Revision of infected hip replacement: Two-stage procedure with a temporary gentamicin spacer

We revised 5 infected totally-replaced hips in 2 stages. At the first operation a gentamicin-loaded modelled cement spacer was inserted, and the definitive prosthesis was inserted 3-8 weeks later. 9-24 months after the last operation, there was a recurrent infection in 1 case. 2 of the patients could walk in the interval.     

Milk Transfer and Neonatal Uptake of Coplanar Polychlorinated Biphenyl (PCB) Congeners in Mice

Abstract: The selective accumulation of 3,3′,4,4′-tetrachlorobiphenyl metabolites in late gestational foetal blood and soft tissues in mice as a result of administration of different coplanar polychlorinated biphenyl (PCB) congeners, is reported elsewhere. The situation in the nursing neonate after maternal exposure to the same congeners is now studied: The ¹⁴C-labelled congeners 3,V,4,4′-telrachlorobiphenyl (IUPAC number CB-77), 3 ,3′,4,4′,5-pentachlorobipheny] (IUPAC number CB-126), 3 ,3′,4,4′,5,5′-hexachlorobiphenyl (IUPAC number CB-169) (all three non-ortho congeners) and 2,3,3′,4,4′-pentachlorobiphenyl (IUPAC number CB-105) (mano-ortho congener) were injected intravenously in lactating mice at day 11 post partum. One day and four days later, milk and neonatal/maternal tissues and plasma radioactivity was monitored by liquid scintillation counting (dose: 2.0 μmol (20-50 μCi)/kg body weight). In milk, CB-126, -169 and -105 showed higher levels (1450-2520 pmol/ml; one day after administration) than did CB-77 (580 pmol/ml), and in neonates, the relative whole-body levels of radioactivity (CB-169 and -105 highest) were related to the levels seen in milk (probably the consequences of their metabolic persistence). The comparably high ¹⁴C-concentration found in neonatal liver (about 15,000 pmol/kg) after CB-126 administration and in plasma (880 pmol/ml) after CB-77 administration could be explained by binding to specific proteins. In general, neonatal mice had two to seven times higher plasma levels than those of their mothers. These results indicate that CB-126, -169 and -105 are transferred via milk to neonates in considerable quantity and are deposited mainly in neonatal liver, whereas CB-77 is transferred in a comparably lower amount and accumulated in neonatal plasma. The lower ^l4C-levels in the NMRI mothers and offspring (about half of C57BL values in maternal and neonatal plasma), could possibly be explained by a differentiated metabolism of CB-77 in these two strains.     

Comparison of growth and reinnervation properties of cholinergic neurons from different brain regions grafted to the hippocampus

Grafts of five different types of central cholinergic neurons, from the septal-diagonal band region, the nucleus basalis magnocellularis region (NBM), the striatum, the pontomesencephalic tegmentum of the brainstem, and the spinal cord, were compared with respect to their ability to grow and to reinnervate the cholinergically denervated hippocampal formation of adult rats. The areas were dissected from 14 to 15-day-old rat fetuses, and the same number of viable cells (35 X 10(4) from each of the different regions were stereotaxically injected as cell suspensions into the hippocampus of rats subjected to a transection of the intrinsic septo-hippocampal cholinergic pathways. At 17-19 weeks after transplantation, the various graft types differed considerably in their volume, the total amount of acetylcholinesterase (AChE)-positive fiber outgrowth, and the innervation pattern and morphology of the AChE-positive fibers growing into the host hippocampus. On average the NBM and spinal cord grafts had grown to become three to four times larger than the septal and the brainstem grafts, and 15-20 times larger than the striatal grafts. By contrast, the total ingrowth score of AChE-positive fibers in the host hippocampus from the septal grafts was about twice that of the NBM and brainstem grafts, about five times greater than the striatal grafts, and about six times greater than that of the spinal cord grafts. The large NBM grafts thus exhibited similar fiber outgrowth to the much smaller brainstem grafts, and the AChE-positive neurons of the grafted spinal cord grew very poorly into the hippocampus despite the fact that they survived very well. The innervation pattern and morphological features of the ingrowing AChE-positive fibers in the host hippocampus proper and in the dentate gyrus resembled those of normal rats in animals with grafts from any of the three forebrain regions (i.e., septum, NBM, or striatum), whereas ingrowth from the brainstem and spinal cord grafts were markedly abnormal with respect to both innervation pattern and fiber morphology. These results provide further evidence that the overall survival, growth, and fiber outgrowth of intracerebral neural grafts depend on interactions with the surrounding host tissue. Since the ability to reinnervate the previously denervated host target was greatest for the neuron type normally innervating that area, i.e., the septal-diagonal band neurons, we conclude that neuronal properties beyond the transmitter type are essential for the optimal performance of implanted neurons in intracerebral grafting experiments.     

Correlation between simultaneous scintigraphic and ultrasonographic measurement of gastric emptying in patients with type 1 diabetes mellitus.

