Disease severity and trigger factors in Danish children with atopic dermatitis: a nationwide study.

BACKGROUND: Atopic dermatitis (AD) is a prevalent chronically relapsing inflammatory skin disease of childhood. However, little is known about self-reported trigger factors, impact on daily life and factors associated with AD severity. METHODS: A nationwide questionnaire study of children in Denmark with hospital-diagnosed AD in the time period 2014-2018. The web-based questionnaire was completed by the legal parents. AD severity was assessed using Patient-Oriented Eczema Measure (POEM) tool. RESULTS: Of 3438 invited parents, 1343 (39%) completed the questionnaire. Factors associated with severe AD were onset during the first 6 months of life, onset of AD on multiple body regions, a history of hay fever, female sex and low maternal educational level. Staying home from daycare or school due to AD, concentration problems and sleep disturbances in the child were more frequently reported by parents to children with severe AD. Overall, 90% reported at least one AD trigger factor, and all were more frequently reported in children with severe AD. The three most commonly reported trigger factors were cold weather (51.9%), chlorinated water (35.7%) and warm weather (30.2%). CONCLUSIONS: We identified factors associated with severe AD in childhood, the impact on daily life, as well as the most common self-reported triggers of AD. These findings may be valuable in clinical practice to inform about prognosis and educate families about trigger avoidance.

The efficacy of wrist protectors in preventing snowboarding injuries.

Injuries of the wrist are common among snowboarders and in-line skaters. Wrist protectors have been developed to protect against injury. Some studies support the use of such wrist protection, but others emphasize the fact that wrist protectors may transfer the injury to other locations in the forearm. We conducted a prospective, randomized, clinical study of 5,029 snowboarders, 2,515 in a braced group and 2,514 in a control group. The primary endpoint was fracture or sprain of the wrist with loss of range of motion and pain of at least a 3-day duration. Concomitant injuries were also recorded. Eight wrist injuries occurred in the braced group and 29 occurred in the control group. This was a significant difference. Beginners (first 5 days on a snowboard) and snowboarders with rented equipment were more prone to injury than others. No injuries could be related to the use of the wrist brace. We conclude that wrist braces are effective in protecting snowboarders against wrist injury. Beginners are a high-risk group.

Risk of injury during alpine and telemark skiing and snowboarding. The equipment-specific distance-correlated injury index.

Estimation of injury risk in alpine sports is difficult. We present a new method of calculating an injury index related to the distance traveled on ski or snowboard. The distance-correlated injury index equals the number of injuries per 100,000 km traveled distance. This injury index can also be correlated to the type of equipment used. The equipment-specific distance-correlated injury index is the same as the distance-correlated injury index, but it is sport-specific. We found the distance-correlated injury index for alpine skiing to be 3.9 (95% Cl = 2.8 to 5.4); for snowboarding, 13.5 (95% Cl = 8.3 to 22.0); and for telemark skiing, 3.0 (95% Cl = 1.0 to 9.4), suggesting a three- to four-times higher incidence of injuries requiring hospital treatment among snowboarders than among alpine and telemark skiers.

[Follow up after potential curative surgery of colorectal cancer. Guidelines from the Norwegian Gastrointestinal Cancer Group]. / Kontrollopplegg etter potensiell kurativ operasjon for kolorektalcancer. Anbefaling fra Norsk Gastrointestinal Cancer Gruppe.

In Norway, about 2,800 cases of colorectal cancer are diagnosed every year. Two-thirds of the patients undergo potentially curative surgery and almost half of them develop local or distant metastases. The follow-up of colorectal cancer patients involves four strategies: Educating the patients about the disease, symptoms of relapse, and risk of hereditariness; Early diagnosis of relapse, to make curative re-surgery possible; Diagnosis of metachronous/synchronous cancer(s); Recording the results of current surgical techniques. The Norwegian Gastrointestinal Cancer Group recommend a four-year follow-up programme (every third month for two years and then twice a year) of colorectal cancer patients. It is suggested that patients treated with low anterior resection are followed regularly by means of rectoscopy and local examination (digital or by ultrasound) undertaken by specialist (surgeon or gastroenterologist). The others should be followed up mainly by general practitioners. Carcinoembryonic antigen (CEA)-monitoring is suggested every third month for two years, and then every sixth month. Colonoscopy is recommended at one and four year follow-up. Patients with normal CEA levels prior to surgery should be evaluated by ultrasound of the liver every sixth month for four years.

Characterization of 'winners' to enoxaparin in the prevention of postoperative venous thromboembolism in digestive surgery.

BACKGROUND: A total of 826 patients were included in three 'play-the-winner' studies to investigate the safety of prophylaxis against venous thromboembolism in digestive surgery. To characterize patients benefiting from prophylaxis with low-molecular heparin, the 445 patients allocated to enoxaparin were investigated. METHODS: A training set consisting of 292 patients from 2 of the studies was analysed by using a linear discriminant model. The reliability of the results was verified on a test set consisting of 153 patients from the third study. RESULTS: A typical 'winner' was a young patient, preferably female, with serum bilirubin in the lower normal range, combined with body temperature, serum sodium, creatinine, and albumin in the upper normal ranges. By using the discriminant function on the test set, 81.7% of the 'winners' and 21.1% of the "losers' were correctly classified. CONCLUSION: The discriminant function for characterization of winners to enoxaparin was found adequate. No rule was acceptable for characterization of losers.

