The effects of standard, fat-rich, protein-rich, and carbohydrate-rich diets combined with either long-term ethanol ingestion or tap water ingestion on the behavior of plasma phospholipase A2 activity during experimental acute pancreatitis were studied in rats. Phospholipase A2 activity was compared with amylase activity in the plasma. Three hundred eighty-four male Wistar rats were randomized into eight groups receiving different diets with either 15 percent (volume for volume) ethanol or tap water for 12 weeks. Thereafter, all groups were subdivided into control (intact) and pancreatitis subgroups. Pancreatitis was induced by retrograde bile infusion into the pancreatic ducts. Sampling was performed 24 hours after induction in the surviving rats. Ethanol ingestion alone and in combination with the fat-rich diet increased the mortality rate (p less than 0.05), whereas the lowest mortality rate was observed in the carbohydrate-rich diet and water and the carbohydrate-rich diet and ethanol groups. Plasma phospholipase A2 activity increased in most of the groups, but it correlated with the mortality rate in the standard diet group only. Plasma amylase activity increased significantly in all groups, but did not correlate with mortality rate. Plasma phospholipase A2 activity seems to be dependent on diet in experimental acute pancreatitis in rats. Plasma amylase activity may be less affected by the dietary composition, but the lack of a correlation with mortality makes it unreliable as a parameter of severity in experimental acute pancreatitis.
The CT features of 66 hepatic haemangiomas and 77 malignant mass lesions were evaluated in a retrospective study. On plain CT the attenuation values of haemangiomas varied from 30 to 50 HU, and 57 (86.4%) of them were homogeneous in density. Two haemangiomas did not enhance after contrast injection, while the others showed immediate peripheral rim-like enhancement, 46 (69.7%) of which enhanced intensely and 18 faintly. 45 (68.2%) haemangiomas enhanced completely, 19 (28.8%) becoming hyperdense within 2 to 13 min (median 5.5 min) and 26 isodense in 3-45 min (median 8 min). The central opacification was incomplete in 19 (28.8%) lesions. The attenuation values in the malignant tumours varied from 10 to 58 HU on the plain scans and 50 (64.9%) were non-homogeneous in density. After contrast injection, 2 did not enhance, 2 enhanced homogeneously and 73 (94.8%) non-homogeneously. Predominantly peripheral enhancement was seen in 42 (54.5%) of the malignant lesions, with 35 (45.5%) being classed as faint and 7 (9.1%) intense. The attempt to identify the haemangiomas among the malignant lesions resulted in 35 true-positive results reflecting a sensitivity of 64.8%, a specificity of 100%, and an accuracy of 85.5%. The results of this study suggest that a proportion of haemangiomas presents CT features which justify a confident diagnosis.
The wrists and elbows of 23 patients were examined at a mean follow-up of 5 years (2-10 years) after excision of the radial head for an isolated fracture. Fourteen elbows and 13 wrists were symptomatic. Proximal migration of the radius was seen in 15 cases; the mean distance of migration being 1.4 mm. Osteoarthritis, mostly mild, was seen in 17 elbows and 14 wrists and limited movement of the elbow was a common finding. Excision of the radial head for fracture had a high complication rate.
Hepatic bile flow and its bile acid composition were determined in a group of 23 rats receiving 20% (W/v) ethanol by daily intubations 5 times a week over a 10-12 week period and in a control group of 23 rats. The aim was to elucidate the well known role of alcohol in pancreatitis. Chronic ethanol administration resulted in a significant increase in 2-h bile production and bile secretion rates. Molar concentrations of total and individual bile acids were determined by the hydroxysteroid dehydrogenase method after thin layer separation. No significant differences in molar concentrations of total or separate bile acid were observed. Special attention was paid to free bile acids. A spot with a Rf value corresponding to cholic acid was found in 10 rats in each group. This was examined by mass spectrometry using direct inlet technique, but no free cholic acid could be identified. Thus it seems that the changes in the amounts of bile acids are not decisive for the origin of acute alcoholic pancreatitis but that increased bile flow caused by chronic alcohol ingestion may favour reflux of bile into the pancreas, resulting in pancreatitis.
PURPOSE: The aim of this paper is to introduce the extended data set inquiries of the Standardised Audit of Hip Fractures in Europe (SAHFE) and to report our experiences of its use. METHOD: The extended SAHFE data set was applied to 238 consecutive patients (mean age 78.4 (50 - 102) years, 52 males, 186 females) aged over 50 years with non-pathological fractures of the hip. The extended data set contains 95 questions concerning the patient's abilities prior fall and at follow-up, detailed background factors, concomitant diseases, additional details of the injury, treatment, fracture type and reduction and complications. RESULTS: Thirty-nine percent of the fractures occurred at home and 38% in a hospital. Thirteen percent of the cervical fractures were non-displaced (Garden 1 & 2) and half of the trochanteric fractures intertrochanteric two-part fractures (A11 - A13). The mean Garden alignment index evaluated from antero-posterior roentgenograms changed from the preoperative 144 degrees to the postoperative 168 degrees and that from lateral projections from 144 degrees to 171 degrees , respectively. Most of the patients (89%) had associated diseases, especially cardiovascular conditions. The patients' functioning was significantly impaired at four months compared with the preoperative situation according to the ADL score. The need for social support and assistance had increased, respectively. A total of 63% of the surgeries were delayed for more than 24 hours. Low molecular weight heparin was given to every patient for thromboembolic prophylaxis and 92% received antibiotic prophylaxis. Urinary tract (21%) and chest infections (7%) were the most common complications. The deep infection rate was 2.5%. CONCLUSION: The extended SAHFE data set is useful and makes it possible to study in more detail the background and outcome factors of hip fractures in a standardized manner.
