Understanding the Interactions Between Loading, Pain Dynamics, and Imaging Characteristics for Osgood Schlatter: A Cross-Sectional Study.

Osgood Schlatter's disease (OSD) is characterized by pain at the tibial tuberosity provoked during knee-loading activities, and is common in adolescent athletes. The aim of this study was to characterize clinical, pain and ultrasound imaging characteristics in participants with OSD compared to controls. This cross-sectional study included adolescents diagnosed with OSD and matched controls. Following baseline evaluation including ultrasound, participants completed the following aggravating activities in a randomized order: single-leg isometric knee hold, single-leg squat, single-leg vertical jump, hopping, running, cutting, lunges, and walking. Participants rated pain intensity on a numeric rating scale (0-10; no pain to worst pain imaginable) and localization during activities. We included 35 participants with OSD (48.5% females, age 13.0 [SD 1.5]) and 21 controls (47.6% females, age 13.4 [SD1.4]). Doppler signal was more prevalent in OSD participants at the tendon (77% vs. 30%) and tuberosity (29% vs. 10%). Tendon thickness was greater in OSD at distal (mean difference = 4.5 mm 95% CI 1.5-7.5) and proximal sites (mean difference = 4.2 95% CI 0.1-8.3). Aggravating activities induced higher pain in OSD. The greatest differences between OSD and control were the dynamic single-leg squat (mean difference = 4.2 (95% CI 3.22-5.1)). Pain was localized at the tibial tuberosity and patellar tendon during activities. Sex, sports participation, bilateral pain, and Doppler were associated with greater pain during aggravating activities. Single-leg activities loading the tibial tuberosity through the tendon appear to provoke OSD-related pain more than other sports specific movements. This may be useful to guide adolescents on which activities are likely to aggravate pain.

A comprehensive MRI investigation to identify potential biomarkers of Osgood Schlatter disease in adolescents: A cross sectional study comparing Osgood Schlatter disease with controls.

BACKGROUND: Osgood-Schlatter disease (OSD) is the most common knee pain complaint among adolescents playing sports. Despite this, there remains controversy over the pathophysiology and whether specific anatomical characteristics are associated with OSD. PURPOSE: This study aimed to systematically and comprehensively characterize adolescents with OSD using magnetic resonance imaging (MRI) compared to pain-free controls, including both tissue abnormalities that may be associated with OSD, as well as anatomical characteristics. A secondary objective was to identify potential imaging biomarkers associated with pain. STUDY DESIGN: Cross-sectional study. METHODS: Adolescents with OSD and controls were recruited from 2020 to 2022. Following a clinical exam, demographics, pain, sports participation, and Tanner stage were collected. Knee MRI was conducted on the participants' most symptomatic knee (OSD) or the dominant leg (controls). RESULTS: Sixty-seven adolescents (46 with OSD and 30 controls) were included. 80% of participants with OSD had at least one tissue alteration compared to 54% of controls. Compared to controls, OSD had 36.3 (95%CI 4.5 to 289.7) higher odds of bony oedema at the tibial tuberosity, and 32.7 (95%CI 4.1 to 260.6) and 5.3 (95%CI 0.6 to 46.2) higher odds of bony oedema at the  tibial epiphysis and metaphysis respectively. Participants with OSD also had higher odds of fluid/oedema at the patellar tendon (12.3 95%CI 3.3 to 46.6), and superficial infrapatellar bursitis (7.2).  Participants with OSD had a more proximal tendon attachment (mean tibial attachment portion difference, -0.05, 95% CI: -0.1 to 0.0, p = 0.02), tendon thickness (proximal mean difference, -0.09, 95% CI: -0.4 to 0.2, p = 0.04; distal mean difference, -0.6, 95% CI: -0.9 to -0.2, p = 0.01). Those with bony/tendon oedema had 1.8 points (95% CI: 0.3 to 3.2) higher pain on palpation than those without (t = -2.5, df = 26.6, p = 0.019), but there was no difference between these groups in a functional single leg pain provocation. CONCLUSION: Adolescents with OSD present with tissue and structural abnormalities on MRI that differed from age-matched controls. The majority had findings in the patellar tendon and bone, which often co-occurred. However, a small proportion of OSD also presents without alterations. It appears these findings may be associated with clinical OSD-related pain on palpation of the tibial tuberosity. CLINICAL RELEVANCE: Our highlight the pathophysiology on imaging, which has implications for understanding the mechanism and treatment of OSD.

