Movement pattern of the Exeter femoral stem; a radiostereometric analysis of 22 primary hip arthroplasties followed for 5 years.

BACKGROUND: The design of the Exeter stem may facilitate distal migration, but radiostereometric analysis (RSA) studies have been limited to 2 years of follow-up. PATIENTS AND METHODS: We followed migration of the Exeter femoral stems in 22 primary hip arthroplasties for 5 years with RSA. RESULTS: All stems migrated distally and the median migration at 2 years was 1.34 mm, while at 5 years it was 1.77 mm. 7 stems migrated above accuracy between 3 and 5 years. (RSA) evaluation of the cement mantle could be performed in 14 cases, and in 5 slight migration was found. Most of the stems rotated towards retroversion and the median rotation at 2 years was 1.2 degrees, while at 5 years it was 1.6 degrees. We found 1 patient with impending clinical failure but no deviation in the RSA migration pattern, and 1 patient with unstable migration pattern but no clinical symptoms. INTERPRETATION: We found a greater distal migration of the Exeter stem for longer periods of time than seen with other types of cemented implants.     

Activities of daily living decrease similarly in hospital-treated patients with a hip fracture or a vertebral fracture: a one-year prospective study in 151 patients

AIMS: A hip fracture is commonly regarded as the most devastating fragility fracture, as regards both morbidity and mortality, while a vertebral fracture is usually regarded as having lower general morbidity. The purpose of this study was to investigate whether hospitalized patients with a hip or a vertebral fracture experience similar functional deterioration following the fracture as regards activity of daily living (ADL) and experienced quality of life (QOL). METHODS: Eighty-seven women and 22 men, mean age 81 (range 66-96), with a hip fracture and 34 women and 8 men, mean age 81 (range 68-92), with a vertebral fracture were followed up for 12 months. ADL before fracture and at 4 and 12 months after the fracture were evaluated as well as QOL at 4 and 12 months after the fracture, by questionnaires. RESULTS: A hip and a vertebral fracture in community dwellers within the same age range confers a similar decrease in ADL during the four months following the fracture. No restoration was seen in ADL or total QOL during the year following the fracture. Patients with a vertebral fracture had a lower QOL than patients with a hip fracture 4 and 12 months after the fracture. CONCLUSION: The need for external community assistance for patients with a vertebral fracture that forces them to have hospital treatment may be similar to the need following a hip fracture.     

Effect of indomethacin on regulation of juxta-articular bone blood-flow during joint tamponade. An experimental study in puppies

Prostaglandins are vasoactive substances which are assumed to play a major role in bone metabolism and bone repair. The purpose of the present study was to investigate the effect of indomethacin on the control of epiphyseal bone blood-flow. By means of simultaneous intra-osseous pressure (IOP) and regional blood flow (RBF) measurements in the distal femoral epiphysis (DFE), aspects of vascular control mechanisms in the distal femoral epiphysis were investigated during knee joint tamponade (50% of mean arterial pressure) before and after administration of indomethacin 7.5 mg/kg. Six dogs aged 3-4 months were investigated in fentanyl anaesthesia. Knee joint tamponade resulted in a significant increase in IOP and calculated venous resistance in the DFE, while no significant changes in regional blood-flow or arterial resistance were encountered. Administration of indomethacin did not affect this reaction. The results suggests that indomethacin 7.5 mg/kg does not influence the regulation of epiphyseal blood-flow during elevation of joint pressure indicating that prostaglandins play only a minor or no role in this regulation.     

Fixed herbal drug combination with and without butterbur (Ze 185) for the treatment of patients with somatoform disorders: randomized,placebo‐controlled pharmaco‐clinical trial

Herbal drugs are often used in patients with somatoform disorders yet, the available evidence is limited. The aim of the present short‐term study was to evaluate in a pharmaco‐clinical trial the additional benefit of butterbur in a fixed herbal drug combination (Ze 185 = 4‐combination versus 3‐combination without butterbur and placebo) in patients with somatoform disorders. For a 2‐week treatment in patients with somatization disorder (F45.0) and undifferentiated somatoform disorder (F45.1), 182 patients were randomized for a 3‐arm trial (butterbur root, valerian root, passionflower herb, lemon balm leaf versus valerian root, passionflower herb, lemon balm leaf versus placebo). Anxiety (visual analogue scale – VAS) and depression (Beck's Depression Inventory – BDI) served as primary parameters, Clinical Global Impression (CGI) was a secondary parameter. The 4‐combination was significantly superior to the 3‐combination and placebo (4‐combination > 3‐combination > placebo) in all the primary and secondary parameters (PP‐population). Analysis of the ITT population confirmed these results. As to safety, no serious adverse events occurred. In total 9 non‐serious adverse events were documented but the distribution did not differ significantly between the treatment groups. This herbal preparation (Ze185) showed to be an efficacious and safe short‐term treatment in patients with somatoform disorders. Copyright © 2009 John Wiley & Sons, Ltd.     

The effects of motion artifact and low perfusion on the performance of a new generation of pulse oximeters in volunteers undergoing hypoxemia.

