Incidence of hip fracture in western Sweden 1974-1982. Comparison of rural and urban populations

Several epidemiological studies in northern Europe have shown that fractures in the elderly exceed the expected increase in the aging populations. We have compared the incidence of hip fracture in the rural county of Skaraborg and the city of G?teborg in Sweden. After adjustment for age changes in the population, the incidence of hip fracture in Skaraborg County was lower than in G?teborg during the period 1974-1984. The non-age-related increase in the incidence of fractures found in the city was not confirmed in the rural area.     

The effect of the lateral decubitus position on the intraocular pressure in anesthetized patients undergoing lung surgery

BACKGROUND: Changing the body position alters the intraocular pressure (IOP). The aim of this study was to investigate the alteration in IOP of the eyes after a positional change from a supine position to a lateral decubitus position in anesthetized patients, in order to detect differences in IOP between the two eyes, possibly due to a gravity effect, in the lateral decubitus position. METHODS: IOP was measured in 20 patients undergoing lung surgery. IOP in both eyes was recorded prior to anesthesia in the supine position (baseline), after anesthetic induction but before tracheal intubation in the supine position, at the end of central venous catheterization in the Trendelenburg position, 5 min after a positional change to the lateral decubitus position, once every 30 min until the end of surgery in the lateral decubitus position, and 5 min after changing back to the supine position. RESULTS: The median IOP (16.3 mmHg; 25-75% percentile, 13-20 mmHg) in the dependent eye 5 min after changing to the lateral decubitus position increased significantly from the baseline median IOP (14.3 mmHg; 13-17.3 mmHg; P < 0.05). The increase in median IOP in the dependent eye persisted until the end of surgery in the lateral decubitus position (19 mmHg; 16.5-22.3 mmHg; P < 0.01 vs. baseline). The median IOP in the dependent eye was significantly higher than that in the non-dependent eye when anesthetized patients were placed in the lateral decubitus position (P < 0.01), and the mean differences in IOP between the eyes in the lateral decubitus position ranged from 2.9 to 4.1 mmHg. CONCLUSION: The IOP was higher in the dependent eye than in the non-dependent eye in anesthetized patients in the lateral decubitus position, and the IOP in the dependent eye increased in anesthetized patients compared with that in awakened and supine-positioned patients.     

Thromboembolieprophylaxe bei hüftgelenknahen Oberschenkelfrakturen-Ergebnisse einer prospektiven randomisierten Studie zwischen Heparin-DHE und,ASS-DHE

The effectiveness of prophylaxis of thromboembolism either by acetyl-salicylic-acid (ASA) 0.5g+dihydroergotamin (DHE) 2.5 mg three times a day or by Heparin 5000 IU+0.5 mg DHE (HDHE) three times a day was compared in 404 patients, elder than 55 years, with fractures close by the hip joint. Effectiveness was proved daily clinical controls, perfusion scintigraphy on the day after admission, the fourth postoperative day and the day before discharge and by autopsy of the died patients. Clinical manifest thrombosis were seen on the operated legs in the HDHE-group in 7.6% of the patients in ASA-DHE-group in 15.6%, on the not operated leg under prophylaxis by HDHE in 3.8%, by ASA-DHE in 4.1% of the patients. Increased postoperative bleeding could be found under HDHE in 16.1% of the patients, under ASA-DHE in 9.3% of the patients, wound haematoma in 9.5% under HDHE and in 5.7% of the patients of the ASA-DHE-group. Superficial wound infections occurred under HDHE in 8.1%, under ASA-DHE in 5.7% of the patients, deep infections under HDHE in 0.5% and under ASA-DHE in 1.6% of the patients. Gastrointestinal bleeding under HDHE in 0.5% of the cases and under ASA-DHE in 3.1% of the cases Prophylaxis had to be discharged in 7.6% of the patients of the HDHE-group and of 19.7% of the ASA-DHE-group. Pathologic perfusion scars sould be found in 54.0% of the patients of the HDHE-group and in 54.9% of the ASA-DHE-group. Pulmonal perfusion became worse despite of prophylaxis by HDHE in 15.6% of the cases and despite prophylaxis with ASA-DHE in 17.6%. Pulmonal perfusion became better under HDHE in 11.9% and under ASA-DHE in 12.4% of the cases. The mortality was 9.7%. Fatal thromboembolism occurred under HDHE in three patients (1.4%) and under ASA-DHE in three patients too 6.25% of the patients without any significant difference between the two groups of prophylaxis. Fatal gastrointestinal     