[Liver injuries]. / Leverskader.

We report on a series of 193 patients with traumatic liver injuries treated at our Trauma Centre I during the period 1983-94; i.e. about 13 patients per year. The centre has a catchment population of 850,000. Most of the patients were severely injured, with 3.2 injured organs per patient among the 151 patients with multiple injuries. The clinical diagnostic work was supplemented with peritoneal lavage, ultrasonography and computer tomography. 38 patients were not operated on, of whom 25 survived. Exploratory laparotomy with or without liver suturing was used in 125 patients and liver resection in 18 seriously injured patients, with more than 50% mortality. Perihepatic packing was used in 12 patients, all with other serious injuries and with a high rate of mortality from these injuries. Liver injuries can be divided into two groups. A few injured patients are admitted in severe shock, and may be treated with immediate thoracotomy and clamping of the aorta, followed by urgent laparotomy to control bleeding by means of packing. The rest of the abdomen is examined quickly and closed, to avoid well known complications of bleeding and multitransfusions, i.e. hypoxaemia, acidosis and hypothermia. Repeat laparotomy follows in 2-3 days, to remove the packing. A stable patient should be referred for computer tomography, and may be treated without operation, but must be followed closely clinically.

[Spontaneous retroperitoneal hemorrhage]. / Spontan retroperitoneal blødning.

Spontaneous retroperitoneal haemorrhage is most frequently due to rupture of an abdominal aortic aneurysm. Pathology in other retroperitoneal organs, most often the kidney and the adrenal gland, may cause retroperitoneal haemorrhage. Spontaneous rupture of veins, especially the iliac vein, and haemorrhage secondary to anticoagulant therapy, are less common causes. The symptoms are variable and non-specific, but most often include acute abdominal pain, hypotension, peritoneal irritation and a palpable abdominal mass. The diagnosis is confirmed by ultrasonography, computerized tomography, and if relevant angiography or scintigraphy. We discuss three patients with spontaneous retroperitoneal haemorrhage, examine the clinical approach and the role of the various diagnostic aids, and consider how the various conditions should be dealt with.

[Thromboembolic complications in ambulatory surgery. A retrospective study of 1691 patients]. / Tromboemboliske komplikasjoner ved dagkirurgi. Retrospektiv undersøkelse av 1691 dagkirurgiske pasienter.

The risk of thromboembolic complications in outpatient surgery is regarded as being low. Thromboembolic prophylaxis is seldom administered as a routine. A retrospective study in our outpatient department, based upon patients readmitted for clinical thromboembolism, showed an incidence of deep vein thrombosis of 0.05% (8/1 691) and of pulmonary embolism 0.0006% (1/1 691). None of the patients received prophylaxis for thrombosis, and all operations were performed under regional anaesthesia of the lower extremity. 50% of the operations were performed using a tourniquet. 2/3 of the patients were women and 2/3 were over the age of 50. Operation time was usually 30-45 minutes. Our study indicates that patients undergoing knee arthroscopy, and operations for varicose veins and hallux valgus are at risk of thromboembolism. Prospective studies of these risk groups are necessary to figure out the need for thrombosis prophylaxis.

[Chemotherapy in colorectal cancer. Recommendations of the Norwegian Gastrointestinal Cancer Group]. / Kjemoterapi ved kolorektalcancer. Anbefalinger fra Norsk Gastrointestinal Cancer Gruppe.

The scientific documentation for fluorouracil-based chemotherapy in patients with colorectal cancer has increased during recent years, both for the adjuvant primary situation and in recurrent and metastatic disease. In the case of operable colorectal cancer (stage Dukes B and C), the patients should be included in the ongoing randomized trial on use of fluorouracil and levamisol. In advanced disease, fluorouracil combined with calcium folinate may have palliative effects in terms of relief of symptoms, improved quality of life, delay of onset of symptoms and probably also prolonged survival in 40-50% of the patients, without serious toxicity. In many cases, however, the patient should not be given chemotherapy.

[Treatment of fixed, primarily non-resected rectal cancer. Recommendations from Norwegian Gastrointestinal Cancer Group]. / Behandlingsopplegg ved fiksert, primaert ikke-resektabel rectumcancer. Anbefaling fra Norsk Gastrointestinal Cancer Gruppe.

In most cases (70%), fixed rectal cancers are primarily non-resectable, and of the ones that are resected, local recurrence will occur in 50-70%. The same trend, but less pronounced, is also seen for partly fixed or tethered tumours. High-dose irradiation (45-60 Gy) has been reported to yield resectability rates up to 70%, with 17% local recurrences and a 5-year disease-free survival of up to 60-70%. Combined chemotherapy and sequential radiation therapy, hyperthermia or addition of intra-operative radiotherapy, have shown promising results, but no randomized studies have been published comparing the different treatment modalities. Surgery should be performed 4-6 weeks after preoperative treatment. Resectability can only be determined by exploratory laparotomy and serious attempts to remove the tumour-bearing segment by anatomic dissection.

