In fit, older patients the results of the study show a clear advantage for arthroplasty over fixation; arthroplasty was more clinically effective and probably less costly over a 2-year period postsurgery. The results suggest that total hip replacement has long-term advantages over bipolar hemiarthroplasty, but these findings are less definite. This study provided support for the use of total hip replacement to treat displaced intracapsular hip fractures in fit, older patients. A larger trial comparing total versus hemiarthroplasty for these fractures could help to verify these findings. It would also be useful to know whether the findings of this study apply to patients aged 60 years or less who are usually treated with reduction and fixation. A clinical trial comparing arthroplasty versus fixation in patients older than 40 years would be a logical extension of the current study.

Novel APDs not only induce diabetes as a result of weight gain in predisposed patients, but can also lead to a reversible state of insulin deficiency, and sometimes ketoacidosis.

1. The effects of birth weight, intra-uterine nutritional status and protein and energy intake on whole-body protein turnover, and skeletal muscle protein breakdown were examined in 40 premature infants. 2. Total-body nitrogen flux was 26% higher in the small-for-gestational-age compared with appropriate-for-gestation-age infants; similarly, whole-body protein synthesis and breakdown were increased by 26 and 35% respectively (P less than 0.01). 3. The lower-birth-weight neonates (less than 1500 g) had higher rates of skeletal muscle protein breakdown; 1.23 +/- 1.12 g day-1 kg-1, as compared with 0.54 +/- 0.28 g for the high-birth-weight group (P less than 0.05). 4. Protein intake was inversely correlated with the fraction of nitrogen flux coming from endogenous protein breakdown (P less than 0.05) and with skeletal muscle protein breakdown (P less than 0.05). There were no significant relationships found between energy intake and the parameters of protein metabolism. 5. On the basis of the turnover data, evidence is presented that the protein requirements for milk-protein fed premature neonates is less than 4.3 g day-1 kg-1.