Calcium regulation by the chick embryo

An artificial air-chamber was produced in White Leghorn chick embryos on the eighth day of incubation. On day twenty, the concentration of calcium in blood and in yolk was found to be lower in the treated embryos than in controls but concentration in bone was similar in both groups. The histological and microradiographic aspect of bone was also similar in both experimental and control embryos. The decrease in the concentration of calcium in blood and in yolk indicates that the experimental procedure succeeded in producing a decrease in calcium intake by the embryo. The fact that bones remained unaffected tends to support the idea that in case of deficient supply of shell calcium, bones can withdraw the calcium they need from the yolk deposit.     

Enflurane Improves the Oxygen Supply /Demand Balance in the Acutely Ischaemic Canine Myocardium

Acute myocardial ischaemia was produced in six dogs by ligation of the anterior descending branch of the left main coronary artery. Enflurane 1.5% inspired produced a significantly smaller reduction in blood flow in the ischaemic than in the non-ischaemic area in myocardium in the presence of a 46% reduction in mean arterial pressure. The improvement in oxygen availability/consumption ratio in the ischaemic in Comparison with non-ischaemic areas was attributed to a 16% reduction in heart rate.     

Declining Coronary Heart Disease Mortality in Iceland: Contribution by Incidence,Recurrence and Case Fatality Rate

Objective : To analyse to what extent the recent decline in coronary heart disease mortality in Iceland is due to changes in incidence, recurrence and case fatality rates. Design : A countrywide registration of myocardial infarction (MI) in people aged 25-74 was performed in Iceland during 1981-1999 according to the MONICA protocol. Possible cases were found by review of all hospital discharge records, autopsy records and death certificates. Results : MI death rate declined by 63% in males and 51% in females, most in the youngest age groups in men (86%) and least in the oldest (49%). In women there was not a significant difference in age groups. Overall the age-adjusted reduction in MI death rate was 55.4% in both sexes combined; of this 23.1% was due to incidence reduction, 22.8% to recurrence reduction and 11.6% to case fatality reduction. In the youngest age groups the decline in incidence contributed most to the decline in MI death rate (62% in men and 71% in women), but thereafter the decline in case fatality in men. In the older age groups decline in recurrence rate has greater weight. Conclusion : The recent decline in MI mortality under the age of 75 years in Iceland is due to reduction in incidence and recurrence rate by about 40% each and to reduction in case fatality by 20%.     

Prognostic importance of the study of venous drainage in cerebral arteriovenous aneurysms

The authors analysed in particular the venous drainage of 370 arteriovenous aneurysms operated during 20 years in neurosurgery at Lille's Hospital. If in many cases the study in details of the different arterious pedicles take an important place in the discussion of the indications and operative technics; in other cases a bad estimate of the interest of careful study of veins can be at the beginning of great disappointments. Also the authors insist on the necessary study of the venous system in totality by seeing after agenesia of some passages, the respective drainage of the angioma and the brain, the existence of a saturation venous phenomenon. The analysis in details of the anatomical and functional distribution of the venous drainage in these malformations can be taken into consideration in the operative decision. The analysis of results in ten preference observations suggest that it is an important element in the arteriovenous aneurisms' evolution and in the final prognostic.     

The Incidence of Osteochondritis Dissecans in the Condyles of the Femur

The incidence of osteochondritis dissecans in the condyles of the femur was studied in a defined population and was found to be twice as common in men as in women; the maximum incidence in both sexes being between the ages of 10 and 20. The site of the lesion in the condyles did not differ between age groups. The incidence of diagnosed cases has increased somewhat in recent years but only in men. The incidence in the population is less than has been suggested in the past.     

