[Effects of catalase activators and inhibitors on ethanol pharmacokinetic characteristics and ethanol and aldehyde-metabolizing enzyme activities in the rat liver and brain].

The effects of catalase regulators (aminotriazole, lead acetate, taurine, di-2-ethylhexylphthalate) on the preference for ethanol, its pharmacokinetics, and activities of rat liver and brain ethanol and acetaldehyde-metabolizing enzymes were studied. Lead acetate (100 mg/kg, i.p., 7 days), aminotriazole (1 g/kg, i.p., 7 days), and taurine (650 mg/kg, i.g., 14 days) decreased ethanol consumption under conditions of free choice (10% ethanol water), whereas di-2-ethylhexylphthalate (300 mg/kg, i.g., 7 days) did not exert any effect on this parameter. Taurine, lead acetate and di-2-ethylhexylphthalate significantly activated liver ADH, MEOS and catalase peroxidase activity. Aminotriazole also activated ADH and MEOS, but inhibited liver catalase. The activities of liver and brain A1DH as well as catalase were insignificantly changed by this treatment. The 7-day administration of lead acetate, di-2-ethylhexylphthalate and aminotriazole administrations significantly influenced the ethanol (2 g/kg., i.p.) pharmacokinetic parameters: the area under the pharmacokinetic curve and the elimination half-life time were significantly reduced, whereas the elimination constant and clearance were increased. This unequivocally indicates accelerated ethanol elimination. The 14-day ingestion of taurine insignificantly changed the parameters of ethanol pharmacokinetics in rats.

[Effects of panthenol and carnitine on aldehyde metabolic enzymes in rats with tetrachloromethane-induced liver injury].

Tetrachloromethane (2 g/kg, intragastric) produced a decrease in the activity of NAD- and NADH- dependent aldehyde dehydrogenases with high Km for aldehydes in rat liver. Panthenol and L-carnitine administered separately normalized the activity of aldehyde dehydrogenases, while a combination of the drugs did not produce any significant effect.

[Adrenal glucocorticoid function in rats with various ethanol-induced sleeping time following ethanol administration].

The effect of single and chronic ethanol (Eth) administration (25 % solution, 3.5 g/kg) on functional activity of the hypophyseal-adrenal system in rats with different sensitivity to the hypnotic action of ethanol (short-sleep - SS; non-sleep--NS, long-sleep--LS, intermediate group--IG), was studied. It has been shown that, after a single Eth administration, the concentration of corticosterone (K) in LS rat plasma was 1.5-fold higher than that in the NS animals although it did not differ from the K level in SS and Ig those. After repeated ethanol load, the corticosterone contents in the NS rat blood plasma was 3.5-fold and 4.9-fold lower compared to the control and LS groups, respectively. The data obtained indicate that the SS and LS animals had initially different basal blood plasma glucocorticoid level. The SS animals showed a decreased blood plasma K, whereas the LS ones--an increased one. The features of the glucocorticoid status are suggested to be a factor determining the sensitivity of rats to the ethanol hypnotic effect.

Natural history and pathogenesis of the patella clunk syndrome.

INTRODUCTION: The current study aims to test the importance of the design of total knee prostheses in the 'patella clunk syndrome', which is one of the possible patellofemoral complications that can occur after total knee replacement. MATERIALS AND METHODS: Three patient cohorts consisting of 75 consecutive patients with 80 Insall-Burstein II (IB II) total knee replacements; 57 patients with 60 Anatomic Modular Knee (AMK) total knee replacements; and 103 patients with 106 Low Contact Stress Rotating Platform (LCS) total knee replacements were studied during the period from 1995 to 2001. This was an unselected series of elderly patients with knee arthritis of comparable demographics; we excluded only those patients receiving revision surgery. We recorded the preoperative and postoperative Knee Society scores, and the patient subgroups with postoperative patellofemoral complications were analysed in detail and were serially followed up. Radiological analysis followed the recommendation of the Knee Society, and the degree of pain was recorded on a visual analogue scale. Also, since the majority of patients with patella clunk syndrome had refused operation and were followed up for several years, an idea of the natural history of this condition was obtained. RESULTS: The relative frequency of occurrence of patella clunk syndrome among patients with the IB II, AMK, and LCS prostheses was 8.8%, 3.3%, and 0%, respectively. The calculated p value is strongly significant when comparing the IB II group with the LCS group (p<0.01); and of borderline significance when comparing the AMK with the LCS group (p=0.05); and not statistically significant between the IB II and AMK groups (p=0.19). Analysis of the results also showed that about half of the patients who underwent conservative treatment still had incapacitating symptoms after several years of follow-up, while the other half showed progressive improvement over time. CONCLUSION: Given a good surgical technique in component placement and debridement of the peripatella synovium, the design of a total knee prosthesis has a strong bearing on the incidence of the patella clunk syndrome. The natural history of the patella clunk syndrome reveals that for as yet uncertain reasons about 50% will improve with time even when given conservative treatment.

