AIM: Dysplastic coxarthritis usually occurs earlier than primary coxarthritis. As a rule dysplastic coxarthritis mostly affects young and active individuals. Bilateral coxarthritis may lead to severe impairment requiring surgical replacement of both hip joints, as the patients are frequently dissatisfied with the substitution of one joint alone. METHOD: In a retrospective study, 15 patients with bilateral hip dysplasia who had received total endoprostheses in both hip joints in a one-stage procedure (group A) were compared to 15 patients with bilateral dysplasia who had been operated on bilaterally in two stages (group B). Group B was subdivided into B1 (first side) and B2 (second side). All dysplasias were classified according to Hartofilakidis and Crowe. RESULTS: On the first postoperative day, group A experienced a mean drop of 33.9% in haemoglobin values, group B1 a mean drop of 25.1% and group B2 a mean drop of 26.3%. Patients of groups A/B1/B2 received on average 1.7/1.1/1.3 units of autologous blood and 1.2/0.1/0.3 units of foreign blood, respectively. Both groups experienced an improvement in their quality of life due to marked improvements in their Harris Hip Score and UCLA Score. Group A had no higher rate of complications. CONCLUSION: Although the single-stage procedure involved greater effort in terms of physiotherapy, patients preferred bilateral implantation of total hip endoprosthesis in a single surgical session because they needed to undergo the process of operation, mobilisation and rehabilitation only once.

Adult↗

PubMedDate not supplied

An animal model for lung volume reduction therapy of pulmonary emphysema.

Stapled lung volume reduction surgery (LVRS) has recently been described for treatment of emphysema. Many questions arise regarding physiologic mechanisms of response from surgical treatment of emphysema. The objective of this study was to develop an animal model for the study of lung volume reduction surgery in diffuse heterogeneous emphysema. We hypothesized that elastic recoil would increase, static respiratory system compliance would decrease, and expiratory flows would increase after lung volume reduction surgery in animals with emphysema. In the study, emphysema was induced in 31 New Zealand White rabbits (3-5 kg) with endotracheally aerosalized porcine elastase (10,000-12,000 U). Lateral thoracotomies were performed 4-6 weeks postinduction under general anesthesia and mechanical ventilatory support. Stapled volume reduction was performed on the right lower lobe using a standard multirow pediatric stapler (U.S. Surgical). Pulmonary function tests were performed at baseline (preinduction), before stapling LVRS (postemphysema induction), immediately post stapling LVRS, and 1 week poststapling. Static respiratory system compliance, flow, conductance and forced expiratory flows, and peak flows at 20 and 40 cm3 of exhaled volume were analyzed. Animals were sacrificed 1 week poststapling, and bilateral lungs were harvested for histopathology. Diffuse but heterogeneous pulmonary emphysema was seen in these animals treated with high-dose aerosolized elastase. Static compliance increased, while expiratory flows and conductance decreased after induction of emphysema. Immediately post stapled volume reduction therapy, animals had decreased static compliance. By 1 week following surgery, animals showed increased forced expiratory flows and decreased expiratory resistance, although compliance was similar to preoperative levels. In conclusion, we describe initial results in an animal model of obstructive emphysema suitable for the study of lung volume reduction surgery. Changes in pulmonary function indicate that unilateral lower lobe LVRS increases airway conductance in the rabbits. Findings from LVRS studies in animal models such as this may help explain clinical improvement following LVRS in humans.

Animals↗

PubMedDate not supplied

Effect of lung volume reduction surgery in a rabbit model of bullous lung disease.

