Über ein Verfahren der Radikaloperation freier Schenkelbrüche

Ohne Zusammenfassung (Mit 6 Abbildungen im Text und 7 stereoskopischen Bildern in Mappe.)     

Does Parental Breastfeeding Knowledge Increase Breastfeeding Rates?

Objective: Although improving mothers' knowledge about breastfeeding can increase rates and duration of breastfeeding, little is known about the influence of fathers' knowledge. The purpose of this study was to assess the knowledge of mothers and fathers about breastfeeding before and after receiving postpartum advice and its relationship to the frequency of breastfeeding. Methods: A clinical trial was performed with mothers and fathers of normal children born at the Hospital de Clínicas de Porto Alegre, Brazil, between July 1994 and March 1995. The study intervention consisted of postpartum advice supplied by means of a video film discussing basic topics of breastfeeding, an explanatory leaflet, and open discussion after viewing the video. The first 208 couples comprised the control group, the next 197 comprised experimental group 1, and the remaining 196 comprised experimental group 2. Immediately after delivery, mothers and fathers in the three groups answered a test on breastfeeding knowledge; they completed the same test at the end of the first month. All families received home visits at the end of the first, second, fourth, and sixth months, or until breastfeeding ceased. Logistic regression was used to evaluate the association between the mothers' and fathers' knowledge and frequency of breastfeeding. Results: Postpartum advice increased the breastfeeding knowledge of mothers and fathers. The mothers with the highest level of knowledge had a 6.5 times higher chance of exclusively breastfeeding at the end of the third month, and 1.97 times higher chance of continuing breastfeeding to the end of the sixth month compared with other mothers. The fathers' knowledge also significantly influenced breastfeeding rates. The children whose fathers knew more had a 1.76 higher chance of being exclusively breastfed at the end of the first month, and 1.91 higher chance of receiving maternal milk at the end of the third month. Conclusion: A simple, inexpensive strategy can increase the level of breastfeeding knowledge of mothers and fathers and, consequently, have a positive impact on the frequency of breastfeeding.     

Biomechanical evaluation of anatomic reduction versus medial displacement osteotomy in unstable intertrochanteric fractures

The biomechanical characteristics of anatomic reduction versus medial displacement osteotomy were compared for four-part intertrochanteric fractures experimentally produced in cadaver femurs. Eighteen pairs of femurs were assigned randomly to either the anatomic (A) or the medial displacement (MD) group and instrumented with multiple strain gauges. The femurs in the MD group were tested while intact and following four-part fracture with fixation. The femurs in the A group were first tested intact, followed by a stable two-part fracture with fixation, and then by a four-part fracture with fixation and perfect reduction of the posteromedial fragment (PMF) with a lag screw, partial reduction of the PMF, and with the PMF omitted. All fractures were fixed with a 135 degrees, four-hole, sliding hip screw. The strain distribution in the MD group changed significantly after fracture. The plate tensile strain increased by 360% while the compressive calcar strain decreased 85%. The plate tensile strain in the A group also increased significantly after four-part fracture when the PMF was perfectly reduced (160%), partially reduced (290%), or discarded (275%); the calcar compressive strains for these subgroups decreased approximately 50%. This laboratory study indicates that anatomic reduction of four-part intertrochanteric fractures with the sliding hip screw, regardless of the presence or position of the PMF, provides significantly higher compression across the calcar region and significantly lower tensile strain on the plate than fractures reduced by medial displacement osteotomy. The more physiologic strain distribution and the increased medial load transmission support the use of anatomic reduction for the treatment of unstable intertrochanteric fractures.     

Visibility of gallstone fragments at US and fluoroscopy: implications for monitoring gallstone lithotripsy

To assess the value of ultrasound (US), fluoroscopy, and spot radiography in the detection, counting, and measurement of gallstone fragments during lithotripsy, in vitro visibility studies were conducted on fragments from 20 stones. Fluoroscopic visibility was evaluated during and after lithotripsy on 185 fragments placed in an anthropomorphic phantom. Three US experiments were performed on the fragments to study the visibility of fragments as a function of size, the accuracy of the count with large numbers of fragments, and the ability of observers to detect and count fragments larger than both 4 mm and 5 mm. With fluoroscopy, fragment detection rates ranged from 20% (fragments larger than 2.5 mm) to 80% (fragments larger than 4.5 mm). With US, all fragments larger than 1.5 mm were detected, and US was significantly better than fluoroscopy and spot radiography for detection of fragments 2.5 mm or smaller. US was also more accurate than fluoroscopy (11% vs 59% error) in the assessment of the number of fragments. When fragments larger than 4 mm or 5 mm were being counted with US, 92% of the fragments were visualized. The results suggest that US is more accurate for monitoring gallstone lithotripsy than fluoroscopy or spot radiography.     

Cement augmentation of intertrochanteric fracture fixation:A cadaver comparison of 2 techniques

We evaluated 2 techniques of cement augmentation to enhance fixation of intertrochanteric hip fractures. 4 fixation groups with 6 cadaver femurs in each group were compared: stainless steel lag screw and side plate with and without cement augmentation and a titanium alloy expandable dome plunger and side plate with and without cement augmentation. Gauges were used to establish the mechanical behavior of intact and then fractured femurs to simple uniaxial loads. Subsequent loading to failure allowed determination of maximum fixation strengths and modes of failure

Cement augmentation of each device increased its load to failure. There was no significant difference between the cemented lag screw and the uncemented dome plunger groups with average loads to failure of 4.0 × 10³ N. The greatest average load to failure was in the cemented dome plunger group (5.6 × 10³ N) with the lowest in the uncemented sliding hipscrew group (3.6 × 10³ N). Device cut-out as a cause of failure occurred mostly in the uncemented lag screw group. Sliding was enhanced by those methods that increased the fixation surface area within the femoral head, unless cement encroached in the region of the barrel-screw junction. Strain analysis showed that the dome plunger unloaded the bone at the calcar, regardless of cement augmentation, while the sliding hip screw allowed for compressive stresses in this area.

Proper cement augmentation increases load to failure and minimizes nail cut-out for both devices studied. However, the dome plunger, a device with a large fixation area in the femoral head, was equally effective and eliminated potential cement encroachment. Failure of intertrochanteric fracture fixation in osteoporotic bone may be minimized by an appropriate choice of device or cement augmentation.     

Cyclopiazonic acid增加SHR和WKY血管平滑肌细胞Ca~(2+)-依赖性外向K~+-电流

采用全细胞及细胞贴附式斑片钳技术记录自发性高血压大鼠(SHR)和Wistar-Kyoto对照鼠(WKY)培养主动脉平滑肌细胞的Ca~(2+)-依赖性外向K~+电流[I_(k(Ca))],测定肌浆网Ca~(2+)泵抑制剂CPA对其影响.CPA能增加I_K(Ca))单通道开放时间,缩短关闭时间,增加全细胞I_(K(Ca))幅度,这些作用与Ca~(2+)相关并可被K~+通道阻断药glybenclamide阻断。CPA作用在SHR和WKY之间无明显差异。结果提示高血压状态下血管平滑肌的功能改变可能与I_(K(Ca))无关。