[Release of the lateral retinaculum of the knee in retropatellar chondropathy]. / Klieven van het laterale retinaculum van de knie bij retropatellaire chondropathie.

Retropatellar chondropathy is a frequent cause of pain in the knee; it usually runs a favourable natural course. When the symptoms interfere with work or sports, reduction of pain can be achieved by cleaving the lateral retinaculum (lateral release). To assess the results, a questionnaire was sent to 96 persons; 80 questionnaires could be evaluated. Only patients who had minor or no visible damage of the patellar cartilage were included in this study. Fifty-three patients reported improvement, in spite of which 34 had persistent mild symptoms which forced 12 of them to change the nature of their work. Thirty-seven patients had to change their sports activities in spite of the operation.

Plasma catecholamines in children.

Plasma catecholamine concentrations in 46 children of various ages were determined by a sensitive radioenzymatic assay. Noradrenaline levels were found to be in the same range as in adults, whereas adrenaline levels in a few of the children were abnormally high.

Initiation of oral anticoagulant therapy in orthopedic and surgical patients: an algorithm compared with routine dosing.

Oral anticoagulant therapy is initiated in most hospitals in The Netherlands by clinicians who routinely dose oral anticoagulants (without using an algorithm). This may explain the low proportion of patients leaving the hospital stabilized. To test this hypothesis this study compared the dosing of acenocoumarol in orthopedic and surgical patients using an algorithm with routine dosing. Because of the routine administration of low molecular weight heparin for at least the first 5 days of acenocoumarol therapy, the study focused on supratherapeutic INR-values during this period. The study included 103 patients and was performed on orthopedic surgery and general surgery wards of a Dutch hospital over 5 months. The patients received acenocoumarol as an oral anticoagulant to prevent venous thromboembolism after general of orthopedic surgery. Patients were randomized into a group routinely dosed by physicians (n=54) and a group dosed using a dosing algorithm (n=49). A patient was defined as stable if he had two consecutive INR values within the range of 2-3 during hospitalization with the first (of the two consecutive INR values within range) having been measured on day 5 or later. The groups did not differ significantly in proportion of patients stabilized, time to stabilization, or length of hospitalization. In the first period (days 1-5) the routine dosing group had significantly more INR values above therapeutic range than the algorithm group, while the algorithm group had more INR values below the therapeutic range. There were two bleeding episodes in the routine dosing group and none in the algorithm group. Despite the lack of differences in stabilization between the two groups, this study suggests an advantage of dosing acenocoumarol using an algorithm in a study population consisting of prophylactically treated, mostly elderly orthopedic patients. The algorithm provides a safe dosing schedule for elderly postoperative patients who use low molecular weight heparin and NSAIDs concomitantly and are thus at high risk for bleeding complications.