Biomedical subjects

O Reikerås

Publications and source records attributed to O Reikerås.

At least 19 recordsLinked to original sources

PubMed2003

Effective pain relief from intra-articular saline with or without morphine 2 mg in patients with moderate-to-severe pain after knee arthroscopy: a randomized, double-blind controlled clinical study.

BACKGROUND: Intra-articular (IA) morphine has given good and prolonged pain relief in some studies when given at the end of arthroscopic procedures in the knee joint. However, similar studies have not been able to document any local analgesic effect of morphine. A large number of the negative studies have not demonstrated any assay sensitivity. We have documented that around 40% of patients have only very mild or no pain after arthroscopic procedures in the knee joint. This obviously is a confounding factor, reducing assay sensitivity when all patients are included in IA morphine studies. METHOD: By leaving a soft catheter IA in 57 patients and including only patients who developed moderate-to-severe pain within 1 h after an arthroscopic procedure in the knee joint under general anaesthesia, we included 40 patients. These patients had a mean pre-treatment baseline pain of about 50/100 on a 100-mm visual analogue scale (VAS) for pain intensity. A randomized, double-blind controlled comparison of saline 10 ml with or without morphine 2 mg followed. Test drugs were administered through the IA catheter. Pain intensity and pain relief, consumption of rescue analgesics and global evaluation of effect and adverse effects were measured up to 36 h thereafter. RESULTS: Pain intensity decreased from about 50 to about 10-15/100 in both groups and the sum of pain intensity differences at 2 and 22 h was not significantly different between the two groups. Global evaluation of effects and adverse effects, as well as consumption of rescue analgesics during 36 h after arthroscopic procedures, were also similar in the two groups. CONCLUSIONS: Only 70% of 57 patients had pain of moderate-to-severe intensity within 1 h after an arthroscopic procedure of the knee joint under general anaesthesia. IA injection of saline 10 ml and saline 10 ml with morphine 2 mg were both associated with pain relief. These findings may have implications for interpretations of a majority of published studies on IA morphine.

Analgesics, Opioid↗

PubMed2001

Vitamin D deficiency and ovariectomy reduced the strength of the femoral neck in rats.

Vitamin D (vit D) deficiency is common in the elderly, and the aim of this study was to investigate whether vit D deprivation in ovariectomized (ovx) and normal rats would reduce fracture strength. Forty mature female Wistar rats were randomized into four groups: two were ovariectomized (ovx) and two were sham-operated (sham). One ovx and one sham group were fed a vit D-deficient diet (Ovx-D and Sham-D), and the control groups were fed normal rat chow (Ovx and Sham) for 12 weeks. Vit D deficiency was substantiated after 12 weeks by undetectable serum concentrations of 25OHD in the Sham-D and Ovx-D groups. 85Sr activity was lower in Sham-D than in the other groups (P < 0.005). Tibial and femoral weights and lengths showed no differences. Distal tibial trabecular bone volume was reduced in both ovx groups compare with sham (P < 0.005). Bone mineral density (BMD) was higher in sham than in Sham-D and both ovx groups (P < 0.005). Femoral area moment of inertia increased and ultimate stress decreased in Ovx-D compared with ovx (P < 0.05). Other biomechanical properties of the femoral shafts did not differ significantly. The femoral neck was significantly weaker in Ovx-D than in the other groups. In conclusion, ovx decreased tibial trabecular bone volume and both ovx and vit D depletion reduced femoral BMD in rats. Vit D depletion reduced the ultimate stress in the femoral shaft, and the combined depletion of estrogen and vit D significantly reduced the fracture strength in the femoral neck. This fits well with clinical evidence of how postmenopausal status combined with vit D deficiency lead to an increased risk of hip fractures, making this animal model a possible tool for investigating measures to prevent such fractures.

Absorptiometry, Photon↗

PubMed2001

The normal development of tibial torsion.

