[Challenges of primary hip arthroplasty with high hip dislocation]. / Herausforderungen der primären Hüftendoprothetik bei hoher Hüftluxation.

BACKGROUND: Endoprosthetic care of high hip dislocation is a surgical challenge. The hip anatomy is greatly altered in these patients, including a rather flat and small acetabulum with impaired bone quality and a relevant chance of a bony defect of the acetabular roof. Additionally, the front coverage and in some cases even the dorsal coverage of the hip are missing. The proximal femur is characterized with an increased antetorsion, a coxa valga position and an enlarged greater trochanter. The medullary cavity is narrowed, the offset is reduced, and the absolut leg length can be enlarged. Further anatomic variations can have been caused by previous surgeries. AIM OF THE TREATMENT: The goal of the endoprosthetic care is the re-creation of a hip with an anatomic center of rotation, an anatomic offset and equal leg length. TREATMENT: This can be achieved by a medial shift of the acetabular cup. An acetabular osteotomy including central cancellous bone graft or a bony graft to reinforce the acetabular roof might be necessary. In cases in which an anatomic acetabular cup placement is not possible, a more cranial placement can be done. Further strategies that are essential in several cases are shortening or re-orientation osteotomies of the femur, reaming of the medullary cavity and correct implant selection. Additionally, thorough soft tissue management is of main importance. Generally, the surgery should be well prepared preoperatively.

[Influence of the necessity of transfusion in anemia on the prognosis of ENT cancer in the protocol with concurrent hyperfractionation of carboplatin and irradiation]. / Influencia de la necesidad de transfusión por anemia sobre el pronóstico del cáncer O.R.L. en un protocolo con hiperfraccionamiento concurrente de carboplatino e irradiación.

Because of the determinant role of hemoglobin level in blood to the response of treatment (viewpoint admitted whether for irradiation or chemotherapic agents) the AA. have lead an analysis of a group of 36 patients suffering an advanced head and neck cancer (18 months mid-follow up and 30 months maximum) which underwent a program of concomitant radio-chemotherapy hyperfraccionated with carboplatin (the cytostatic) as part of each therapeutic fraction. The results in patients being transfused with an erytrocyte concentrate were compared with those from patients not having had any transfusion. The purpose of this study was the assessment of which are the influence on the prognostic of ENT-cancer resulting of the compulsory necessity of transfunding erytrocyte concentrates aroused by serious anemia presenting during the development of the schedule treatment. In brief, in that kind of patients needing transfusions of red blood cells concentrates because of serious anemia during the treatment (17% of the totality treated) were recorded 50% local failures, 33% metastases and only 17% of the totality were free of neoplasma at the end of the follow-up fixed. Instead between patients not having had transfusions (for treating anemia) the differences registered were 20% failures of loco-regional control and 13% metastases, whereas 67% were free of tumor at the end of the study. The conclusion drawn out is: the important influence on the prognostic of these tumors, when in the course of the scheduled treatment, appear severe anemia making the transfusions compulsory.

[Prediction of the severity of fetal erythroblastosis using the erythrocyte phagocytosis test and evaluating anti-Rh antibody titers and their levels by autoanalysis]. / Przewidywanie ciezkosci choroby hemolitycznej noworodków za pomoca testu erytrofagocytozy, miana przeciwcial anty-Rh i ich stezenia ocenianego w autoanalizatorze.

Erythrophagocytosis++ test was performed in 45 pregnant Rh-negative women together with routine anti-Rh antibodies assay with indirect antiglobulin test and their concentration determined in an autoanalyser. It was found that the degree of ++phagocytosis of the standard erythrocytes immunized with maternal anti-Rh antibodies by the monocytes from healthy subjects is an important predictive factor enabling to foresee a severity of hemolytic disease in newborn babies. ++Phagocytosis over 50% predicts a severe course of the disease whereas under 20%--a mild form of the serologic conflict.

Experimental investigations on the influence of stroma-free haemoglobin solution on kidney function in exchange transfusion models.

