Both poor cardiorespiratory and weak muscle fitness are related to a high concentration of oxidized low-density lipoprotein lipids.

Good physical fitness is associated with favorable serum lipids. Oxidized low-density lipoprotein (ox-LDL) could be even more atherogenic than serum lipids. We studied the association of ox-LDL and serum lipids with physical fitness. Healthy young (mean age 25 years) men (n=846) underwent maximal oxygen uptake (VO(2max)) and muscle fitness index (MFI) tests and completed a leisure-time physical activity (LTPA) questionnaire. Age (ANCOVA1), age+waist circumference+systolic blood pressure+fasting blood glucose+smoking (ANCOVA3) were used as covariates. The groups with the lowest VO(2max), MFI and LTPA had 23%, 16% and 8% higher concentrations of ox-LDL than the groups with the highest VO(2max) (P<0.0001), MFI (P=0.022) and LTPA (P=0.039) groups, respectively. Subjects with poor fitness (low VO(2max) or low MFI) or low LTPA had elevated levels of ox-LDL/high-density lipoprotein (HDL)-cholesterol, total cholesterol, LDL-cholesterol, triglycerides and a low level of HDL-cholesterol (ANCOVA1, in all, P<0.05). Furthermore, low VO(2max) is associated with a high level of ox-LDL/HDL-cholesterol and triglycerides, and with a low level of HDL-cholesterol (ANCOVA3, in all, P<0.05). Also, subjects with low LTPA had a high ratio of ox-LDL/HDL-cholesterol (ANCOVA1, P=0.001). In conclusion, both poor fitness (both low VO(2max) and low MFI) and low LTPA are associated with a higher concentration of ox-LDL lipids and serum lipids, which may indicate a higher risk for atherosclerosis.

Blunt Abdominal Trauma in a European Trauma Setting: Need for Complex or Non-Complex Skills in Emergency Laparotomy.

BACKGROUND AND AIMS: Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon. MATERIALS AND METHODS: The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006-2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated. RESULTS: A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4). CONCLUSION: The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.

Perioperative platelet rich plasma (PRP) in total hip arthroplasty through the Hardinge approach: protocol to study the effectiveness for gluteus medius healing.

BACKGROUND: Platelet-rich plasma (PRP) has been used to support tendon regeneration mainly in sports medicine. PRP is a concentrate of platelet-rich plasma proteins derived from whole blood by centrifugation to remove erythrocytes and leukocytes. PRP has high amounts of platelets which may promote healing tendons affected by degenerative conditions. These platelets contain growth factors and are known to facilitate the regeneration of injured tendon structures. Total hip arthroplasty (THA) through the Hardinge approach may leave the patient with impaired gait and poor regeneration of the gluteus medius tendon if the tendon is not reattached properly after closure of the surgical wound. METHODS: The study will be a multicenter, double-blinded and randomized study enrolling 90 patients based on power calculations. The efficacy of perioperative PRP treatment will be assessed by subjective and objective outcome variables. The participants will be randomized (sealed envelope) into either a placebo (saline) or a PRP group (1:1). For subjective outcomes, the Oxford Hip Score (OHS) will be collected before surgery and 3 and 12 months after surgery. The objective measures are findings at magnetic resonance imaging and plain radiographs and recorded values of measured strength. DISCUSSION: We present the perioperative use and the ways to measure the clinical efficacy of PRP. As PRP may have benefits regarding degenerative tendon regeneration, studies on the use of PRP in hip arthroplasty are warranted to facilitate postoperative recovery. TRIAL REGISTRATION: This study has been approved by the ethics committee of the Hospital District of Southwest Finland and approved by the local institutional research board. The study has been registered in ClinicalTrials.gov ( NCT02607462 ).

Tendon Graft Healing in Multiligament Reconstructed Knee Detected by FDG-PET/CT: A Pilot Study.

