthetic infections in Scandinavia is less than 1 percent, with the majority hematogenous. Coagulase-negative staphylococci and anaerobes are involved in more than half of the cases. The diagnosis is sometimes difficult; preoperative aspiration often gives misleading results; and granulocyte scanning usually adds valuable information. In deep infection the current strategy is to revise with a two-stage procedure. Revisions should be carried out at specialized centers with bacteriologic competence and sufficient experience with implants.

Prophylaxis with systemic antibiotics versus gentamicin bone cement in total hip arthroplasty. A five-year survey of 1688 hips.

In Sweden in 1976, nine orthopedic departments organized a prospective, randomized, and controlled study in which the prophylactic effect of systemic antibiotics (SA) was compared to gentamicin bone cement (GBC) in 1688 consecutive total hip arthroplasties (THAs). After a follow-up period of one to two years, there was a statistically significant difference in the infection rate between the two groups in favor of the gentamicin cement. After five years or more, the difference was unaltered. Altogether, 16 deep infections had occurred in the SA group (1.9%) and seven (0.8%) in the GBC group. Roentgenographically, aseptic loosening had occurred in 29% and 24% of the hips in the SA and GBC groups, respectively, which suggests that admixture of the antibiotic did not weaken the cement. The results of this five-year review clearly showed the prophylactic value of gentamicin cement against deep infection after THA but did not support the hypothesis that this effect was prolonged over one year.

Analgesic efficacy and safety comparison of ketorolac tromethamine and Doleron for the alleviation of orthopaedic post-operative pain.

The analgesic efficacy and safety of ketorolac tromethamine (ketorolac), a potent analgesic with anti-inflammatory and antipyretic activities, were evaluated and compared with Doleron, a combination analgesic, in 115 patients with moderate to severe orthopaedic post-operative pain. This was a randomized, double-blind (double-dummy), parallel-group comparison of a single oral dose of one capsule of 10 mg ketorolac with a single oral dose of two Doleron tablets (each tablet contained 150 mg dextropropoxyphene napsylate, 350 mg aspirin and 150 mg phenazone). During the 6 h following treatment, 80% of ketorolac treated patients and 82% of Doleron treated patients experienced adequate pain relief. There were no statistically significant differences in the overall analgesic efficacy between the treatment groups. Three patients (one on ketorolac, two on Doleron) withdrew because of adverse events (vomiting). Nausea (two patients in each treatment group), vertigo (none on ketorolac, three on Doleron) and sore throat (none on ketorolac, two on Doleron) were the only drug-related adverse events reported by more than one person in a treatment group during the trial. A total of 82% of patients given ketorolac and 76% given Doleron experienced no adverse events. A single oral dose of 10 mg ketorolac was shown to be as effective and safe as two Doleron tablets in the treatment of moderate to severe orthopaedic post-operative pain.

Revision operations on infected total hip arthroplasties. Two- to nine-year follow-up study.

One hundred two of 110 infected hip arthroplasties revised with the protection of gentamicin-loaded cement were followed for a minimum of two years. In 77 of 102 hips the infection healed after one revision operation and in five of eight hips after a second revision operation, representing a final healing rate of 80%. No significant difference in healing rate could be demonstrated with regard to individual bacterial species. However, in infections with a mixed flora, the healing rate was only 27% (p less than .01). After an average of six years, 33 of 82 healed hips had signs of roentgenographic loosening, nine of which had been revised. The modified Merle d'Aubigne and Postel score averaged 5.3 for pain, 3.7 for walking ability, and 4.0 for range of motion (ROM) in patients with healed infections.

Prevention of thromboembolism in total hip replacement. Aspirin versus dihydroergotamine-heparin.

In a prospective and controlled study, we compared the prophylactic effect of high-dose acetylsalicylic acid (ASA) and dihydroergotamine-heparin (DHEH) in 82 patients over 50 years of age undergoing total hip replacement. The patients were screened by pulmonary scan and 125I fibrinogen uptake. Phlebography was done if the 125 I fibrinogen test was positive. According to our criteria, thromboembolism developed in 9 of 40 receiving ASA and in 5 of 42 patients receiving DHEH. The effect of ASA was limited to men; in 16 men on this therapy, none had thromboembolism versus 9 of 24 women. Twenty-two patients showed wound hematomas, but none needed surgical intervention.

Radiographic loosening after revision with gentamicin-containing cement for deep infection in total hip arthroplasties.

Seventy-two infected total hip arthroplasties were revised with cement containing gentamicin and were followed up with regular radiograms for periods of up to six years. The infection healed in 61 cases and persisted in 11. An analysis of the radiographic changes in regard to the signs of loosening showed that about half of the cases with a healed infection had a minimal demarcation between bone and cement. In about one-third of the patients, a radiolucent zone of up to 2 mm in thickness developed during the first one to two years and then seemed to remain stable. In the other cases, a progressive resorption, indicating true loosening, was observed. All the cases with remaining infection (except one patient who died of heart disease) exhibited progressively increasing resorption zones. Progress, however, was possibly slowed by the effects of the gentamicin cement and the systemic antibiotic treatment.

Prevention and treatment of deep infection following total hip replacement.

Three different methods of prophylaxis in total hip replacement are discussed and evaluated: the systemic use of antibiotics, use of gentamicin-containing bone cement and the ultraclean technique. The lowest incidence of deep infection is achieved with a combination of the clean room and antibiotics either in local or systemic form. The results after revision using gentamicin-impregnated bone cement show that a healing rate of 80% is possible; however, there is a high risk of aseptic loosening during the postoperative course.

Systemic antibiotics and gentamicin-containing bone cement in the prophylaxis of postoperative infections in total hip arthroplasty.

In a prospective controlled multicenter study, the prophylactic effect of gentamicin-containing bone cement on postoperative infections in total hip arthroplasties was compared with that of systemically given antibiotics; 812 arthroplasties were randomly assigned to an antibiotic and 821 to a gentamicin-cement group. When the patients had been followed for a period of one to two years, 13 deep infections were diagnosed in the antibiotic group and three in the gentamicin-cement group. The difference was statistically significant.

Function of fifty-seven septic, revised and healed total hip arthroplasties.

An evaluation of hip function was made 2-5 years postoperatively in 57 patients reoperated using gentamicin-containing bone cement because of deep infection after total hip arthroplasty. Forty patients were completely free from pain and 17 had slight intermittent pain. Fifty-one had normal or nearly normal walking ability. Most patients managed dressing and getting in and out of a bath without help. It is concluded that revision in most case offers a satisfactory solution for the patient and gives a better functional result than simple removal of the prosthesis.

An alternative method for exchange operation of infected arthroplasty.

The use of bone cement balls in chains loaded with gentamycin (gentamycin-PMMA-ketten) as part of a two-stage exchange operation has proven to be a good method of treatment for infected arthroplasty. The procedure is illustrated by three case reports.

Revision with gentamicin-impregnated cement for deep infections in total hip arthroplasties.

Seventy-seven total hip arthroplasties complicated by deep infection were treated by reoperation and fixation of a new prosthesis with gentamicin-containing cement. The infection was proved in each case by positive bacterial cultures. Systemic antibiotic treatment was continued for six months postoperatively. Sixty hips were considered healed; the patients had no pain and had normal sedimentation rates and roentgenograms. Nine still had pain or an abnormal sedimentation rate and were classified as doubtful with regard to eradication of the infection. Eight were still infected. The patients were followed for six months to three and one-half years after reoperation.