Showing papers by "Leicester Royal Infirmary published in 1993"
TL;DR: Study of children in The Gambia attending out-patient and under-five clinics with clinically suspected pneumonia during periods of high or low malaria transmission finds clinical overlap between pneumonia and malaria has important implications for case management strategies and evaluation of disease-specific interventions.
Abstract: Pneumonia and malaria are common causes of childhood morbidity and mortality in many developing countries and simple guidelines have been proposed to facilitate their diagnosis by relatively unskilled health workers. We have studied children in The Gambia attending out-patient and under-five clinics with clinically suspected pneumonia (cough or difficulty in breathing and a raised respiratory rate) during periods of high or low malaria transmission. During a period of high malaria transmission, 33% of these children had radiological evidence of pneumonia (with or without malaria parasitaemia) compared to 38% who had malaria parasitaemia, no radiological evidence of pneumonia and no other obvious cause of fever. Corresponding figures during a period of low malaria transmission were 48% and 6% respectively. The clinical overlap between pneumonia and malaria has important implications for case management strategies and evaluation of disease-specific interventions in regions in which both pneumonia and malaria are prevalent.
219 citations
TL;DR: From a very low initial level, thrombolytic drug use rose slowly for several years after publication of the trial results and reached a plateau in 1991-92, when it is estimated that 35-50% of patients admitted with acute myocardial infarction were receiving throm bolytics.
207 citations
TL;DR: A multicentre, randomized, double‐blind, controlled crossover clinical trial was conducted on 33 patients with severe refractory atopic dermatitis, to determine the effects of cyciosporin (5 mg/kg/day) on their health‐related quality of life.
Abstract: A multicentre, randomized, double-blind, controlled crossover clinical trial was conducted on 33 patients with severe refractory atopic dermatitis, to determine the effects of cyclosporin (5 mg/kg/day) on their health-related quality of life. Treatments were administered for 8-week periods. One group (n = 16) received placebo followed by cyclosporin, and the other (n = 17) received cyclosporin and then placebo. Health-related quality of life was assessed at 0, 8 and 16 weeks using a general measure, the United Kingdom Sickness Impact Profile (UKSIP), an eczema-specific measure, the Eczema Disability Index (EDI), and a global 5-point rating scale of overall health (very good to very poor). In addition, clinical assessments (i.e. extent and activity of disease) were made by the investigators. UKSIP and EDI scores indicated significant improvement in quality of life (P < 0.05-P < 0.01) of patients with atopic dermatitis after treatment with cyclosporin. Although no patient required withdrawal from the study, 20 patients receiving cyclosporin reported adverse events, compared with eight taking placebo. There was a close correlation (P < 0.05-P < 0.01) between the UKSIP and EDI scores. In contrast, there was either no correlation, or only a very poor correlation, between the quality of life parameters and clinical measures of extent and activity of eczema. When cyclosporin was stopped, relapse was rapid, but the mean scores for disease activity and extent of disease were less than their baseline values (i.e. an improvement of greater than 25% was maintained in 11 patients at week 4).(ABSTRACT TRUNCATED AT 250 WORDS)
204 citations
TL;DR: To compare the outcome of two methods of maternity care during the antenatal period and at delivery, a midwife‐led and consultant‐led approach was proposed.
171 citations
TL;DR: This study, which avoided the methodological and analytical problems of previous studies, found no effect of essential fatty acid supplementation in atopic dermatitis.
140 citations
TL;DR: Findings show that two independent loci influence different haemodynamic components of blood pressure, and that pulse pressure has a specific genetic determination.
Abstract: Several genetic loci involved in blood pressure regulation have recently been localized in experimental models of hypertension, but the manner in which they influence blood pressure remains unknown. Here, we report a study of the Lyon hypertensive rat strain showing that different loci are involved in the regulation of steady-state (diastolic pressure) and pulsatile (systolic – diastolic, or pulse pressure) components of blood pressure. Significant linkage was established between diastolic blood pressure and a microsatellite marker of the renin gene (REN) on rat chromosome 13, and between pulse pressure and the carboxypeptidase B gene (CPB) on chromosome 2. These findings show that two independent loci influence different haemodynamic components of blood pressure, and that pulse pressure has a specific genetic determination.