OBJECTIVE: Pathological rotation of the leg is a well-known problem in paediatric orthopaedics. In this study the normal development of tibial torsion during growth was evaluated by computed tomography (CT). DESIGN: Seventy-eight normal individuals (52 children, 26 adults) aged 3-51 years were examined with CT. In axial scans the angle between a line tangential to the posterior part of the femoral condyles and the intermalleolar line, a line through the centre of the lateral and medial malleolus, was measured. The radiation exposure was evaluated and accepted by The National Department for Radiation and the Regional Committee for Ethics in Science. RESULTS: CT showed that the average lateral torsion of the leg at the age of 4 years was 28 degrees with an individual variation of 20 degrees-37 degrees. Later the increase in tibial torsion was on average 1 degrees/year until 10 years of age and, thereafter, 4 degrees until maturity when the mean lateral torsion was 38 degrees (18 degrees-47 degrees). CONCLUSION: Tibial torsion in children mainly develops during the first 4 years of life. After this the increase was of less clinical significance.

Adolescent↗

PubMed2001

Influence of flexible nailing in the later phase of fracture healing: strength and mineralization in rat femora.

In this experimental study, the influence of flexible nailing in the later phase of femoral fracture healing was investigated. Sixty rats were randomly assigned to three groups. In 20 rats no intervention was performed, and they served as a control group. Fracture and reamed nailing with a rigid steel nail was performed in the left femur in the other 40 rats. These rats were reoperated after 30 days, and the medullary nail was removed. In one group (20 rats) a flexible polyethylene nail was installed (flexibly nailed group), while the rats in the other group received a steel nail identical to the one that was removed (rigidly nailed group). At 60 and 90 days, the left femurs of 10 animals in each group were studied clinically, radiologically, and biomechanically, and bone mineralization was measured by dual-energy X-ray absorptiometry. Radiographs in two planes revealed a clearly visible fracture line in both intervention groups at 60 days. At 90 days, the fracture line was clearly visible in the flexibly nailed group, while bridging callus was apparent after the rigid nailing. At 60 and 90 days, the callus area in the flexibly nailed group was significantly larger than that in the rigidly nailed bones. Biomechanically, flexible nailing reduced maximum bending load and fracture energy at 60 and 90 days compared with findings in rigidly nailed bones, while bending rigidity was similar in the two groups. All values for biomechanical characteristics were reduced at 60 and 90 days in flexibly nailed bones compared with intact femurs, while in the rigid nailing group, bending load and fracture energy were similar to those in intact bones at 90 days. Bone mineral content in the callus segment and diaphysis was greater in the rigidly nailed bones than in the flexible nailing group at 60 days, while at 90 days, no differences were detected. In conclusion, this animal study indicates that: (1) flexible nailing in the later phase of fracture healing increases callus formation, while (2) the quality of bone healing is reduced.

Absorptiometry, Photon↗

PubMed2001

Reduced tibial torsion in congenital clubfoot: CT measurements in 24 patients.

We determined leg torsion with CT scans through the femoral condyles and the ankle joints in 24 children (17 boys) with congenital clubfoot. In 16 cases, there was a bilateral clubfoot, in 5 cases it was left-sided and in 3 cases, it was on the right side. These children were compared to 17 healthy boys and 7 girls. The ages of all children ranged between 3 and 12 years. The average external torsion of the leg in the patients with clubfoot was 20 (15) versus 31 (7) degrees in the healthy children (p = 0.002). This study shows that there are great variations in leg torsion in children with congenital clubfoot and, on average, the external torsion is significantly lower than in healthy subjects.

Bone Diseases↗

PubMed2001

Fibrinolytic activity and postoperative salvaged untreated blood for autologous transfusion in major orthopaedic surgery.

OBJECTIVE: To evaluate the fibrinolytic activity in a closed surgical wound, in postoperatively drained blood, and during autologous transfusion. DESIGN: Prospective study. SETTING: National hospital, Norway. PATIENTS: 9 patients operated on for thoracic scoliosis. MAIN OUTCOME MEASURE: Concentrations of plasmin/antiplasmin (PAP), alpha2-antiplasmin, and D-dimers in drained, arterial, and mixed venous blood before, during, and after infusion of 10 ml/kg body weight of postoperatively drained, untreated blood. RESULTS: In drained blood the concentration of alpha2-antiplasmin was 31% of the preoperative arterial control value. Together with the increased concentrations of PAP to 18076 microg/L and D-dimers to 126 mg/L, this indicates extensive fibrinolytic activity in the closed wound. The postoperative autologous transfusion of drained, untreated blood increased the concentration of PAP from 507 to 2453 microg/L and of D-dimer from 0.7 mg/L to 15.3 mg/L in systemic blood. CONCLUSION: The systemic concentration of fibrin(ogen) degradation products, indicated by D-dimers, after recirculation of drained, untreated blood might impair coagulation. The extensive activation of plasmin might exhaust available alpha2-antiplasmin in the wound and result in postoperative rebleeding.

