Effects of calcium and phosphate on catecholamines, ATP and dopamine beta-hydroxylase of chromaffin medullary granules.

Isolated bovine chromaffin granules lost their catecholamines to a significantly higher degree when incubated in isotonic sucrose-buffer of pH 7.4 containing 10 and 25 mM sodium phosphate, respectively, than during incubatation in sucrose with 4 mM sodium phosphate. 2. In 4mM sodium phosphate-sucrose, CaCl(2) in a final concentration of 1 and 2 mM, respectively, produced only traces of an amorphous precipitate of calcium phosphate which increased the efflux of catecholamines only to a small degree. The same concentrations of CaCl(2) in 10 and 25 mM sodium phosphate containing sucrose solutions caused larger amounts of calcium phosphate precipitate and simultaneously a very high efflux of catecholamines. Small amounts of exogenous ATP (1 mM) and MgCl(2) (0.3 mM) effectively antagonized the efflux of catecholamines from the granules evolked by calcium phosphate...

Augmentation with the longitudinal patellar retinaculum in the repair of an anterior cruciate ligament rupture.

Most authors advocate repair of the acutely ruptured ACL by augmentation or some form of primary reconstruction. Strong autogenous tissues like the patellar and semitendinosus tendons and the iliotibial band are often used when augmentation is the surgical choice. This paper describes a surgical procedure using a strip of the longitudinal patellar retinaculum as an augmentation of the repaired ACL. The retinaculum adds stability and strength to the repaired ACL during the healing period. Moreover, the retinaculum may enhance the healing process of the ruptured ACL by revascularization. It may also increase the stimulation of synovial tissue proliferation over the repaired ACL. Twenty-eight patients have been clinically and objectively evaluated at a mean follow-up time of 78 months (range, 63 to 94 months). The patients' own evaluation of their knee function was excellent or good in 86% (24 patients). Eighty-two percent (23 patients) could return to their preinjury activities at the same intensity level as before injury, whereas at an intermediate followup at 18 months only 64% (18 patients) had done so. Anterior tibial displacement was objectively evaluated at both followups by means of the anterior drawer test, with 20 degrees to 30 degrees and 90 degrees of knee flexion, in a testing device. The operated knee usually showed a tendency to a slightly increased anterior displacement when compared with the uninjured knee. The repair of a ruptured ACL with an augmentation using the longitudinal patellar retinaculum has been shown to give good results after more than 5 years.

Postoperative pain following knee arthroscopy: the effects of intra-articular ketorolac and/or morphine.

BACKGROUND AND OBJECTIVES: Morphine and nonsteroidal antiinflammatory drugs (NSAID) have been found to be effective in relieving postoperative pain. The goal of this study was to determine whether ketorolac alone or in combination with morphine provides superior pain relief following arthroscopy performed with local anesthesia (LA). METHODS: This was a randomized, double-blind, prospective, study in 100 healthy patients from 15 to 60 years of age. Knee arthroscopy was performed with LA using 40 mL prilocaine (5 mg/mL) with adrenaline (4 microg/mL). At the end of the operation, a catheter was inserted intra-articularly, and one of the following solutions diluted to a total volume of 40 mL was injected: group P (40 mL normal saline), group M (3 mg morphine), group K30 (30 mg ketorolac), group K60 (60 mg ketorolac), and group KM (3 mg morphine + 30 mg ketorolac). Visual analog scale (VAS) pain scores (0-100 mm) were measured preoperative and at 30, 60, 90, 120 minutes postoperative and thereafter 4, 8, 24, and 48 hours at rest and on movement of the knee. The total number of distalgesic tablets (325 mg paracetamol + 32.5 mg dextropropoxyphene) consumed during the 48 hours postoperative was recorded. RESULTS: Significant differences in VAS pain scores were seen between group P and group KM at 4, 8, and 24 hours (P < .05) and between group M and group KM at 4, 8, 24, and 48 hours (P < .01) after the operation at rest. During mobilization of the knee, a significant difference in VAS pain score was found between group P and group KM at 8, 24, and 48 hours (P < .05) and between group P and group K60 at 24 and 48 hours (P < .05). The total consumption of distalgesic tablets did not differ among the groups. CONCLUSIONS: The combination of 3 mg morphine plus 30 mg ketorolac provided significantly better analgesia than either placebo alone or morphine alone. This result could be a synergistic effect.

