Association of COVID-19 With Achieving Time-to-Surgery Benchmarks in Patients With Musculoskeletal Trauma

Question

Were resource constraints due to the COVID-19 pandemic associated with a delay in urgent fracture surgery beyond national time-to-surgery benchmarks?

Findings

In this cohort pre-post study that included 3589 patients, there was no association between time to surgery and COVID-19 in either open fracture or closed femur/hip fracture cohorts.

Meaning

Despite concerns that the unprecedented challenges associated with the COVID-19 pandemic would delay acute management of urgent surgery, many hospital systems within the US were able to implement strategies in keeping with time-to-surgery standards for orthopedic trauma.

Importance

In response to the COVID-19 pandemic, many hospital systems were forced to reduce operating room capacity and reallocate resources. The outcomes of these policies on the care of injured patients and the maintenance of emergency services have not been adequately reported.

Objective

To evaluate whether the COVID-19 pandemic was associated with delays in urgent fracture surgery beyond national time-to-surgery benchmarks.

Design, Setting, and Participants

This retrospective cohort study used data collected in the Program of Randomized Trials to Evaluate Preoperative Antiseptic Skin Solutions in Orthopaedic Trauma among at 20 sites throughout the US and Canada and included patients who sustained open fractures or closed femur or hip fractures.

Exposure

COVID-19–era operating room restrictions were compared with pre–COVID-19 data.

Main Outcomes and Measures

Surgery within 24 hours after injury.

Results

A total of 3589 patients (mean [SD] age, 55 [25.4] years; 1913 [53.3%] male) were included in this study, 2175 pre–COVID-19 and 1414 during COVID-19. A total of 54 patients (3.1%) in the open fracture cohort and 407 patients (21.8%) in the closed hip/femur fracture cohort did not meet 24-hour time-to-surgery benchmarks. We were unable to detect any association between time to operating room and COVID-19 era in either open fracture (odds ratio [OR], 1.40; 95% CI, 0.77-2.55; P = .28) or closed femur/hip fracture (OR, 1.01; 95% CI, 0.74-1.37; P = .97) cohorts. In the closed femur/hip fracture cohort, there was no association between time to operating room and regional COVID-19 prevalence (OR, 1.07; 95% CI, 0.70-1.64; P = .76).

Conclusions and Relevance

In this cohort study, there was no association between meeting time-to-surgery benchmarks in either open fracture or closed femur/hip fracture during the COVID-19 pandemic compared with before the pandemic. This is counter to concerns that the unprecedented challenges associated with managing the COVID-19 pandemic would be associated with clinically significant delays in acute management of urgent surgical cases and suggests that many hospital systems within the US were able to effectively implement policies consistent with time-to-surgery standards for orthopedic trauma in the context of COVID-19–related resource constraints.

Effects of competition on acute phase proteins and lymphocyte subpopulations - oxidative stress markers in eventing horses

The aim of the study was to evaluate markers of the acute phase response (APR) in eventing horses by measuring acute phase proteins (APP) (haptoglobin, Hp, and serum amyloid A, SAA), lysozyme, protein adducts such as pentosidine-like adducts (PENT), malondialdehyde adducts (MDA), hydroxynonenal adducts (HNE) and total advanced glycation/glycoxidation end products (AGEs), complete blood count and lymphocyte subpopulations (CD4+, CD8+ and CD21+) both at rest and at the end of an eventing competition. Blood samples were collected from eight Warmblood horses (medium age 10 ± 3) during an official national 2-day event competition at rest (R) and 10 min after the arrival of the cross-country test on the second day. Exercise caused a significant increase in red blood cell number, haemoglobin, packed cell volume, neutrophils, white blood cell and lymphocyte number; however, these values remained within the normal range. The CD4+ and CD8+ cells significantly increased, whereas the CD21+ lymphocytes decreased; a significant increase in serum SAA, lysozyme and protein carbonyl derivates was also observed. Two-day event causes significant changes in APR markers such as lysozyme, protein carbonyl derivates (HNE, AGEs, PENT) and lymphocyte subpopulations. The data support the hypothesis that 2-day event may alter significantly APR markers. Limitations of the study were the relatively small sample size and sampling time conditioned by the official regulations of the event. Therefore, further studies are needed to investigate the time required for recovery to basal values in order to define the possible effects on the immune function of the athlete horse.

