[Influence of local air suction on the density of air-borne bacteria during cementation of alloplasties]. / Punktsugs indflydelse på koncentrationen af bakteriebaerende partikler i luften under cementering af alloplastikker.

At joint replacement operations local air suction is used to reduce the air pollution from organic solvents in the operation theatre during insertion of cement and prosthesis. In order to find out whether the local suction in an ultraclean-air operation theatre with laminar airflow influenced the number of colony forming units (cfu) of bacterial in vicinity of the wound, one m3 of air was sampled 20 cm and one metre from the wound before, during and after use of local suction during insertion of cement and prosthesis using a Sartorius membrane filter sampler. There was no significant difference between the groups in the numbers of cfu of bacteria found. It is concluded that use of local air suction over the operative area while cementing hip prosthesis does not affect the number of bacteria in the vicinity of the operation.

Locked nailing of comminuted and unstable fractures of the femur.

Forty comminuted or unstable fractures of the femoral shaft were treated by closed intramedullary reaming and locked nailing. Twenty-four fractures were severely comminuted, and the other 16, in the distal or proximal third of the shaft, were classified as unstable. At 12 to 30 months postoperatively all the fractures had healed. Three patients had lateral rotation deformity of 5 degrees to 10 degrees, three had shortening of 1 to 2 cm and two had lengthening of about 1 cm. There were no infections or delayed unions. Closed intramedullary locked nailing can provide stability in fractures of the femoral shaft, irrespective of the degree of comminution and the site of injury.

[Dihydroergotamine and orthostatic hypotension in elective hip surgery]. / Dihydroergotamin og ortostatisk blodtryksfald ved elektiv hoftekirurgi.

The authors undertook a prospective double-blind, controlled trial to investigate the effect of prophylactic low-dose heparin/dihydroergotamine, low-molecular heparin/dihydroergotamine and a placebo on the blood pressure and postural hypotension on postoperative mobilization. A material of 120 patients admitted for hip surgery was subdivided at random into three groups. Examination for postural hypotension was undertaken on the fifth postoperative day. No significant differences were present between the three groups as regards age distribution, systolic and diastolic blood pressures and pulse rates. This investigation did not reveal any significant effect of the antithrombotic combined treatment with heparin/dihydroergotamine on the blood pressure or postural hypotension on postoperative mobilization following elective hip surgery. No cases of ischaemic side effects were observed. However, this investigation cannot disprove a slight hypotensive effect and, for this reason, this treatment should be contraindicated in patients with circulatory disturbances.

Chondromalacia induced by patellar subluxation in the rabbit.

A unilateral patellar malalignment was induced in 20 young and 20 mature rabbits by lateral displacement of the tibial tuberosity, the other knee serving as osteotomized in situ control. At 6 weeks, all the knees appeared macroscopically normal, but histologically definite cartilage degeneration was found on the experimental side. At 3 months, macroscopic changes occurred in 5 of 10 mature rabbits, and histologic cartilage degeneration was found in all the experimental knees, most pronounced in mature animals, and particularly in joint facets submitted to high pressure. This experimental model produces changes resembling chondromalacia patellae and early arthrotic changes suggesting the importance of malalignment in the development of patellofemoral cartilage degeneration.

Alternatives in the treatment of ipsilateral fractures of the hip and femur.

Eight cases of ipsilateral femoral neck and shaft fractures were reviewed. The diagnosis of the femoral neck fracture was delayed in two cases. Seven of the femoral shaft fractures were comminuted. In six cases, both fractures were treated with rigid internal fixation. A combination of traction and internal fixation was used in two cases. Two cases of avascular necrosis of the femoral head were observed. The fracture reduction was insufficient in both cases and the diagnosis of femoral neck fracture was delayed in one case. A radiograph of the pelvis is mandatory in high-velocity trauma victims. Ipsilateral fractures of the femoral neck and shaft should be stabilized by internal fixation as early as possible. Intramedullary locked nailing seems to be an attractive alternative in the treatment of the comminuted femoral shaft fracture.

Prevention of thromboembolism in hip-fracture patients. Comparison of low-dose heparin and low-molecular-weight heparin combined with dihydroergotamine.

In a prospective, double-blind, controlled study, we compared the antithrombotic efficacy of low-dose heparin with dihydroergotamine (A), low-molecular-weight heparin with dihydroergotamine (B), and placebo (C). Two hundred and thirteen patients surgically treated for fractures of the hip were randomly divided into three groups. One hundred and sixty-one patients were analyzed. All thrombi were verified by ascending phlebography. Nine patients died within 1 month after operation. A and B proved to be equally safe but failed to provide any protection against deep-vein thrombosis, although B showed a tendency to reduce the incidence. Mortality within 1 month of operation was unaffected by the type of prophylaxis.