Participatory design for computerization of clinical practice guidelines.

There have been made many attempts on computerization of clinical practice guidelines (CPGs), none have, however achieved any general application in clinical work practice. The objective of this paper is: (1) to raise awareness about the impact the design method used for computerization of CPGs have on the final solution and (2) to explore the potential benefits--and disadvantages--of participatory design (PD) as an approach to design. However, rather than attempting to comprehensively cover the whole field of PD pertinent to healthcare, we focus on providing details on three aspects of PD: PD as a design philosophy, PD as a toolbox and PD as a way to create a shared realm of understanding among IT-designers and health professionals as these are areas of utmost relevance for the design of computerized CPGs. Additionally, the application of PD for computerization of CPGs is illustrated by two cases. We conclude that PD is a beneficial approach for design of computerized CPGs.

Cardiovascular and respiratory changes and convalescence in laparoscopic colonic surgery: comparison between carbon dioxide pneumoperitoneum and gasless laparoscopy.

HYPOTHESIS: Gasless laparoscopy produces smaller cardiopulmonary and systemic changes than carbon dioxide (CO2) laparoscopy during colonic surgery. DESIGN: Prospective randomized trial. SETTING: Department of Surgery in a university hospital. PATIENTS: Twenty-two patients scheduled for laparoscopic colonic resection; 5 patients were excluded because of conversion to open surgery (N = 17). INTERVENTIONS: Patients were randomized to either gasless (n = 9) or conventional CO2 (n = 8) surgery. MAIN OUTCOME MEASURES: Intraoperative assessment of hemodynamic factors and pulmonary function, and postoperative assessment of pain, pulmonary function, convalescence, and various injury factors were done several times until 30 days after surgery. Surgical complications were noted. RESULTS: Descending aorta blood flow after 30 minutes (P=.03) and heart rate after 150 minutes were higher in the CO2 group (P=.009). Central venous pressure, PaCO2 inspiration pressure, and end tidal CO2 level were significantly higher in the CO2 group (P = .05, .03, .04, and .01, respectively). Patients in the CO2 group had less pain during mobilization and coughing (P = .008 and .006, respectively), and were significantly more fatigued (P = .04). No other important differences were observed in intraoperative hemodynamic factors, postoperative convalescence, immunocompetence, or pulmonary function. CONCLUSION: No clinically important differences in cardiovascular and systemic response were observed between patients undergoing CO2 or gasless laparoscopy for colonic disease.

Changes in plasma potassium concentration during carbon dioxide pneumoperitoneum.

Hyperkalaemia with ECG changes had been noted during prolonged carbon dioxide pneumoperitoneum in pigs. We have compared plasma potassium concentrations during surgery in 11 patients allocated randomly to undergo either laparoscopic or open appendectomy and in another 17 patients allocated randomly to either carbon dioxide pneumoperitoneum or abdominal wall lifting for laparoscopic colectomy. Despite an increasing metabolic acidosis, prolonged carbon dioxide pneumoperitoneum resulted in only a slight increase in plasma potassium concentrations, which was both statistically and clinically insignificant. Thus hyperkalaemia is unlikely to develop in patients with normal renal function undergoing carbon dioxide pneumoperitoneum for laparoscopic surgery.

Incidence and prevention of deep venous thrombosis occurring late after general surgery: randomised controlled study of prolonged thromboprophylaxis.

