A displasia coxo-femoral tem sido descrita como moléstia de origem genética, caracterizada por incongruência articular, com alterações dos tecidos conectivos da articulação. Podendo afetar qualquer raça, é particularmente prevalente em raças grandes e gigantes e está apontada como a principal causa do desenvolvimento de osteoartrite em cães. Muitas técnicas são apontadas para o tratamento destes quadros, e novas pesquisas têm sido desenvolvidas no intuito de se obter técnicas mais eficazes e menos cruentas, diminuindo também o tempo de recuperação. Destas, a denervação da articulação coxo-femoral surge como técnica simples e eficaz que recupera a atividade funcional dos membros afetados em tempo significativamente menor em relação às demais. Esta técnica consiste em remoção do periósteo acetabular, eliminando as fibras nervosas sensitivas da região com conseqüente promoção da analgesia. Este estudo visou quantificar as fibras nervosas presentes na região descrita, relacionando a densidade encontrada com a técnica cirúrgica, na intenção de torná-la mais precisa e eficaz. Foram utilizados 30 acetábulos, provenientes de 15 cães, machos e fêmeas, com peso variando entre 22,0 Kg e 62,0 Kg. A dissecção macroscópica revelou simetria bilateral com variação individual da enervação regional, com ramos originados dos nervos glúteo cranial, isquiático e femoral. A enervação do periósteo acetabular foi estudada por método de impregnação pela prata e os resultados obtidos apontam uma diferença estatística significativa entre a densidade (fibras/mm2) da região crânio-lateral em relação à região caudo-lateral do acetábulo. Demonstraram ainda haver simetria entre os antímeros estudados. As fibras nervosas apresentam disposição quase vertical no periósteo acetabular, em direção à cápsual articular, o que sugere a densidade nervosa também presente na região. / Hip dysplasia has been described as a genetic disease, caracterized by articular incongruence with alterations in the articular connective tissues. It may affect all breeds, prevailing in large and very large ones and it is supposedly the main cause in the development of osteoarthrites in dogs. Many techniques are indicated for the treatment of this disease, and new researches are being developed in the meaning of obtaining more efficient and less traumatic techniques, keeping the post operative time as short as possible. Among these, the denervation of the hip joint capsule comes as a simple and effective technique, that recovers the functional activity of the affected limbs in significantly less time then the others. This surgical procedure consists in removing the acetabular periosteum, eliminating the nervous fibers with consequent analgesy This study tried to quantify the nervous fibers present in the mentioned region, relating the density found with the surgical technique, intending to make it more efficient. Thirty acetabular fragments, from 15 dogs, both male and female, weighting between 22,0 and 62,0 Kg, were used. Macroscopic dissection showed bilateral symmetry, with individual variation of regional innervation, and branches from the cranial gluteal, ischiaticus and femoral nerves. The acetabular periosteal innervation was studied by silver staining and the results showed a significatn difference between the nervous fiber density (fibers/mm2) of the cranial lateral portion and caudal lateral portions of the acetabulum. They also showed both antimeres are symmetric. Nervous fibers are positioned almost in a vertical position in the acetabular periosteum, running directed to the joint capsule, suggesting nervous density also in that region.

No description available.