Estimation of the workload in horses during an eventing competition

The aim of this study was to evaluate workload using suitable parameters related to the physical effort exerted by horses involved in eventing competitions in order to describe the workload intensity and energy demands placed upon such horses. Heart rate (HR), running speed (S), distance covered (Dist), performance duration (D) and blood lactate (Lact) concentrations were measured in horses competing at either the intermediate level (IL) or advanced level (AL) in order to identify workload differences between experience classes. Ten warmblood horses were monitored during an official two-day eventing competition; mean HR (HRmean, bpm), maximum HR (HRmax, bpm), mean S (Smean, m/min), max S (Smax, m/min), D (min) and Dist (m) were assessed during the warm-up and competition phases of each eventing test (dressage, show jumping, cross country). To calculate heart rate recovery (HRR), HR data were collected within the first 3 minutes following the completion of each of the 3 competition phases. Energy expenditure (EE) was estimated using the HR/VO2 relationship. Differences between the groups (AL vs. IL) in HRmean, HRmax, %HRmean, %HRpeak (HR expressed as a percentage of the maximum HR peak obtained during a fast gallop training session), S, D, and Dist were assessed using one-tailed unpaired t-tests for both warmup and competition phases; also differences for EE were evaluated. The relationship between HR and S was also determined for warm-up and competition phases using one-tailed Person's correlations. The relationship between HR decrease during the first 3 min following competition phase completion and recovery time was investigated by multiple nonlinear curve estimation procedures. The results reveal the cross country test to be the most demanding of the eventing competition, requiring significantly greater levels of muscular and energetic effort, in terms of Lact production and EE, with higher values recorded in the AL horses compared to IL horses. The data also show that riders need to optimise warm-up duration and quality in accordance with their competition category. The calculation of HRR is also shown to be an appropriate approach for gauging workload after high-intensity exercise, but not after low-intensity exercise since HRR may be influenced by external factors, like how excited a horse is.

Identification of functional alpha-adrenoceptor subtypes in the bovine female genital tract during different phases of the oestrous cycle

The concentration and functionality of the alpha-adrenoceptor (alpha-AR) subtypes in the genital tract of cyclic heifers were investigated. In each tissue sample, a single class of alpha1-ARs was observed, whereas two distinct classes of alpha2-ARs were discriminated: low-affinity (LA) and high-affinity (HA) alpha2-ARs. Statistical analysis showed the presence of significantly (p < 0.05) higher concentrations of all alpha-AR subtypes in the follicle than in the corpus luteum. No significant differences were found in the ovary or myometrium between the luteal and follicular phases. In the ovary, the density of alpha1-ARs was significantly (p < 0.05) higher than that of alpha2-ARs. By contrast, there were significantly (p < 0.05) more alpha2-ARs than alpha1-ARs in the myometrium. As far as alpha2-ARs are concerned, LA alpha2-ARs were significantly (p<0.05) higher than HA alpha2-ARs in all tested tissues. Competition studies suggested that the rank order of potency of antagonists for alpha1-ARs was prazosin > phentolamine > yohimbine, whereas for alpha2-ARs the order of potency was yohimbine > or = phentolamine>prazosin. Functional assays performed on myometrium showed that noradrenaline, phenylephrine and clonidine elicited concentration-dependent contractions only in dioestrus and pro-oestrus preparations and that clonidine was more effective than phenylephrine as a contractile agent. It appeared that there were no significant modifications in alpha-AR affinity or concentration during the different stages of bovine oestrous cycle, whereas the uterine spontaneous activity and the responsiveness to alpha-adrenergic stimulation was strongly influenced by hormonal levels. The modifications of uterine contractility observed during the oestrous cycle may be related to modifications induced in the transductional mechanisms of alpha-ARs.

Characterization of alpha-adrenoceptor subtypes in smooth muscle of equine ileum

OBJECTIVE

To determine the concentration and binding characteristics of alpha-adrenoceptor subtypes in smooth muscle cell membranes of equine ileum.

SAMPLE POPULATION

Segments of longitudinal and circular smooth muscle from the ileum of 8 male and 8 female adult horses.

PROCEDURE

Distribution of alpha-adrenoceptor subtypes was assessed by use of radioligand binding assays incorporating [3H]-prazosin and [3H]-rauwolscine, highly selective alpha1- and alpha2-adrenoceptor antagonists, respectively. Characterization of adrenoceptor subtypes was performed by use of binding inhibition assays.

