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Introduction: The aim of In this study was to verify the relationship among clinical indicators of patellofemoral pain syndrome (PFPS) and the results of modifying radiological investigation. Previous research suggests that there is a poor association between them. Therefore we have employed a technique for the functional evaluation of PFPS based on measuring the stiffness of the knee joint during passive flexion (biorheometry)., Method: The correlation between clinical examination and a standardized Lysholm score, radiological and biorheometric measures was investigated in the 28 knee joints of 14 subjects exhibiting clinical features of PFPS. A modified axial radiological projection of the patellofemoral articulation in 90° of flexion provided the parameters quantifying the anatomical - morphological arrangement of the patellofemoral joint. The biorheometric properties of the knee were evaluated using a custom made measuring apparatus during passive flexion and extension of the knee., Results: Our results confirm that the link between the clinical findings and the X-ray imaging examinations was not evident. On the contrary, the biorheometric examination proved to correlate well with the clinical symptoms of PFPS. Parameters were identified which can characterize the biorheograms of people suffering PFPS., Conclusions: Analysis of the relationship among the clinical, radiological and biorheometric examinations leads to the recommendation that biorheometric examination is an effective method for the objective assessment of PFPS., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Sorfova Monika reports administrative support was provided by Charles University. ], (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Operative mortality after acute aortic dissection type A is still high, and prolonged stay at the intensive care unit is common. Little has been documented about factors influencing the intensive care unit length of stay. The aim of this study was to determine such variables., Methods: During a 10-year period, 67 patients (47 male, 20 female) were operated on for acute aortic dissection type A. In 42 patients (63%), an ascending aortic replacement was performed, 23 patients (34%) underwent a Bentall procedure, and 2 patients (3%) received a valve-sparing David type of operation. In 14 of these cases (20%), an additional partial or total arch replacement was performed., Results: Hospital mortality was 9 of 67 (14%). Median postoperative intensive care unit length of stay was 5 days (range, 1 to 72 days). Intensive care unit stay was in univariate analysis significantly influenced by the following factors: age (p = 0.008), body mass index (p = 0.039), cardiopulmonary bypass time (p = 0.018), aortic cross-clamp time (p = 0.031), postoperative low cardiac output syndrome (p < 0.001), and postoperative lactate levels (p = 0.01). By multivariate analysis, age (p = 0.012), cardiopulmonary bypass time (p = 0.037), and the presence of a postoperative low cardiac output syndrome (p < 0.001) significantly influenced intensive care unit stay., Conclusions: Stay in the intensive care unit after operation for acute aortic dissection type A seems to be determined by age, cardiopulmonary bypass time, and the postoperative presence of a low cardiac output syndrome.

Despite intensive medical treatment to control chest pain, about one-third of patients with unstable angina have an unfavourable outcome within a period of 1 to 2 months. Holter monitoring can identify patients with silent myocardial ischaemia that are at a high risk of sustaining a major cardiovascular event. The present paper describes the use of dynamic, continuous, computerized on-line vectorcardiography for real-time monitoring of QRS-complex and ST-segment changes in patients with unstable coronary disease. In many patients a pattern of frequent repetitive episodes of QRS change was observed, with or without concomitant ST change. Whereas no patient had episodes of ST-vector change without also having episodes of significant QRS change, 15 patients had several episodes of QRS changes without any episode of significant ST change. The number of episodes of significant increase of the QRS vector difference correlated weakly but significantly with the number of episodes of significant ST-vector magnitude change (r = 0.34, p less than 0.05). The present study suggests that myocardial ischaemia will influence the QRS complex as well as the ST segment. The mechanism behind the QRS changes observed is not clear but episodes of QRS change without ST change or chest pain, may reflect sudden depressions of left ventricular function, as has been reported by others to occur in patients with coronary artery disease. Dynamic vectorcardiography offers the opportunity to monitor all parts of the QRST complex in real time.

The maternal and fetal metabolic effects of three commonly used intravenous fluids administered before regional anesthesia were studied in 32 gravid women undergoing elective cesarean section at term. Patients were randomized into one of three groups to receive 1 L of either 5% dextrose (50 gm of glucose) or Ringer's lactate or isotonic saline solution before epidural anesthesia. Acute glucose infusion resulted in maternal hyperglycemia, hyperinsulinemia, and an increase in the blood lactate level. Cord blood glucose, insulin, and lactate levels were also increased in this group. The key finding of this study was the significant lowering of pH in the umbilical cord vein (7.31 +/- 0.04) and artery (7.21 +/- 0.06) in the glucose-infused group when compared with the non-glucose infusion groups (p less than 0.05). Confounding perinatal factors such as maternal position, maternal hypotension, and prolonged time of surgery did not influence the fetal acid-base status. Thus acute maternal glucose infusion in normal patients can cause fetal hyperglycemia, metabolic acidosis, and neonatal hypoglycemia. These findings may be of particular clinical importance when fetal distress or fetal hypoxemia is due to other perinatal events. Under these circumstances, acute maternal glucose infusion may further contribute to fetal metabolic acidosis.