Pain and function in eight hundred and fifty nine patients comparing shoulder hemiprostheses, resurfacing prostheses, reversed total and conventional total prostheses

Purpose

Functional results of reversed total prostheses (RTP) have—to a very limited degree—been compared with those of other shoulder prosthesis types. The aim of our study was to compare results of four different types of shoulder prostheses in terms of function, pain, and quality of life (QoL).

Methods

Questionnaires were completed by 859 patients with shoulder prostheses registered in the Norwegian Arthroplasty Register. Patients with osteoarthritis (OA), rheumatoid arthritis (RA), or fracture sequela (FS) were included. Symptoms and function were assessed using the Oxford Shoulder Score (OSS, scale 0–48), and the EuroQoL-5D (EQ-5D) was used to assess QoL.

Results

Best functional results were obtained using conventional total prostheses (TPs) and RTPs —mean OSS improvement 18 and 16 units, respectively, vs 11 with hemiprostheses (HPs). For patients with OA, TPs performed best; for those with RA and FS, RTPs performed best; and those with HPs had the worst results in all diagnostic groups. The greatest improvement in QoL was seen in patients with TPs and RTPs.

Conclusions

Conventional TPs provide the best improvement in pain, function and QoL in OA patients; RTPs are superior in patients with RA and FS.     

Evidence of an autoregulatory mechanism of regional bone blood flow at hypotension

Background

Blood flow in various organs is determined by an autoregulatory mechanism that guarantees constant organ perfusion over a wide range of arterial blood pressure changes. This physiological principle has been proven for the kidney, brain and intestinal tract, but so far not for bone. This study was carried out to determine whether there is an autoregulatory mechanism of bone or not.

Methods

The fluorescent microsphere reference sample method was used to determine blood flow within the bone and kidneys. Eight anesthetized female New Zealand rabbits received left ventricular injections of fluorescent microspheres over a wide range of arterial pressure levels prior to removal of kidney, femur and tibia. Blood flow values were calculated by measurement of fluorescence intensity in kidney and bone and correlated to fluorescence intensity in the peripheral blood (reference sample).

Results

Despite a reduction of mean arterial pressure from 100 to 80 mmHg bone blood flow remained constant. Further reduction of mean arterial pressure results in a linear decrease in bone blood flow.

Conclusion

The correlation between arterial pressure and organ perfusion in the bone is similar to blood flow within the kidney, indicating the presence of an autoregulated blood flow mechanism within the bone tissue.     

Anaesthesia for abdominal vascular surgery

Although there are a number of abdominal pathologies requiring vascular surgical intervention, aortic aneurysmal disease is by far the most common and the focus of this article. The most obvious development in this area has been the implementation of a national screening programme for abdominal aortic aneurysm (AAA). Recent changes to try and improve elective mortality figures from around 8% for open repair have been essential to make the screening programme effective. Endovascular aneurysm repair (EVAR) is now the most common technique for elective management. Longer term risks and benefits of endovascular versus open repair is still an area of some controversy. Also controversial is the role of endovascular repair in the emergency ruptured setting. In this article we give an overview of all these areas as well as reviewing current indications for aortic aneurysm surgery. We also include an update of anaesthetic best practices for these patients.     

The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery

Objective—To investigate the effects of deep breathing performed on the second postoperative day after coronary artery bypass graft surgery.

Design—The immediate effects of 30 deep breaths performed without a mechanical device (n?=?21), with a blow bottle device (n?=?20) and with an inspiratory resistance‐positive expiratory pressure mask (n?=?20) were studied. Spiral computed tomography and arterial blood gas analyses were performed immediately before and after the intervention.

Results—Deep breathing caused a significant decrease in atelectatic area from 12.3?±?7.3% to 10.2?±?6.7% (p?<?0.0001) of total lung area 1?cm above the diaphragm and from 3.9?±?3.5% to 3.3?±?3.1% (p?<?0.05) 5?cm above the diaphragm. No difference between the breathing techniques was found. The aerated lung area increased by 5% (p?<?0.001). The PaO ₂ increased by 0.2?kPa (p?<?0.05), while PaCO ₂ was unchanged in the three groups.