127 citations
TL;DR: The calculated transmitted mucosal pressures were substantial for all three sizes of cuff and potentially exceeded the capillary perfusion pressure of the adjacent pharyngeal mucosa, despite apparent pharygeal accommodation to the mask.
Abstract: SUMMARY Ten patients were studied for each of the sizes 2, 3 and 4 laryngeal mask airways (LMA) in order to calculate the pressure exerted by the cuff upon the pharyngeal mucosa. Using a non-invasive method of comparing intracuff pressures recorded both in vitro and in vivo, the transmitted pharyngeal mucosal pressures were calculated over the clinical range of injection volumes. Cuff inflation with the “normal” injection volumes recommended resulted in the residual volumes of the cuffs being exceeded. The intracuff pressures recorded with the mask in situ at these normal injection volumes were in the range 103-251 mm Hg. The calculated transmitted mucosal pressures were substantial for all three sizes of cuff and potentially exceeded the capillary perfusion pressure of the adjacent pharyngeal mucosa, despite apparent pharyngeal accommodation to the mask. (Br. J. Anaesth. 1993; 70: 25–29)
126 citations
TL;DR: Given the increasing competition for voluntary workers, the sensitive management of change is seen as vital if LOROS is to maintain the commitment of its volunteers and maintain its attractiveness as an organisation which should be supported by voluntary work.
113 citations
TL;DR: The CAMPATH-1 antigen is also expressed at a high level in the male reproductive system, being found in the epididymis, seminal vesicle, seminal plasma and on the surface of mature (but not testicular) spermatozoa.
110 citations
TL;DR: A randomized prospective clinical study of diaphyseal tibial fractures treated with external fixation showed a significant reduction in time to healing when micromovement was imposed, and controlled fracture site movement can be imposed very early after fixator frame application.
Abstract: Axial fracture movement and loading has been measured during weight bearing in 45 patients with tibial diaphyseal fractures treated with unilateral external skeletal fixation. Mean axial fracture displacement reached a maximum of 0.6 mm between seven and 12 weeks postfracture. Very little movement occurred during the first five weeks after fracture. A micromovement module attached to the fixator increased axial movement at the fracture site by 50% during walking. Weight bearing reached 75% of mean body weight by ten weeks after the fracture. Weight bearing was not decreased by any biofeedback mechanism. A randomized prospective clinical study of diaphyseal tibial fractures treated with external fixation showed a significant reduction in time to healing when micromovement was imposed. Controlled fracture site movement can be imposed very early after fixator frame application when mechanical stimulation may be most effective, and the active loading by the patient is least.
105 citations
TL;DR: Movements between dependency states, institutionalization and death are investigated in a general practice cohort of people aged 75 years and over with follow-up at 5 and 7 years from initial interview, with women at each age more likely to become dependent whilst men had higher mortality.
Abstract: Movements between dependency states, institutionalization and death are investigated in a general practice cohort of people aged 75 years and over with follow-up at 5 and 7 years from initial interview. Initially, 1203 people were interviewed, 1124 living in the community and 79 in institutions. By 5 years, 42% (510) had died and by 7 years 58% (700) had died. Dependency was defined as requiring help or aids with at least one activity of daily living (ADL). Of those initially independent, 34% were still independent 7 years later. Women at each age were more likely to become dependent whilst men had higher mortality. Those rating their health as fair or poor were more likely to lose independence at both 5 and 7 years than those rating their health as good. These differences remained, even after adjustment for age, sex and baseline ADL status. With the assumption that once institutionalized a person did not return to live in the community (an assumption upheld by the present data), 7% (79/1124) of those initially resident in the community were institutionalized during the 7 years; the rates for men (6%) being slightly lower than for women (7.5%).
TL;DR: Ultrasound scans were made of the hips of 209 neonates born consecutively over a two-week period and results showed poor reliability on both counts.
Abstract: Ultrasound scans were made of the hips of 209 neonates born consecutively over a two-week period. Of the 418 scans, 62 images were selected at random and 25 of these were duplicated to give a total of 87 scans. These static images were then presented to five experienced observers who each made nine different assessments and measurements. Interobserver and intraboserver agreement was calculated and expressed as kappa values. Our results showed poor reliability on both counts.
TL;DR: This study analysed 148 severely ischaemic limbs in 133 non-diabetic patients who presented with rest pain, tissue necrosis or a combination of these symptoms to determine the relevance of the definition in clinical practice.
