Felodipine versus placebo in stable effort-induced angina pectoris in patients inadequately controlled with metoprolol--a dose-finding study.

We compared the antianginal and antiischemic effect and tolerability of four different doses of felodipine extended-release (ER) tablets with placebo in patients with stable effort-induced angina pectoris treated with beta-blocker [metoprolol controlled release (CR) 100 mg once daily, o.d.]. Seventy-five patients were enrolled in the study. At the end of a 2-week single-blind period, all patients performed two exercise tests. If total exercise time did not vary by > 15% between the two tests and both tests were limited by anginal discomfort and concomitant ST depression of at least 1 mm, the patients were randomized to double-blind treatment (66 patients). Each patient received three of the following treatments: felodipine 2.5, 5, 10, or 20 mg, or placebo. The treatments were given o.d. in a cross-over, balanced incomplete block design with three of 3-week treatment periods. Exercise tests were performed 12 and 24 h after dose intake at the end of each treatment period. Fifty-nine patients completed the study. Twelve hours after dose administration, 10 and 20 mg felodipine increased time to onset of anginal pain by 60 and 63 s on the average, respectively, as compared with placebo (p = 0.001). Time to 1-mm ST depression was prolonged by 29 s after 10 mg (p = 0.14) and by 30 s after 20 mg (p = 0.13) felodipine. Time to end of exercise was increased by 28 s (p = 0.07) and 15 s (p > 0.20), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Physical causes of accidental falls among the elderly in their own homes]. / Fysiske årsager til aeldres fald i eget hjem.

Accidental falls in elderly persons involve considerable illness and great hospital costs. During the period 1971-1986, the incidence has risen from 14 to 19 per 1000 annually. Four hundred and seventy-three individuals aged 60 years or more who had fallen in their own homes and who sought help in Odense Hospital after the accident were interviewed consecutively. The replies to these interviews described the circumstances involved in the fall together with the health and social conditions. Women constituted 78% of the material with preponderance of people living alone as compared with the background population. Just under half of the patients had had a previous fall. Fractures were sustained in 40% of the cases. In 51% of the cases, a definite or probable external circumstance was the cause of the fall. In 150 out of 237 accidental falls, caused by external circumstances, the accident was considered to have been preventable by means of eg more accessible lighting, non-slip carpeting, removal of doorsteps, more suitable arrangement of furniture and better supportive measures beside stairs. The risk of falling is found to increase markedly in persons aged 75 years or more. Prophylactic measures are recommended before patients reach this age by means of information to elderly persons and to persons involved in home care about situations involving risks.

Total wrist arthroplasty. Experience with Swanson flexible silicone implants, 1982-1988.

In a study of the results of silicone rubber arthroplasty of the wrist 18 patients (19 operated wrists) were re-examined after a mean follow up of five years. Experience with the ulnar head implant was discouraging, and it was not used in the last eight wrists. This did not affect the outcome, patients having good supination and pronation without pain. The range of motion with the radiocarpal prostheses was 0-70 degrees, mean 39 degrees. Radiological results showed severe subsidence in all patients followed up for more than two years, and prosthetic fracture in five (26%), which was disappointing. Nevertheless the patients had a useful range of motion and all but two were relieved of pain. By the patients' own assessments 16 wrists were considered good, one fair, and two poor. Predictors of failure (prosthetic fracture) were poor alignment before operation, postoperative range of motion of more than 50 degrees, and rupture of the carpal extensor tendon. With these reservations we recommend the silicone spacer as the best solution for most patients with severe problems of the wrist as a result of rheumatoid arthritis.

A double pulp flap technique for creating nail-folds in syndactyly release.

A method is described of creating nail-folds in the release of cases of complete syndactyly. A double pulp flap was used as a one-stage technique in 13 patients in whom webs were separated. All patients were reviewed after a minimum of one year. Fullness of pulp was achieved in all fingers. The nail-fold was considered normal in 14 of 18 fingers covered with a broad flap and in 8 of 18 fingers covered with a narrow flap. In the remaining cases the nail-fold was small but never absent. No flap loss was encountered and there was no late nail deformity from scarring.

Dislocation of the lunate, triquetral, and hamate bones. Case report.

A patient sustained multiple injuries during a road traffic accident, including closed palmar luxation of the lunate together with dislocation of the triquetrum and hamulus of the hamate bone. Initially the injury was treated closed, but redislocation necessitated closed reduction and stabilisation with K-wires. Three years later movement was painless and slightly restricted despite persisting palmar dislocation of the lunate and triquetral bones as well as ulnar translocation.