Clinical use of staple lung volume reduction surgery (LVRS) has proliferated for treatment of emphysema despite limited data regarding efficacy or optimal techniques. Recent studies in animal models of obstructive lung disease describe the decrease in lung compliance and increase in airway support as mechanisms of an improvement in pulmonary functions analogous to human data. We describe contrasting results in an animal model of bullous lung disease with a mixed but predominantly restrictive pattern of lung disease. Mixed restrictive and bullous lung disease was induced in 17 New Zealand white rabbits with i.v. Sephadex beads and endotracheally instilled carrageenan. Unilateral stapled lung volume reduction surgery was performed at 5 weeks postinduction of emphysema on the right lower lobe by lateral thoracotomy using a pediatric stapler. Static trans-pleural pressures were measured at 60, 40, and 20 cm3 inflation at preinduction (baseline), pre- and postoperatively, and 1 week postoperatively in anesthetized animals. Lungs were then harvested en bloc and examined histopathologically. The effects of volume reduction surgery on static lung compliance, lung conductance, and forced expiratory flows (FEF) were assessed. Five weeks after induction of lung disease, the animals had no significant change in static compliance and forced expiratory volume in 0.5 s (FEV0.5) or lung conductance compared to baseline. Immediately following LVRS, the animals showed a significant decrease in static compliance, FEV0.5, and conductance. One week postoperatively, compliance increased to approximately baseline levels along with a slight increase in FEFs and conductance toward preoperative levels. Histology examination revealed restrictive and bullous lung disease. Thus, we have demonstrated the feasibility of using an animal model for evaluation of volume reduction therapy for restrictive-obstructive lung disease. Physiologically, this model showed decrease conductance and decreased forced expiratory flows following lung volume reduction despite increased recoil. This is in contrast to increased conductance and flows seen in humans with severe emphysema following surgery and suggests that current criteria excluding patients with a significant restrictive component to their lung disease from LVRS surgery may be justified.

Animals↗

PubMedDate not supplied

The possible role of bradykinin as a mediator in bronchial asthma.

A variety of antiasthmatic drugs were examined in a bioassay of uterine cornua of rats for determining their influence upon Bradykinin induced contractions. 4 different actions were seen: pronounced, moderate and weak suppression of enhancement of Bradykinin-activity. The most pronounced blocking effect was seen with Fenoterol, Adrenaline and Pheniramine, a moderate effect with Prednisolone and Tolazoline, a weak effect with Propranolol and DSCG. Noradrenaline showed a stimulating effect. It is postulated that Bradykinin acts via alpha-stimulation with concomitant cAMP-decrease after specific binding to Bradykinin-receptors. The results of the study suggest that Bradykinin still must be discussed as a possible mediator in obstructive airway-disease.

Animals↗

PubMedDate not supplied

Psychological correlates of blood pressure: a closer examination of hostility, anxiety, and engagement.

Recent studies by other investigators have shown that hypertensives are more hostile and anxious than normotensives. The first part of this study examined the relationship between blood pressure measured daily over a one-week period and responses to a series of questions specifically developed to distinguish hypertensives from normotensives. Responses from this sample of undergraduates did not distinguish those with high blood pressure from those with normal values. Mean resting blood pressure was related to hostility and anxiety factor scores among males but not among females. Our second study used a sample of municipal employees and examined blood pressure as a function of comparable anxiety and hostility scores as well as a trait measure of overall "engagement-involvement." More highly engaged workers were no different in anxiety or hostility than less engaged workers. There was some evidence of more variable blood pressure for the former group. It is suggested that stable personality traits such as hostility and anxiety may both precede and follow the diagnosis of blood pressure. For nurses it is important to assess the patient's general psychological profile as well as his of her emotional state at the time of measurement. Repeated blood pressure readings are recommended especially for highly engaged individuals.

Adult↗

PubMedDate not supplied

Use of gene marking technologies in oncology.

Investigation of the mechanism of relapse in patients receiving stem cell rescue as therapy for malignant disease has been facilitated by gene marking studies. These studies have shown the marker gene to be present in malignant cells in the patient at the time of relapse, indicating that infused stem cells can contribute to disease recurrence. As normal progenitor cells are also marked and can be tracked in vivo, these studies have also helped us learn how haemopoietic stem cells respond to manipulation, for example with growth factors. Second generation studies with multiple, modified vectors are beginning to provide information about a wider variety of clinical and biological issues, including the efficacy of purging. Although marker studies have been useful for haematological malignancy and for neuroblastoma, they are hampered by the low efficiency of marking achieved by retroviral vectors. For many malignancies, marking efficiencies are insufficient for useful information to be obtained. This problem may be overcome by the introduction of vectors that, unlike retroviruses, can stably integrate in cells that are not in cycle at the time of vector exposure. Other improvements will focus on the marker genes themselves, using marker elements that are simpler to track and will not produce any modification of the cells' behaviour. Finally, marker studies have proved safe so far, but follow-up of the treated patients continues.

Adoptive Transfer↗