Adolescent↗

PubMed2000

Changes in plasma IL-1beta, TNF-alpha and IL-6 after total hip replacement surgery in general or regional anaesthesia.

Different anaesthetic methods influence the neuro-immuno-endocrine biologic responses to surgery and may thus possibly interfere with the postoperative course and development of complications. The neuroendocrine system is closely related to the cytokine network. In this study, the effects of general anaesthesia (n=6) and regional spinal/epidural anaesthesia (n=6) on the cytokine response (IL-1beta, TNFalpha, IL-6) to uncemented total hip replacement surgery were evaluated. The postoperative clinical course was uneventful in every case. In both groups, only very low values of plasma IL-beta were measured perioperatively, whereas plasma IL-6 increased postoperatively with peak values 4 h after surgery. The changes in plasma TNF-alpha were not significant. No significant differences in plasma TNF-alpha or IL-6 were found between patients operated in general or in regional anaesthesia. This suggests minor influence of plasma cytokines on the possible beneficial effects of regional anaesthesia on the clinical course after surgery in low risk patients. There were slightly higher TNF-alpha and IL-6 levels after the operation and significantly lower cortisol levels during the operation in the regional anaesthesia group compared to the general anaesthesia group, giving rise to a significant inverse correlation between peak values of IL-6 and peak values of cortisol. This supports the theory that after surgery the inhibitory effect of cortisol on monocyte cytokine production overrides adrenergic stimulation.

Anesthesia, General↗

PubMed2000

Magnetic resonance imaging as a screening procedure to avoid arthroscopy for meniscal tears.

The objective of this study was to evaluate the role of magnetic resonance imaging (MRI) as a screening procedure before arthroscopy of meniscal tears. Forty-one knees in 40 patients underwent MRI and arthroscopy. Compared with arthroscopy, the sensitivity, specificity, positive predictive value and negative predictive value for MRI for the nmedial meniscus were 100%, 77%, 71% and 100%, respectively, while the values for the lateral meniscus were 40%, 89%, 33% and 91%, respectively. The overall accuracy for MRI of the medial and lateral menisci combined was 84%. On the basis of the high predictive value of negative MRI, we conclude that MRI is useful to exclude patients from unnecessary arthroscopy.

Adolescent↗

PubMed2000

Tissue factor antigen and activity in serum of postoperatively shed blood used for autologous transfusion.

Orthopaedic surgery involves extensive dissection of connective and richly vascularised tissues rich in tissue factor (TF). It was, therefore, of interest to quantify the amount of TF antigen and activity in postoperatively drained, unwashed wound blood collected for the purpose of autologous transfusion. In nine young patients subjected to surgery for idiopathic thoracic scoliosis, samples were drawn postoperatively from collected shed blood, a pulmonary artery catheter and a radial arterial cannula prior to, during and after reinfusion of shed blood (10 ml/kg body weight), and analysed for TF antigen and activity. Preoperative arterial control samples contained 128 pg/ml TF antigen compared with 40 pg/ml postoperatively. During reinfusion of drained blood, arterial TF concentration rose to 96 pg/ml and dropped to 64 pg/ml after infusion. Arterial and mixed venous blood did not differ significantly in TF levels. Serum from drained blood contained high concentrations of TF antigen (773 pg/ml), but no TF activity was detected. It is concluded that the high concentrations of TF antigen in serum from postoperatively drained blood collected for autologous transfusion are devoid of procoagulant activity. The TF antigen in plasma of drained blood is suggested to be a soluble, proteolysed TF-apoprotein or a TF complex inactivated by the TF pathway inhibitor (TFPI).

