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Biomedical subjects

A Alho

Publications and source records attributed to A Alho.

At least 145 records · Page 8Linked to original sources
PubMed1980

Internal fixation versus endoprosthesis in the treatment of femoral neck fractures in the elderly. A prospective analysis of the comparative costs and the consumption of hospital resources.

The consumption of hospital resources and the costs involved in treating femoral neck fractures in the elderly were studied and a comparison was made between internal fixation (von Bahr screws) and primary prosthetic replacement (Christiansen's endoprosthesis). The 1-year results of screw fixation were excellent or good in 55% of the patients, fair in 17% and poor in 28%, compared with 79% excellent or good results, 13% fair and 8% poor results in the prosthetic group. As regards the initial stay in hospital, prosthetic replacement was found to be associated with 2.4 times higher costs. This difference was reduced, however, by a more expensive follow-up and more frequent readmissions and reoperations in the internal fixation group. Considering the total costs, prosthetic replacement was found to be 1.6 times more expensive than internal fixation.

Aged↗
PubMed1980

Acetabular protrusion following endoprosthetic hip surgery: a multifactorial study.

Acetabular protrusion was found in 56 out of 211 patients fitted with a hemiprosthesis. The indication for operation was acute femoral neck fracture or failure following a previous internal fixation. A number of radiological variables were analysed with respect to their possible association with preoperative, operative and follow-up variables. After a preliminary screening of variables a deeper analysis was performed by fitting log-linear models to the data. Our analysis showed that the development of protrusion has a significant association with follow-up time. A previous hip operation was also significantly associated with the development of protrusion. This may be an indication for total hip replacement in some patients who now receive a hemiprosthesis as a secondary operation. Acetabular protrusion was significantly associated with the development of postoperative pain, while the other clinical symptoms and signs lacked any direct association with protrusion. Although acetabular protrusion and loosening of the prosthetic stem showed a significant association the analysis indicated that pain was primarily due to protrusion.

Acetabulum↗
PubMed1980

Fat embolism syndrome: etiology, pathogenesis and treatment.

A special type of respiratory distress syndrome has been described in connection with fractures of the long bones, called fat embolism syndrome. In addition to the respiratory signs - tachypnoea, hypoxaemia and snow storm infiltrations in the chest x-ray films- the syndrome consists of petechiae, thrombocytopenia, cerebral disturbances, pyrexia etc. The respiratory insufficiency in this syndrome may be explained by a coagulation disorder, in which the release of tissue thromboplastins from the traumatized tissues results in an interstitial pneumonitis and peripheral thrombocytopenia. Accumulation of fat in the lung microvasculature has been observed both clinically and post morten. The importance of fat for the pathogenesis of the syndrome is not clear, but fat globuli are present in quantities, which are not encountered in other types of post-traumatic pulmonary insufficiency. Careful observation of a patient with multiple fractures is the cornerstone of early diagnosis. Cautions handling and early stabilization of fractures reduce the tissue trauma and may thus reduce the manifestations of the fat embolism syndrome. Respiratory assistance is given when necessary, and most often the syndrome is self-resolving. Fulminant cases with increasing symptomatology are treated with methylprednisolone and respirator.

Embolism, Fat↗
PubMed1980

Hyperbaric oxygen treatment in gas-producing infections.

Thirty patients with gas-producing infections were treated with surgery, antibiotics and hyperbaric oxygen during 1964-1977. Fourteen patients were infected with C. perfringens or C. septicum, 8 patients with B. fragilis or B. melaninogenicus, in 7 patients only aerobic bacteria were found, and in one patient no bacteria could be demonstrated. Thirteen patients had infections due to wounds, lacerations and/or compound fractures. Nine patients had gas-producing infection after surgery. Eight patients had abscesses and gas-producing infection. Of the 14 patients with clostridial infections, 2 patients died, and 6 underwent amputation. Four of the 8 patients with Bacteroides infection died, no amputation having been performed. Of the 7 patients in whom only aerobic bacteria were demonstrated, 3 patients died.

Adolescent↗
PubMed1979

Allogeneic transplantation in low-grade malignant bone tumours. A new operative technique to avoid amputation.

A massive allografting of deep-frozen cadaver bone or hemi-joint was performed in 11 patients with tumours which were diagnosed as aggressive, low-grade malignancies. One patient died from a pre-existing hepatic insufficiency. The other 10 patients have been followed up from 1 to 8 years. These patients received two bone grafts and eight hemi-joint grafts around the knee joint. The operative procedure consisted of fixation of the graft by stable osteosynthesis, surrounding the graft-host junction with an autogeneic iliac chips cuff and, in cases of hemi-joint grafts, reconstruction of the ligaments. X-ray, scintigraphy and biopsy were used to judge the incorporation of the graft. The patients had to be prepared to face a considerable morbidity with long non-weight-bearing periods and possibly further operations. A full restitution of function was achieved in the bone graft cases. The patients with hemi-joint grafts were also able to retain their limb with a good or satisfactory function. No metastases or recurrences were experienced. The allograft procedure appears to be useful for younger adults, whose long life expectancy makes this operation justifiable, although the fate of cartilage still is unpredictable.

Adolescent↗
PubMed1978

Corticosteroids in patients with a high risk of fat embolism syndrome.