[Should oral contraceptives and postmenopausal hormonal substitution be withdrawn prior to surgery? A questionnaire study in departments of surgery and gynecology]. / Skal peroral antikonsepsjon og postmenopausal hormonsubstitusjon seponeres før operasjon? Spørreundersøkelse blant kirurgiske og gynekologiske avdelinger.

We conducted a survey among the surgical and gynaecological departments of all Norwegian hospitals, about today's practice concerning oral contraceptives and surgery. Most of the surgical and gynaecological departments recommend discontinuance of the pill two and four weeks prior to surgery, and reintroduction upon mobilisation postoperatively. In surgical emergencies amongst women who use the pill, 4/5 surgical and 2/3 gynaecological departments would prefer to give thrombosis prophylaxis. Low molecular weight heparin was recommended most. Surgical departments especially recommend stopping the use of the progestogene only contraceptive pill, and post menopausal oestrogen substitution, before elective surgery. Both gynaecological and surgical departments give inadequate information about the use of alternative birth control during the period when the pill is not taken. The survey did not show any difference between university and central/county hospitals.

[Abdominal injuries after blunt trauma]. / Abdominalskade etter stumpt traume.

We present a series of 331 patients admitted to hospital in 1980-87 with abdominal injuries after blunt trauma. The patients included 230 males and 101 females. The median age was 29 years. More than half of the patients were injured in traffic accidents. 11% were transferred to our Trauma Center from other hospitals, median five hours after the accident. A doctor-manned helicopter transported 52 patients (18%) directly to our hospital. 70% had extra-abdominal injuries as well. A minimum of 20% were intoxicated by alcohol and/or drugs. Severe injuries (AIS greater than 3) were present in 46%. 168 patients underwent laparotomy, in 56% within two hours of admission. In 27 of the 168 laparotomized patients (16%) no intraabdominal injury was encountered that needed repair.

[Grading and prognosis of blunt abdominal injuries]. / Gradering og prognostikk ved stumpe abdominalskader.

From 1 January 1980 to 31 December 1987, 297 patients were admitted to Ullevål Hospital, Dept. of Surgery, with abdominal injury after blunt trauma. The Injury Severity Score (ISS) was determined in retrospect, and correlated to mortality, morbidity and use of resources. 50 patients (16.8%) died. Mortality increased with increasing ISS, until ISS was above 34. In this group, mortality was 75%. In the survivors, hospital costs (days in the hospital, in the intensive care unit, on mechanical respiration, and number of blood units transfused) increased with increasing ISS. The likelihood of developing septicaemia adult respiratory distress syndrome (ARDS) or multiple organ failure also increased with increasing ISS. Those who died were older and had a higher ISS than the survivors. In patients over 55 years old, the mortality increased significantly. The ISS is well suited for identification of seriously injured patients after blunt abdominal trauma. The ISS can be used to predict mortality, morbidity and cost of treatment in groups of patients.

[Delayed surgery in blunt abdominal trauma]. / Forsinket operasjon ved stumpe buktraumer.

Abdominal organ injuries caused by blunt trauma are notoriously difficult to diagnose, and for this reason an operation may be dangerously delayed. 426 abdominal organ injuries were registered in a series of 331 patients admitted after blunt abdominal trauma. 151 of these patients had 199 abdominal organ injuries which required surgical repair. In 31 patients (20%) with 44 organ injuries, operation was delayed for more than six hours after admission, in most cases because of missed diagnosis. One of these patients died as a result. Hollow viscus injuries were the most commonly missed. In addition to repeated clinical evaluation, peritoneal lavage, repeated if necessary, and diagnostic imaging must be used as valuable tools of diagnosis, especially in comatous patients, in patients with multiple injuries, and in intoxicated patients.

[Penetrating abdominal injuries]. / Penetrerende abdominalskader.

We have reviewed the medical records of 111 patients treated for abdominal stab wounds during the period 1980-87. Our two hospitals serve a catchment area of about 450,000 people. Exploratory laparotomy was performed in 89 patients with suspected peritoneal penetration. In 16 patients the laparotomy was negative, and in 15 patients only minor injuries were noted. There were no serious complications in these 31 patients. Twenty-seven patients had thoracic wounds below the fourth intercostal space, 15 with intraabdominal injuries. The most common injuries were lacerations of the liver, the small bowel and the diaphragm. The mortality in the series was 2%. Stab wounds are infrequent in Norway, and most surgeons have limited experience of such injuries. We discuss whether to employ immediate exploratory laparotomy or selective management when the peritoneum has been penetrated. When there is no evidence of evisceration or omental protrusion, local exploration of the wound should be performed in order to confirm or exclude peritoneal penetration. Injury to the diaphragm and intraabdominal viscera should always be suspected in thoracic stab wounds below the fourth intercostal space.