Adolescent↗

PubMed1999

[Patients with chronic degenerative spinal disease--can conservative treatment reduce the waiting list for surgery?].

Patients with a degenerative lumbar disorder selected for spinal fusion surgery by an experienced orthopaedic surgeon, were invited to participate in an exercise and behavioural modification programme. The goal was to let the patients experience that it is safe to move. 50 patients; mean age 49 years (19-76 years), mean duration of complaints ten years (2-39 years), agreed to participate. 26 patients had undergone back surgery. 80% were on sick leave or disability pension; 85% had either previously diagnosed psychiatric disorder or high scores for somatization or abnormal illness behaviour. At follow-up, 21 (42%) patients wanted surgery, 8 (16%) were uncertain, and 18 (36%) did not want surgery, 17 patients reported improved main symptoms, 18 were unchanged, and 12 had deteriorated. Previous surgery, illness behaviour and weak trunk muscles were associated with poor improvement and desire for surgery. Age, gender, emotional distress, intensity of pain, neurological or radiological signs or the number of exercise sessions taken did not influence results.

Adult↗

PubMed1999

Inflammatory cytokines and their receptors in arterial and mixed venous blood before, during and after infusion of drained untreated blood.

Wound blood for postoperative autologous transfusion is drained through an area of damaged tissue, the surgical wound, and contains inflammatory mediators. The inflammatory cytokines interleukin-1-beta (IL-1beta), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumour necrosis factor-alpha (TNF-alpha) and their modulators interleukin-1-receptor antagonist (IL-1Ra), interleukin 6 soluble receptor (IL-6sR), soluble tumour necrosis factor receptor 1 (sTNF-R1) and interleukin 10 (IL-10), together with white cell count (WCC) and white cell differential count were measured in arterial and mixed venous blood before, during and after infusion of postoperatively drained untreated blood in nine patients operated for thoracic scoliosis. We found a transient increase in IL-6, an increase in TNF-RI, an increase in IL-8 with granulocytosis and a decrease in IL-10 in the systemic circulation. The increase in IL-6 was higher in mixed venous than in arterial blood.

Adolescent↗

PubMed1999

The cytokines IL-1beta and IL-1 receptor antagonist, IL-2 and IL-2 soluble receptor-alpha, IL-6 and IL-6 soluble receptor, TNF-alpha and TNF soluble receptor I, and IL10 in drained and systemic blood after major orthopaedic surgery.

OBJECTIVE: To measure the concentration of the cytokines interleukin-1beta (IL-1beta), interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumour necrosis factor-alpha (TNF-alpha) and the modulators of their function interleukin-1 receptor antagonist (IL-1Ra), interleukin-2 soluble receptor alpha (IL-2 sRalpha), interleukin-6 soluble receptor (IL-6sR) and soluble tumour necrosis factor receptor I (sTNFR-I) in systemic and drained blood for the first six hours after a major orthopaedic operation. DESIGN: Prospective study. SETTING: University hospital, Oslo. PATIENTS: 8 patients operated on for thoracic scoliosis. MAIN OUTCOME MEASURE: Concentrations of IL-1beta, IL-2, IL-6, IL-10, TNF-alpha, IL-1Ra, IL-2 sRalpha , IL-6sR, and sTNFR-I were measured together with haemoglobin (Hb) concentration, white cell count (WCC), and differential count in arterial and drained blood at wound closure and 1, 2, 4, and 6 hours postoperatively. RESULTS: IL-1beta and IL-6 concentrations increased significantly in drained blood, whereas that of TNF-alpha increased only in arterial blood. The modulating factors IL-1Ra, sTNFR-I, and IL-10 were increased both in arterial and drained blood. IL-6sR had decreased slightly at 6 hours in drained blood. No IL-2 was found and IL-2 sRalpha decreased simultaneously with the haemodilution. In arterial blood there was a granulocytosis and in drained blood a relative lymphocytosis. CONCLUSION: Cytokine responses to surgical trauma include modulating factors such as soluble receptors and receptor antagonists that have different responses systemically and locally.