OBJECTIVE: To compare scintigraphic measurements of total stomach emptying of a semisolid meal with ultrasonographic measurements of changes in antral area as estimates of antral emptying in type 1 diabetic patients. METHODS: Eleven patients with insulin-dependent diabetes mellitus were studied with simultaneous measurements of gastric emptying by scintigraphy and ultrasonography. Patients were imaged immediately after ingestion (time 0) and every 15 minutes over 120 minutes. The gastric emptying rate was expressed as percent reduction in antral cross-sectional area from 15 to 90 minutes after meal ingestion. RESULTS: Ultrasonographic measurements showed a postprandial maximal antral area at 15 minutes, continuously decreasing with time, and reaching a plateau 45 to 90 minutes after the end of meal ingestion, whereas the scintigraphic counts attained their maximum immediately after the meal and began to fall thereafter. Between 15 and 90 minutes, the residual radioactivity and antral ultrasonographically measured distension curves were concordant. The curves then showed a tendency toward deviation for the last 15 minutes (median, 51% versus 59% at 105 minutes and 40% versus 57% at 120 minutes, respectively). A strong significant correlation could be seen between the ultrasonographic gastric emptying rate and scintigraphic half-time values (r = -0.94; P < .001). Comparing scintigraphic and ultrasonographic half-time values showed a systematic measurement error of 9.9 minutes and a random measurement error of 18.6 minutes. CONCLUSIONS: The use of standardized real-time ultrasonography to determine the gastric emptying rate of semisolid meals in diabetic patients, with the use of the change in gastric antral cross-sectional area in a single section of the stomach 15 and 90 minutes postprandially, offers a valid method for clinical practice.     

In vivo acetylcholine release as measured by microdialysis is unaltered in the hippocampus of cognitively impaired aged rats with degenerative changes in the basal forebrain

Acetylcholine (ACh) release was studied in awake, freely moving animals using in vivo microdialysis in the hippocampus of young (3-month-old) and aged (24-month-old) female Sprague-Dawley rats. Two groups of aged rats were selected on basis of their spatial learning performance in the Morris water maze: non-impaired aged rats which performed as well as the young control animals, and impaired aged rats which learnt the task very poorly. Baseline ACh overflow (in the presence of 5 microM neostigmine) was 1.9 +/- 0.3 +/- pmol/15 min in the young animals and 1.6 +/- 0.4 pmol/15 min in both the impaired and the non-impaired aged rats; these levels did not differ from each other. Depolarization by KCl (100 mM) or muscarinic receptor blockade by atropine (3 microM) added to the perfusion fluid produced dramatic, 4-6-fold, increases in ACh overflow that was similar in magnitude in both the young and the aged impaired and non-impaired rats. Behavioral activation by either handling or electrical stimulation of the lateral habenula produced 2-3-fold increases in extracellular ACh-levels in the hippocampus similarly in all three groups. The results indicate that hippocampal ACh release is maintained in aged rats that exhibit severe spatial learning and memory impairments and that the septo-hippocampal cholinergic system retains its capacity to increase its ACh release in response to both K(+)-induced depolarization and behavioral activation in the aged rat.(ABSTRACT TRUNCATED AT 250 WORDS)     

Trends in cancer incidence,survival and mortality in northern sweden 1960-1986

The impact of cancer on a population may be measured in several ways. Incidence, relative survival and mortality are frequently utilized for this purpose. Incidence and relative survival are, however, often influenced by changes in the diagnostics of incident cancer, particularly by an altered rate of detection of non-fatal cancer. Mortality, as traditionally studied, is often influenced by changes of death causes diagnostics or of cocling routines. In an attempt to overcome some of these difficulties, the concept of excess mortality was suggested, which is independent of death cause diagnoses or cocling routines, as well as of the rate of detection of non-fatal cancer. In order to elucidate time trends in the overall effects of cancer we analysed incidence, survival and mortality from all cancer in the northern region of Sweden 1960—1986. An increasing age-adjusted cancer incidence was paralleled by an improvement in relative survival, whereas age-adjusted cancer mortality was mainly unchanged, at least when studied as excess mortality. We interpreted these finclings as due mainly to an increased detection of non-fatal cancer, and to an unchanged occurrence rate of fatal cancer.     

Early respiratory depression during Caesarean section following epidural meperidine

A case of respiratory depression which occurred following administration of epidural meperidine during Caesarean section is described. Epidural meperidine, 75 mg (10 mg.ml-1) was given after delivery of the infant to provide postoperative analgesia. Oxygen desaturation (SaO2 90%) and a decrease in respiratory rate (4.min-1) were noted 30 min after epidural meperidine was administered. Naloxone, 0.1 mg, was given iv which resulted in prompt improvement in both respiratory rate and oxygen saturation. Vascular absorption of meperidine from the epidural venous plexus is the most probable explanation for this case of early respiratory depression. We recommend a maximum bolus dose of 50 mg of epidural meperidine for pain management after Caesarean section. It is also important to monitor oxygen saturation continuously during the intraoperative period, and to monitor the patient closely in the recovery room for at least one hour for evidence of respiratory depression.     