Comparison of three different treatments for ruptured lateral ankle ligaments.

Two hundred consecutive patients with arthrographically verified rupture of one or both of the lateral ankle ligaments were allocated to treatment with either an operation and a walking cast, walking cast alone, or strapping with an inelastic tape - all for 5 weeks. Eighty-seven percent of the patients attended follow-up after 1 year. Only 5 percent in each treatment group were unsatisfied with the result. There were no differences between the treatment groups in ankle stability or symptoms during different activities, regardless of rupture of the anterior talofibular ligament alone or combined with rupture of the calcaneofibular ligament. However, the patients treated with tape had fewer symptoms, fewer complaints when running, and more ankles recovered to the preinjury state. Therefore, in lateral ankle ligament rupture, tape bandages seem preferable.

Heparin/dihydroergotamine for venous thrombosis prophylaxis: comparison of low-dose heparin and low molecular weight heparin in hip surgery.

In a prospective, double-blind controlled study we have compared the prophylactic efficacy against deep vein thrombosis of low-dose heparin + dihydroergotamine (A), low molecular weight heparin + dihydroergotamine (B) and placebo (C). A total of three hundred and fifty-six patients undergoing total hip replacement were randomized into three groups and 316 patients were analysed. All thrombi were verified by ascending phlebography. One-third of the patients developed deep vein thrombosis in group A and B, differing significantly from group C. The operative blood loss in group B was higher than that in groups A and C. However, the number of patients transfused and their transfusion requirements did not differ. Severe bleeding occurred in one patient in each group. No deaths were registered during the study. Our study indicates that prophylactic treatment against postoperative deep vein thrombosis with low molecular weight heparin + dihydroergotamine once daily is as effective and safe as conventional low-dose heparin + dihydroergotamine twice daily in patients undergoing total hip replacement. The once-daily regimen has the advantage of better patient acceptance and less nursing time.

Prognostic value of serial determinations of circulating immune complex levels in malignant melanoma.

A total of 50 melanoma patients free of distant metastatic disease and 54 healthy controls were analyzed for circulating immune complexes (cIC) and complement split product (C3d), using solid-phase Clq-anti-IgG radioimmunoassay (RIA), Clq-protein A RIA, and anti-C3d anti-IgG RIA for cIC detection. No significant differences in cIC and C3d levels could be demonstrated between the controls and the 31 patients with primary malignant melanoma analyzed before surgery. To evaluate the prognostic value of serial measurements, samples from the 50 patients were taken at regular intervals for 4 to 27 months (median, 20 months). Surgery was the only treatment given. Significant changes in the cIC and C3d levels were defined by reference to the changes that occurred in 23 of the 54 healthy controls observed for a period of 6 to 55 months (median, 23 months). During the period of serial sampling, recurrent disease developed in 8 of the patients. In only 3 of these 8 patients (versus 10 of 42 patients without recurrence) did significant changes occur, and the changes occurred either at the same time or after the clinical diagnosis of recurrence. During the entire clinical observation period of 6 years, a total of 11 patients developed recurrences. Significant changes were only observed in 4 of these 11 patients versus 8 of 37 patients without recurrence. In conclusion, changes in cIC and/or C3d levels were not found to be indicative of early or long-term recurrence of malignant melanoma.

Longitudinal split anterior tibial muscle flap with preserved function.

Exposure of the tibia, preferably the upper three-fifths, can be easily covered by splitting the adjacent anterior tibial muscle longitudinally from behind and transferring the medial part of the muscle to cover the medial surface of the tibia. The function of this important muscle is preserved.

The influence of general anesthesia and surgery on cell-mediated cytotoxicity and interferon production.

The effect on cell-mediated cytotoxicity of surgery and anesthesia for removal of a primary malignant melanoma was studied in 47 patients. The cytotoxic ability of peripheral blood lymphocytes has been investigated using 2 melanoma cell lines or 2 leukemia cell lines as target cells, with or without addition of interferon or specific antibodies. The cytotoxic ability was clearly reduced in all assays 1 day after the operation. After 6 days about half the patients were totally restored; others showed increase in cytotoxicity without reaching the initial values, whereas one fourth of the patients were still heavily depressed with only a small or no increase at all. The number of macrophages in the effector cell population was followed, and the ability to produce interferon on stimulation with viral or melanoma antigens was investigated, as alterations in these parameters could influence cytotoxicity. There were no fluctuations in these parameters.