Adolescent↗

PubMed1999

Complement activation and increased systemic and pulmonary vascular resistance indices during infusion of postoperatively drained untreated blood.

In nine healthy young patients, operated on for thoracic scoliosis, a pulmonary artery catheter was inserted for the study of haemodynamic variables and blood sampling during autologous transfusion of postoperatively drained blood. At 1-3 h after wound closure, 10 ml kg/body weight of drained untreated blood from the wound was collected and recirculated over a l-h period. The concentration of the complement activation product, C3bc, increased from a mean of 5.4 (SD 1.5) AU ml-1 before infusion to 11.1 (3.9) AU ml-1 during infusion and then returned to 7.8 (2.8) AU ml-1 after infusion. The concentration of the terminal complement complex (TCC) increased from 0.5 (0.2) to 1.3 (0.5) AU ml-1 and was reduced to 0.7 (0.3) AU ml-1 after infusion. Only TCC exceeded the reference values which are 14 AU ml-1 for C3bc and 1.0 AU ml-1 for TCC. Pulmonary vascular resistance index concomitantly increased from a mean of 130 (SD 52) to 195 (88) dyn s cm-5 m-2 and was reduced to 170 (86) dyn s cm-5 m-2 after infusion. Systemic vascular resistance index increased from a mean of 1238 (SD 403) to 1349 (473) dyn s cm-5 m-2 and returned to 1196 (401) dyn s cm-5 m-2 after infusion. White blood cell count (WCC) increased from 14.4 (4.3) x 10(9) litre-1 before infusion to 17.8 (7.2) x 10(9) litre-1 during and after infusion. No change in platelet count during infusion was observed. There were no differences in WCC or platelet count between mixed venous or peripheral arterial blood. Pulmonary and systemic vascular resistance indices may be influenced by activated complement in drained untreated blood when it is recirculated.

Adolescent↗

PubMed1999

Fibrinogen, fibrin and its degradation products in drained blood after major orthopaedic surgery.

The aim of this study was to evaluate the fibrinogen enzymatic conversion in blood collected postoperatively from a surgical wound. Ten otherwise healthy patients (aged 11-28 years) in need of surgical treatment for thoracic scoliosis were included in the study. Arterial blood preoperatively and at wound closure were compared with samples of drained blood from the wound at closure and from a collection system for autologous transfusion 2.8 +/- 1.1 h later. There was a decrease in the fibrinogen content in arterial blood from 2.17 +/- 0.35 g/l to 1.23 +/- 0.42 g/l, which followed a 40% haemodilution estimated from the blood loss of 1.6 +/- 0.9 l during the operation. Drained blood contained high concentrations of D-dimer (85 +/- 53 mg/l from the wound and 121 +/- 47 mg/l from the collection system), but no clottable fibrinogen. The Western immunoblots all visualized the same patterns; in drained blood there were split-products mainly from cross-linked fibrin, in contrast to arterial blood which contained only normal fibrinogen. This indicates a strong fibrinolysis in the surgical wound after closure, with concentrations of fibrin degradation products that may impair local coagulation, and if infused, might interfere with general haemostasis.

Adolescent↗

PubMed1999

Early muscle-periosteal lesion inhibits fracture healing in rats.

We assessed the effects of muscular detachment from the periosteum on fracture healing, focusing on a muscle-periosteal lesion in the initial healing process. In 30 male Wistar rats we produced a partial osteotomy in the mid-diaphysis of the left femur which was then manually broken. All fractures were reamed and stabilized with a 1.6 mm steel pin. The animals were randomly assigned to 3 groups. In group 1, an extraperiosteal detachment between muscle and periosteum was created in the middle third of the diaphysis. In group 2, an extraperiosteal detachment was created with application of an ePTFE sheath (Gore-Tex expanded polytetrafluoroethylene) around the shaft between muscle and periosteum during the first 2 weeks following fracture. In group 3, the dissection was identical, while the ePTFE sheath was installed after 2 weeks. The rats were killed after 4 weeks, and their bones were evaluated radiographically and mechanically by the three-point bending test. The fractures healed by production of external callus, and radiographs revealed various degrees of periosteal callus with a radiolucent fracture line, most evident after early muscle-periosteal isolation. The callus area was significantly smaller after early muscle isolation, compared to extraperiosteal dissection alone and later tissue isolation. Bending moment and stiffness were also less in this group than in groups 1 and 3, while fracture energy was less than in group 1. No differences in mechanical properties were detected between extraperiosteal dissection alone and late-tissue isolation. This animal study underlines the importance of early muscle-periosteal apposition for fast periosteal healing of diaphyseal fractures.