尿路复合性恶性肿瘤（附21例报告）

报告２１例尿路复合性恶性肿瘤，位于肾盂２例，膀胱１９例。主要临床表现为血尿，绝大多数病人伴有尿路刺激症状。低分化的移行细胞癌（ＴＣＣ）与继发性复合肿瘤有密切关系。２１例中１例为ＴＣＣ复合肉瘤，１１例为ＴＣＣ复合鳞癌，７例为ＴＣＣ复合腺癌，２例为腺癌复合鳞癌。本组２例肾盂肿瘤分别行肾输尿管全长加膀胱袖口状切除术和肾部分切除术，术后存活６个月和１年；膀胱肿瘤１４例行膀胱部分切除术，已生存３年４例，１年２例，未满１年２例，３例１～２年内死亡，失访３例；２例根治性膀胱全切术已生存５年和３年以上；３例行ＴＵＲＢｔ，已生存３年１例，１５年１例，未满１年１例。对尿路复合性恶性肿瘤的组织学、临床和病理特征进行了讨论。     

Problems in therapy of thoracic esophageal cancer in view of recurrence in the lymph nodes

The forms of recurrence from the first onset were confirmed in 171 out of 776 patients with thoracic esophageal cancer excised at our Department from 1959 to 1987; 87 patients (50.9%) had recurrence in the lymph nodes. Postoperative radiation in order to prevent recurrence in the lymph nodes was useful for the prevention of recurrence in the cervical lymph nodes, but radiation myelopathy/radiation pneumonitis might be of therapeutic difficulty in patients with recurrence in the areas of radiation. Moreover, patients treated by irradiation were apt to be involved in visceral recurrence. Incidence of recurrence in the lymph nodes was less in patients who had dissection in three areas than that in patients who received dissection in one or two. However, recurrence was observed in the border region between the cervix and the thorax, on the left side of the trachea, in the anterior portion and on the left side of the hilum in the areas of dissection. Useful postoperative chemotherapy is desirable in consideration of the fact that recurrence in the lymph nodes was observed at the posterior region of the pharynx, at the temporal region and in the pelvis and that dissemination and visceral recurrence were increased.     

Tuberculosis of the breast: Report of eight cases

In the 8 cases here reported (Table II), the average age was thirty-two years; youngest twenty years, oldest forty-six years. The nodular type was present in 7, the sclerosing type in one. The left breast was involved in 4, the right in 4. The upper outer quadrant alone was the seat of disease in 2, the inner lower quadrant alone in one, the outer lower quadrant alone in 2, the inner lower quadrant in one, and the outer lower and outer upper quadrants together in 2. The tuberculous mass was fixed in all 8 cases. The overlying skin was attached to the mass in 7 cases and not attached in one case. Pig-skin appearance was present in 6, including the mixed case (II) of carcinoma and tuberculosis, and not present in 2. Retraction of the nipple was present in 5 and not in 3. No case gave a history of discharge from the nipple. The breast was fixed to the chest wall in 5 cases and not so in 3 cases. A sinus was present in 4 cases and absent in 4. Axillary nodes were palpable in 7 cases. Clinical evidence of tuberculosis elsewhere in the body was present in only one case of the 8. The initial symptom was a lump in 6 cases, painful in 2 and not painful in 4 cases of the 6. An acute abscess was the initial symptom in 2 of the 8 cases. Only one case gave a positive past history of tuberculosis and possibly one other (V) who reported adenitis of neck nine years previously. Family history was negative in all cases. Only one case gave a history (VIII) of previous acute inflammation of breast. Five of the 8 cases gave a history of lactation, 6 of the 8 of pregnancy and 2 had never been pregnant. The shortest time from onset to admission to hospital was four weeks: the longest time one and onehalf years. The Wassermann reaction was positive in 3 cases, negative in 4, not recorded in one. The clinical diagnosis was tuberculosis in 2, carcinoma in 6. Tubercle bacilli were demonstrated in none. The diagnosis of tuberculosis of the breast was made by microscopic study of the tissues in all 8 cases. Six of the 8 patients were reported living and well; 1 eight years, 1 four years, 1 two years, and 3 one year each, after the operation. One patient died of shock within twenty-four hours after operation and one (II) died of metastatic cancer fifteen months after operation.     