RESULTS

On the basis of binding affinity for specific radioligands, low- and high-affinity alpha1- and alpha2-adrenoceptors were detected. Concentration of low-affinity alpha2-adrenoceptors was significantly greater in male horses, compared with females. Competition studies confirmed the specificity of the radioligands used in the binding assays. Alpha1-adrenoceptors of both subtypes in male and female horses had a higher affinity for prazosin than phentolamine, whereas yohimbine did not compete with the radioligand for binding. For alpha2-adrenoceptors regardless of subtype, potency of inhibition elicited by each drug varied between sexes. In males, yohimbine was a more potent inhibitor than phentolamine, which was more potent than prazosin. In females, yohimbine was more potent than prazosin, which was more potent than phentolamine.

CONCLUSIONS AND CLINICAL RELEVANCE

High- and low-affinity alpha1- and alpha2-adrenoceptors were detected in smooth muscle of equine ileum. Because alpha-adrenoceptor subtypes, particularly alpha2-adrenoceptors, are involved in the regulation of gastrointestinal tract function, characterization of these receptors may represent the basis for development of new therapeutic strategies for the control of gastrointestinal disturbances in horses.

Canine dilated cardiomyopathy: lymphocyte and cardiac alpha(1)- and beta-adrenoceptor concentrations in normal and affected great danes

Serum catecholamine levels and myocardial and lymphocyte adrenergic receptor (AR) concentrations were measured in adult great danes affected by canine dilated cardiomyopathy (DCM) and compared to those of healthy animals. A non-homogeneous population of beta -AR, consisting of beta(1)-AR and beta(2)-AR, was observed in healthy (41 and 59%, respectively) and affected (17 and 83%, respectively) dog lymphocytes. Binding assays revealed that total beta -AR, beta(1)-AR and alpha(1)-AR were significantly downregulated (P<0.05;P<0.01;P<0. 001), both in lymphocyte and myocardial cell membranes of affected dogs. beta(2)-Adrenergic receptor concentrations were significantly reduced only in lymphocyte and right atrium cell membranes (P<0.05). Downregulation was not associated with alterations in receptor binding characteristics, as no significant differences in K(d)values were found. Mean plasma catecholamine levels were significantly higher (P<0.01) in DCM dogs (939+/-41) than in normal subjects (348+/-32), thus suggesting a sympathetic activation. The present study indicates a condition similar to that observed in human patients affected by DCM and that adrenergic receptors in canine lymphocytes reflect the fluctuation of adrenergic receptor concentrations in the myocardium.

Modifications of receptor concentrations for adrenaline, steroid hormones, prostaglandin F2alpha and gonadotropins in hypophysis and ovary of dairy cows with ovarian cysts

Receptor concentrations for adrenaline, steroid hormones, PGF2alpha, LH and FSH were measured in the hypophysis and ovary of dairy cows with ovarian cysts and the results were compared with those of healthy animals. Significant modifications were found in all receptor concentrations, either between follicular and luteal structures or between the hypophyseal and ovarian receptorial status. The correlations between catecholaminergic and steroidal systems have already been demonstrated, particularly those existing between beta-adrenoceptors and steroid hormone receptors. Particular attention has been given to the possibility that a derangement in neurogenic inputs may be at the basis of some ovarian pathologies. The results of the present study suggest that the modifications of the ovarian and hypophyseal receptorial status of healthy and affected cows could play an important role in the pathogenesis of ovarian cysts.

Enhanced responsiveness of blood pressure to sodium intake and to angiotensin II is associated with insulin resistance in IDDM patients with microalbuminuria

We assessed blood pressure (BP), body weight, renal hemodynamics, and insulin sensitivity (by euglycemic-hyperinsulinemic clamp) in nine normoalbuminuric and seven microalbuminuric IDDM patients after 6 days on a low-sodium diet (20 mEq) and after 6 days on a high-sodium diet (250 mEq). In microalbuminuric but not in normoalbuminuric IDDM patients, switching from a low to a high-sodium diet was associated with a significant increase in mean BP (from 92 +/- 3 to 101 +/- 4 mmHg; P < 0.001) and in body weight (2.91 +/- 0.63 vs. 1.47 +/- 0.26 kg; P < 0.05). Moreover, under high-sodium conditions, angiotensin II infusion (3 ng x kg(-1) x min(-1)) caused a greater increase in mean BP (14 +/- 2 vs. 7.4 +/- 1 mmHg; P < 0.05) and a smaller reduction in renal plasma flow (-122 +/- 29 vs. -274 +/- 41 ml x min(-1) x 1.73 m2; P < 0.05) in microalbuminuric than in normoalbuminuric IDDM patients. Under low sodium conditions, aldosterone increments after angiotensin II infusion were lower (P < 0.05) in microalbuminuric than in normoalbuminuric IDDM patients. Insulin-mediated glucose disposal was not affected by sodium dietary content, but it was lower in microalbuminuric (P < 0.05) than in normoalbuminuric IDDM patients. The salt-induced changes in mean BP were related to insulin sensitivity (r = -0.78; P < 0.001). In conclusion, in IDDM patients, microalbuminuria is associated with 1) an increased responsiveness of BP to salt intake and angiotensin II, 2) impaired modulation of renal blood flow, and 3) insulin resistance. Therefore, salt sensitivity in IDDM patients clusters with other factors that are likely to play an important role in the pathogenesis of diabetic nephropathy and its cardiovascular complications.