Sacral epidural abscess complicating closed sacral fracture: a case report.

OBJECTIVE: To describe the clinical course of the development of an epidural abscess with a rare localization. SUMMARY OF BACKGROUND DATA: Epidural abscess usually presents with severe back pain and neurologic deterioration. Spinal fracture may lead to the development of epidural abscess. To the author's knowledge, this is the first reported case of epidural abscess following sacral fracture. MATERIALS AND METHODS: The patient was observed closely in the hospital after a sacral fracture with bilateral S2, S3 dermotome numbness. Fever, bacteremia, and urinary tract infection developed. Fever responded partially with antibiotics. RESULTS: Sacral laminectomy for decompression was performed. Unexpectedly, sacral epidural abscess was found during the operation. Sacral roots were decompressed. Epidural abscess was drained. CONCLUSION: A rare case of sacral epidural abscess following sacral fracture was reported.

Duplex ultrasonography after total hip or knee arthroplasty.

We prospectively studied all patients admitted for total hip (THR) or knee (TKR) arthroplasty from July 2000 to February 2001. No pharmacological anticoagulation was given. All patients received a standardized postoperative rehabilitation regimen. Forty-six patients with known risk factors for deep vein thrombosis (DVT) were excluded. Eighty patients were studied (22 THR, 58 TKR; 55 women, 25 men). Mean age was 68 (30-90) years. Duplex ultrasonography on both lower limbs was performed on days 5-7 postoperatively. Location and extent of any thrombus were documented. In patients with distal DVT, a follow-up scan was done on days 10-14. If proximal propagation was observed, patients received full anticoagulation. If no propagation was detected, the distal thrombus was considered stable and clinical observation was continued. In the THR group, 1/22 and in the TKR group 9/58 were found to have distal DVT. All were asymptomatic. On follow-up scanning, none showed proximal propagation. All patients were followed up for at least 18 months, and none showed postthrombotic symptoms. Isolated distal DVT in "low-risk" Chinese patients after THR or TKR is not uncommon. Clinically they are usually "silent." If routine perioperative pharmacologic antithrombotic prophylaxis is not practiced, monitoring with duplex ultrasonography may need to be considered.

The shape and size of femoral components in revision total hip arthroplasty among Chinese patients.

OBJECTIVE: 39 sets of preoperative hip X-rays were studied to find out whether Chinese patients need revision femoral components with a different shape and size from western patients. METHODS: From July 1998 to June 2001, the pre-revision X-rays of 39 revision total hip replacements among 38 Chinese patients (21 men and 17 women) were studied. The component size that produced the best distal canal-filling in the anteroposterior X-ray was determined by using templates of 200-mm femoral components used commonly for Caucasian patients. RESULTS: The diameter of the component needed was 13.5 mm or less in 54% of cases, compared with only 17% for Caucasian patients as reported in the literature (p<0.01). When lateral templates of the corresponding size were put over the lateral X-rays, the anterior cortex of the 200-mm straight stem was shown to have thinned by 2.0 mm or more in 36% of hips; for 200-mm bowed stem, there was thinning of the anterior cortex by 2.0 mm or more in only 5% of hips (p<0.01). CONCLUSION: Chinese patients are likely to need smaller femoral components than Caucasian patients, and may benefit from bowed-stem components in femoral revision.

Distal fixation with Wagner revision stem in treating Vancouver type B2 periprosthetic femur fractures in geriatric patients.