Diagnostic usefulness of endorectal magnetic resonance imaging with dynamic contrast-enhancement in patients with localized prostate cancer: Mapping studies with biopsy specimens

BACKGROUND: New diagnostic criteria for dynamic magnetic resonance (MR) imaging in prostate cancer are presented. The diagnostic usefulness of endorectal MR imaging with dynamic contrast-enhancement in localized prostate cancer and the validity of these criteria were evaluated. METHODS: Eighteen untreated patients who were suspected of localized prostate cancer were included in the study. They received endorectal dynamic MR imaging before systematic sextant needle biopsy. First. a mapping study with the findings of MR images and histopathology of biopsy specimens was performed in eight patients out of 18 to compare the difference in T2-weighted images with the endorectal coil and the body coil in the same individuals. Second, another mapping study was performed in all 18 patients by analyzing the findings of endorectal dynamic MR images. For the diagnosis of prostate cancer in MR imaging, we offered diagnostic criteria from our experience in addition to those in plain T2-weighted images from the literature. RESULTS: The overall diagnostic rates of endorectal dynamic MR imaging were 88.9% in accuracy, 100% in sensitivity, and 81.8% in specificity. In the comparison of the endorectal and body coils in T2-weighted images in eight patients, there was no difference in the diagnostic rates except for one more histopathologic false positive portion in endorectal MR imaging. In the second mapping study in 18 patients, the diagnostic rates were 92.6% in accuracy, 88.9% in sensitivity and 93.3% in specificity. Endorectal dynamic imaging raised the diagnostic sensitivity from 77.8 to 88.9%. CONCLUSION: The data demonstrated the validity of this diagnostic criteria and the diagnostic usefulness of endorectal dynamic MR imaging in localized prostate cancer.     

Hemodynamics during laparoscopy in the supine or prone position

During laparoscopy elevations in arterial pressure and a decrease in cardiac output have been reported. Laparoscopic surgery performed in the prone position may be advantageous for some surgical procedures, but the hemodynamic effects of pneumoperitoneum in this position have not been studied. We studied the effects of different levels of increased intraabdominal pressure on hemodynamics and oxygen transport in eight pigs in the prone and the supine position. Increases in intraabdominal pressure did not result in decreased cardiac output or in a reduction of oxygen transport and consumption in either position. These results suggest that laparoscopy in the prone position does not result in more severe hemodynamic depression than laparoscopy in the supine position.     

Subchondral cysts arise in the anterior acetabulum in dysplastic osteoarthritic hips

The distribution of subchondral cysts in 57 dysplastic osteoarthritic hips of 38 patients was assessed by computed tomography and by a new computerized technique. The cyst count in osteoarthritic hips was inversely correlated with the width of the joint space. A greater accumulation of cysts was found in the acetabulum than in the femoral head, and more cysts were found in the anterior part of the hip than in the posterior part. Osteoarthritic change was more predominant in the acetabulum than in the femoral head, and was more predominant in the anterior part of the hip than in the posterior part.     

Inhibition of Sperm Maturation Through Intervention of the Carnitine System

Carnitine, acetylcarnitine and carnitine acetyltransferase (E.C.2.2.1.7) are present in 6–120 fold higher concentrations in human spermatozoa than in seminal plasma. Carnitine uptake by epididymal tissue in vitro in the rat is most active in the same segments of epididymis where the highest concentrations of carnitine are found in man. Radiolabelled carnitine is not taken up by mature human spermatozoa. Carnitine suppresses oxygen uptake in bovine ejaculated spermatozoa but not in human ejaculated or in rat or bovine epididymal spermatozoa. These findings indicate that the epididymis contributes to the accumulation of carnitine in caput spermatozoa and that carnitine may not be primarily responsible for the quiescent state of the spermatozoa in the cauda epididymis.
Extensive changes in carnitine uptake in the epididymis can be encouraged by a hormonal treatment which has no effect on the carnitine uptake by the heart. This raises the possibility of interference with the carnitine balance in the epididymis without effecting the pattern of carnitine uptake in other tissues.     

Recurrent anterior dislocation of the shoulder: Results of Eden-Hybbinette and Putti-Platt operations

The results of surgery in 74 cases of recurrent anterior dislocation of the shoulder are reported. The procedures used were Eden-Hybbinette (E-H) in 48 cases and Putti-Platt (P-P) in 26 cases.

The recurrence rate in the 62 shoulder joints re-examined some 4 years postoperatively was 3/41 in E-H cases and 3/21 in P-P cases. The clinical results were excellent in 46 cases, satisfactory in 11, unsatisfactory in four and poor in one case without notable difference between the methods. A restriction of the outward rotation of more than 10 degrees could be observed in half the cases regardless of method.