The effects of methylprednisolone on the clinical fat embolism syndrome were studied in a series of 60 patients who had at least two fractures of the pelvis, femur and tibia and who did not have any other important injuries. This series was dichotomized at random, and 29 patients were given 10 milligrams per kilogram of methylprednisolone three times, once upon admission and, then, at eight and 16 hours post-traumatically. Thirty-one patients served as controls. Fat embolism syndrome was defined as a combination of hypoxemia, bilateral "snow storm" infiltrations of the lungs, petechial rash, mental disturbances, pyrexia, anemia and thrombocytopenia. Varying degrees of the syndrome were observed in two patients given methylprednisolone and in 15 patients in the control group. Methylprednisolone reduced all individual signs. There were no fatalities in this series of fracturers. No complications were observed from the use of methylprednisolone. Methylprednisolone in an early pharmacologic dosage is effective in fulminant instances of fat embolism that occur in spite of adequate respiratory care and the proper treatment of fractures.

Adolescent↗
PubMed1978

Blunt hepatic injury.

Fifty-six cases with blunt hepatic injuries occurred in 255 laparotomies on patients with multiple injuries. Pre-operatively, one-half of the patients were in profound shock. In these cases hepatic bleeding was often accompanied by bleeding in other sites, usually from a ruptured spleen or into a retroperitoneal haematoma. Diagnosis was aided by laparocentesis and peritoneal lavage. In 3 cases the diagnosis was delayed for 8--12 hours. The lacerations were sutured in 43 cases, a local resection was made in 10 cases and a lobar resection in 3 cases. Manual compression of the liver was the best way of achieving temporary haemostasis. In cases where haemodynamic stability was not achieved post-operatively, immediate re-operation to attain haemostasis was definitely advantageous. The mortality from multiple blunt injuries was high (17%) but especially so in cases with hepatic injury (41%). Liver injuries after blunt trauma can often be managed by suturing, and hepatic resection in seldom necessary.

Abdominal Injuries↗
PubMed1977

Red and white muscle fibres in meniscectomy patients. Effects of postoperative physiotherapy.

Clinical examination of the knee joint of 16 meniscectomy patients was performed and muscle biopsies were taken preoperatively and four weeks postoperatively from the vastus medialis of the quadriceps muscle. Corresponding investigations were performed in 15 healthy volunteer controls. One group of the meniscectomy patients was given routine postoperative physiotherapy, the other group intensive physiotherapy. Type I and II muscle fibres were determined from the muscle biopsies of the myosin-ATPase staining method. No difference was observed in the clinical and histochemical findings between the patients given routine and intensive physiotherapy respectively. Compared with the controls, the older patients had clinical quadriceps atrophy preoperatively, but there were no differences in the muscle fibre composition. After meniscectomy the patients developed even more marked quadriceps atrophy, which was more manifest in the patients with a good preoperative muscle status. The surface areas of the type I and II fibres of the operated patients diminished compared with the samples from the healthy volunteer controls. Only in the male patients was the decrease in the type I muscle area considerable. The present data indicate that meniscectomy is accompanied by a marked change in the clinical and histochemical appearance of the quadriceps muscle compared with the muscle status following meniscus injury; the extent of physiotherapy as carried out in the present study did not significantly modify the results.

Adenosine Triphosphatases↗
PubMed1977

Catecholamines in shock.

The role of endogenous catecholamines in various clinical shock and stress states is reviewed; the effects, especially on the peripheral circulation, of catecholamine secretion are the same independent of the cause. Risks of using sympathomimetic agents in the treatment of shock are evaluated. A prolonged noradrenaline activity is to be expected in surgical stress states, e.g. multiple injuries, fat embolism syndrome, burns and infections; therapeutic approaches to minimize the sympathoadrenal activity are outlined.

Catecholamines↗
PubMed1977

Short term prognosis in sciatica. A prospective study of factors influencing the results with special reference to myelography.

334 Types of follow-up data were collected in 158 patients with sciatica. The following information was obtained: (a) in L4-L5 herniations, Achilles tendon reflex disturbance was not explained by S1 root compression, as visualized at this level on myelography, (b) a water-soluble myelogram was also reliable for extreme lateral herniations and only those herniations dislocated into the intervertebral root canal remained undiagnosed, (c) a positive neurological or myelographic diagnosis of herniation did not mean a better short-term prognosis. Operative removal of a large herniated mass gave the best chance of good recovery. The main indication for myelography is a guide to the surgeon for the correct operative level.

Adolescent↗
PubMed1976

[Serum enzymes in seriously injured patients].

In 45 patients with multiple injuries due to trauma, admitted consecutively to our clinic, the following enzyme activities were studied, beginning at the onset of treatment: SDH, GPT, GLDH, and acid phosphatase. The mean levels of SDH rose in all patients between 2 and 24 h after trauma. The mean values of GPT were above normal between 2 and 48 h after trauma; this rise was more pronounced and statistically significant in those patients who eventually died of trauma than in the less severely injured ones. Twenty-four hours after trauma, the levels of GLDH were 16 times higher in the first group of patients than in the less severely injured group. These results lead us to the conclusion that through serum level measurements of these enzymes particularly of GPT it is possible to evaluate the degree of tissue damage and the general state of this group of patients.

Acid Phosphatase↗