OBJECTIVE: To study the incidence of late deep venous thrombosis (DVT), and to evaluate a regimen of prolonged thromboprophylaxis after general surgery. DESIGN: Randomised, controlled, open trial, with blinded evaluation. SETTING: University hospital, Denmark. SUBJECTS: 176 consecutive patients undergoing major elective abdominal or non-cardiac thoracic operations, of whom 118 were eligible for evaluation. INTERVENTIONS: Thromboprophylaxis with a low-molecular-weight heparin, tinzaparin, given for four weeks (n = 58), compared with one week (control group, n = 60). MAIN OUTCOME MEASURES: Presence of DVT established by bilateral venography four weeks after the operation. RESULTS: The incidence of late DVT in the control group was 6/60 (10%, 95% confidence interval (CI) 4% to 21%). In the prophylaxis group it was 3/58 (5.2%, 95% CI 1% to 14%) (p = 0.49). CONCLUSION: Prolonged thromboprophylaxis had no significant effect on the incidence of DVT occurring late after general surgery.

[Laparoscopic cholecystectomy in patients with earlier laparotomy]. / Laparoskopisk kolecystektomi hos patienter med tidligere laparotomi.

Previous abdominal surgery has been reported as a relative contraindication to laparoscopic cholecystectomy. A retrospective analysis of 356 laparoscopic cholecystectomies was undertaken to determine whether previous abdominal surgery led to increased morbidity. The results of 116 patients who had had previous abdominal surgery were compared with those of 240 patients without previous abdominal surgery. The rate of conversion to open operation was not increased. The operating time was a little increased. There were no increases in either minor or major postoperative complications in patients with previous abdominal surgery, and the in-hospital stay time was the same. The median recovery time was respectively ten versus eight days in patients with and without previous surgery. We conclude that previous abdominal surgery is not a contraindication to laparoscopic cholecystectomy.

Colour Doppler flow imaging ultrasonography versus venography as screening method for asymptomatic postoperative deep venous thrombosis.

OBJECTIVE: To evaluate colour Doppler flow imaging ultrasonography (CDFI), compared with venography, as a screening method for postoperative deep venous thrombosis (DVT) in a clinical trial on thromboprophylaxis. METHODS: Patients undergoing major abdominal or thoracic surgery were prospectively screened for DVT by CDFI. Patients were examined preoperatively, and on post-operative days 1, 3, 7, 14, 21, and 28. When the CDFI was positive venography was performed. Bilateral venography was performed on day 28 in all patients. The study group comprised 82 patients who underwent CDFI and venography on the same day: four because of suspected DVT (positive CDFI), and 78 on day 28 according to protocol. RESULTS: DVT was detected by venography in seven patients, in three of whom CDFI was positive. CDFI was falsely positive in one case. There were two popliteal and five calf DVTs, of which CDFI detected one and two, respectively. The sensitivity of CDFI was 43%, the specificity 99%. The PVpos for CDFI was 75%, and the PVneg 96%. CONCLUSION: Due to low sensitivity, CDFI cannot stand alone as a screening method for asymptomatic postoperative DVT.

Palliation of rectosigmoid neoplasms with Nd:YAG laser treatment.

PURPOSE: The aim of this study was to evaluate the effect of Nd:YAG laser treatment as palliation for rectosigmoid neoplasms. METHODS: Indications for laser therapy, the degree and duration of symptom relief, complication rate, and survival time were recorded in consecutive patients. RESULTS: Seventy-four patients entered the study. Poor general health in older patients, and disseminated or complicating disease were the most frequent indications for therapy. Fifty-five (74 percent) patients experienced good symptomatic effect from the treatment. Six complications occurred: five cases of perforation and one case of moderate bleeding. There was no mortality. The median survival was seven months (range, 14 days-39 months). CONCLUSION: Laser treatment is a good palliative method in patients with colorectal cancer, especially in patients with local recurrence or symptoms from non-resected tumors.

[Mesenteric venous thrombosis]. / Mesenteriel venetrombose.

Mesenteric venous thrombosis (MVT) is a serious though rare abdominal disease. MVT often takes a subacute course with non-specific symptoms. The absence of simple and precise diagnostic tools result in delayed start of treatment and high mortality. Through information retrieval we have here given an overview of the incidence, etiology, pathophysiology, symptomatology, diagnosis, treatment and prognosis of MVT.