Vários estudos demonstram que a atividade física é capaz de trazer benefícios para as cartilagens articulares. Estes manifestam-se reduzindo os riscos de lesão articular, prevenindo aderências na articulação, aumentando e mantendo sua mobilidade e combatendo a obesidade, grande fator de risco para o desenvolvimento de lesões articulares. Por outro lado, sabe-se que o envelhecimento provoca alterações deletérias em vários tecidos, inclusive nas cartilagens articulares. O objetivo deste trabalho foi verificar se a atividade física regular promove alterações no processo de envelhecimento da cartilagem articular da cabeça do fêmur de ratos Wistar corredores. Para este estudo foram utilizados 24 ratos Wistar corredores, os quais foram divididos em três grupos de oito animais cada: Sedentários (S) - ratos adultos sedentários; Treinados (T) - ratos adultos treinados; e Controle (C) - ratos adultos jovens. As cartilagens articulares das cabeças femorais foram analisadas por dois métodos: microscopia de luz (três de cada grupo) e microscopia eletrônica de varredura (cinco de cada grupo). Os resultados em microscopia de luz foram obtidos a partir do método esteriológico. Os valores não foram estatisticamente diferentes em relação à idade e ao treinamento para os parâmetros: volume total da cartilagem, número total de condrócitos, densidade de volume de matriz e volume total de matriz (P=0,05). Os dados foram significantes em \"border line\" para idade nos parâmetros densidade do volume celular e volume celular indireto (P=0,058) e para treinamento no parâmetro densidade celular (P=0,058). À microscopia eletrônica de varredura foi possível observar que no grupo S a superfície articular da cabeça femoral apresentava-se lisa e com áreas de erosões bem evidentes, enquanto que, no grupo T e C, haviam nítidas ondulações, sem presença de erosões. Estes dados nos levam a concluir que um programa de atividade física constante durante o envelhecimento é benéfico para a cartilagem articular da cabeça do fêmur, pois sugere que a cartilagem dos animais do grupo S foi mais susceptível a lesões do que as do grupo T e C, e que a atividade física promoveu a estimulação dos condrócitos, aumentando, assim, a resistência da cartilagem às modificações deletérias do envelhecimento. / Several studies has demonstrate that the physical activity can bring benefits for the articular cartilage. These show a reduction in articular lesion risks, preventing the adherences in the articulation, increasing and maintaining its mobility and combating the obesity, which is a great risk factor for the development of articulate lesions. On the other hand, it is known that the aging provokes harmful alterations in several tissues, including articular cartilage. The objective of this work was to verify if the regular physical activity promotes alterations in the process of aging of the articular cartilage of the femoral head of Wistar runner rats. For this research were used 24 Wistar runner rats. The animals were divided in three groups containing eight animals each one: Sedentary (S) - adult sedentary rats; (T) - adult trained rats; and Control (C) - young adult rats. The articular cartilages of the femoral heads were analyzed by two methods: light microscopy (three each group) and scanning electron microscopy (five each group). The results in light microscopy were obtained using stereological method and there were not statistically significant differences in relation to age and training for the parameters: total volume of the cartilage, total number of chondrocytes, volume density of extra cellular matrix and total volume of extra cellular matrix (P=0,05). The data were statistically significant in \"border line\" for age in the parameters chondrocyte volume density and mean chondrocyte volume (P=0,058) and for training in the parameter cellular density (P=0,058). By scanning electron microscopy was possible to observe that in S group, the surface of articular cartilage of the femoral head came flat and with areas of evident erosions, while, in T group, there were clear undulations, without the presence of erosions. These data take us to conclude that a program of constant physical activity during the aging promotes benefits for the articular cartilage of the femoral head by suggests that the cartilage of the animals of the S group was more susceptible to lesions than the ones of the T and C group and that the physical activity promoted the stimulation of the chondrocytes, increasing the resistance of the cartilage to the harmful modifications of the aging.