TL;DR: Front seat position, pain within 12 h of injury, past history of neck pain and degenerative changes on radiographs were associated with a longer duration of significant pain, and early onset of pain was alsoassociated with a worse level of pain at review.
Abstract: We studied the natural history and prognostic factors in 100 patients who had sustained neck sprains in rear impact road traffic accidents, and who had all originally been seen for medicolegal reports. They were seen for clinical and radiological review at a mean of 8 years after injury. The detailed medicolegal reports from the early years were available on all patients, and were used to supplement the information obtained at review. Of the patients, 50 per cent had significant pain at 8 months, decreasing to 22 per cent at 2 years and 18 per cent at 3 years. At review, 45 per cent were free of pain, and 14 per cent had significant pain. Front seat position, pain within 12 h of injury, past history of neck pain and degenerative changes on radiographs were associated with a longer duration of significant pain (P < 0.05). Early onset of pain was also associated with a worse level of pain at review. The timing of compensation was not associated with improvement in symptoms. The injury had not accelerated the development of degenerative changes.
TL;DR: Two unrelated male and female patients with an identical syndrome of diaphragmatic hernia, exomphalos, hypertelorism, agenesis of the corpus callosum, severe sensorineural deafness, and severe myopia are described.
Abstract: We describe unrelated male and female patients with an identical syndrome of diaphragmatic hernia, exomphalos, hypertelorism, agenesis of the corpus callosum, severe sensorineural deafness, and severe myopia. One child had an iris coloboma. After the birth of the first affected child in each family subsequent pregnancies were monitored with ultrasound scan and a further affected fetus was identified in both families. We conclude that this constellation of anomalies represents a distinct, previously unreported syndrome with likely autosomal recessive inheritance. © 1993 Wiley-Liss, Inc.
TL;DR: There was a very small but statistically significant association between observer ratings of deficits in social functioning (daily social and living skills) and self-reported family social networks size and Behavioural problems were also associated with smaller family networks.
Abstract: It has been suggested that deficits or impairments in social functioning may explain the depleted support networks of the mentally ill. With this in mind, 145 long-term users of day care psychiatric facilities, 57% of whom had a life-time diagnosis of schizophrenia, were examined to determine whether deficits in social and survival skills explained deficits in their social networks. Compared with patients with acute depression, long-term patients had smaller social networks. There was a very small but statistically significant association between observer ratings of deficits in social functioning (daily social and living skills) and self-reported family social networks size. Behavioural problems were also associated with smaller family networks. Among the long-term patients, duration of service contact and type of disorder (affective vs nonaffective psychosis) were not related to network size. These preliminary findings are discussed.
TL;DR: Children with newly diagnosed diabetes may be safely and effectively managed out of hospital according to the commitment of consultants specialising in diabetes working in close cooperation with general practitioners, specialist nurses in diabetes, and dietitians.
Abstract: OBJECTIVES--To document the number of children aged less than 15 years who developed diabetes and were managed within one large health district, and to evaluate the outcome of those children managed without hospital admission at diagnosis. DESIGN--A retrospective study over 1979-88, when a paediatrician and a physician with special interests in childhood diabetes initiated joint clinics. Data collected from the district diabetes register and files of consultants and health visitors specialising in diabetes. SETTING--Referral of children to consultants in Leicestershire (total population 863,000). MAIN OUTCOME MEASURES--The proportion of children managed without hospital admission, comparison of readmission rates and glycated haemoglobin concentrations between children admitted and those not admitted. RESULTS--Over 10 years 236 children aged 10-14 years developed diabetes (annual incidence rate 12.8/100,000 child population (95% confidence interval 11.3 to 14.7)). In total 138 were not admitted to hospital but received supervised management based at home. Admitted children were younger or acidotic or their family doctors did not contact the diabetes team. Duration of admission declined from seven days in 1979-80 to three days in 1987-8. Ninety two were not admitted to hospital during the 10 years for any reason. Significantly fewer children who received management at home were readmitted for reasons related to diabetes than the group treated in hospital (30 (22%) v 40 (41%); p = 0.004). Concentrations of glycated haemoglobin were no different between the two groups. CONCLUSIONS--Children with newly diagnosed diabetes may be safely and effectively managed out of hospital. Domiciliary or community based management depends on the commitment of consultants specialising in diabetes working in close cooperation with general practitioners, specialist nurses in diabetes, and dietitians.
