Are military fitness tests safe for members with a total hip arthroplasty?

INTRODUCTION: Canadian Armed Forces (CAF) members must complete an annual fitness evaluation. Members with a total hip arthroplasty (THA) may be at risk of injury during these strenuous tests. To inform CAF policy, we sought expert consensus on the safety of fitness testing for members with a THA. METHODS: We conducted a three-round Delphi study with a panel of hip arthroplasty experts to determine the safety of CAF operational fitness evaluations for members with a THA. The experts evaluated videos of the 10 individual tasks included in the evaluations. RESULTS: All individual tasks were judged to be safe by consensus. One task, which involves digging with a shovel, was considered safe provided that participants avoid deep hip flexion. The nine other tasks were judged to be safe without modifications or interventions. The experts also supported a policy recommendation that would allow members to perform military fitness evaluations if they (1) have a primary THA, (2) had no episodes of instability, (3) are at least 12 months postoperatively and (4) have been cleared by an orthopaedic surgeon and a physiatrist/physiotherapist. CONCLUSION: A panel of arthroplasty experts concluded, based on video analysis, that CAF fitness evaluations are generally safe for members with a THA.

Comparative pharmacology and clinical efficacy of newer agents in treatment of heart failure.

The animal and human pharmacology of several new drugs (prazosin, trimazosin, pirbuterol, and carbazeran) useful in the treatment of congestive heart failure (CHF) is delineated in relation to the pharmacology of other agents employed for CHF management. Prazosin and trimazosin are selective alpha 1-blockers that cause a balanced increase in cardiac output (CO) and reduction in left ventricular filling pressure (LVFP); the reduction in diastolic blood pressure with these drugs is significantly related to increase in treadmill exercise, fall in LVFP, and increase in CO. Pirbuterol is a relatively selective beta 2-agonist with somewhat greater effects on CO than on LVFP. Early promise in CHF therapy is being shown by a novel series of cyclic adenosine monophosphate (cAMP) phosphodiesterase inhibitors with combined direct inotropic and vasodilator effects. Double-blind long-term studies demonstrate persistent efficacy of prazosin and trimazosin in CHF as measured by improvement in New York Heart Association functional class, treadmill exercise performance, and noninvasive measures of cardiac function; these data are supported by studies in which repeat cardiac catheterization has been performed after several months of therapy. Double-blind studies of other CHF drugs are in progress.

Compounds with gastric antisecretory activity. 1. Phenoxyalkylamines.

A series of 0-alkylphenoxyalkylamines, derived from classical H1 antagonists, has been found to inhibit histamine-induced gastric acid secretion. The most potent compound was trans-1-[2[2-[2-(1-adamantyl)vinyl] phenoxy] ethyl]pyrrolidine (54). The 0-acylphenol 23 required for the preparation of 54 was obtained by the novel reaction of 1-bromoadamantane (21) with 4-hydroxycoumarin (20) using diethyl phosphonate as solvent. The product 22 was then hydrolyzed under basic conditions to give 23 in high yield. 54 was not an H2 antagonist and its mode of action remains unknown. The compound had no significant anticholinergic, antiinflammatory, anticonvulsant, sedative, or H1-antihistaminic activity.

Isoprenaline- and exercise- induced tachycardia in the assessment of beta-adrenoceptor blocking drugs; a comparison between tolamolol, practolol and propranolol.

The effects of tolamolol, propranolol and practolol on both isoprenaline- and exercise-induced tachycardia have been studied in conscious dogs. Tolamolol was approximately equipotent to propranolol and 50 times more potent than practolol in antagonizing exercise-induced tachycardias, but was approximately 12 times less potent than propranolol and 8 times more potent than practolol in blocking isoprenaline-induced tachycardia. It is suggested that antagonism of the tachycardia induced by exercise affords a more meaningful assessment of the possible therapeutic potential of beta-adrenoceptor blocking drugs than does that induced by isoprenaline.