Periprosthetic fractures around hip prostheses are difficult problems. We reviewed the results of treatment with Wagner revision stems in geriatric patients (> or = 65 years old) with Vancouver type B2 periprosthetic fractures. Over a 5-year period, 14 patients with Vancouver's type B2 periprosthetic fractures in the proximal femur were revised. The mean follow-up for these patients was 58.5 months (range, 36 to 64 months). The average age was 74.5 years (67 to 83 years). Twelve patients were available for assessment; all 12 reconstructions showed a stable prosthesis and solid fracture union. Seven patients had excellent outcome, 3 had a good outcome, and 2 had a poor outcome. Our series shows that the Wagner revision stem is a satisfactory prosthesis in revision of Vancouver type B2 periprosthetic fractures in geriatric patients.

Deep venous thrombosis after total hip or knee arthroplasty in a "low-risk" Chinese population.

Scarcely any information has been published on deep vein thrombosis (DVT) in Chinese patients after total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, generally, no prophylaxis is given to patients who do not have conventional high-risk factors because they are believed to be at "low risk." We performed a prospective study on 80 such "low risk" patients undergoing THA or TKA (58 TKA and 22 THA) without prophylaxis and performed duplex ultrasonography on both lower limbs 6 to 8 days after surgery. A total of 22 patients (27.5%) showed ultrasonographic evidence of DVT. Eighteen (31%) TKAs and 4 (18.1%) THAs were complicated by DVT. Three patients showed bilateral involvement, all of whom underwent TKA. Two patients had symptomatic pulmonary embolism. The sensitivity and positive predictive value of the clinical examination was 27.2% and 31.6%, respectively. This study showed that patients who are labeled "low risk" for DVT actually had a significant risk and suggests that the current practice of providing prophylaxis to only patients deemed at "high risk" should be revised.

Sealing the intramedullary femoral canal with autologous bone plug in total knee arthroplasty.

In a prospective study of 262 consecutive patients with total knee arthroplasty, we compared the postoperative suction drainage and transfusion requirement in cases in which the defect made by the femoral intramedullary rod was either unplugged (n = 134) or plugged (n = 128). All operations were performed with a single surgical approach and technique. Inflammatory arthritis and lateral releases were excluded. Blood loss was recorded at 24, 48, and 72 hours. The difference in postoperative suction drainage was not statistically significant. The hemoglobin decrease in the unplugged group (3.5 g/dL) was different from that in the plugged group (2.3 g/dL) (P<.05). Of patients, 64.4% (n = 85) in the unplugged group and 35.9% (n = 46) in the plugged group required transfusion (P<.05). Sealing the femoral canal is effective in reducing hemoglobin decrease and blood transfusion in total knee arthroplasty.

[Effect of acetaldehyde on ethanol- and aldehyde-metabolising systems of the liver and brain of rats]. / Vliianie atsetal'degida na étanol- i al'degidmetaboliziruiushchie sistemy pecheni i mozga krys.

Lately the mechanism of craving for alcohol has been related to the local level of brain acetaldehyde occurring in ethanol consumption and depending on the activities of the brain and liver ethanol and acetaldehyde-metabolizing systems. In this connection, we studied the effect of chronic acetaldehyde intoxication on the activities of alcohol dehydrogenase (ADH), aldehyde dehydrogenase (ALDH), the microsomal ethanol oxidizing system (MEOS) and liver and brain catalase as well as ethanol and acetaldehyde levels in the blood. The results showed that the chronic acetaldehyde intoxication did not alter significantly the activities of liver ADH, MEOS and catalase as well as liver and brain ALDH. In parallel with this, the systemic acetaldehyde administration led to shortened time of ethanol narcosis and activation of catalase in the cerebellum and left hemisphere, which may indicate involvement of this enzyme into metabolic tolerance development.

[Effect of pyruvate, threonine, and phosphoethanolamine on acetaldehyde metabolism in rats with toxic liver injury]. / Vliianie piruvata, treonina i fosfoétanolamina na obmen éndogennogo atsetal'degida u krys s toksicheskim porazheniem pecheni.

