[Emergency admissions to a general hospital. Why emergency admission? Is there an alternative?]. / Akutte medicinske indlaeggelser på et centralsygehus. Hvorfor akut indlaeggelse? Er der et alternativ?

A study was conducted where the GPs in a district answered a questionnaire on reasons for hospital admission, divided into the categories: needed hospital investigation, hospital treatment, or needed care and nursing. They judged whether the admission could have been prevented. Finally, a multidisciplinary panel discussed ways to obtain better courses of admission. Of 266 admissions, 40 (15%) were due to a need for care and nursing. Ninety-seven (37%) of the admissions could be replaced by a short one-day stay, and 52 (20%) could have been postponed until the next day if that was possible. The panel discussion showed that municipalities can do more to strengthen the local professional support. It is concluded that the interface between primary care and the hospital should offer better opportunities for one-day admissions or sub-acute admissions, and that municipalities must be more aware of their responsibility for the care of fragile and ill people.

Periosteal and perichondral grafting in reconstructive surgery.

Periosteum consists of multipotent mesodermal cells, and the influence of the environment on differentiation of cells of free periosteal grafts has been demonstrated in experimental studies. Periosteum has the capacity to form all varieties of connective tissue. The periosteum has osteogenic capacity, but it can also be used to promote cartilage formation in a chondrotrophic environment. Free periosteal grafts transplanted to the completely chondrectomized articular surfaces of patellae in experimental animals differentiated into cartilage. Joint motion appeared to be one of the chondrogenesis-promoting factors. The authors are optimistic about the potential clinical results with these types of grafts. Also, periosteal resurfacing of the metatarsal head was found to be suitable in the treatment of hallux rigidus and Freiberg's disease. Findings in growing rabbits showed that spinal fusion can be achieved with free periosteal grafts. This technique has been used to treat lumbar lytic spondylolisthesis in young patients, and the method produced clinical and radiologic results that were comparable with those obtained using bone transplants. This work indicates that some of the adverse effects of lumbar spinal fusion (e.g., postoperative spinal stenosis) can be avoided by using osteoperiosteal fusion. Also, periosteal grafting has proved useful in the treatment of thoracolumbar scoliosis. Free periosteal grafting has been used to treat congenital clefts of the maxilla and tracheal cartilage defects.

Glued periosteal grafts in the knee.

Periosteal grafting was performed in 4 patients with osteochondritis dissecans of the medial femoral condyle and 1 patient with osteonecrosis of the lateral femoral condyle following prednisone therapy. The lesions were drilled out deep into the cancellous bone. The periosteal graft was taken from the medial facet of the tibia and fixed to the excavated bony defect by the tissue glue Fibrinkleber Human Immuno (Tisseel). The patients were followed clinically, by arthroscopic examination and by radiography at 3, 6, and 12 months. After 1 year the borderline between the new and surrounding cartilage was hardly visible.

Osteochondrogenesis of free periosteal grafts in the rabbit iliac crest.

The influence of the bone marrow, cortical bone and apophyseal cartilage of the iliac crest on osteochondrogenesis from free autogenous periosteal grafts was studied histologically in 8-week-old rabbits. Tibial periosteum was transplanted around the iliac crest, from which the periosteum had been removed from the inner side, periosteum and cortical bone in an area on the outer side and perichondrium from the apophyseal cartilage. Most bone formation occurred in the area with periosteum in contact with the bone marrow of the cancellous bone. By means of an isolating Nucleopore filter, it was revealed that the most vigorous of this bone formation originated from the periosteal graft. Further, it was noted that in the series with the Nucleopore filter, bone formation was slower than in the series without the filter, suggesting some inductive factors. No bone formation occurred in the apophyseal area.

Reconstruction of articular cartilage defects with free periosteal grafts. An experimental study.

The chondrogenic potential of free autogenous periosteal grafts was studied histologically in 6-month-old rabbits. The grafts were taken from the tibia and transplanted to 7 x 14 mm large artificial defects of the femoral articular cartilage. The results revealed that the defects were repaired and filled after 4 weeks with a hyaline-like cartilage which was histologically similar to the cartilage adjacent to the transplant. The tissue maintained this morphology after 1 year of observation. In control animals where no periosteum was transplanted to the defect, no real cartilage was found. The tissue which partially filled the defect was a variable mixture of fibrous tissue and fibrocartilage.

Chondrogenesis in repair of articular cartilage defects by free periosteal grafts in rabbits.

The origin of the cartilaginous tissue in articular defects after periosteal grafting was studied histologically in 6-month-old rabbits. The grafts were taken from the tibia and transplanted to artificial defects in the femoral articular cartilage. An isolating Nuclepore filter, hindering the penetration of cells, was placed between the graft and the cancellous bone, in order to trace the origin of the proliferating cells. The histological results revealed that the cartilage tissue which proliferated in the defect originated from the periosteal graft and not from the subchondral bone. The effect of the depth of the defect was studied by making a superficial and deep part in the defect. Cartilage tissue was found in both parts of the defect, though there was less in the more superficial defect.

Effects of joint motion on the repair of articular cartilage with free periosteal grafts.

The effects of joint motion on the chondrogenic potential of free autogenous periosteal grafts were studied histologically in 6-month-old rabbits. The grafts were taken from the tibia and transplanted to artificial defects of the femoral articular cartilage. The joint was postoperatively first immobilized and then remobilized for various periods. The results revealed that immobilization for 3 weeks had an inhibitor effect on the chondrogenesis, which was even more pronounced after 6 weeks of immobilization. After remobilization the chondrogenesis partially recovered. This recovery of chondrogenesis was more pronounced after 3 weeks' immobilization than after 6 weeks' immobilization. However, degenerative changes were observed in both series.