[Tuberculous osteomyelitis in children--a problem of immigrants?]. / Tuberkuløs osteomyelitis hos børn--et indvandrerproblem?

The incidence of tuberculosis in Denmark has increased in recent years, owing to immigrants from, primarily, Somalia. Bone and joint TB are mainly seen in young immigrants and a case of tuberculous ostitis of the tarsal bones and surrounding soft tissue is described.

Decreasing incidence of major amputations in people with diabetes.

AIMS/HYPOTHESIS: To assess the results of the strategy used in avoiding major amputations in patients with diabetes mellitus. METHODS: A retrospective study for the years 1981 to 1995 in a central district hospital in Copenhagen with a catchment area population of about 178,000. RESULTS: There were 463 major leg amputations and the incidence decreased from 27.2 to 6.9/100,000 population (75%). The decrease in patients with Type I (insulin-dependent) diabetes mellitus was from 10.0 to 4.1 (59%) and in Type II (non-insulin-dependent) diabetes mellitus from 17.2 to 2.8/100,000 people (84%). Analysis showed that the diabetic population remained constant despite a considerable fall in the number of older people. During the study period infra-popliteal arterial bypass was introduced for the treatment of critical lower limb ischaemia and in diabetic patients the number of bypasses increased from zero to 13/100,000 population. The total number of revascularisation procedures in people with diabetes increased from 2.6 to 19.2/100,000 population. Moreover, a multidisciplinary diabetic foot clinic was established. CONCLUSION/INTERPRETATION: A 75% reduction in the incidence of major amputations coincided with a sevenfold increase in revascularization procedures and the establishment of a multidisciplinary diabetic foot clinic suggesting these measures are important in the prevention of diabetic leg amputations.

[Hand symptoms and pregnancy]. / Håndgener og graviditet.

The purpose of the present study was to identify the incidence of hand symptoms related to pregnancy in a Danish population. Three hundred and thirty-five consecutive postpartum patients were interviewed by questionnaire. Hand symptoms had been noted by 16%, among these 30% described a classic median-nerve symptom distribution (carpal tunnel syndrome) and 24% of patients described an ulnar nerve distribution. Most symptoms were bilateral, commenced in the third trimester and resolved soon after delivery. There was a significant correlation of hand symptoms in pregnancy with the presence of swelling and a significant correlation to parity (first). Hand function and sleep had been disturbed in half of the patients. Half of the patients had mentioned their symptoms to their doctor and one had been sent to treatment. Hand symptoms during pregnancy are common, and their severity is often underestimated. Symptoms of the carpal tunnel syndrome are easily relieved by a night splint.

Hypertrophic scars and keloids: a recurrent problem revisited.

Excess scarring caused by pathologically overabundant collagen deposition is a problem known by all surgeons. Such complications to wound healing known as hypertrophic scars and keloids might turn out aesthetically unacceptable to the patient and some scars might even cause anatomic dysfunction. Reviewing the literature in planning a strategy of treatment the surgeon encounters an overwhelming amount of hypotheses on the topic. There seems to be no absolutely effective treatment for hypertrophic scars and keloids and the number of treatment modalities illustrate the lack of understanding concerning this kind of pathologic scarhealing. Most studies have not been well controlled and have produced conflicting results. This review outlines the nature of hypertrophic scars and keloid. Based on a critical assessment of current treatment modalities some guidelines for the choice of treatment is proposed.

[Reduced frequency of amputation in diabetic patients]. / Amputationsfrekvens hos diabetikere reduceres.

The number of major amputations performed for vascular disease in Bispebjerbx Hospital, Copenhagen, has decreased from 122 to 29 per year during the period 1981 to 1994. In diabetic patients the frequency decreased from 25.5/100,000 to 5.5/100,000, i.e. a reduction of 78 percent, and in non diabetics it decreased from 42.2/100,000 to 14.6/100,000, i.e. a reduction of 65 percent. During the period vascular surgery has become a surgical specialty (1983), bypass to infra-popliteal arteries (from 1988) and graft surveillance by colour duplex scanning (from 1983) has become routine and in 1993 a diabetic foot center was established. Initial experience with a diabetic foot center in a vascular surgery unit is reported.

Injury producing factors in sport parachuting.

On the basis of a study of the literature and a description of the parachute jump, the injury producing factors of civil parachuting is described. The majority of injury happens during landing; the assuming of a correct "prepare to land attitude" and the execution of a good parachute landing fall may prevent a great part of the injuries to the spine and the lower extremities. The factors mentioned are often correlated to ignorance, inexperience or to willful neglect of current regulations. A revision of the education of student parachuters and instructors in order to meet the same quality demands in all parachuting centres is proposed. Safer parachutes and a simplification of the parachute landing fall may also reduce the incidence of casualties.