[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.

[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.

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.

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.

[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.

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.

[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.

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 long term outcome of open total and partial meniscectomy related to the quantity and site of the meniscus removed.

Two hundred patients were randomly selected for either a partial or a total meniscectomy for a meniscal tear during open operation. They were followed for a median of 7.8 years after operation. After partial meniscectomy, posterior horn tears had the worst outcome, but this was only apparent when more than two-thirds of the meniscus had been removed. The amount of meniscal tissue excised was inversely related to the function of the knee, except with bucket-handle tears treated by partial meniscectomy. Patients with bucket-handle, anterior and posterior horn tears had similar functional results after total meniscectomy. Preservation of the peripheral rim of the meniscus following partial meniscectomy produces the best functional results.

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.

Articular cartilage changes following meniscal lesions. Repair and meniscectomy studied in the rabbit knee.

A well-defined, longitudinal lesion in the avascular part of the medial meniscus of the right knee was made in 30 rabbits. After 3 months, the lesion was repaired surgically in 12 rabbits, was untreated in 12 rabbits, and a meniscectomy was performed in 6 rabbits. The articular cartilage was studied macroscopically and microscopically at 3-month intervals. Cartilage changes 3 months after meniscectomy were more pronounced than after meniscal repair or than in untreated lesions. However, meniscal repair did not reverse the cartilage changes.

Repair of three-month-old experimental meniscal lesions in rabbits.

Repair of three-month-old longitudinal meniscal lesions in the central avascular portion of the knee joint was investigated in 18 rabbits. Three months after a longitudinal incision was made in the avascular portion of the meniscus, no healing was observed. At that time a full-thickness radial cut from the lesion to the joint capsule, without using synovial flaps or implants, was performed in ten of the 18 rabbits. Three months later, nine of the ten menisci had healed mainly with cartilaginous tissue, although the repaired areas were different from the normal fibrocartilage both histologically and at gross inspection. Synovitis with hyperplasia of the lining cells, which was present in all cases at the time of repair, may play an important role in the healing process.

Epidemiology of meniscal lesions in the knee. 1,215 open operations in Copenhagen 1982-84.

In a suburban area of Copenhagen with approximately 620,000 inhabitants, all the openly operated on meniscal lesions of the knee joint between 1982 and 1984 inclusive were reviewed. The mean annual incidence of meniscal lesions per 10,000 inhabitants was 9.0 in males and 4.2 in females. The highest incidences were seen in the 3rd, 4th, and 5th decades of life. A higher frequency of trauma related to onset of symptoms was found among males (77 percent) than among females (64 percent). The bucket-handle lesion was the most frequent type of meniscal lesion in males (35 percent), whereas peripheral detachment was the most frequent in females (41 percent). A variable frequency of trauma inducing the lesions in males and females did not explain differences in type of meniscal lesion. Nineteen percent of our 1,215 patients had a partial meniscectomy, whereas 0.7 percent had meniscal repair.

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.

Effects of halothane and other chlorinated hydrocarbons on alpha 2-adrenoceptors in the mouse cortex.

A number of general anaesthetics and organic solvents were tested for their ability to inhibit the binding of 3H-clonidine to alpha 2-adrenoceptors in mouse cerebral cortex membranes. The order of potency of the tested agents was: chloroform greater than halothane greater than trichloroethylene greater than carbon tetrachloride greater than dichloromethane. Of these agents halothane was tested further. When saturation curves of 3H-clonidine were constructed, halothane (25 mmol/l added directly to the assay) was found to induce a proportionally greater inhibition at low 3H-clonidine concentrations than at high. Computer modelling these saturation curves indicated that halothane reduced the apparent affinity of 3H-clonidine; Kd = 4.2 nmol/l in the absence of halothane and Kd = 6.0 nmol/l in its presence. Gassing the cortex membranes with 3% halothane induced a practically identical reduction in the affinity for 3H-clonidine; Kd = 4.6 nmol/l for the control versus Kd = 10.7 nmol/l for halothane. The effects of halothane was compared to that of the non-hydrolyzable GTP analog Gpp(NH)p. Gpp(NH)p in the concentration range 10(-8)-10(-3) mol/l dose-dependently reduced the binding of 1 nmol/l 3H-clonidine, the effect being essentially maximal at 10(-4) mol/l. Computer modelling of saturation curves of 3H-clonidine indicated that 0.1 mmol/l Gpp(NH)p reduced the apparent affinity of 3H-clonidine; Kd = 5.4 nmol/l in the absence of Gpp(NH)p and Kd = 9.3 nmol/l in its presence. In addition Gpp(NH)p caused some reduction in the apparent number of 3H-clonidine binding sites. The effect of halothane on 3H-clonidine binding was tested both in the absence and presence of 0.1 mmol/l 1 Gpp(NH)p. During these conditions halothane was slightly more potent in the presence of Gpp(NH)p (IC50 of halothane = 17 mmol/l) than in its absence (IC50 = 41 mmol/l).(ABSTRACT TRUNCATED AT 250 WORDS)

Trichloroethylene and halothane inhibit uptake and metabolism of 5-hydroxytryptamine in rat lung slices.

The effect of exposure to organic solvents on uptake and metabolism of 5-HT was studied in rat lung slices. It was found that under control conditions 5-HT was both taken up and metabolized to 5-HIAA. When halothane (35,000 ppm) or trichloroethylene (18,000 ppm) were equilibrated with the incubation medium the uptake of 5-HT decreased by approximately 50% after 30 min of incubation, and the production of 5-HIAA was inhibited by approximately 70% and 80%, respectively. The results are consistent with earlier studies using a much more elaborate technique, in which halothane and trichloroethylene were found to depress 5-HT uptake in isolated perfused rat lungs. Our results demonstrate that the simpler technique employing lung slices can also be used, to investigate factors affecting pulmonary uptake of endogenous amines, and, potentially, the uptake of other compounds as well.