Pyruvate dehydrogenase, threonine aldolase and phosphoethanolamine lyase can produce acetaldehyde during normal metabolism. We studied the effect of loading with the substrates of these enzymes (pyruvate, 500 mg/kg, i.p., threonine 500 mg/kg, i.p., and phosphoethanolamine, 230 mg/kg, i.p.) on the blood concentrations of endogenous acetaldehyde and ethanol and the activities of enzymes producing and oxidizing acetaldehyde in the liver of normal rats and rats with liver injury provoked by chronic carbon tetrachloride (CCl4) treatment (0.2 ml i.p. per rat, 2 times a week during 4 weeks). Blood was collected before the treatment and then 30 min and 1 h following the administration of the substrates to intact and CCl4-treated rats. Endogenous acetaldehyde and ethanol were determined by headspace GC. The CCl4 treatment resulted in decreased liver alcohol dehydrogenase and aldehyde dehydrogenase activities and a significant elevation of liver endogenous ehtanol and a clear tendency to enhance blood acetaldehyde levels. Pyruvate increased blood endogenous acetaldehyde in CCl4-treated animals and endogenous ethanol--in the control group of animals. Threonine elevated endogenous acetaldehyde in normal rats. Phosphoethanolamine increased endogenous ethanol in the intact and CCl4 groups. At the same time, in CCl4-treated rats pyruvate administration increased the liver pyruvate dehydrogenase, threonine decreased threonine aldolase, whereas phosphoethanolamine decreased phosphoethanolamine lyase. Thus, the CCl4 effect on blood endogenous acetaldehyde and ethanol may be mediated through decreased liver ALDH and ADH activities. Liver injury promotes the accumulation of acetaldehyde, derived from physiological sources, including the degration of pyruvate and threonine by decreased acetaldehyde oxidation.

Prognosis of acute pelvic fractures in elderly patients: retrospective study.

OBJECTIVE: To analyse the pattern of acute pelvic fractures, prognostic indicators, and intermediate-term functional outcome among elderly patients. DESIGN: Retrospective study. SETTING: Community-based hospital, Hong Kong. PATIENTS: Sixty patients older than 60 years who were admitted to hospital with acute pelvic fracture between 1 November 1993 and 31 December 1996. MAIN OUTCOME MEASURES: Review of medical records and X-ray assessment to determine the patients' demographic data, medical comorbidities, aetiology and mechanism of injury, associated injuries, and clinical outcome indicators such as complications, duration of hospital stay, ambulatory status, and 1- and 2-year mortality rates. RESULTS: The mean follow-up period was 29 months (range, 12 to 65 months). Eighty-seven percent of patients were women and the predominant fracture pattern was Tile A2. The leading cause of injury was low-energy fall injury (75%). The 1-year mortality rate was nearly 12%. Thirty-six percent of patients experienced a decline in ambulatory status. Twenty-five percent of superior rami fractures involved the low anterior column of the acetabulum. There was a high incidence of associated cardiovascular disorders. CONCLUSIONS: Pre-existing medical conditions and acetabular involvement are important adverse factors affecting postinjury ambulatory status. A significant decline in ambulatory status and a significant mortality rate at 1 year were found following pelvic fracture in elderly patients.

A rare complication of percutaneous iliosacral screw in a vertically unstable pelvic disruption in a child.

The use of iliosacral screws in managing vertically unstable fractures in adults has been popularised and the early results are quite promising. However, the role and indication of this technique in paediatric patients are not clear. There has been a concern about its safety and risk of screw misplacement.

Radiologic analysis of the tibial intramedullary canal in Chinese varus knees: implications in total knee arthroplasty.

Seventy-two lower limb long radiographs were reviewed with respect to mechanical and anatomic axes. A template of an intramedullary tibial guide rod was employed to determine the accuracy of the intramedullary guide in producing ideal tibial cuts (ie, 90 degrees ) and acceptable tibial cuts (ie, 90 degrees +/- 2 degrees ). The mean difference of the angle formed by the 2 axes was 1.84 degrees +/- 1.42 degrees. In our findings, 22.2% of patients would have unacceptable cuts if an intramedullary device were employed for the tibial cut during a total knee arthroplasty. A radiograph showing the whole tibia is required preoperatively to identify varus tibiae that are not suitable for the intramedullary method.