Hung Hoi Yan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 138-160). / Abstracts in English and Chinese. / ABSTRACT --- p.i / ACKNOWLEDGEMENTS --- p.v / PUBLICATIONS BASED ON THE WORK IN THIS THESIS --- p.vi / TABLE OF CONTENTS --- p.vii / ABBREVIATIONS --- p.ix / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- Prostanoids and vasoconstriction --- p.1 / Chapter 1.1.1 --- EP3 receptors --- p.2 / Chapter 1.1.2 --- EP1 receptors --- p.16 / Chapter 1.1.3 --- FP receptors --- p.23 / Chapter 1.1.4 --- TP receptors --- p.30 / Chapter 1.2 --- Role of Ca2+ in vascular smooth muscle contraction --- p.36 / Chapter 1.2.1 --- Ca2+ as second messenger --- p.36 / Chapter 1.2.2 --- Ca2+ sensitization --- p.41 / Chapter 1.3 --- Aim of study --- p.48 / Chapter CHAPTER 2 --- METHODS AND MATERIALS --- p.49 / Chapter 2.1 --- Experiments with rat femoral artery --- p.49 / Chapter 2.2 --- Experiments with guinea-pig trachea --- p.56 / Chapter 2.3 --- Materials --- p.59 / Chapter 2.4 --- Data analysis --- p.61 / Chapter 2.5 --- Measurement of rat knee joint blood flow --- p.62 / Chapter CHAPTER 3 --- RESULTS --- p.68 / Chapter 3.1 --- Effects of EP3 agonists and other vasoactive agents on the rat femoral artery preparation --- p.68 / Chapter 3.2 --- Interactions between EP3 agonists and other vasoactive agents --- p.69 / Chapter 3.2.1 --- Interactions with phenylephrine --- p.69 / Chapter 3.2.2 --- Interactions with KCl --- p.71 / Chapter 3.3 --- Effect of nifedipine --- p.72 / Chapter 3.4 --- Effects of Rho-kinase inhibitors --- p.73 / Chapter 3.5 --- Effect of EP1 receptor antagonist --- p.76 / Chapter 3.6 --- Other properties of the rat femoral artery --- p.77 / Chapter 3.8 --- Effect of sulprostone on blood flow of rat knee joint --- p.79 / Chapter CHAPTER 4 --- DISCUSSION --- p.118 / Chapter 4.1 --- Effect of PGE analogues on rat femoral artery --- p.118 / Chapter 4.1.1 --- Prostanoid receptor (s) responsible for the contractile effects --- p.118 / Chapter 4.1.2 --- Prostanoid Receptors involved in the synergism --- p.122 / Chapter 4.1.3 --- Synergism models --- p.124 / Chapter 4.2 --- Mechanisms of synergistic contractions --- p.126 / Chapter 4.2.1 --- Role of Ca2+ influx --- p.126 / Chapter 4.2.2 --- Role of Ca2+ sensitization --- p.127 / Chapter 4.3 --- Effect of sulprostone in vivo --- p.132 / Chapter 4.4 --- Conclusion --- p.136 / REFERENCES --- p.138

Tem havido grande interesse na investigação de substâncias de ação sistêmica que atuam sobre o sistema musculoesquelético, no sentido de melhorar a qualidade óssea e muscular, e assim, evitar fraturas patológicas decorrentes de osteoporose. Os esteroides anabólicos androgênicos têm importante atuação no metabolismo sistêmico geral, sendo que no osso aumenta sua resistência, massa e, no músculo, combate a sarcopenia. Entretanto, não há investigações consistentes sobre a possível atuação dessas substâncias na consolidação óssea. Este estudo teve como objetivo avaliar o efeito do decanoato de nandrolona na consolidação óssea e na qualidade óssea de fêmures de ratos machos adultos jovens da linhagem Wistar. Foram utilizados 112 animais, divididos em 04 grupos com 02 subgrupos (14 e 28 dias). Um grupo controle (n=17) foi formado por animais sem intervenção, mas apenas com a injeção de veículo inerte. Em outro grupo foi provocada fratura da diáfise do fêmur (n=26). No terceiro grupo os animais receberam apenas decanoato de nandronola (n=23). No quarto grupo foi provocada fratura na diáfise do fêmur associada à administração da mesma dosagem de decanoato de nandrolona (n=26). A fratura provocada no fêmur foi pelo método fechado e obtida com auxílio de uma guilhotina com lâmina romba. Em seguida, a fratura foi fixada por um fio de Kirschner de 1,0 mm de espessura, inserido no canal medular, e o membro pélvico foi radiografado em perfil. O decanoato de nandrolona foi aplicado na dose de 10 mg/kg de massa corporal, por via intramuscular, 02 vezes por semana, durante 14 ou 28 dias, conforme o subgrupo. Após a eutanásia os fêmures direitos foram dissecados e tiveram o comprimento medido. A densidade mineral óssea e o conteúdo mineral ósseo foram determinados pelo método da absorciometria de raios X de dupla energia (DXA). A resistência óssea foi determinada pelo ensaio mecânico de flexão em dois pontos, com o cálculo com a da força máxima e rigidez. O calo ósseo foi avaliado microscopicamente em cortes histológicos corados pela hematoxilina e eosina e examinados em luz comum para a obtenção do seu volume por técnica morfométrica. As outras secções foram coradas em picrosirius red e examinadas em luz polarizada para a quantificação do colágeno tipo I. A significância estatística foi estabelecida em 5%. Não houve diferença significante entre os animais tratados e não tratados pelo decanoato de nandrolona quanto à densidade mineral óssea, conteúdo mineral ósseo, resistência mecânica, tanto para o osso sem fratura, quanto para o calo ósseo. A quantidade de colágeno tipo I também não foi diferente, entretanto, o volume de osso neoformado nos grupos que receberam o esteroide anabolizante foi significantemente maior. A massa corporal foi maior nos grupos que receberam decanoato de nandrolona, embora sem significância estatística. O comprimento ósseo foi maior aos 28 dias no grupo tratado com decanoato de nandrolona. A massa do calo também teve valor significativamente maior aos 28 dias nos animais que receberam o decanoato de nandrolona. Com base nos resultados encontrados, sob as condições experimentais e métodos de avaliação empregados, o decanoato de nandrolona não causou efeitos significativos benéficos ou maléficos, tanto na qualidade do calo ósseo, como