INTRODUCTION: Motion artifact and low perfusion often lead to faulty or absent pulse oximetry readings in clinical practice. OBJECTIVE: Determine the impact of motion artifact and low perfusion on newly introduced pulse oximetry technologies during hypoxemic episodes in healthy volunteers. METHODS: Five different pulse oximeters from 4 manufacturers (the Datex Ohmeda 3900P; the Agilent; the Nellcor N-3000; the Nellcor N-395; and the Schiller OX-1, which is the European version of the Ivy SatGuard 2000 with Masimo SET) were compared with respect to their ability (separated or in combination) to provide accurate readings in the presence of motion artifact and low perfusion. Four of these oximeters represent the latest available oximetry technology, and one (the N-3000) represents a previous generation of oximeters. Oxygen saturation values (S(pO(2))) and pulse rate from the oximeters were recorded during episodes of induced hypoxemia in 10 healthy volunteers. Standardized and repeatable motion artifacts were generated by a motion machine and by having the test subject perform tapping and scratching motions. Perfusion to the finger was reduced by an inflatable balloon impinging on the brachial artery. The pulse oximetry readings from the test oximeters were compared to readings from control pulse oximeters on the unperturbed reference hand. The pulse rates from the test oximeters were compared to the electrocardiographically-measured heart rate. RESULTS: The frequency of faulty readings was increased by increasing motion interference and decreasing perfusion. The S(pO(2)) deviation was within +/- 3% of the reference reading > 95% of the time for all instruments during the control desaturation period in the absence of motion and with normal perfusion. With the combination of motion and low perfusion, the S(pO(2)) error was within +/- 3% less than 62% of the time for all oximeters tested. A significant difference in the frequency of large S(pO(2)) errors was observed only in the direct comparison of the N-395 and N-3000. The N-395 exhibited less frequent S(pO(2)) error exceeding 6% of S(pO(2)) in the combination of the most challenging situations (motion and motion with reduced perfusion). In the same situation the Datex-Ohmeda 3900P and Nellcor N-3000 showed significantly higher pulse rate errors than the other devices (Datex-Ohmeda 3900P 53% of the time and N-3000 37% of the time). CONCLUSIONS: The established model of creating motion artifact and low perfusion is capable of simulating a hierarchy of severe clinical situations. With solely motion or solely reduced perfusion the percentage of errors exceeding +/- 3% of S(pO(2)) increased by 20% and 10%, respectively, compared to the control period. Simultaneous presence of motion and reduced perfusion leads to a relative incidence of > 35% of errors > 3% of S(pO(2)) for the various oximeters. In this situation the N-3000 and the Datex-Ohmeda 3900P exhibited differences between estimated pulse rate and electrocardiographically-measured heart rate > 25 beats/min > 37% of the time.     

Litmus tests for verification of feeding tube location in infants: evaluation of their clinical use

Aims. To examine the clinical use of litmus paper tests for the assessment of aspirates in infants. Background. In connection with establishing a programme for home care of infants with requirement of tube feeding with parents as the infants’ carers, the need for a research‐based method for verification of feeding tube position was identified by nurses as a complement to other methods. In adult care the litmus paper test is commonly used when visual inspection is not sufficient for assessment of aspirates obtained from feeding tubes. Design. Observational study. Methods and material. Nurses performed litmus tests for verification of feeding tube location in a convenience sample of 60 infants born at a gestational age (GA) of 24–42 weeks. Presence/absence and volumes of aspirates were recorded as well as positive/negative litmus test reactions. Analyses on the association between test results and the infants’ GA and postmenstrual and postnatal age at the time of the tests were conducted. Results. Data were obtained from 2970 tube feeds. Aspirates were present on 1840 occasions (62%). A higher proportion of infants with absence of aspirates were born at a GA below 32 weeks. A positive reaction occurred in 97% of the tests in volumes between 0.01 and 22 ml. Birth at a GA below 32 weeks and respiratory problems were associated with negative tests. Conclusion. The high ratio of positive litmus reactions at all maturational levels supports the bedside use of analysis of pH in gastric aspirates for verification of feeding tube location. Relevance to clinical practice. Application of pH indicator paper is recommended as a complementary method for assessment of aspirates from feeding tubes.     

Bactericidal properties of Campylobacter jejuni-specific immunoglobulin M antibodies in commercial immunoglobulin preparations.

Campylobacter jejuni is one of the most common enterocolitis-causing microorganisms worldwide. It is of particular importance in immunodeficient patients, who frequently are prone to develop extraintestinal manifestations. Since these cases respond poorly to antibiotic treatment, a supportive immunomodulating therapy including the administration of C. jejuni-specific immunoglobulins would be desirable. In the present study, nine commercial immunoglobulin preparations for intravenous use were tested for the presence of C. jejuni lipopolysaccharide (LPS)- and outer membrane protein (OMP)-specific antibodies by using immunoblot and enzyme-linked immunosorbent assay techniques. The immunoglobulin G (IgG) antibody reactivities against these antigens were comparable in eight of nine tested immunoglobulin preparations. Only in one preparation were C. jejuni OMP- and LPS-specific IgM antibodies found. In this preparation the immunoblot test revealed a strong reactivity against both flagellin and a major OMP. Moreover, all immunoglobulin preparations recognized OMPs of C. jejuni serotypes Lior 4, 9, 11, and 29 equally strongly, while the reactivity to an anti-Lior 36 isolate was less marked. Furthermore, the bactericidal properties of three immunoglobulin preparations were tested by means of chemiluminescence signaling in and bacterial killing by human polymorphonuclear leukocytes (PMNL). The results show that the IgM preparation enhanced Campylobacter-triggered chemiluminescence signaling in PMNL as well as killing of C. jejuni by PMNL, while the other immunoglobulin preparations did not do so. These results suggest that the administration of immunoglobulin preparations containing C. jejuni-specific IgM antibodies would be beneficial for patients with severe C. jejuni infections.