Differences between longitudinal and circular smooth muscle in beta-adrenergic control of motility of isolated equine ileum

OBJECTIVE

To identify beta-adrenoceptor subtypes involved in motility inhibition of circular and longitudinal smooth muscle layers of equine ileum.

SAMPLE POPULATION

Isolated strips of equine ileum circular smooth muscle and membrane preparations from circular and longitudinal muscle layers.

PROCEDURE

Functional assays of circular muscle preparations and radioligand binding assays and measurements of cAMP production in smooth muscle membranes from circular and longitudinal layers.

RESULTS

Selective beta-adrenergic agonists exerted inhibitory effects on circular muscle preparations. Binding studies of cell membranes indicated that the density and distribution of 3 beta-adrenoceptor subtypes did not differ between longitudinal and circular muscle layers. Measurement of cAMP production in membrane preparations of longitudinal and circular muscle after selective beta-stimulation confirmed presence of the 3 adenylate cyclase-coupled beta-adrenoceptor subtypes; however, preparations from the 2 layers had differing cAMP production efficacy.

CONCLUSIONS

The data may partly explain the differing functional responses between circular and longitudinal muscle preparations.

CLINICAL RELEVANCE

Findings support the important role of beta-atypical adrenoceptors in the inhibitory regulation of equine ileum motility.

Identification of beta-adrenergic receptor subtypes mediating relaxation in isolated equine ileum

OBJECTIVE

To identify beta-adrenergic receptor subtypes in ileum smooth muscle of the horse.

SAMPLE POPULATION

Isolated strips of equine longitudinal ileum smooth muscle and membrane preparations from smooth muscle of the intestinal wall.

PROCEDURE

Functional assays and radioligand binding assays.

RESULTS

Relaxation of ileum longitudinal smooth muscle proved to be mainly caused by stimulation of beta-atypical and beta 2-adrenergic receptors. Binding studies on cell membranes indicated that the total beta-adrenergic receptors population consists of 54% beta-atypical, 34% beta 2- and 12% beta 1-subtypes.

CONCLUSIONS

The data suggest that sympathetic relaxation of equine ileum smooth muscle depends mainly on beta-atypical receptor subtypes activation, with a minor contribution by beta 2-subtypes.

CLINICAL RELEVANCE

The important role of beta-atypical adrenergic receptor subtypes in the relaxation of equine ileum suggests possible clinical use of selective beta-atypical receptor agonists to control intestinal disturbances.

Evidence for functional beta-adrenoceptor subtypes in CG-5 breast cancer cell

beta-adrenergic receptors (beta-ARs) were identified in CG-5 breast cancer cells using a radiometric assay. The total beta-AR concentration was measured using the highly potent beta-adrenergic antagonist (-)[3H]CGP 12177, and the densities of beta-AR subtypes were discriminated in the presence of highly selective unlabelled ligands (CGP 20712A and ICI 118551). Scatchard analysis revealed good linearity (r > 0.95) and Kd values (0.05-1 nM) indicated the presence of high affinity binding sites in CG-5 cell membranes. beta 2-AR concentrations (74%) were significantly (P < 0.05) higher than beta 1-AR concentrations (36%). Displacement studies indicated that tested adrenergic agonists displaced (-) [3H]CGP 12177 from its specific binding sites in the order of potency (-)isoproterenol > (+/-)clenbuterol > (-)adrenaline > (+/-)dobutamine > > (-)noradrenaline, whereas beta-adrenergic antagonists inhibited the binding in the following order of potency: (-)propranolol > > ICI 118 551 > > CGP 20712A. The functionality of beta-ARs identified in CG-5 cell membranes was demonstrated by the significant increase in cAMP production induced by different concentrations of isoproterenol vs unstimulated cells (control). The pathophysiological role of beta-ARs in breast cancer cells is still undefined, but their presence suggests the possible adrenergic regulation of some cellular activities such as proliferation and/or differentiation.