[Effect of alcohol intoxication and aldehyde dehydrogenase inhibitors on lipid peroxidation in rat liver]. / Vliianie alkogol'noi intoksikatsii i ingibitorov al'degiddegidrogenazy na peroksidnoe okislenie lipidov v pecheni krys.

A single intraperitoneal administration of ethanol (3.5 g/kg) to rats induced a marked increase in lipid peroxidation and a decrease of antioxidative activity in the liver after 1 h when assessed by chemi-luminescence in liver homogenates. The pretreatment with aldehyde dehydrogenase inhibitor, disulfiram (200 mg/kg 24 hr before ethanol), caused a 10-fold elevation of the blood acetaldehyde levels, with no effect on the hepatic lipid peroxidation compared to control. Cyanamide (50 mg/kg, 2 h before the ethanol) increased approximately 100-fold the acetaldehyde levels, however, the changes in lipid peroxidation were not significantly different from that produced by ethanol alone. The present results suggest, that the metabolism of acetaldehyde and not acetaldehyde itself is responsible for the in vivo activation of lipid peroxidation during acute alcohol intoxication. Disulfiram prevents the ethanol-induced lipid peroxidation in the rat liver.

[Activity of the enzymes of ethanol and acetaldehyde metabolism in rats with varying initial sensitivity to alcohol]. / Aktivnost' fermentov metabolizma étanola i atsetal'degida u krys s razlichnoi iznachal'noi chuvstvitel'nost'iu k alkogoliu.

The experiments were carried out on male rats with different sensitivity to alcohol. To assess sensitivity to ethanol effects, we have used ethanol-induced sleep time and variations in rectal temperature of alcohol-intoxicated animals. Activity of alcohol dehydrogenase, microsomal ethanol-oxidizing system, catalase and aldehyde dehydrogenase in the liver as well as ethanol and acetaldehyde levels in the blood were determined after alcohol intoxication (3.5 g/kg, i.p., 8 days). The development of alcohol tolerance was accompanied by induction of the microsomal ethanol-oxidizing system in long-sleeping rats and in short-sleeping rats as well as by an increase in ethanol and acetaldehyde levels in the blood.

[Diagnostic effectiveness of determining the activity of certain serum enzymes in alcoholism patients]. / Diagnosticheskaia éffektivnost' opredeleniia aktivnosti nekotorykh syvorotochnykh fermentov u bol'nykh alkogolizmom.

Activities of alcohol, aldehyde dehydrogenases (ADH, A1DH, respectively) and gamma-glutamyl transferase (GGT) were estimated in blood serum of patients with Stages I-III alcoholism (54 men) on admission to the hospital, within 1 hr after ethanol testing (in a dose of 0.4 g/kg of body mass) and during the treatment course. Distinct activation of ADH and GGT and decrease in activity of A1DH were found in the patients as compared with healthy volunteers. Alcohol test did not alter noticeably the enzymatic activity studied. The activity of ADH and GGT was normalized in patients with Stages I-II alcoholism during the treatment course. A1DH exhibited the highest diagnostic efficacy, whose sensitivity and specificity were 92% and 84%, respectively; those for ADH 74% and 86% and for GGT 44% and 90%, respectively. Simultaneous estimation of the activity of the three enzymes improved the sensitivity and efficacy of diagnostic technique and enabled the test to be used as an additional criterion in the diagnosis of alcoholism and in the evaluation of the patients' state and therapeutical efficacy.

[Effect of drugs possessing antialcoholic activity on ethanol pharmacokinetics]. / Vozdeistviia preparatov s protivoalkogol'noi aktivnost'iu na farmakokinetiku étanola.

Furazolidone, lithium carbonate, chlorprotixen and pyrroxan exert different effects on ethanol pharmacokinetics. Furazolidone decreases clearance of ethanol, increases its half-life with a simultaneous reduction of blood acetaldehyde concentration. Pyrroxan increases clearance and maximal concentration of ethanol. Chloprotixen effect is characterized by a concurrent increase of ethanol and acetaldehyde concentrations in the first hours after ethanol administration. Lithium carbonate produces no significant changes in ethanol pharmacokinetic parameters.