Principles of evaluation and results in microsurgical treatment of major limb amputations. A follow-up study of 26 consecutive cases 1978-1987.

A total of 26 microvascular extremity replantations/revascularizations with a survival rate of 85% were followed for an average of 4.5 years. The material consisted of 11 upper arms, 11 lower arms, 1 wrist and 3 feet. In this comparatively small and inhomogenous material there was no significant influence found on the functional results regarding level of amputation, time of ischaemia or age of the patients. Sharp injuries had the best outcome. The functional results were evaluated following the principles outlined by Chen & Yu and by Tamai. Good and excellent results were found in 63% of the upper extremities according to these classifications and in 47% according to our own classification. Some of the difficulties in establishing indications and contraindications to replantation are outlined. To facilitate comparison of materials a modified and more realistic version of the score system of Tamai is recommended as a standard for evaluation of functional results following above-wrist-replantation. This will enable early detection of progress in the treatment of extremity amputations.

[Intraosseous ganglia of the carpal bones]. / Intraossøse ganglier i karpalknogler.

Symptom-producing cystic lesions in the carpal bones may be caused by intraosseous ganglia. Two different types occur: a completely intraosseous type and a rarer penetrating type. Two cases of the latter type are presented. In both of the types, the symptoms consist of pain following prolonged stress. In the penetrating type, a soft tissue tumour can be palpated. A cystic region of decalcification is visible radiographically. As a rule, no degenerative joint changes are encountered. Treatment consists of emptying of the cyst and bone transplantation in rare cases. Recurrence is rare.

[External causes of accidents. How do the new registration rules function?]. / Ydre årsager til skader. Hvordan fungerer de nye registreringsregler?

On January 1, 1987 a new codification system was introduced in Denmark to replace the former E-codification. The function of the codification system was investigated by comparing two parallel registers comprising the same group of patients. During a one-year period from January 1 1987 to December 31 1987, a total of 1,475 patients were admitted to an orthopaedic department. Complete agreement between the two registers was found in 53% of all patients. The result of the investigation stresses the need for careful instruction to those who carry out the registration. The purpose of the registration is that it should be usable in the health care system as an instrument for registration of external causes of injury. The registration should also be a tool for the planning and managing of the resources spent on health services. This purpose is only partly achieved in the present registration.

[Functional results after replantation/revascularization of major parts of the extremities]. / Funktionelle resultater efter replantation/revaskularisation af større ekstremitetsafsnit.

Twenty-five patients who were submitted to replantation or revascularization of a total of 11 upper arms, 11 forearms, one wrist and three feet were followed-up with the object of assessing the functional status. 85% of the replantated/revascularized parts survived. The follow-up examination included assessment of the level of amputation, mechanism of the injury, duration of ischaemia and the age of the patient in relation to the joint mobility achieved, strength, sensibility, cosmetic inconveniences and the return to previous employment. Out of 19 surviving upper limbs and three feet, the results were classified as excellent and good after Tamai's and Chen's methods. The best results were found after sharp lesions but the investigation revealed that even in severe avulsion lesions, it proved possible to obtain good results. It is thus not possible to establish definite directives for the indications for replantation. The final decision concerning reconstruction cannot be made until after contact with one of the departments in which replantation can be undertaken.

Influence of time and physical activity on blood pressure and heart rate during treatment with beta-blocking agents once daily.

In a cross-over study of 52 middle-aged patients with mild to moderate essential hypertension, we have compared the effect and tolerability of 100 mg atenolol and 100 mg metoprolol given once daily. After 1 1/2 and 3 months of treatment, both systolic and diastolic blood pressure 24 hours after drug intake were significantly lower on atenolol. There were no significant differences after 3 months when blood pressure was read 3-4 hours after dose intake. During exercise, systolic blood pressure and heart rate were--at all work-loads--significantly lower on atenolol. Four patients on metoprolol and one patient on atenolol discontinued treatment owing to side-effects. The results support the need for thorough analysis of the duration of action and influence of physical activity and sympathetic tone in comparisons between presumedly equivalent antihypertensive drugs.

The Q-T syndrome--a family description.

This paper describes a family of nine siblings of whom five suffer from the surdocardiac syndrome. All five are deaf-mute and have medical histories typical of the syndrome, with frequent syncopal attacks during the childhood, often caused by stress. Two of these five siblings have not suffered more than single attacks since puberty and are still alive. The other three had had continuous frequent attacks into adult years and died in connection with syncopes at 20, 27 and 37 years of age. The diagnosis, pathogenesis, treatment and genetics of the syndrome are discussed.