TL;DR: It is suggested that the prepubertal duration of diabetes is an important phase and that the years prior to puberty do contribute to the risk of developing microvascular injury.
Abstract: This study investigated the relationship between the development of diabetic retinopathy and pubertal status at onset of diabetes in 521 Type 1 diabetic patients diagnosed between 1950 and 1985. Pubertal status was based on age at onset (girls > or = 11 years and boys > or = 12 years). Retinopathy (all forms) developed in 112 patients (21.5%; 65 background and 47 proliferative retinopathy). For subjects diagnosed in either the prepubertal or postpubertal period, a similar proportion survived without developing retinopathy for any given duration of diabetes (chi 2 = 0.3822, p = 0.54). However, if only the postpubertal duration of diabetes is considered, then the proportion of patients surviving without retinopathy was significantly less for those diagnosed in the prepubertal period (chi 2 = 14.2, p = 0.002). This study suggests that the prepubertal duration of diabetes is an important phase and that the years prior to puberty do contribute to the risk of developing microvascular injury.
TL;DR: It is demonstrated that outpatient hysteroscopy is well tolerated by perimenopause patients and the advantages of outpatient hysteroscope to the perimenopausal woman are discussed.
TL;DR: The findings suggest that direct lytic infection of myocytes by virus is responsible for myocaiditis in these cases, rather than an autoimmune process, which has been suggested previously.
Abstract: This is a combined study using in situ hybridization and the polymerase chain reaction to investigate the presence of Coxsackie virus RNA in formalin-fixed tissue from cases of childhood myocarditis. Of the ten cases studied, two were positive by both methods. The virus RNA was predominantly located in areas showing an inflammatory cell infiltrate and myofibre necrosis. These findings suggest that direct lytic infection of myocytes by virus is responsible for myocaiditis in these cases, rather than an autoimmune process, which has been suggested previously. The findings in one case, where the virus showed a marked sub-endocardial distribution, may have implications for the aetiology of endocardial fibroelastosis by confirming a viral tropism for this location. The techniques used in this study are easily repeatable and can be directly applied to look for viruses in a number of other diseases where a viral aetiology is suspected.
TL;DR: The trends in necropsy rates during the 1980s in three groups of British teaching hospitals in Leicester, Manchester, and Sheffield were compared in a retrospective study to illustrate the importance of monitoring differential necropsies rates.
Abstract: The trends in necropsy rates during the 1980s in three groups of British teaching hospitals in Leicester, Manchester, and Sheffield were compared in a retrospective study. The clinical necropsy rates declined in all three cities: in Leicester, from 16 to 10 per cent; in Manchester, from 14 to 8 per cent; and in Sheffield from 18 to 11 per cent. The medico-legal and overall necropsy rates showed variable trends between the cities. Specific events and changes in organization during the review period were correlated with the changing trends. The observed trends emphasize the continued decline in clinical necropsy rates over the last decade and illustrate the importance of monitoring differential necropsy rates.
01 May 1993
TL;DR: The results show that excellent limb salvage can be successfully achieved in severely ischaemic patients by adopting an aggressive approach to Femorodistal bypass, and that age, gender and poor medical condition are not contraindications to femorodistsal bypass.
Abstract: The merits of an aggressive policy of distal reconstruction have been questioned by some observers. To determine the factors affecting graft patency and mortality, we analysed 78 consecutive infragenicular femorodistal vein grafts performed in 72 patients with critical limb ischaemia. The primary, primary assisted and secondary graft patency rates at 36 months were 29, 57 and 64%, respectively. The limb salvage and patient survival rates at 36 months were 67 and 74%, respectively. Univariate analysis (log-rank test) was performed to identify factors affecting graft patency, limb salvage and mortality at 1 month (perioperative) and 1 year. Independent variables of age, sex, diabetes, presentation, level of anastomosis and vein technique (reversed or in situ ) did not affect graft patency. The ankle systolic pressure did not predict graft patency but was an independent variable affecting mortality ( p = 0.047), as did diabetes ( p = 0.019). These results show that excellent limb salvage can be successfully achieved in severely ischaemic patients by adopting an aggressive approach to femorodistal bypass, and that age, gender and poor medical condition are not contraindications to femorodistal bypass. The difference between the primary and primary assisted patency rates in this series is dramatic and reflects the impact of a vein graft surveillance programme in preventing graft occlusion.