Cervical collars in rheumatoid atlanto-axial subluxation: a radiographic comparison.

Atlanto-axial subluxation occurs with a frequency varying from 6% to 45% in rheumatoid arthritis. Most patients are treated conservatively with a cervical collar. The effectiveness of different cervical collars in inhibiting anterior atlanto-axial subluxation was tested in 11 patients with classical rheumatoid arthritis. None of the collars had any major influence in inhibiting anterior subluxation of the atlas in maximal flexion. Furthermore, the harder collars with a stable cervical stand forced the atlas to subluxate anteriorly in some of the patients.

An alternate method for posterior fixation in anterior and inferior atlanto-axial dislocation.

A modification of common methods is described for fixation of anterior and inferior atlanto-axial dislocation (AAD and IAD). In AAD a wire is passed around the atlas arch and knotted around the spinous process of the axis in a way that a figure 8 arrangement is achieved as seen in the lateral view. In IAD a wire is passed through holes in the occiput and knotted around the spinous process of the axis. A rectangular bone graft is inserted between the occiput and the spinous process of the axis, thus preventing further inferior dislocation. In both methods methyl methacrylate and bone grafts are as a rule added for further long-time stabilization. The methods have been used in 15 cases of AAD and in three cases of IAD. On radiologic examination with attention focused on the immediate postoperative fixation the follow-up time has been three months. The long-time results of fixation have been recorded with a follow-up time of six years. The fixation proved to be satisfactory in 14 patients with AAD and in the three patients with IAD. The clinical results were good in the 14 patients with AAD and in the three with IAD.

Metatarsal head resection in the treatment of the rheumatoid forefoot.

When conservative treatment in the management of the painful rheumatoid forefoot fails, surgery should be advocated. The aim is to relieve the sole from pressure on the metatarsal heads, which causes callosities on and pain in the forefoot. Various surgical procedures have been described, but they have in common to replace or remove the fat pad under the metatarsal phalangeal joints, to resect the metatarsal heads and, in doing this, restore the metatarsal ends to a flat arc. For if the intermediate metatarsals are left too long, new pressure points may develop, with ensuing pain. In this investigation a 4 1/2-year follow-up is presented of 32 patients operated on with metatarsal head resection in 59 feet. Twenty-two patients representing 39 feet were very satisfied, whereas 8 patients representing 15 feet were dissatisfied. Walking ability improved considerably; standing on toes improved; muscle power of toes improved. Despite attempting to maintain the metatarsal arc as a flat curve, this proved to be uneven in 25 feet, but did not jeopardize the results. The complications were minor and did not influence the final results. These, however, were decidedly influenced by the functional class of the patient at the time for investigation. Surgical management of the painful rheumatoid forefoot appears to be a recommendable procedure.

The Swedish experience with Salter's innominate osteotomy in the treatment of congenital subluxation and dislocation of the hip.

The results of 83 Salter's innominate osteotomies (i.o.) performed to correct congenital subluxation and dislocation of the hip joint in 76 patients were reviewed. The overall radiographic results were classified as excellent or good in 34 hips (41%) and as fair or failure in 49 hips (59%). The best results were obtained in subluxated hips, previously not treated or treated only with closed reduction, prior to i.o. in patients operated on before the age of 5 years. In that group of hips, excellent or good results were obtained in 18 of 20 hips (90%). The poorest results were obtained in hips with residual subluxation or dislocation after previous operation with a result of fair or failure obtained in 26 of 28 hips (93%).

Psychological factors related to health, back pain, and dysfunction.

Psychosocial variables may be important determinants of experienced back pain as well as dysfunction. This paper reports on differences on a battery of psychosocial variables between women, from the same work place, off work because of back pain, having only back pain (not off work), and those without back pain. The groups suffering pain had similar levels of pain intensity and frequency and the covariates of age and work load were used in MANCOVA analyses. The results showed significant overall differences on the Coping Strategies Questionnaire, Handicap Index, Duke Health Profile, as well as items concerning family support and the relation of pain to work. Several variables differed between the Healthy group on the one hand and the two groups suffering pain on the other hand. However, coping strategies and perceived health produced significant differences between all three groups in univariate analyses. Unlike other studies the Work APGAR produced no significant results. These data suggest that work status is not directly related to pain intensity, but rather to an interaction between psychosocial factors and the pain experience. Future research should delineate which variables may be used in screening.