Trichlorethylene and halothane inhibit uptake of 5-hydroxytryptamine in the isolated perfused rat lung.

Lung uptake of 5-hydroxytryptamine (5-HT) was determined in isolated perfused and ventilated rat lung, and was found to decrease with time according to a two-compartmental model. When the lungs were exposed to either trichlorethylene (TRI) or halothane, the uptake of 5-HT was drastically reduced. Both TRI and halothane gave log dose inhibition curves, which were superimposed, i.e. they were equally potent to inhibit lung uptake of 5-HT. At a concentration TRI of 18,000 ppm, the extraction of 5-HT was inhibited by 80 +/- 2 (X +/- S.E.M.) per cent, at 8500 ppm the inhibition was 65 +/- 6 per cent and 25 +/- 1 per cent at 3000 ppm. When the lungs were exposed to halothane, the inhibition was 85 +/- 6 per cent at 40,000 ppm, 48 +/- 1 per cent at 6000 ppm, and 15 +/- 0.3 per cent at 2000 ppm. When exposure to the solvent was discontinued, extraction of 5-HT was rapidly normalized. There was no detectable displacement of [3H]-5-HT from lungs saturated with the amine when they subsequently were exposed to solvent-containing atmosphere. This inhibition of lung uptake of 5-HT from the circulation is therefore postulated as to be an effect dependent on concentration solvent in the tissue, and is probably due to a reversible membrane stabilization of the endothelium.

Uptake of zimelidine and inhibition of uptake of 5-hydroxytryptamine in the isolated, ventilated and perfused rat lung.

Uptake of zimelidine from the perfusate in isolated perfused rat lung was concentration-dependent. Accumulated zimelidine was released from the lung according to a two-compartment model and lidocaine injected as a bolus did partially displace zimelidine. The properties of the displacement curves indicated, however, that the affinity to the lung tissue was greater for zimelidine than lidocaine. Uptake of 5-hydroxytryptamine added to the perfusion buffer was inhibited by zimelidine. The displacement of zimelidine by lidocaine did not, statistically, significantly alter the extraction of 5-hydroxytryptamine.

Late changes in bone mineral density of the proximal tibia following total or partial medial meniscectomy. A randomized study.

The adaptive bone remodeling in the proximal tibia following medial meniscectomy was measured quantitatively by dual photon absorptiometry. Thirty-three patients who had undergone a meniscectomy (randomized to either total [n=19] or partial [n=14] meniscectomy) performed by open joint surgery approximately 12 years earlier were included in the study. Bone mineral density was measured in the previously injured legs and in the healthy contralateral legs in areas located medially and laterally in the cortical bone of the subchondral plates and below in the trabecular bone of the medial and lateral tibial condyles. The distribution of bone mineral within the proximal tibia showed a characteristic and significant pattern. In the trabecular bone of the healthy contralateral knees, bone mineral density was 15% higher in the medial tibial condyles compared with the values laterally; a total or partial meniscectomy increased this difference to 25%. With regard to the cortical bone of the subchondral plates, the bone mineral density in the healthy knees was 24.8-29.4% higher medially than laterally, whereas after total and partial meniscectomy the differences were, respectively, 37.7 and 41.4%. No significant differences in the distribution of bone mineral density, at either cortical or trabecular measuring sites, were found between totally and partially meniscectomized knees.

Symptoms and level of sports activity in patients awaiting arthroscopy for meniscal lesions of the knee.

Thirty-six patients who had symptoms suggestive of lesions of the meniscus of the knee were put on a waiting list for arthroscopy. Patients who had a locked knee, had had more than two episodes of locking, or had unrelieved swelling were given preference on the waiting list and were not included in the study. By the time of admission to the hospital for elective arthroscopy, six to twenty-four months after being placed on the waiting list, none of the thirty-six patients had worse symptoms: four had no change in symptoms (although two of these had stopped or reduced their sports activity), nine had no symptoms (but six of these no longer participated in sports), and the remaining twenty-three had partial relief of symptoms (but seventeen of the twenty-three no longer participated in sports or had reduced their activity). Four patients remained unable to work. Only two of the twenty-seven who had engaged in sports before they had symptoms resumed their normal sports activity. By the time of admission to the hospital, fourteen patients had decided not to go ahead with the arthroscopy; eight of these had decided to give up sports indefinitely. Of the twenty-two patients who had an arthroscopy, a meniscal abnormality was found in twelve. In two of these, a healed meniscal lesion was found.

Pneumococcal arthritis in the wrist and ankle. A case report and short review of the literature.

In this paper we report a 48-year-old man with septic arthritis of the wrist and ankle due to Streptococcus pneumoniae. No known predisposing factor was found. Only about 300 cases of pneumococcal arthritis have been reported in the literature since 1888 and less than 10% of these affect the wrist. The management of bacterial arthritis is reviewed.

Pes anserinus and iliotibial band transfer for anterior cruciate insufficiency.

Twenty-one patients with chronic anterior cruciate ligament insufficiency were treated with a combined iliotibial band (Ellison) and pes anserinus (Slocum-Larson) transfer procedure. Preoperatively, the most prominent instabilities were drawer laxity in 16 patients and anteromedial rotation in 5 patients. After a median of 34 months of followup, 15 patients were absolutely satisfied with the result, 2 were fairly satisfied, and 4 were not satisfied at all, including 2 patients who had been reoperated. All of the patients with unsatifactory results had a pivot shift and a positive Slocum test. Intraarticular derangements had no influence on the results. At followup, 14 patients demonstrated an anteromedial rotatory instability, indicating that the lateral stabilization procedure acted better than the medial one. Only a few patients returned to their preinjury levels of sports activity. Compared with other extraarticular procedures in the literature, the results were quite similar. The operative procedures used in this study cannot be recommended in cases with combined instabilities of the knee.