Down-regulation of beta-adrenergic receptors and up-regulation of estrogen and progesterone receptors induced in the reproductive system of female veal calves by dietary clenbuterol

Effects induced by long-term administration of clenbuterol at anabolic dosages (20 micrograms/kg of body weight for 40 days) on beta-adrenergic receptor (beta-AR) subtypes, estrogen receptors (ER), and progesterone receptors (PgR) in the reproductive system of female veal calves were investigated. Clenbuterol treatment induced a significant (P < 0.01) down-regulation of beta-AR subtypes (beta 1-AR, beta 2-AR, myometrial high-affinity beta 2-AR, and ovarian low-affinity beta 2-AR). On the other hand, a significant (P < 0.01) increase of uterine and ovarian ER and PgR receptors was observed in treated calves. Treatment did not affect dissociation constant values of beta-AR, ER, or PgR. In similar manner, clenbuterol did not significantly modify distribution of ER and PgR in the various tissues of the genital tract. In fact, these receptors were significantly (P < 0.05) more concentrated in the uterus than in the vagina in treated and untreated calves. Data indicated that prolonged clenbuterol exposure induced homologous beta-AR down-regulation (down-regulation of its specific receptors) and heterologous ER and PgR up-regulation (up-regulation of different types of receptors, not specifically bound by clenbuterol) in the genital tract of veal calves. Modification of the receptorial status could be reasonably related to the pathologic changes observed in long-term treated calves (eg, hydrometra, dilatation of uterine glands, cystic ovaries). The increased concentrations of ER and PgR suggested the possible existence of subcellular mechanisms regulated by repeated beta-adrenergic stimulation.

Identification of beta-adrenoceptor subtypes in bovine ovarian and myometrial cell membranes

Beta-adrenoceptor (beta-AR) concentrations were measured in the ovary and in the myometrium of 36 adult Friesian cows using a radiometric assay. The beta-AR content in both tissues was determined using the highly specific antagonist (-) [3H]CGP 12177 and the amounts of beta-AR subtypes were discriminated in the presence of highly selective unlabelled ligands (CGP 20712A, ICI 118 551, CGP 25827A). Scatchard analysis revealed a good linearity and Kd values suggested the existence of high affinity beta-adrenergic sites in the bovine genital tract. Total beta-AR concentrations in the ovary and in the myometrium were, respectively, 87 +/- 7 (SEM) and 240 +/- 27 fmol mg-1 of membrane protein. beta 2-AR concentrations were significantly higher (P < 0.01) in the ovary (66 +/- 5) and the myometrium (180 +/- 29) than those of beta 1-AR (21 +/- 4 and 60 +/- 5, respectively). Significant differences (P < 0.05) were also to be found between high affinity state beta 2-AR and low affinity beta 2-AR concentrations, but their values correlated negatively in the two different tissues. Natural and synthetic agonists inhibited (-) [3H]CGP 12177 binding to beta-AR in the following order of potency: (-)isoproterenol > (+/-)clenbuterol > or = (-)adrenaline >> >> (-)noradrenaline, whereas synthetic antagonists inhibited binding in the following order of potency: (-)propranolol >> (+/-)ICI 118 551 >> >> (+/-)CGP 20712A.

Specific binding of dl-cloprostenol and d-cloprostenol to PGF2 alpha receptors in bovine corpus luteum and myometrial cell membranes

Prostaglandin F2 alpha receptors (PGF2 alpha Rs) were measured in bovine corpus luteum and myometrial cell membranes using a radiometric method. The inhibition of labelled PGF2 alpha binding exerted by d-cloprostenol, dl-cloprostenol, PGF2 alpha and PGE1 (10(-11) M to 10(-4) M) was evaluated in vitro. Results strongly suggest that cloprostenol binding to PGF2 alpha Rs is stereospecific. d-Cloprostenol and PGF2 alpha were equipotent, about 150 times more potent than dl-cloprostenol (P < 0.05) and approximately 280 times more potent than PGE1 (P < 0.05) in inhibiting [3H]PGF2 alpha binding to corpus luteum cell membranes. Such differences were less evident in myometrial cell membranes, where d-cloprostenol and PGF2 alpha were about 10 times more potent than dl-cloprostenol (P < 0.05) and approximately 95 times more potent than PGE1 (P < 0.05).