na qualidade do osso normal íntegro do rato adulto jovem. / There has been a great interest in investigating systemic substances that can positively act on the musculoskeletal system to improve the bone quality thus avoiding osteoporotic fractures. The anabolic androgenic steroids have an important influence on general metabolism and can increase the bone resistance and bone mass. On muscle, it improves sarcopenic conditions. However, there is no consistent investigation of a possible action of these substances on bone callus. Thus, the aim of this study was to evaluate the effect of decanoate of nandrolone on fracture healing and bone quality of young adult male Wistar rats. One hundred animals were divided into 04 groups and 02 subgroups (14 and 28 days). A control group consisted of animals without any intervention (n=17). In the second group, a femoral shaft fracture was performed (n=26). In the third group, the animals received only decanoate of nandronole (n=23). In the fourth group, a fracture in the femoral shaft was performed and associated with administration of the same dose of decanoate of nandrolone (n=26). The fracture created in the femur was obtained by closed method and achieved with the aid of a blunt blade guillotine. After that, the fracture was fixed with a 1.0 mm thick Kirschner wire that was inserted into the medullary canal, and the limb was X-rayed in profile. Ten mg/kg of body mass of decanoate of nandrolone was administered intramuscularly, 02 times a week for 14 or 28 days, depending on the subgroup. After euthanasia, the right femurs were dissected and had the length measured. Bone mineral density and bone mineral content were determined by the dual-energy x-ray absorptiometry method (DXA). The mechanical properties maximum force and stiffness were determined by the twopoint bending test. The bone callus was evaluated microscopically in sections stained with hematoxylin and eosin and examined under ordinary light microscope to calculate the volume of bone callus by the morphometric technique. Other sections were stained in picrosirius red and examined under polarized light for quantification of type I collagen. The statistical significance was set at 5%. There was no significant difference between the animals treated and not treated with nandrolone decanoate for bone mass density, bone mineral content, mechanical resistance and type I collagen, both for the intact bone and for the bone callus. However, the body mass was higher in the groups that received nandrolone decanoate, although without statistical significance. The femur length was greater in the 28th day in the group treated with nandrolone decanoate. Callus mass also had significant increase at 28 days for animals that received nandrolone decanoate. Based on the results and under the experimental conditions and methods of evaluation, the decanoate of nandrolone did not cause significant benefit or harmfull effects both on callus and on bone qualities.

The prevalence of cardiovascular disease (CVD) among law enforcement officers (LEOs) is slightly higher than the general population. Furthermore, the prevalence of CVD doubles among LEOs following retirement compared to the general population. The measure of arterial stiffness serves as an independent risk factor that has prognostic value for future incidence of CVD. However, there is limited research on lifestyle, occupational, and demographic factors that may be associated with increased arterial stiffness in LEOs. Therefore, the purpose of this investigation was to compare the level of arterial stiffness among LEOs versus the general population and to identify lifestyle, occupational, and demographic predictors of arterial stiffness in LEOs. Seventy male career LEOs between the ages of 24 to 54 years from Kentucky and southwest Ohio participated in this study. LEOs completed a variety of questionnaires related to health/occupational histories, occupational stress, and diet. LEOs’ body composition (bioelectrical impedance), central and brachial blood pressures, and physical activity (triaxial accelerometers) were assessed. The dependent variable of arterial stiffness was measured by carotid-femoral pulse wave velocity (cfPWV). A variety of statistical techniques including 1 sample t-tests, Pearson product moment correlations, and multiple linear regression were utilized in study analyses, with a level of significance set at p < 0.05. Compared to the general population cfPWV was significantly lower among LEO’s under 30 years of age (mean difference = -0.6 m·s-1), but significantly higher among LEOs 50-55 years of age (mean difference = 1.1 m·s-1). Utilizing stepwise multiple linear regression, age, relative body fat, and diastolic blood pressure explained the most variance in LEO’s cfPWV (adj. R2 = 0.56, p < 0.001). The primary findings of this investigation demonstrate that arterial stiffness may progress more rapidly in LEOs compared to the general population and that LEOs should focus on maintaining appropriate levels of relative body fat and blood pressure to regulate arterial stiffness and risk of CVD.