BACKGROUND AND AIMS: The detection of graft viability is challenging in the multiligament reconstructed knee. Magnetic resonance imaging gives structural information but lacks the capability to assess biological activity of the grafts. (18)F-labeled fluorodeoxyglucose positron emission tomography combined with computer tomography is shown to be a sensitive method for imaging tissue metabolism and viability. The aim of the present study was to evaluate the feasibility of fluorodeoxyglucose positron emission tomography combined with computer tomography imaging in the detection of the replacement graft metabolism in multiligament reconstructed knees. MATERIALS AND METHODS: Seven patients (17-44 years) with multiligament reconstructed knee underwent fluorodeoxyglucose positron emission tomography combined with computer tomography to evaluate the biological activity of replacement grafts. The degree of fluorodeoxyglucose uptake reported as standard uptake values from the region of interest was analyzed 3-24 months postoperatively. RESULTS: In all patients, the fluorodeoxyglucose positron emission tomography combined with computer tomography showed increased fluorodeoxyglucose uptake in all replacement grafts at different follow-up time points. Furthermore, fluorodeoxyglucose was higher at femoral condyles of operated knees compared to contralateral reference values. CONCLUSION: This pilot study shows a significant increase in tendon graft metabolism during two first years of postoperative healing. The fluorodeoxyglucose positron emission tomography combined with computer tomography imaging seems to be adequate method of assessment of graft metabolism and viability during postoperative healing. The clinical value of fluorodeoxyglucose positron emission tomography combined with computer tomography imaging, however, warrants further evaluation with longitudinal studies with a larger patient population.

Update of safety of cefotaxime.

Adverse reactions to various antibacterial drugs were compared in a review of the following: multiple-dose studies of cefotaxime (n = 3,463), cefazolin (n = 554), the combination gentamicin-clindamycin (n = 163), and cefoxitin (n = 18); prophylactic studies of cefotaxime (n = 300) and cefazolin (n = 149); and single-dose studies of cefotaxime (n = 314) and penicillin G procaine (n - 265). The demographic and background characteristics of the groups were similar. Results of extensive pretreatment and posttreatment laboratory tests, measures of vital signs, and physical examinations revealed no clinically important intergroup differences. In the multiple-dose studies, side effects were reported in 9.8% of the cefotaxime, 3.8% of the cefazolin, 17.2% of the gentamicin-clindamycin, and 16.7% of the cefoxitin patients. The most frequent side effects were reactions at the injection site, of the skin and appendages, and of the digestive and urogenital systems, the only significant difference being fewer injection-site reactions in the cefazolin group than in the other three groups. In the prophylactic studies one cefotaxime patient reported rash and pruritus. In the single-dose studies, side effects were reported in 1.6% of the cefotaxime and 4.2% of the penicillin patients. Side effects sufficiently severe to warrant drug discontinuation were reported in 2.1% of the cefotaxime, 0.7% of the cefazolin, 1.8% of the gentamicin-clindamycin, and in none of the cefoxitin patients. Posttreatment prolongation of prothrombin time was found in one cefotaxime patient, whose pretreatment value was also abnormal, and in two gentamicin-clindamycin patients. No patient deaths were attributed to any of the drugs.

Antibiotic prophylaxis in genitourinary surgery: a comparison of cefotaxime and cefazolin.

In a prospective, single-blind study, the efficacy of cefotaxime and cefazolin in the prevention of postoperative infection was compared in 133 patients admitted for elective genitourinary surgery (over half of whom were undergoing transurethral resection). In regimen 1, cefotaxime was given perioperatively (before, during, and up to two hours after surgery); in regimen 2, cefotaxime was given perioperatively and for 24 hours postoperatively; and in regimen 3, cefazolin was given perioperatively and for 24 hours postoperatively. All doses equaled 1 gm and were given either intramuscularly or by intravenous bolus. All patients had negative urine cultures preoperatively. The criterion for absence of infection was a negative urine culture (less than 10(5) organisms/ml) after surgery. At the final evaluation, 113 of the 133 patients (85%) were free of infection--39 of 45 (86.7%) on regimen 1, 40 of 45 (88.9%) on regimen 2, and 34 of 43 (79.1%) on regimen 3. All 20 patients who had postoperative infections had been catheterized for at least three days. Only 12 patients had temperatures greater than or equal to 101 F two days after surgery, and none had been clinically septic. No side effects other than a mild rash and itching in one patient on regimen 2 were reported. Both cefotaxime regimens were slightly more effective, bacteriologically and clinically, than the standard prophylactic cefazolin regimen. It is concluded that cefotaxime given perioperatively (up to two hours postoperatively) and/or up to 24 hours postoperatively effectively prevents postoperative complications associated with genitourinary surgery.