Recently, it has been shown that hip fractures can be effectively prevented by use of hip protectors. To determine who would gain most benefit from use of hip protectors, we conducted a study with the aim to clarify factors that contribute to the occurrence of fracture in individuals who fall on their hip. Hip fracture patients were compared with individuals who had fallen on their hip without sustaining a fracture. The study group consisted of 123 consecutive hip fracture patients aged 70 years or over (mean age 82 years, female 82 years and male 80 years). The control group comprised 132 individuals (mean age 81 years, female 81 years and male 80 years) obtained from a prospective study on falls, who had experienced a fall that caused a visible soft tissue injury (bruise or wound) at the hip or gluteal region without sustaining a fracture. Patients were questioned about associated diseases, medications, place of residence, walking ability, need for locomotor aids and some activities in daily living (ADL). Patients who sustained a hip fracture were more likely to be women, living in long-term institutional care, using neuroleptics, dependent in ADL and had more history of previous stroke with hemiparesis, more Parkinsonism and lower body mass indexes (BMI) than those who did not sustain a fracture on fall on the hip. According to a logistical regression model, institutional residence, low BMI and history of stroke with hemiplegic status differed between fracture cases and controls. Institutional residence, low BMI and history of hemiplegic stroke discriminate hip fracture patients from fallers who sustain a soft tissue injury on the hip region. In clinical practice, patients who have these characteristics would be potential candidates to use hip protectors and other preventive measures.
The effects of chronic ethanol ingestion combined with fat-rich, protein-rich or carbohydrate-rich diets on the histology of the intact rat pancreas were studied. 192 male Wistar rats were randomly divided into four different dietary groups. Half of each group received 15% (v/v) ethanol in their drinking solution and the rest were used as controls and given tap water. After a 12-week diet period the pancreas were removed and histological specimens were stained with hematoxylin and eosin. No significant difference was observed between the groups in occurrence of edema, but inflammatory cells were found in (9/24) rats in the fat-rich group receiving water (p less than 0.01. In the fat-rich diet group receiving ethanol this finding was observed in 5 of 24 rats. In these groups slight parenchymal cell necrosis was also observed in conjunction with the inflammatory cells. All specimens in the other groups were normal. It is suggested that inflammatory changes caused by a fat-rich diet may be due to unknown toxic effects of this diet.
BACKGROUND AND AIMS: As a rule, follow-up for at least one year is recommended for fracture studies. This is considered the shortest reliable interval. Still, in the case of hip fractures of the elderly, shorter follow-up might be more practical, since the life expectancy of these patients is often short. The aim of this study was to see if a short four months follow-up period would be acceptable in hip fracture surveys. MATERIAL AND METHODS: Information on 196 consecutive non-pathological hip fracture patients aged 50 years or over (mean 79 years) was collected using a standardised hip fracture audit concentrating on functional measurements at admission and at four and twelve months' follow-ups. RESULTS: 167 patients were alive at four months and 152 and at one year. The patients who died between four and twelve months had poorer functional capacity in the four- month evaluation than those who survived one year. The analysis of repeated measures, including only the patients alive at the last follow-up, showed that residential status, use of walking aids and 6 out of 10 and ADL variables (bathing, toileting, shopping, household activities, doing laundry, banking) did not change significantly. Walking ability and the rest 4 ADL variables (dressing, eating, food preparation, use of transportation) improved and pain decreased. CONCLUSIONS: Due to high mortality and age-related deterioration of functioning, no steady state i.e. "final result" is ever reached after hip fracture in the elderly. Four-month follow-up is justified as the shortest possible period, because the socioeconomically most important variable, i.e. place of living, and most of the ADL functions do not change significantly after that.
The aim of the study was to assess the change in function and residential status four months after hip fracture in patients over 50 years of age and living independently at home at the time of fracture. All consecutive hip fracture patients treated at Oulu University Hospital during 1989--1999 were followed up. Data collection was done on standardized hip fracture forms, which were filled in at admission and at four months postoperatively. The forms included demographic data, place of residence, locomotor ability, use of walking aids, data on the fracture and its treatment, hospital stay, place of discharge and pain. At four months, 16.0% of the men and 14.3% of the women were permanently institutionalized. Preoperatively, 81.1% of the patients had been able to walk out of doors either alone or accompanied, while at 4 months, less than half of the patients (149 men, 391 women) were able to do so. Two thirds of the hip fracture patients had been able to walk without walking aids before the fracture, the corresponding proportion being one fifth at four months after the fracture. Cumulative mortality at 4 months was 9.9%, being higher among the male (15.5%, n=53) than the female patients (7.9%, n=75). The original study population was also divided into two subgroups operated at different period of time (1989--92 and 1993--99), the functional results seemed to improve with time. Hip fracture leads to the institutionalization of every seventh patient able to live at home at the time of fracture and impairs markedly one's functional capacity. To restore the pre-fracture status as well as possible and to reduce the burden of the consequences of hip fracture, it might be beneficial to evaluate and improve the existing rehabilitation system.