Håkan Linderholm

INTRAOSSEOUS HYPERTENSION AND PAIN IN THE KNEE

The intraosseous pressure in the femur and tibia near the knee and in the internal saphenous vein at knee level was measured in fifty-three patients with suspected knee lesions. There were four groups: with and without degenerative osteoarthritis and with and without aching rest pain of the knee region. Low intraosseous pressures were found in patients with neither osteoarthritis nor rest pain, and in half the patients with osteoarthritis but without rest pain. Low pressures were found in the tibia, but very high intraosseous pressures were found in the femur in most patients with osteoarthritis and rest pain. Patients with no osteoarthritis but with rest pain mostly had high pressures in both the tibia and the femur.

IMMEDIATE EFFECT OF OSTEOTOMY ON THE INTRAMEDULLARY PRESSURE OF THE FEMORAL HEAD AND NECK IN PATIENTS WITH DEGENERATIVE OSTEOARTHRITIS

Recently, Arnoldi, Linderholm & Miissbichler (1971, and to be published) demonstrated a considerable hypertension in the cancellous bone marrow of the proximal part of the femur in patients with advanced stages of coxarthrosis. Simultaneous examinations by means of intraosseous phlebography indicated that the high pressure was accompanied by impaired venous drainage from the femoral head and neck. There are indications that intramedullary hypertension may be a causative factor for the aching rest pains typical of these patients. Therefore we have thought it of interest to investigate the effect upon intramedullary pressure of two operative procedures routinely performed for painful conditions in osteoarthritis of the hip. In both procedures the medullary space is opened and drained, in osteotomy, in the subtrochanteric region, in Smith Petersen cup arthroplasty by removal of bone and cartilage from the femoral head. In the present study the immediate effect of both procedures upon the intramedullary pressure was tested. MATERIAL Two groups of patients with degenerative osteoarthritis of the hip joint were examined. The first group consisted of seven patients treated by means of intcrtrochanteric osteotomy. In the second group, containing eight patients, Smith Petersen cup This work was supported by the Swedish Medical Research Council (Project No.

Prediction of Spirometric Values in Patients with Scoliosis

The prediction of normal spirometric values requires a measure of the non-deformed body height of scoliotic patients. The arm-span method has been used for estimating the non-deformed body height in spite of the fact that opinions about the normal relationships between body height and arm span differ. In order to minimize the error of estimation of non-deformed body height, the normal relationships between body height and arm span were determined for 91 males and for 118 females of ordinary body stature, varying age (5-78 years), and Swedish origin. The body-height/arm-span relationships were described by linear regression equations taking age into account. The results indicate significant sex and age differences in the arm-span/height ratio. Multiple regression equations including arm span and age as regressors were used to calculate the non-deformed body height in scoliotic patients. The arm-span method was compared with the method using the degree of lateral curvature of the spine for calculation of non-deformed body height of scoliotic subjects. The arm-span method resulted in a correction of body height and predicted spirometric values that agreed closely with those obtained by the method using the degree of curvature of the spine. The two methods may be used alternatively. In accordance with earlier reports, the predicted spirometric values were underestimated when the measured body height was used.

Arsenic and Raynaud's phenomenon

SummaryOccupational and environmental exposure to inorganic arsenic is associated with the occurrence of Raynauds phenomenon and objectively registered abnormal finger systolic blood pressure at local cooling (FSP). A subnormal FSP during cooling indicates a vasospastic tendency. It is not known whether these phenomena are related to recent or historical long-term exposure to arsenic. Twenty-one workers from a Swedish smelter were selected on the basis of exposure to arsenic dust for more than 14 years and a previously (three years earlier) recorded subnormal FSP during local cooling. The workers were examined before and after a 4 to 8 week summer vacation. After this intermission in arsenic exposure the urinary excretion of arsenic decreased to normal values, whereas the vasospastic reaction in the fingers remained. Thus the vasospastic tendency seems to be unrelated to the most recent urinary arsenic levels. FSP levels on cooling were significantly increased as compared with the measurements made three years earlier. This suggests a gradual improvement in finger blood circulation caused by decreased exposure to arsenic as evaluated over a time period of several years. The data thus indicate that peripheral vascular disturbances caused by arsenic are dependent on long-term arsenic exposures and are independent of short-term fluctuations in arsenic exposure.

Isometric Bite Force in Children and its Relation to Body Build and General Muscle Force

Bite force, muscle strength in various muscle groups and body build (skeletal dimensions) were examined in 12 year old children, 37 boys and 42 girls. There were no statistically significant differences in bite force between boys and girls, and only small differences between the children and adults (20-30 years of age) who had been examined earlier with the same technique. In the children, maximum bite force covariated slightly with muscular force and skeletal dimension (r = 0.24 – 0.28, P<0.05), while no statistically significant correlation was found in similarly examined adults. It is suggested that masticatory training is important for bite force while factors relating to body build seem less important.

Effect of the Milwaukee brace on vital and ventilatory capacity of scoliotic patients.

The vital capacity (VC) and the maximal voluntary ventilation (MVV) were studied in 29 patients with scoliosis (predominantly idiopathic). The results obtained confirmed earlier observations that scoliotic patients have decreased VC and MVV. The immediate effect of the application of the Milwaukee brace was a slight though statistically significant decrease in MV, whereas there was no significant effect on VC. Treatment with the Milwaukee brace for a mean period of 15 months did not appreciably influence the VC or MVV, as a percentage of the predicted normal values of the patients, when measured without the brace applied.

Comparative Toxicity of Gentamicin and Cefotetan

In a prospective, randomized, comparative study, the renal, hepatic and gastrointestinal toxicity and effects on the vitamin K dependent coagulation factors of gentamicin and cefotetan were compared. Gentamicin, which in all but one patient was combined with a penicillin, was found to cause a significant decrease of glomerular filtration rate (GFR) after 1 week of treatment. In 6/14 patients a further decrease of GFR was found during the week following the last treatment day. The renal proximal tubular cells were affected by gentamicin, as evident from significant increases in urinary activity of 2 tubular enzymes, alanine aminopeptidase (AAP) and N-acetyl-beta-D-glucosaminidase (NAG), as well as rises of urinary beta 2-microglobulin. Changes in GFR and tubular function were reversible. No statistically significant changes of these variables were seen with cefotetan. One cefotetan treated patient developed diarrhoea of moderate severity and 2 patients in the same group developed minor increases of liver transaminases. A small but statistically significant decrease of the activity of the vitamin K dependent coagulation factors occurred during cefotetan treatment. No gastrointestinal or hepatic adverse reactions were observed in the gentamicin treated patients.