Effects of intraocular perfusion with two alternating irrigation solutions on the simultaneously recorded electroretinogram of albino rabbits

The direct current electroretinogram (DC-ERG) of 15 unilaterally vitrectomized albino rabbits was studied during continuous intraocular irrigation with a recently developed solution (PHS) produced by Pharmacia Ophthalmics. The mean amplitudes of the b- and c-waves were somewhat lower than corresponding values of previously investigated reference subjects, but not statistically different. In 11 of the 15 rabbits PHS was then replaced by the commonly used balanced salt solution (BSS). The fluids were subsequently repeatedly alternated (PHS, BSS, PHS, BSS, PHS). During irrigation with BSS the average amplitude of the b-wave was reduced to 87% (p < 0.02) and that of the c-wave to 63% (p < 0.001) of the levels obtained during perfusion with PHS. In two rabbits the ERG was studied about one month after vitrectomy, where PHS-irrigation was used both during surgery and for 30 min after its completion. No marked differences were observed between the treated and the untreated eyes as to the b- and c-wave amplitudes at stable stages of the recording. Thus, judged by the ERG, retinal and pigment epithelial functions were influenced unfavorably by BSS, whereas they seemed to be well preserved with PHS. From this point of view PHS appears to be an excellent irrigation solution for vitreoretinal surgery that ought to be clinically tested.     

Two cases of gastric carcinoids: Diagnostic and therapeutic aspects

Two cases of gastric carcinoid tumors with the foregut carcinoid syndrome are presented. Due to elevated urinary levels of 5-hydroxyindoleacetic acid (5-HIAA), primary tumors of midgut origin were suspected. Provocation with pentagastrin (PG) elicited atypical flushing and severe bronchoconstriction, most probably caused by the release of histamine. Excessive excretion of the main histamine metabolite, tele-methylimidazole acetic acid (MeImAA), in urine of both patients was demonstrated. Both patients had good symptomatic relief with prednisolone and blockade of histamine receptors. One of the patients had excessive secretion of serotonin (5-HT) as well as of histamine. Peripheral blockade of 5-HT₂receptors was therefore added to the medical treatment. This patient had a subjective and biochemical response to cytotoxic treatment with streptozotocin and later responded well to a somatostatin analogue.On clinical suspicion of a foregut carcinoid tumor, or in patients with carcinoid tumors without anatomical localization, PG provocation should not be used until the excretion of MeImAA has been determined.

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Resumen Se presentan 2 casos de tumores carcinoides gástricos con el síndrome carcinoide del intestino anterior. Los altos niveles urinarios de ácido 5-hidroxiindolacético (5-HIAA) hicieron sospechar la presencia de tumores primarios de origen en el intestino medio. El estímulo con pentagastrina (PG) provocó un flush atípico y broncoconstricción severa, muy probablemente causada por liberación de histamina. La excreción excesiva del metabolito principal de la histamina, el ácido tele-metilimidazolacético (MeImAA) fue demostrada en ambos pacientes, y ambos obtuvieron mejoría sintomática con prednisolona y bloqueo de los receptores de histamina. Uno de los pacientes presentó secreción excesiva de serotonina (5-HT) así como de histamina. Por ello se decidió añadir el bloqueo periférico de los receptores 5-HT₂ al regimen terapéutico. Este paciente mostró respuesta subjetiva y bioquímica al tratamiento citotóxico con estreptozotocina y ulteriormente respondió bien a un análogo de la somatostatina.Cuando se sospeche de un tumor carcinoide del intestino anterior, o en presencia de pacientes con tumores carcinoides sin ubicación anatómica, la prueba de estímulo con PG no debe ser utilizada hasta cuando se haya determinado la excreción de MeImAA.

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Résumé Deux cas de tumeurs carcinoïdes de l'estomac s'accompagnant d'un syndrome carcinoïde sont rapportés par les auteurs. En raison de l'élévation des taux du 5-HIAA (acide 5 hydroxyindolacétique) le diagnostic de tumeurs carcinoïdes d'origine digestive fut envisagé. L'emploi de la pentagastrine (PG) provoqua un flushing atypique et une broncho-constriction intense plus que probablement provoqués par la libération d'histamine. Une excrétion anormalement élevée du métabolite principal de l'histamine, l'acide acétique téléméthylimidazole (MeImAA) dans l'urine des 2 malades fut mise en évidence. Ils bénéficièrent d'une nette amélioration des symptômes qu'ils présentaient grâce à la prednisolone et au blocage des récépteurs histaminiques. Un des 2 malades accusait une sécrétion excessive de sérotonine (5-HT) et d'histamine; le blocage périphérique des récepteurs 5-HT₂ fut de ce fait adjoint au traitement. Ce malade répondit favorablement sur le plan clinique et biochimique à un traitement cystotoxique par la streptozotocine et plus tard par un analogue de la somatostatine. Chez les malades qui sont suspects d'être porteurs d'une tumeur carcinoïde de siège indéterminée l'emploi de la pentagastrine doit être écarté jusqu'à ce que l'excrétion de la MeImAA ait été mise en évidence.

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This work supported by the Swedish Medical Research Council (grant nos. 2235, 2207, 5520, 6534) and the Swedish Life Insurance Company.