Femoral acetabular impingement (FAI) is a bony hip condition that often results in tears to the acetabular labrum. Patients with FAI experience pain, decreased function, and quality of life. FAI and its’ sequela are treated definitively with hip arthroscopy. Hip arthroscopy is being performed with increasing frequency, and while most patients respond favorably, a subset of 10-20% of patients have suboptimal outcomes. Previous research suggests that mental status may be a primary driver in the way patients with FAI respond to and feel pain. Measures of mental status include the presence of mood disorders and psychosocial patient reported outcomes (PROs). Psychosocial constructs that have yet to be examined in patients with FAI include self-efficacy, kinesophobia, and pain catastrophizing. The Pain Self-Efficacy Questionnaire (PSEQ) gauges an individual’s confidence, or self-efficacy, in their ability to complete tasks despite their current pain. Previous research has established that a patient’s self-efficacy is an important determinant of long-term success following orthopedic surgery. Kinesophobia, measured via the Tampa Scale for Kinesiophobia (TSK), is a measure of movement-related fear. In contrast to self-efficacy, fear of movement has been identified as a predictor of early success following orthopedic surgery. Lastly, pain catastrophizing is a set of maladaptive behaviors including ruminating on pain, feeling helpless to overcome painful situations, and magnifying the circumstances surrounding the painful experience. Catastrophizing behaviors, measured via the Pain Catastrophizing Scale (PCS), have been repeatedly linked to increased pain and decreased functionality in a variety of orthopedic populations. To date, the relationship between these psychosocial variables and pain has not been examined in patients with FAI. The primary aim of this dissertation was to evaluate the role of psychosocial factors on pre and postoperative pain in patients with FAI undergoing hip arthroscopy. To accomplish this aim we performed a series of three studies. The first study was a retrospective chart review to determine the prevalence of mental health disorders and compare preoperative clinical presentation between patients with and without mental health disorders. The second was a cross-sectional study designed to determine if any psychosocial variables could predict preoperative hip pain. The final study utilized a longitudinal, cohort design. Patients were tested preoperatively and at 12-weeks postoperative. The primary outcomes measured were self-efficacy, kinesiophobia, pain catastrophizing, and hip pain at rest and during activity measured via a visual analog scale (VAS). The purpose of this study was to determine the effect of preoperative psychosocial variables on postoperative pain, and to determine if these variables were predictive of persistent postoperative pain three months following hip arthroscopy. Based on the results from these studies we can conclude the following: 1) Mental health disorders are more common in patients with FAI than other orthopedic populations, and self-reported pain and function are worse in this subset of patients, but neither symptom chronicity nor the severity of joint deformity differs; 2) Low self-efficacy is predictive of worse preoperative pain in patients with FAI; and 3) Patients with high preoperative pain catastrophizing or low self-efficacy are more likely to have increased postoperative pain. Low preoperative self-efficacy is predictive of persistent hip pain during activity three months following hip arthroscopy, while low self-efficacy and mental health disorders are predictive of persistent hip pain at rest. Future studies are necessary to develop and implement interventions targeting low self-efficacy and elevated catastrophizing in patients undergoing hip arthroscopy to improve patient outcomes for this high-risk group.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009.