Radiographically, the Bankart lesion of the glenoid rim could be observed in two-thirds of the cases and osteoarthrosis of the glenohumeral joint was evident in one tenth. The transplanted bone block used in the E-H reconstruction was still in position in the majority but some degree of resorption could usually be observed. These observations did not correlate with the clinical results.     

Impact of changes in posture and bladder filling on the mechanical properties of the urethra in healthy and stress-incontinent females

A pressure/cross-sectional area probe was used to examine the impact of changes in posture and bladder filling on the mechanical properties of the urethra in 29 healthy females and in 28 patients with genuine stress incontinence (GSI). Measurements were performed at the bladder neck, in the high-pressure zone, and distally in the urethra. When changing posture from supine to standing position the urethral pressure at the bladder neck and midurethrally increased statistically significantly (P>0.01) in both groups. The urethral pressure increase was most pronounced in the midurethra which indicates that active muscle contraction is involved. Maximum urethral closure pressure was unchanged in the control group while it decreased statistically significantly (P>0.01) in the GSI group. Urethral elastance increased midurethrally in healthy women while it decreased in GSI women in the upright posture. Although these changes were not statistically significant, elastance was statistically significantly higher midurethrally in the erect position in the control group. These findings indicate impaired striated muscle function in or around the urethra in GSI women. Filling the bladder to 50% of the functional capacity did not change any urethral parameter in the two groups of women. The wide divergency in previously reported results is discussed.     

Effects of ligamentous injury on ankle and subtalar joints: a kinematic study.

Using 10 normal fresh cadaveric legs, kinematic effects of ligamentous injuries around the ankle joint were studied while the ankle joint moved from maximum plantar flexion to maximum dorsiflexion in saggittal plane. A series of anteroposterior and lateral sequential roentgenograms was taken both in the normal and subsequently created injured condition, to evaluate instant center of rotation and horizontal rotation pattern in the hindfoot complex. Although the pattern of instant center of rotation of the ankle joint varied among normal condition, the majority fell in a prescribed area. The deviation of instant centers from those in uninjured condition was most evident in lateral ligament injury. The average horizontal rotation between the tibia and calcaneus was 8 degrees in the uninjured condition; 6 degrees in the subtalar joint and 2 degrees in the ankle joint. In both medial and lateral injuries, more rotation in the subtalar joint was noted in plantar flexion phase. In the ankle joint, the degree of excessive rotation in plantar flexion range was greater in lateral injury than medial injury, but that in dorsiflexion range was greater in medial injury. It appeared that while every component of collateral ligaments around the ankle was important in controlling rotation in plantar flexion range, the posterior portion of the deltoid ligament is most important in the forsiflexion range.     

Liver transplantation and portal thrombosis

One hundred and thirty-eight transplants were performed between April 1986 and June 1990 in 116 patients of whom 9 (7.75%) were affected by liver cirrhosis complicated by portal vein thrombosis. Occlusion of the vascular lumen was total in 3 cases, semitotal in 1 case and the percentage of obstruction ranged between 25% and 75% in the remaining patients. Venous dissection and thrombectomy were performed in 6 cases and simple thrombectomy in 3 cases in order to obtain a satisfactory blood flow. Anastomosis was effected using the spleno-mesenteric confluence in 2 cases and the portal vein itself in other patients. Recurrent thrombosis occurred in the first 4 patients in the series, but it was only fatal in 2 cases. The paper analyses the data obtained from the study and in conclusion confirms the use of transplant in cirrhotic patients with portal vein thrombosis.     

Comparison of hepatic protein synthesis in vivo versus in vitro in the tumor-bearing rat

We have used the model of the freshly isolated hepatocyte to study liver metabolism in a rat tumor model and have reported elevations in the rates of protein synthesis, gluconeogenesis, alanine transport, and oxygen utilization by the tumor-influenced hepatocyte. While the metabolic activity of the isolated hepatocyte has been taken to reflect metabolism in the in vivo state, this assumption has not been validated. In the present study, we measure hepatic protein synthesis in vivo using a flooding dose of tracer amino acid, and in vitro in hepatocytes freshly isolated from tumor-bearing (TB) and pair-fed control rats. Increased protein synthesis was observed for the TB rats using both methods of analysis. However, the degree of stimulation seen in the TB animals was much greater in the in vitro assay than in the in vivo approach, suggesting that absolute protein synthetic rates in vitro must be interpreted with caution when extrapolating to the in vivo state.