Primary total hip arthroplasty for displaced intracapsular fracture of the femoral neck: Medium-term functional and radiographic outcomes

The number of complications after primary total hip arthroplasty for displaced intracapsular fractures of the femoral neck is higher than that after operations for osteoarthritis. The aim of this study is to evaluate the number of complications and mid-term functional and radiological findings of patients after primary THA for displaced intracapsular fractures of the femoral neck. Between 1995 and 1998, we operated on a total of 89 patients for acute displaced intracapsular fractures of the femoral neck, i.e. Garden Type 3 and 4. In all the patients we evaluated intraoperative and early postoperative complications. We reviewed clinical and radiological results in 65 patients. The only intraoperative complication was abruption of the greater trochanter. Early postoperative complications occurred in 13 patients (15%). The specific complications, THA dislocation, occurred in 3 patients. Non-specific complications were recorded in 10 patients. No delayed healing of the surgical wound, neural lesion or early, delayed or late infection was recorded. Of 65 patients followed-up for an average of 78 months (range, 62–109 months), 8 patients underwent revision surgery. Of 57 patients with primary THA, very good and good clinical results according to the Harris Hip Score were recorded in 48 patients (84%) and poor results in only 2 patients (4%). Nine of 57 followed-up patients showed radiological signs of loosening (16%). The radiolucent line could be seen in 3 patients in the region of the cup, in 1 patient in the region of the femoral component and in 5 patients in both components. Clinical complaints that would result in indication for reimplantation were recorded in none of the mentioned patients. Number of complications, functional results and resumption of full self-reliance by patients after THA for an intracapsular fracture of the femoral neck are so positive that we consider the indication of THA for a displaced femoral neck fracture fully justified.     

Effects of early enteral nutrition on intestinal permeability and the development of multiple organ failure after multiple injury

Objective: To determine how immediate enteral nutrition (EN) affects gut permeability and the development of multiple organ failure (MOF) in multiply injured patients. Design: Prospective, randomised clinical trial. Setting: 20-bed surgical intensive care unit (ICU), university hospital. Patients: 28 consecutive multiply injured patients, admitted in shock and stabilised in 6 h. Interventions: Patients were randomly assigned to EN started not later than 6 h after admission to the ICU (group A), and to EN started later than 24 h after admission (group B). Measurements and main results: The lactulose/mannitol (L/M) test was performed in patients on days 2 and 4 after trauma, and in 5 healthy volunteers. MOF scores were calculated daily. The mean MOF score from day 4 onwards was 1.84 in group A versus 2.81 in group B (p < 0.002), and was correlated with the time of initiation of EN after injury and the L/M ratio on day 2. The median L/M ratio on day 2 was 0.029 for group A and 0.045 for group B, while on day 4 it was 0.020 and 0.060, respectively. On day 2 after trauma, the L/M ratio was significantly higher in group B (p < 0.05) than in normal volunteers (median 0.014) and was positively correlated with the time of starting EN. Conclusions: In contrast with normal volunteers, the patients started on EN later than 24 h after admission to the ICU demonstrated increased intestinal permeability on the second day after sustaining multiple injury. Also, they had a more severe form of MOF than the group placed on EN immediately upon admission. However, early EN had no influence on the length of ICU stay or the time of mechanical ventilation. Received: 16 March 1998 Final revision received: 15 September 1998 Accepted: 18 September 1998     

Syndrom der polyzystischen Ovarien (PCOS)

Polycystic ovary syndrome (PCOS), including chronic anovulation, hyperandrogenism and polycystic ovaries, is the most common endocrine disorder in women of reproductive age, affecting around 5–10% with familial clustering. Although the pathophysiology of PCOS is not fully understood, insulin resistance with consecutive hyperinsulinemia plays a central role. Among obese women the observed insulin resistance is at least partially explained by excess adipose tissue, but lean women are affected as well. The symptoms of PCOS range from the cutaneous stigmata of hyperandrogenism and sterility to metabolic syndrome. Because of the severe health implications of the metabolic syndrome, the diagnosis of PCOS should include all facets, especially disturbed glucose metabolism. An optimal form of treatment that targets all symptoms does not exist. This review sheds light on some important aspects of PCOS with the aim of raising awareness about its complexity and its consequences.     

Development of a Master of Health Policy and Management programme in the framework of the Tempus project at the Centre School of Public Health,Belgrade

Background  

The most important instrument of EU support for the reforms of higher education in the European countries with the final goal of joining the European Higher Education (HE) Area by the year 2010 is TEMPUS (Trans-European Mobility Programme for University Studies). So far, Tempus is the only EU programme providing support for the reform of HE in the Western Balkans.     

Serologische Krebsdiagnose mittels proteolytischer Systeme

Zusammenfassung Es wird eine Modifikation der Carcinomreaktion nachFuchs beschrieben, die auf Grund einer Kritik der Originalreaktion vonFuchs ausgearbeitet wurde. Der Unterschied von der Originalreaktion besteht darin, daß zwei, genetisch gepaarte Carcinomsubstrate benützt werden, und zwar das Carcinomblutfibrinsubstrat und ein Carcinomgewebesubstrat. Der Beweis der Proteolyse wird durch eine Modifikation der Colimethode vonWollman durchgeführt.Eingegangen am 30. Juli 1942.Die Arbeit wurde unter Mithilfe der Prosektur des Allgemeinen öffentlichen Krankenhauses Prag XII (Vorstand Prosektor Dr.Stolz) ausgeführt.     

Determination of cystathionine beta-synthase activity in human plasma by LC-MS/MS: potential use in diagnosis of CBS deficiency

Cystathionine β-synthase (CBS) deficiency is usually confirmed by assaying the enzyme activity in cultured skin fibroblasts. We investigated whether CBS is present in human plasma and whether determination of its activity in plasma could be used for diagnostic purposes. We developed an assay to measure CBS activity in 20 μL of plasma using a stable isotope substrate - 2,3,3-²H serine. The activity was determined by measurement of the product of enzyme reaction, 3,3-²H-cystathionine, using LC-MS/MS. The median enzyme activity in control plasma samples was 404 nmol/h/L (range 66–1,066; n = 57). In pyridoxine nonresponsive CBS deficient patients, the median plasma activity was 0 nmol/ho/L (range 0–9; n = 26), while in pyridoxine responsive patients the median activity was 16 nmol/hour/L (range 0–358; n = 28); this overlapped with the enzyme activity from control subject. The presence of CBS in human plasma was confirmed by an in silico search of the proteome database, and was further evidenced by the activation of CBS by S-adenosyl-L-methionine and pyridoxal 5′-phosphate, and by configuration of the detected reaction product, 3,3-²H-cystathionine, which was in agreement with the previously observed CBS reaction mechanism. We hypothesize that the CBS enzyme in plasma originates from liver cells, as the plasma CBS activities in patients with elevated liver aminotransferase activities were more than 30-fold increased. In this study, we have demonstrated that CBS is present in human plasma and that its catalytic activity is detectable by LC-MS/MS. CBS assay in human plasma brings new possibilities in the diagnosis of pyridoxine nonresponsive CBS deficiency.