[Palliative treatment of rectal and sigmoid cancer with Nd-YAG laser]. / Palliativ behandling af rectum- og sigmoideumcancer med Nd-YAG-laser.

Nd-YAG laser treatment was employed as palliative treatment in 47 patients with colorectal cancer. Thirty-eight patients (81%) experienced good symptomatic effect from the treatment. Four complications occurred: three cases of perforation and one case of moderate bleeding. There was no mortality. It is concluded that laser treatment is a good palliative method in patients with colorectal cancer, especially in elderly patients with complicating diseases and in patients with local recurrence or symptoms from nonresected tumours.

Monoclonal antibodies define genus-specific, species-specific, and cross-reactive epitopes of the chlamydial 60-kilodalton heat shock protein (hsp60): specific immunodetection and purification of chlamydial hsp60.

Ocular and urogenital tract infections with Chlamydia trachomatis can progress to chronic inflammatory diseases that produce blindness and tubal infertility. The pathophysiology of these chronic disease conditions is thought to be immunologically mediated, and the chlamydial 60-kDa heat shock protein (hsp60) has been implicated as a major target antigen that stimulates the immunopathological response. The lack of chlamydial hsp60 antibodies and purified hsp60 has severely restricted studies to define more thoroughly the role of this protein in the immunopathogenesis of chlamydial disease. We produced a panel of antichlamydial hsp60 monoclonal antibodies (MAbs) and defined their specificities by immunoblotting against lysates of C. trachomatis, C. psittaci, and six other genera of bacteria. Three patterns of anti-hsp60 immunoreactivity were observed: chlamydial species specific, chlamydial genus specific, and cross-reactive. The epitopes recognized by these MAbs were localized within the primary amino acid sequence of hsp60 by immunoblotting against recombinant amino-terminal truncated hsp60 fusion polypeptides and then precisely mapped by use of overlapping synthetic peptides. The majority of the MAbs mapped to either the amino or the carboxyl termini of hsp60. Epitopes defining all three MAb reactivities mapped within amino-terminal residues 6 to 16. Genus-specific hsp60 MAbs mapped to epitopes located within this region and to residues 17 to 28 and 177 to 189. Antichlamydial hsp60 MAbs stained inclusions as effectively as MAbs specific for the major outer membrane protein. Homogeneous preparations of full-length recombinant chlamydial hsp60 and amino-terminal truncated recombinant hsp60 polypeptides were obtained by immunoabsorption chromatography with an hsp60 MAb reactive to the carboxyl terminus of the protein. Thus, the antichlamydial MAbs described here should be extremely useful for the specific immunodetection of hsp60 in tissues from individuals having different disease manifestations and for the purification of hsp60 or truncated hsp60 polypeptides for use in serologic and lymphocyte proliferation assays. The availability of these MAbs will facilitate studies to define more precisely the role of hsp60 in the immunopathogenesis of chlamydial disease.

[Complications and costs of indwelling catheters]. / Komplikationer og omkostninger ved kateter à demeure.

The complication rate and morbidity were registered in a group of 53 outpatients with indwelling catheters. The complication rate is found to be high, especially for patients with catheters on account og incontinence. It is also demonstrated that the transportation costs for the out-patients are high. It is recommended that ordinary changes of the catheter are carried out by specially trained "homenurses" if possible. The indications for indwelling catheter should regularly be reconsidered as needs and suitable measures are constantly changing.

The Chlamydia trachomatis hyp operon is homologous to the groE stress response operon of Escherichia coli.

The Chlamydia trachomatis serovar A hyp operon was cloned, sequenced, and expressed in Escherichia coli. Two cotranscribed open reading frames, hypA and hypB, encoded polypeptides of 17 and 57 kilodaltons, respectively. The deduced amino acid sequences of serovar A HypA and HypB proteins were (respectively) 85 and 94% identical with HypA and HypB proteins of Chlamydia psittaci GPIC, and HypB was greater than 50% identical to 60-kilodalton stress response proteins from other procaryotes and eucaryotes. The sequence should be useful in defining the antigenic structure of the Chlamydia trachomatis HypB protein, a necessary step toward understanding the relationship between the immune response to this protein and the pathogenesis of human chlamydial diseases.