In the continuing search for promoting the bio-pharmacological characteristics of an excellent oxygen carrier, the Stroma-free Haemoglobin Solution (SFHS), in the presented work, the authors were investigating the composition changes of SFHS infused to dogs. In 10 mongrel dogs a total exchange of the circulating blood was done for replacing it with SFHS. For the observing the physico-chemical changes in circulating and excreted fluids electron spectroscopy was used in view of good spectral characteristics of haemoglobin, and a high sensitivity of this method to changes taking place in the analyzed molecule. Comparing the spectral curves characterizing the solution used for exchange transfusion with the spectral curves obtained from circulating SFHS samples and haemoglobin excreted in the urine, and from the ascites, during the 6 hours course of the experiment, no essential structural changes were observed in the hemin molecule, in the visible range.

Influence of stroma-free hemoglobin solution on renal function in dogs.

In the presented series of experiments, stroma-free hemoglobin solution (SFHS) was used as a perfusate for extracorporeal perfusion of kidneys and for exchange transfusion. It was shown that SFHS was adequatly oxygenated both as perfusate during the extracorporal perfusion and in the lungs after the blood exchange. Furthermore, there was provided evidence that oxygen was being transported and released in the tissues. Histologic examination of the kidneys demonstrated hemoglobin casts in the glomerules. Most of them were seen after extracorporal perfusion of isolated kidneys, less frequently after perfusion in situ and few casts were present after exchange transfusion. The cause of these depositions may be small remnants of stroma in the preparation. Furthermore it is possible, that at the beginning of the extracorporal perfusion of the kidneys the urine pH was below 6 and then a hemoglobin casts formation could occur. There were essential no changes in urine pH in the course of blood exchange. In this group were only few casts present in the kidneys.

[Fate of C-14 labeled hydroxyethyl starch in mice]. / Utrzymywanie sie [14C]-znakowanej hydroksyetylowanej skrobi w tkankach i narzadach myszy.

Three preparations of hydroxyethyl starch having MS 0.55, 0.65 and 0.8 respectively and labelled with 14C in hydroxyethyl residue were administered to mice. After 1, 5, 10, 20 and 60 days the mice were sacrificed and radioactivities determined in the following organs and tissues: blood, spleen, liver, kidneys, heart, lungs and muscles. Most of the initial dose of radioactivity was eliminated from mice within 24 h. The remaining portion was eliminated slowly and even after 60 days 0 07--1.2% of the initial dose could be detected in different organs. The rate of clearance of radioactivity was fastest for hydroxyethyl starch with MS = 0.55 and slowest for the preparation with MS = 0.8. The retention of radioactivity was most conspicous in the muscles.

Infusion of physiological saline supplemented with adenine, pyruvate and phosphate.

After controlled bleeding 20 ml/kg enriched infusion fluid containing 0.005 mol/1 adenine, 0.1 mol/1 pyruvate, 0.1 mol/1dibasic sodium phosphate and 0.15 mol/1 sodium chloride was given to 14 dogs. Three dogs received after bleeding the same infusion fluid without adenine. One dog received only dextran after blood withdrawal and served as control Before and after bleeding and 1, 4, 24, 48 and 72 hours after infusion the levels of 2,3-DPG, ATP and P50 index were determined. After infusion of enriched fluid with and without adenine the level of 2,3-DPG and the value of P50 index increased. No rise in the ATP level was observed.

Investigations on tensile strength of intestinal anastomosis in pharmacologically induced blood clotting disturbances.

The authors present the results of investigations on tensile strength of intestinal anastomosis in pharmacologically induced blood clotting disturbances in the postoperative period (1-16 days). Experiments were carried out on 50 male rabbits in two groups- a treated group and another for control only. Animals in the experimental group were treated with Sincumar 24 hours before and in the postoperative period. The dosis of Sincumar was calculated to reduce the prothrombin index below 40 percent. The tensile strength of intestinal anastomosis was tested the 2nd, 3rd, 5th and 15th day after operation and in the same time histological examinations of anastomosis specimen were performed. In conclusion the authors found that the reduction of the prothrombin index below 40 percent does not influence the process of healing of anastomosis of the small intestine, prevents the formation of adhesions and inflammatory peritoneal reaction following operation.