TL;DR: Dependency levels in residential care have risen substantially, particularly in the private sector, even beyond levels expected from the greater numbers of elderly people, with the impending move to community care.
Abstract: OBJECTIVE--To determine the changes between 1979 and 1990 in demography and dependency levels in elderly people in residential care. DESIGN--Censuses of those aged 65 years and over in any type of residential care at midnight on 11 December 1979 and 27 November 1990. SETTING--Leicestershire District Health Authority (population 865,133, 1991 census), coterminous with county and social services boundaries. MAIN OUTCOME MEASURES--Age, sex, length of stay, and dependency levels (measured by activities of daily living). RESULTS--In 1990 (1979), 6079 (4678) elderly people were enumerated in 241 (133) establishments, a 30% increase in the numbers of elderly people in residential care and an 82% increase in the number of establishments between 1979 and 1990. Dependency levels rose between 1979 and 1990 in all but the geriatric sector, the greatest increases being found in private residential homes where the largest percentage increase in the number of residents had occurred. CONCLUSIONS--Dependency levels in residential care have risen substantially, particularly in the private sector, even beyond levels expected from the greater numbers of elderly people. With the impending move to community care, dependency levels are likely to rise further, and more appropriate staff training and medical input to homes will become necessary.
TL;DR: It is demonstrated that synthesis of many complement components occurs in normal, RA and OA synovial membrane, and that this may be explained in part by synthesis in mononuclear phagocytes, endothelial cells and fibroblasts.
Abstract: We have studied synthesis of the complement components and regulatory proteins of the alternative pathway and the membrane attack complex in synovial membrane. RNA was extracted from synovial tissue of patients with rheumatoid arthritis (RA) or osteoarthritis (OA) as well as from normal synovial membrane. Dot blot analysis showed the presence of mRNAs for all the complement components and regulatory proteins (C3, factor B, factor D, C5, C6, C7, C9, factor H, factor I, S-protein, SP-40, 40, DAF, MCP, CR1, CD59), except for properdin, C8α, C8β and C8γ in all three types of synovial membrane studied. In an attempt to determine which components were synthesised by each cell type, monocytes (mononuclear phagocytes), human umbilical vein endothelial cells (HUVEC), synovial membrane fibroblasts (from normal, OA and RA synovial membrane) and peripheral blood lymphocytes were cultured in vitro and secretion rates of individual components were measured and total cellular RNA analysed by northern blotting. Monocytes secreted properdin, C3, and factor H but not factor B, factor I, C5, C6, C7, C8 or C9. Fibroblasts and endothelial cells secreted factor B, factor H and factor I, but not properdin, C5, C6, C7, C8 or C9. Lymphocytes did not secrete any of these components. mRNAs encoding C3, factor B, factor H, S-protein, SP-40, 40, MCP and DAF were detected in all three other cell types (monocytes, fibroblasts and HUVEC), but factor I and CD59 mRNAs were not detected in monocytes. C5, C6, C7, C8α, C8β, CD8γ and C9 mRNAs were not detected in any of the cell types studied. Cell-specific differences were observed in the expression of the different mRNA species for DAF, MCP and CD59. The results of the present study demonstrate that synthesis of many complement components occurs in normal, RA and OA synovial membrane, and that this may be explained in part by synthesis in mononuclear phagocytes, endothelial cells and fibroblasts. The cellular sources of C5, C6, C7 and C9 mRNAs in synovial membrane have not been determined. The data also show that there are important cell-specific differences in the expression of the genes encoding both the alternative complement pathway components and the membrane regulatory components. These differences require further investigation.
TL;DR: The advantages of proton beams are outlined and the relative merits of different treatment systems compared together with the results of studies of comparisons of treatment planning with protons with that using conventional photon therapy are reviewed.
Abstract: The use of high-energy protons in radiotherapy was first proposed in 1946. In the last decade there has been a significant growth in the number of centres using protons in the treatment of malignant and nonmalignant disease. To date (January 1993) a total of more than 11,500 patients have been treated world-wide. Encouraging clinical results have been reported in the literature. The author outlines the advantages of proton beams and reviews current developments in physics and engineering applied to the field of proton therapy. Particular emphasis is placed on proton accelerator technology and the development of proton therapy facilities. The production of clinically useful beams is discussed and the relative merits of different treatment systems compared. Reference is also made to the factors affecting the absorbed dose in a patient and to proton radiobiology together with the results of studies of comparisons of treatment planning with protons with that using conventional photon therapy. The dosimetry of proton beams is also reviewed.