Antibiotic prophylaxis in genitourinary surgery.

Antibiotic prophylaxis in surgery, particularly genitourinary surgery, has been controversial for years. At best, the results have been more testimonial than scientific because of the failure to observe proper experimental design. A survey of the literature indicates that antibiotic prophylaxis in genitourinary surgery probably has little influence on postoperative fever; it appears to favorably affect the incidence of postoperative bacteriuria and bacteremia in the short term without encouraging nosocomial or resistant infections. The regimen for prophylaxis must be perioperative and continued for no longer than 24 hours postoperatively. Given that antibiotic prophylaxis in elective genitourinary surgery has merit, a comparison between cefazolin and cefotaxime was undertaken. Of 160 evaluable cases, a total of 23 patients had positive cultures within the first nine days; only two occurred within the first five days. When cefazolin and cefotaxime were administered in the same dosage regimen, the infection rate for cefazolin was 19% compared with 10% for cefotaxime.

The 24-hour effects of glyburide and chlorpropamide after chronic treatment of type II diabetic patients.

A single-blind, randomized, comparative evaluation of glyburide (GL) and chlorpropamide (CP) therapy was performed in twenty previously untreated patients with non-insulin dependent diabetes mellitus (NIDDM) of about two years duration. Only newly diagnosed patients who were never treated and whose fasting blood glucose (FBS) levels were greater than 140 mg/dl after a six to eight week trial of dietary restriction were evaluated. Metabolic studies were performed before and after four months of therapy. GL and CP produced essentially the same effects on serum levels of glucose, insulin, glucagon (IRG), growth hormone (GH), cholesterol, and triglyceride. The mean 24-hour glucose levels for both the GL and CP groups were significantly lower than the pretherapy values (p less than 0.001). The mean 24-hour insulin levels did not change significantly during therapy (p greater than 0.05). Excellent control of plasma glucose was possible during the entire day without producing nocturnal hypoglycemia. Neither GL nor CP therapy influenced the mean 24-hour levels of IRG, GH, or cholesterol. However, mean 24-hour levels of triglyceride were lower in both groups. IRG levels were elevated and the pattern of change in the insulin and IRG levels paralleled each other, which suggested that glucagon may play a role in the resistance of insulin action in NIDDM. GH levels were normal and remained unchanged during therapy. It was concluded that detailed 24-hour studies are important for better understanding the spectrum of abnormalities in newly diagnosed patients with NIDDM who were never treated.(ABSTRACT TRUNCATED AT 250 WORDS)

Buserelin as primary therapy in advanced prostatic carcinoma.

The effectiveness of buserelin, a luteinizing hormone-releasing hormone agonist, was tested in 28 patients with Stages C or D adenocarcinoma of the prostate. Of 24 evaluable patients, there were 13 partial responses (54%) by National Prostatic Cancer Project criteria, median duration greater than 6 months. Nine patients had stable disease (38%), median duration greater than 5 months, and only two patients progressed. Performance status improved in 38%, patient-scored pain improved in 46%, and quality of life improved in 57%. Symptoms occurring during treatment consisted of hot flashes, loss of libido, and impotence. A flare of symptoms was observed in only one patient, despite a transient 25% increase in testosterone in 36% of patients. Buserelin is an effective treatment for inducing frequent and meaningful remissions in advanced prostatic cancer.