Conclusion—A significant decrease of atelectatic area, increase in aerated lung area and a small increase in PaO ₂ were found after performance of 30 deep breaths. No difference between the three breathing techniques was found.     

Differences and commonalities in the judgment of causality in physical and social contexts: An fMRI study

Understanding cause and effect is a fundamental aspect of human cognition. When shown videos of simple two-dimensional shapes colliding, humans experience one object causing the other to move, e.g., one billiard-like ball seeming to hit and move the other. The impression of causality can also occur when people attribute social interactions to moving objects. Whether the judgment of social and physical causality engages distinct or shared neural networks is not known. In a functional magnetic imaging (fMRI) study, participants were presented with two types of dynamic videos: a blue ball colliding with a red ball (P; physical condition) and a blue ball (“Mr. Blue”) passing a red ball (“Mrs. Red”) without making contact (S; social condition). Participants judged causal relationships (C) or movement direction (D; control task) in both video types, resulting in four conditions (PC; SC; PD; SD). We found common neural activations for physical and social causality judgments (SC>SD)∩(PC>PD) in the right middle/inferior frontal gyrus, right inferior parietal lobule, the right supplementary motor area, and bilateral insulae. For social causal judgments (SC>PC), we found distinct neural activity in the right temporo-parietal junction (rTPJ). These results provide evidence for a common neural network underlying judgments of causality that apply to both physical and social situations. The results also indicate that social causality judgments recruit additional neural resources in an area critical for determining animacy and intentionality.     

Quantitative MRI and loss of free ambulation in Duchenne muscular dystrophy

The purpose of this ethics approved trial was to correlate quantitative MRI with functional abilities in both ambulant and non-ambulant Duchenne muscular dystrophy (DMD). Twenty patients with genetically confirmed DMD were recruited. Physical assessment was performed using the motor function measurement (MFM) scale. Axial 3T MRI scans of the thighs were acquired using T1-weighted in- and opposed-phase images (TR = 20 ms, TE₁ = 2.45 ms, TE₂ = 3.68 ms, flip angle = 15°) to calculate the relative fat fraction according to the two-point Dixon method in the knee extensors, flexors, and adductor muscles. The average MFM was 65.3 % and correlated negatively to age (r ² = 0.60). Overall mean fat fraction correlated positively to age (r ² = 0.51–0.64). An average of 5 % increase in mean fat fraction per year was calculated. Mean fat fraction of the quadriceps showed a high negative correlation (r ² = 0.93) to the D1 (standing position and transfers) component of the MFM. A cutoff for mean fat fraction of 50 % predicted loss of ambulation with a sensitivity of 100 % and a specificity of 91 %. Therefore, quantitative muscle MRI seems to be a promising endpoint for short clinical trials evaluating the effect of newer treatments on the time of loss of ambulation in DMD.     

Utbredelsen av stoffbruk hos unge menn i Norge i 1972–1973

Two methods of providing an educational intervention for families of patients with schizophrenia in Finland were compared. The aims of the intervention were to improve relatives' level of knowledge about the illness, and change the level of expressed emotion (EE), objective burden and psychological distress. Sixty-nine persons participated in the oral presentation groups comprising eight sessions and 128 persons participated in the video education comprising six sessions. The education led to significant knowledge gains and to an increase in the psychological well-being of the participants, but there were no significant changes in objective burden or EE status after intervention. Furthermore, there was only one difference between the two methods of information delivery. The participants in the video groups felt more often that the lessons were useful to them than did the participants in the oral presentation groups. The evidence suggests that brief educational intervention can yield significant benefits in meeting the needs of family members. Better designed, randomized studies investigating the efficacy of brief educational interventions are needed.