Heterotopic bone in hip arthroplasties. Cemented versus noncemented.

Sixty-six hip arthroplasties in 55 patients were reviewed to specifically study cemented versus noncemented procedures, as related to heterotopic bone formation (HBF). Other factors considered included the type of arthroplasty, surgical approaches, preoperative and postoperative medicines, preoperative predisposing diagnoses, range of motion, and pain. The overall percentage of heterotopic ossification was 64%. There was no significant difference between cemented (67%) and noncemented (55%) procedures. Except for an increased percentage (80%) of ossification after a trochanteric osteotomy, there were no significant differences between the three reviewed surgical approaches. Male osteoarthritics had the highest overall HBF. Eighty percent of patients who previously had developed HBF also did so with a contralateral hip surgery. Surprisingly, all patients with gout (100%) developed HBF. Acetylsalicylic acid used prophylactically for anticoagulation had no significant effect. Resurfacing arthroplasty procedures accounted for half of the severe grades of HBF. A decreased range of motion occurred with more severe grades of HBF.

[In vivo effects of high density lipoprotein rich serum fractions (HDLF) in the human. 2. Effect of repeated HDLF infusions on atherogenic risk factors and arteriosclerotic vascular changes in patients with and without hyperlipoproteinemia]. / In-vivo-Wirkungen High-Density-lipoprotein-reicher Serumfraktionen (HDLF) beim Menschen. 2. Mitteilung: Einfluss wiederholter HDLF-Infusionen auf atherogene Risikofaktoren sowie auf arteriosklerotische Gefässveränderungen bei Patienten mit und ohne Hyperlipoproteinämie.

10 patients with hyperlipoproteinaemia and 4 normolipaemic smokers with angiographically proved arteriosclerosis of different degrees of severity were infused in 2-week intervals 100 ml HDL-rich Cohn-IV-1 fractions each. After the infusion for 5 days essential phospholipids were injected and a permanent medication with cholestyramin and a choleretic drug were prescribed. In the patients with HLP increases of concentration, decreases of concentration, constancy of the plasma lipids and apoproteins independent of the phaenotype of the HLP as well as an improvement of the state of the antioxidant state were observed. In 6 of 10 patients in reproducible vascular areas regressions of athero- und arteriosclerotic findings could be made evident. Progressions were not observed also in extremely changed arteries in contrast to the normolipaemic smokers and the patients of the control group.

[Coronary surgery in females]. / Koronarchirurgie bei Frauen.

In the last three years, of a total of 617 patients undergoing surgery for ischemic heart disease, 53 were women (8.6%). With one exception, all were in or shortly before the menopause. As compared with men, the women were found to have a preponderance of risk factors. The most unfavorable combination, that of hypertension and hypercholesterolemia, was present in one-third of the patients. Hospital mortality for isolated revascularization was higher in women at 4.9% than in men at 1.5%. The one-year survival rates, however, of 94.4% and 95%, respectively, did not differ between the two sexes. In women, the number of grafts per patient was 2.1 as compared with 2.9 in men. Complete revascularization was achieved less frequently in women than in men; similarly graft patency rate at one year of 66% in women was less than the 84% observed in men. The more marked coronary sclerosis as well as morphologic characteristics of coronary arteries in women construe a special challenge to the surgeon and prerequisite a high degree of technical skill.

Cadmium, cobalt, chromium, and experimental myocardial infarction.

In the case of experimental heart muscle infarction, the infarcted tissue of 18 pigs had a cadmium content of 0.38 µg/g dry weight and a cobalt content of 0.45 µg/g dry weight. In 25 non-infarcted pig hearts, the cadmium concentration amounted to 0.27 µg/g dry weight and the cobalt concentration to 0.37 µg/g dry weight. Thus, as far as the infarcted heart muscle tissue is concerned, there is a highly significant increase in the cadmium content (p<0.01) and a significant increase in cobalt content (p<0.05) compared to a non-infarcted heart. No differences were established with regard to chromium concentrations.

[Myocardial scintigraphy using technetium-99m-diphosphate in combination with selective coronary perfusion scintigraphy and coronary angiography]. / Die Myokardszintigraphie mit Technetium-99m-Diphosphonat in Verbindung mit der selektiven koronaren Perfusionsszintigraphie und Koronarographie.

The findings of the scintigraphy of the myocardium with Technetium-99m-diphosphonate (Tc-99m-DP) of 45 patients with nearly exclusively ischaemic heart disease were compared with those of the selective coronary angiography and those of the selective coronary perfusion scintigraphy. 12 patients exhibited an enlargement of the activity in the myocardium (positive scintigramme). These cases were particularly described in this paper. The levocardiogramme proved disturbances of the motility of the walls in 6 patients. In 5 patients a positive scintigramme of the myocardium was registered. Therefore, the scintigraphy of the myocardium with Tc-99m-DP is regarded as a supplementing, non-invasive method for the diagnosis of more pronounced disturbances of the motility of the heart wall. Furthermore, positive scintigrammes of the myocardium were registered in angina pectoris, condition after aorto-coronary bypass-operation, cardiomyopathy and myocarditis. Since the scintigraphy of the myocardium with Tc-99m-DP is a sensitive method for the poor of cell lesions of the myocardium, it allows a judgment of the floridity of the myocardial process. From this among other results that the scintigraphy of the myocardium may be a help for the indication to the aorto-coronary bypass operation. Clear relations between the scintigraphy of the myocardium, the number of the coronary-sclerotically changed heart vessels and the development of stenosation are not to be established. An immediate connection between the size of the disturbance of the perfusion and the results of the scintigraphy of the myocardium is also not to be recognized.

[Foundations and indications for selective coronary perfusion scintigraphy]. / Grundlagen und Indikationen der selektiven doronaren Perfusionsszintigraphie.

By means of coronarography in the most favourable case only the morphology and function of the vessels up to a diameter of 0.1 mm may be established. By the selective coronary perfusion scintigraphy this gap is closed, for it allows a judgment also of the terminal vascular system of the myocardium. The basis of this method is an occlusion of the arterioles and capillaries by radioactively labelled microspheres, in which case, however, only every 10,000th to 20,000th vessel is embolized for a short time. Thus the proper selective perfusion scintigraphy is for the patient a procedure which is not stressing, which, however, demands a sounding of the coronary vessels. On the basis of our own previous results this investigation method is indicated in the diagnostics of the ischaemic heart disease also in its atypical form, in the indication to the vascularisation operation with aortocoronary bypass and its postoperative control as well as in the cardiomyopathies. Also in load examinations and in pharmacological tests by their use as double nuclide method an enlarged information can be got. The importance of the perfusion scintigraphy is among others shown in patients with normal coronarogramme, but with perfusion disturbances which can be proved by means of this method. The most comprehensive invasive diagnostics in the diseases mentioned is at present achieved by the combination of coronarography, ventriculography and selective perfusion scintigraphy.