Chlamydial disease pathogenesis. The 57-kD chlamydial hypersensitivity antigen is a stress response protein.

Chlamydia trachomatis infection of humans is commonly a localized inflammation that can result in infertility, blindness, and perhaps arthritis. The pathogenic process(es) that cause these sequelae are thought to be immunological. A 57-kD protein that is common among Chlamydia elicits ocular inflammation when introduced onto the conjunctivae of guinea pigs or nonhuman primates previously sensitized by chlamydial infection. This protein is thought to mediate the immunopathology that follows chlamydial infection. To more thoroughly characterize this chlamydial component, we cloned its gene from a C. psittaci strain and identified a particular recombinant that produced the 57-kD polypeptide. The recombinant gene product was immunoreactive with a monospecific anti-57-kD serum, and elicited an ocular inflammation similar to that produced by the 57-kD antigen isolated from chlamydiae. Sequencing identified two ORFs that encode polypeptides of 11.2 and 58.1 kD and are co-transcribed. These two polypeptides show homology with Escherichia coli groE and Coxiella burnetii htp heat-shock proteins. Striking homology (greater than 50%) was found between the 57-kD protein and the HtpB, GroEL, 65-k Mycobacterium tuberculosis and Hsp60 proteins. Thus, the 57-kD chlamydial protein, previously implicated as mediating a deleterious immunologic response to chlamydial infections, is a stress-induced protein similar to those that occur universally in both prokaryotic and eukaryotic organisms.

[Tuberculous appendicitis]. / Tuberkuløs appendicitis.

A case of probable tuberculous appendicitis and associated pulmonary tuberculosis is reported. The latest literature concerning abdominal tuberculosis is reviewed.

[Bicycle accidents in preschool children]. / Cykelulykker blandt før-skolebørn.

During the period from June 1st 1984 to May 31st 1987, 108 bicycle accidents were registered among children aged 0-6 years in the Emergency Department, Sundby Hospital. In 95 of the accidents, the child was riding the bicycle. The majority of the accidents were solo accidents where the child fell with the bicycle. 64% had head injuries and 11% of these were hospitalized for observation for concussion. Interviews made at the local nursery schools and play groups revealed that all children over the age of four years owned bicycles. Only 2% of the children employed bicycle helmets. The use of helmets by children is recommended. These should preferably also provide tooth protection.

Chlamydial disease pathogenesis. Ocular hypersensitivity elicited by a genus-specific 57-kD protein.

Recurrent or persistent infections with Chlamydia trachomatis are thought to provide the antigenic stimulus for the chronic inflammation associated with blinding trachoma. We used the guinea pig model of inclusion conjunctivitis to identify chlamydial antigens that may be involved in this deleterious immune response. We purified from chlamydial elementary bodies a genus-specific 57-kD protein that elicited an ocular hypersensitivity response when placed topically onto the conjunctiva of ocular immune guinea pigs. This response was characterized by a predominantly mononuclear macrophage and lymphocyte cellular infiltrate of the submucosal epithelium. The clinical and histological findings were consistent with those of a delayed hypersensitivity response. These data demonstrated that the 57-kD chlamydial protein was a potent stimulator of ocular delayed hypersensitivity. Our findings may be critical to understanding the pathogenesis of the debilitating chlamydial diseases associated with chronic inflammation, such as trachoma and many urogenital syndromes.

Leiomyomas of the small intestine: a rare cause of abdominal emergency. Case report.

Two cases of spontaneous perforation of small bowel leiomyomas are discussed, one previously asymptomatic, the other with a single episode of hematemesis two years earlier. Perforation of these tumours is rarely seen. Selective visceral angiography seems to be the most sensitive radiologic examination. New types of enteroscopes are being developed.