Σκοπός της πρόδρομης αυτής τυχαιοποιημένης μελέτης ήταν να εκτιμήσουμε την αποτελεσματικότητα της εξωτερικής ακτινοβόλησης και την προφυλακτική της δράση στην μείωση της επαναστένωσης του αυλού της επιπολής μηριαίας αρτηρίας μετά από αγγειοπλαστική και τοποθέτηση μεταλλικής ενδοπρόθεσης (stent). Στην μελέτη συμπεριελήφθησαν ασθενείς με σοβαρού βαθμού στένωση ή απόφραξη της επιπολής μηριαίας αρτηρίας, οι οποίοι υποβλήθηκαν σε διαδερμική αγγειοπλαστική με μπαλόνι και τοποθέτηση stent για την αποκατάσταση του προβλήματός τους, και τυχαιοποιήθηκαν σε δυο ομάδες. Οι ασθενείς της πρώτης ομάδας υποβλήθηκαν σε αγγειοπλαστική με μπαλόνι και τοποθέτηση stent στην περιοχή της στένωσης ή της απόφραξης χωρίς να υποβληθούν σε εξωτερική ακτινοβόληση της περιοχής. Οι ασθενείς της δεύτερης ομάδας, 24 ώρες μετά την αγγειοπλαστική με μπαλόνι και τοποθέτηση stent στην περιοχή της στένωσης ή της απόφραξης, υποβλήθηκαν σε εξωτερική ακτινοβόληση στην περιοχή, με συνολικά χορηγούμενη δόση 24Gy που δόθηκαν σε 6 συνεδρίες ανά 48 ώρες. Μετά το τέλος της ακτινοβόλησης οι ασθενείς παρακολουθούνταν ανά τακτά χρονικά διαστήματα. Η συνολική διάρκεια παρακολούθησης ήταν 1 έτος, με τελικό σημείο αξιολόγησης το 1 έτος. / Purpose: To evaluate the long-term results of external beam irradiation (EBI), for the prevention of neointimal hyperplasia, after percutaneous transluminal angioplasty (PTA) and stenting of the superficial femoral artery. Materials and methods: A prospective randomised study was conducted from November 2000 to February 2002. A total of 60 patients who suffered from superficial femoral artery stenoses or short occlusions included in this study. Following successful post-angioplasty stenting, patients were randomly assigned in two groups and thirty of them received external beam irradiation (6 MV photons, total dose of 24 Gy in 6 fractions,during a 2 week period) at the stented area (EBI group) while the rest thirty received no radiation therapy (Control group).All patients were advised to receive anti-platelet therapy. Results and conclusions: Radiation therapy was technically feasible in all patients, without radiation related side effects. Statistically significant differences (p<0,05) observed at the 1- year follow-up concerning the primary patency (66% for the irradiated patients vs 33% for the control patients) and re-intervention rates (40% for the irradiated patients vs 70% for the control patients) between the two groups. Irradiated patients revealed re-stenotic lesions mainly at the stent ends, while control group patients suffered extensive re-stenotic lesions within the stent lumen and the stent ends.Our study suggests that EBI is feasible, safe and effective method for the prevention of neointimal hyperplasia at the superficial femoral artery. Further studies are deemed necessary to optimize the radiation dose and the number of fractions.

Acute confusional state (ACS) or delirium according to DSM-III-R holds a central position in the medicine of old age. ACS is a common and sometimes the only symptom of diseases and medical complications in the elderly patient. The aim of this study was to elucidate ACS in patients with femoral neck fractures and patients with acute stroke with regard to frequency, predictors, possible pathogenetic mechanisms, associated complications, assessment and documentary routines and the clinical outcome for the patients. An intervention program to prevent postoperative ACS based on our results was developed and evaluated. The main findings of the study were high frequencies of ACS in elderly patients with femoral neck fractures (61 %) and in patients with acute stroke (48 %). The main risk factors for ACS in patients with femoral neck fractures were old age, diseases and drug treatment interfering with cerebral cholinergic metabolism. There was no link between anaesthetic technique and ACS but the connection between peroperative hypotension, early postoperative hypoxia and ACS was close. In stroke patients the degree of extremity paresis and old age were independent ACS risk factors. ACS was commonly associated with post stroke complications such as myocardial infarction, pneumonia, urinary infection and urinary retention. In stroke patients there was a close connection between high hypothalamic-pituitary-adrenal axis (HPA-axis) activity and ACS. High HPA-axis activity and disturbances in the cerebral cholinergic system may be two important ACS mechanisms. A correct diagnosis is a prerequisite for proper treatment of ACS and its underlying causes. In the orthopaedic wards both physicians and nurses diagnosed and documented ACS poorly and therefore associated complications were insufficiently treated. The intervention program for postoperative ACS, aimed mainly at protecting the cerebral oxidative metabolism and thereby the cerebral cholinergic metabolism which is especially sensitive to hypoxia. Postoperative complications associated with ACS were also treated. The intervention resulted in reduced frequency, duration and severity of postoperative ACS and in shorter orthopedic ward stay for patients with femoral neck fractures.Key words: Acute confusional state, delirium, elderly / <p>S. 1-76: sammanfattning, s. 77-175: 6 uppsatser</p> / digitalisering@umu