Partial versus total meniscectomy. A prospective, randomised study with long-term follow-up.

Two hundred patients with a meniscal lesion were peroperatively allocated to partial or total meniscectomy in a random manner. The results were compared at one year and at 6.3 to 9.8 years (median 7.8). After one year more patients with partial meniscectomy (90%) than with total meniscectomy (80%) had no complaints. At the later review these figures were 62% and 52%, respectively (p = 0.18). However, patients with partial meniscectomy had higher functional scores. The deterioration in function between the first review and the second showed no significant difference in the two treatment groups. The incidence of mediolateral instability rose from 8% to 47% and was more frequent after total than after partial meniscectomy. Between the two reviews the radiological signs of knee degeneration increased with no difference between the two treatment groups.

The value of scintigraphy in hips with slipped capital femoral epiphysis and the value of radiography and MRI after 10 years.

Preoperative bone scintigraphy of the femoral head in 33 hips with slipped capital femoral epiphysis, showed no relation to duration of symptoms or degree of slip. The preoperative uptake was always normal or increased. Two hips had postoperative femoral head uptake below normal, both had complications affecting the vascular supply, resulting in necrosis of the femoral head and severe arthrosis. At follow-up after 10 (5-15) years of 28 hips, no relation could be demonstrated between Adolescent Hip Questionnaire which included clinical data, and radiography or magnetic resonance imaging. We only recommend scintigraphy after complications jeopardizing the vascular supply of the femoral head in slipped capital femoral epiphysis.

[Partial versus total meniscectomy. A prospective, randomized study]. / Partiel versus total meniskektomi. Et prospektivt, randomiseret studie.

Two hundred patients with a meniscus lesion were peroperatively allocated to partial or total meniscectomy. The results were compared at one year and at 6.3-9.8 years (median 7.8). After one year, more patients with partial meniscectomy (90%) than with total meniscectomy (80%) had no complaints (p = 0.029). At the late review these figures were 62% and 52% respectively (p = 0.18). However, patients with partial meniscectomy had the highest functional scores. In five percent knee joint function had improved and in 35% deteriorated, in the latter group without detectable difference between partial and total meniscectomy. The incidence of lateral laxity rose from eight to 47%, most frequently seen after total meniscectomy. During the observation period radiological signs of knee joint degeneration changed from solely joint line narrowing into additional ridge formation and flattening of the femoral condyle, but unrelated to whether partial or total meniscectomy had been performed. Following partial meniscectomy posterior horn lesions had the poorest functional outcome, but only if more than one third of the meniscal surface had been removed. The amount of meniscal tissue excised was inversely correlated to the level of knee joint function except in bucket handle lesions treated with partial meniscectomy. These lesions had the largest areas of meniscal tissue removed, but higher functional scores than posterior horn lesions. Preservation of the peripheral rim of the meniscus following partial meniscectomy was essential for the functional outcome after surgery.

[Osteogenesis imperfecta. The effect of intramedullary nails in long tubular bones]. / Osteogenesis imperfecta. Effekt af marvsøm i lange rørknogler.

INTRODUCTION: The aim of the study was to describe the clinical, radiological, and functional results of intramedullary nailing of deformities in the lower extremities of children with osteogenesis imperfecta after the use of multiple osteotomies and non-telescoping rods (rush pins). MATERIAL AND METHODS: Eight children with osteogenesis imperfecta, who consecutively underwent surgery during 1991-1994, were entered in the study. RESULTS: Sixteen operations were performed on eight children: 12 on the femur and four on the tibia. Like others, we found a high complication rate, 50%. Radiological correction of angular deformities was good. The functional outcome was satisfactory and the patients were satisfied. CONCLUSION: Correction and stabilisation of deformities in the lower extremities in children with osteogenesis imperfecta with the use of non-telescoping rods is an acceptable method of decreasing fractures and allowing most formerly non-ambulatory children to walk. Furthermore, the cosmetics were improved.

[Bilateral Achilles tendon rupture in individuals with renal transplantation]. / Bilateral akillesseneruptur hos nyretransplanterede.

Increased incidence of tendinitis and tendon ruptures is reported in recipients of a kidney transplant. Two cases of bilateral achilles tendon rupture after minimal trauma are described. Tendon ruptures are more frequent in individuals with kidney disease in dialysis or after transplantation compared with patients receiving other organ transplantations. It is therefore more likely that tendon ruptures are related to metabolic changes associated with kidney disease rather than with transplantation or with glucocorticoid treatment per se. Clinical symptoms of achilles tendinitis should be considered as warning signs prior to tendon rupture and treated appropriately to avoid further morbidity. There is no contraindication towards surgical suturing of an achilles tendon rupture in patients receiving immunosuppressive treatment including glucocorticoids.

[No development of HIV infection after transfusion with HIV-contaminated blood and postexposure antiviral prevention]. / Manglende udvikling af hiv-infektion efter transfusion med HIV-kontamineret blod og efterfølgende antiviral forebyggelse.

In the case reported here, transfusion or HIV RNA-positive HIV seronegative blood did not lead to infection of the recipient, probably because potent postexposure antiretroviral therapy was initiated promptly.