Animals↗

PubMed1999

Reduced acetabular depth in hip instability in the newborn.

This study assessed the frequency of ultrasonographic hip instability and compared the results with clinical and morphological ultrasonographic evaluations of the hip in the newborn infant. Hip stability in 2016 consecutive births (1074 boys and 942 girls) was assessed clinically and ultrasonographically. Ultrasonography included dynamic stability testing and morphologic evaluations. Compared with ultrasonography, clinical stability testing had a specificity of 0.998 and a sensitivity of 0.667. The incidence of instability was 0.007 for hips and 0.010 for babies. Acetabular depth in 3994 normal hips was 8.3 +/- 0.9 mm, femoral head diameter was 15.4 +/- 1.3 mm, and acetabular bony coverage of the femoral head was 54 +/- 4.3%. Hip instability was significantly associated with a reduced acetabular depth. As the femoral head diameter was within normal in the unstable hips, coverage was significantly reduced.

Acetabulum↗

PubMed1999

Sacroiliac joint involvement in activation of the porcine spinal and gluteal musculature.

In the search for causes of low back pain, the sacroiliac joint has gained renewed interest as a possible pain generator. There is reason to believe that the sacroiliac joint plays a regulatory role involving reflex muscle activation, which controls trunk mobility and stability, as well as locomotion. The aim of this experimental study was to determine whether stimulation of nerves in the sacroiliac joint and joint capsule could elicit contractions in porcine gluteal or lumbar spinal muscles. Via a lateral retroperitoneal approach and using hypodermic needles, bipolar stimulating wire electrodes were inserted into the ventral area of the sacroiliac joint and directly under the surface of the capsular membrane, in 10 adolescent pigs (45 kg). This procedure was performed bilaterally, thus establishing two bilateral stimulation sites in the joints. Six electromyographic electrodes were unilaterally inserted into the following muscles: multifidus, gluteus medius, gluteus maximus, and quadratus lumborum. On stimulation within the ventral area of the joint, predominant responses occurred in both the gluteus maximus and quadratus lumborum muscles. However, when stimulating the capsule, the greatest muscular responses were detected in the multifidus muscles. This study addressed the possible regulatory function of the sacroiliac joint, namely, its involvement in activation of the spinal and gluteal muscles, which help control locomotion and body posture, as well as provide stability on the segmental level in the lumbar spine.

Animals↗

PubMed1998

Five-year follow-up study of a controlled clinical trial using light mobilization and an informative approach to low back pain.

STUDY DESIGN: A controlled clinical trial. OBJECTIVES: To examine the long-term effect of an informative approach to low back pain. SUMMARY OF BACKGROUND DATA: In management and prevention of low back pain, back school based on an ergonomic approach have played in important role. The effect of such informative interventions is not clear. METHODS: A 5-year follow-up study was done on patients included in a previous study. The outcome was measured by return to work or still on sick leave. The patients were allocated to an intervention group (n = 245) and a control group (n = 244). Only the intervention group was called in for examination and intervention and answered a battery of tests for psychological and health factors. The intervention apart from the clinical examination consisted of education in an "mini back school." The program was based on a new medical model for low back pain. RESULTS: Forty-seven (19%) of the patients in the intervention group, compared with 84 patients (34%) in the control group, were still on sick leave after 5 years (P < 0.001). There were fewer recurrences of sick leave (P < 0.03) in the intervention group than in the control group. Based on Internal Health Locus of Control, number of children, and income, 75% were correctly classified as nonreturners in the intervention group. CONCLUSIONS: This study indicates that subchronic low back pain may be managed successfully with an approach that includes clinical examination combined with information for patients about the nature of the problem, provided in a manner designed to reduce fear and give them reason to resume light activity.

Adolescent↗