Regulation of uterine estrogen receptors (ER) by beta-adrenergic stimulation in immature rats

The effects of a 3-day intramuscular (i.m.) administration of clenbuterol (25 micrograms/Kg), propranolol (12 mg/kg), clenbuterol (25 micrograms/kg) plus propranolol (12 mg/Kg) and estradiol (0.5 microgram) upon the female reproductive system were investigated in immature Sprague-Dawley rats. Clenbuterol and estradiol treatments induced a significant increase in uterus weight and in relative uterus weight, whereas in the groups treated with propranolol and clenbuterol plus propranolol no differences were detected versus controls. The uterine estrogen receptor levels were significantly increased by clenbuterol administration. In the rats dosed with propranolol and clenbuterol plus propranolol, no modifications occurred in estrogen receptor concentrations when compared with control values. Uterine progesterone receptors were never significantly affected by any of the considered treatments. Data obtained indicate that clenbuterol treatment induces an increase in uterus weight and in estrogen receptor levels and that these effects are regulated by acute beta-adrenergic stimulation, as the contemporaneous administration of high doses of a beta-blocker inhibit such effects.

Effects of long-term administration of clenbuterol in mature female rats

Female Sprague-Dawley rats were treated IM with 0, 2.5, 25, and 50 micrograms of clenbuterol HCl/kg of body weight/d for 21 days. In all treated rats, significant increase in body weight gain (P < 0.05) and improvement in feed conversion ratio (P < 0.05) were recorded. Hydrometra was observed in the uterus of treated rats, and histologically, it was possible to see dilatation of luminal glands and ovarian alterations. Clenbuterol treatment induced significant (P < 0.05) increase in uterine estrogen receptor concentration of rats treated with the 2 higher doses. Treatment apparently failed to enhance the rate of oxidative and conjugative biotransformations, except for glucuronidation of p-nitrophenol (P < 0.05). On the basis of the data obtained, we could affirm that high doses of clenbuterol affect the female reproductive system of rats inducing, almost in part, estrogen-like modifications, but probably by a different mechanism of action correlated to intense adrenergic stimulation.

Effects of a beta 2-agonist (clenbuterol) on cultured human (CG-5) breast cancer cells

In order to gain further knowledge about the possible oestrogen-like activities of clenbuterol (a beta 2-adrenergic drug illegally used as partitioning agent in food producing animals), we treated a hormone dependent human breast cancer cell line (CG-5) with different concentrations of the drug (10(-3) M to 10(-8) M). The effects of clenbuterol and oestradiol on cell proliferation were compared. Both oestradiol and clenbuterol, at low concentrations (10(-7) M and 10(-8) M) stimulated cell proliferation, but the effects of clenbuterol were less marked and significant. Probably clenbuterol elicited cell proliferation through a different mechanism, since it did not affect the cellular oestrogen receptor concentration. Clenbuterol failed in binding to the high affinity oestrogen receptors present in the CG-5 cells. As the beta-adrenergic receptors and the susceptibility to their stimulation have been recently demonstrated in vivo and in vitro in many tumour and normal cells, it is reasonable to suppose that clenbuterol may induce cell proliferation through beta-adrenergic stimulation.

Mediastinal chondrosarcoma. Case report

A 34-year-old man and a 71-year-old woman underwent radical removal of mediastinally sited chondrosarcoma, presumably originating in the periosteum of the vertebral body. The man (with mesenchymal chondrosarcoma) died of remote metastasis 6 years postoperatively. The woman (poorly differentiated chondrosarcoma, grade 2-3) is still alive 2 years after the operation.

Blood kinetics of sulfamonomethoxine and oxytetracycline following intrauterine spray injection in dairy cows

Intrauterine administration was performed in six Friesan cows with a disposable spray preparation containing 3 g of sulfamonomethoxine and 3 g of oxytetracycline, in order to investigate their serum kinetics. Sulfamonomethoxine levels were determined by a reversed-phase HPLC method, whilst oxytetracycline quantities were detected by a microbiological method. The sulphonamide had a peak 1.17 h after the administration, the tetracycline reached its highest concentration after 8 h. The bioavailability of both drugs was low and detectable drug amounts were no longer recovered after 24 h.

[Carcinoma of the male breast (our experience and a review of the literature)]

The authors consider their experience in male breast cancer. Making a review of the literature they point out the risk factors and the prognosis of this disease.