TL;DR: It is shown that a linear continuous density gradient can be produced within the 2991 bag, that allows as much as 40 ml of digest to be successfully purified and provides the optimal method for density-dependent islet purification.
Abstract: The use of the COBE 2991 cell processor (COBE Laboratories, Colorado) for large-scale islet purification using discontinuous density gradients has been widely adopted. It minimizes many of the problems such as wall effects, normally encountered during centrifugation, and avoids the vortexing at interfaces that occurs during acceleration and deceleration by allowing the gradient to be formed and the islet-containing interface to be collected while continuing to spin. We have produced cross-sectional profiles of the 2991 bag during spinning which allow the area of interfaces in such step gradients to be calculated. This allows the volumes of the gradient media layers loaded on the machine to be adjusted in order to mazimize the area of the gradient interfaces. However, even using the maximal areas possible (144.5 cm2), clogging of tissue at such interfaces limits the volume of digest which can be separated on one gradient to 15 ml. We have shown that a linear continuous density gradient can be produced within the 2991 bag, that allows as much as 40 ml of digest to be successfully purified. Such a system combines the intrinsic advantages of the 2991 with those of continuous density gradients and provides the optimal method for density-dependent islet purification.
TL;DR: The results are unsatisfactory: the use of the ABC carbon and polyester prosthetic ligament is not recommended: it is recommended not to use this prosthetics ligament.
Abstract: We treated 39 knees with chronic deficiency of the anterior cruciate ligament by reconstruction using the ABC carbon and polyester prosthetic ligament; 31 (79.5%) were reviewed at an average follow-up of 34 months. There had been four complete failures requiring revision. The remaining 27 were studied in detail. On the Lysholm rating, only 11 knees (41%) had good results with a score of over 76. The mean anterior drawer movement was reduced from 7.6 mm before operation to 5.8 mm at review. The mean difference from the opposite uninjured knee was 3.9 mm before operation, 1 mm (in 21 patients) at mean follow-up of 7.4 months and 2.5 mm (in 27 patients) at 34 months, indicating progressive loss of effect. In our opinion the results are unsatisfactory: we do not recommend the use of this prosthetic ligament.
01 Jul 1993
TL;DR: While the molecular basis of the action of most anaesthetic agents is unknown, it is a commonly held view that general anaesthetic drugs have a more pronounced effect on synaptic mechanisms in the central nervous system than on the propagation of electrical signals along axons.
Abstract: While the molecular basis of the action of most anaesthetic agents is unknown, it is a commonly held view that general anaesthetic drugs have a more pronounced effect on synaptic mechanisms in the central nervous system (CNS) than on the propagation of electrical signals along axons [39]. A more contentious issue relates to whether or not anaesthetic agents act generally, producing a range of metabolic alterations which together result in anaesthesia or at, as yet, unidentified specific sites in neuronal mechanisms [25]. Sensory information is passed from cell to cell in the CNS by neurotransmitters. These transmitter substances are released in the synaptic cleft between adjacent cells and, depending on the particular synapse, can interact with presynaptic and/or postsynaptic receptors. The postsynaptic actions of transmitter substances are mediated classically via excitatory postsynaptic potentials (EPSP) or inhibitory postsynaptic potentials (IPSP) and the size of these can be modulated by the regulation of transmitter release from the nerve terminal by the interaction of neurotransmitter substances at receptors in the presynaptic membrane.
TL;DR: The application of skin traction to patients with fractures of the upper femur is time-consuming and it is recommended therefore that its routine use should be discontinued.
Abstract: We report the results of a randomised trial to determine the effects of skin traction on 252 patients awaiting surgery for fractures of the proximal femur. They were allocated randomly to be nursed free in bed or to receive Hamilton-Russell skin traction. No differences were found between the groups in terms of pain suffered, analgesia required, frequency of pressure sores or ease of operation. The application of skin traction to patients with fractures of the upper femur is time-consuming and we recommend therefore that its routine use should be discontinued.