Functional results of braced humeral diaphyseal fractures: why do 38% lose external rotation of the shoulder?

A total of 67 humeral diaphyseal fractures treated with functional bracing was studied. The median follow-up was 30 weeks. Sixty-one fractures (91%) healed and 6 fractures (8.9%) progressed to non-unions. Fifty-four fractures could be functionally classified according to a modified Wasmer score. Pain, range of motion in the shoulder and elbow, and changes in activities of daily life were recorded. Loss of external rotation in the shoulder was most prominent, being present in 21 (38%) of the fractures. To evaluate the cause of loss of external rotation, 21 of the patients were selected for two groups to be studied with computed tomography (CT). Twelve patients had normal clinical findings without a loss of external rotation, while 9 patients had subnormal external rotation in the shoulder of the injured limb. Fracture consolidation in malrotation was seen frequently, and a linear correlation between the clinical loss of external rotation and CT findings was indicated, but no statistical agreement could be proved. The time between injury and brace application could possibly contribute to consolidation in malrotation.

The distribution of oedema in the lower limb of patients with chronic critical limb ischaemia: a study with computed tomography.

BACKGROUND: A substantial number of patients with chronic critical limb ischaemia (CLI) have considerable oedema at the distal leg and foot of non deep venous thrombosis origin. The primary aim of the present study was to quantify the distribution of oedema in the different tissues of the leg and foot by applying computed tomography and planimetry. The interstitial fluid hydrostatic pressure (Pif) in the subcutaneous tissue was measured to evaluate the effect of oedema on local tissue pressure. PATIENTS AND METHODS: Six men and 12 women with unilateral CLI and peripheral pitting oedema were included. Cross sectional areas (CSA) of subcutaneous tissue, muscle and bone were measured by computer tomography combined with planimetry to assess the distribution of oedema within the soft tissues. Pif was measured by "wick-in-needle" technique. RESULTS: The median total CSA of soft tissue, subcutaneous and muscle tissues at the foot level were respectively 17%, 34% and 9% greater in the limbs with CLI compared to the contralateral limb (p < 0.001). At ankle level these differences were 13%, 30% and 4%, respectively (p < 0.001). At the level of the calf these differences were not significant. Mean Pif in the limbs with CLI was 0.3 mmHg, significantly higher than in limbs without CLI (-1.8 mmHg), (p < 0.003). CONCLUSION: The study verified oedema of considerable magnitude at the ankle and foot. The great part of the oedema was located within the subcutaneous tissue, which was associated with a relatively moderate, but significant increase in Pif confirming the high compliance of the subcutaneous tissue. The combination of the excessive fluid and increased Pif in the interstitial tissue might aggravate the microcirculation. The aetiology of oedema formation is probably multifactorial.

[Historical retrospect on women's health in our century]. / Historiske tilbakeblikk på kvinnehelse i vårt århundre.

At this turn of the century, we may look back on a hundred years of major social changes with a huge impact on women's health, many of them related to women's role in reproduction. Effective contraception has become available to all women, and access to safe abortion has been secured through legislation. The majority of women are now in paid employment and women's position in society is dramatically improved. The decrease in mortality has affected women and men differently. Women live longer than men, but they tend to be afflicted by chronic non-lethal diseases. Issues which earlier were kept out of the public debate on women's health are now part of that debate. The improvements in women's health are not only a consequence of changing living conditions and better health services; they are also linked to changing attitudes to sexuality, love and marriage.

Factors predicting antenatal hospital admission in pregnancy.

OBJECTIVE: To identify factors predicting hospital admission in pregnancy before the delivery. DESIGN: A case-control study within a cohort study of pregnant women admitted and not admitted to hospital during pregnancy. SETTING: University obstetric departments in three Scandinavian cities. SUBJECTS: 451 parous pregnant women attending antenatal care. Eighty-eight women were admitted to hospital before delivery, and 363 women were not hospitalized. MAIN OUTCOME MEASURES: Antepartum hospital admission in pregnancy. RESULTS: There were significant differences between the groups with respect to health-related characteristics to explain the observed difference in hospital admission. Furthermore, significantly more women hospitalized in pregnancy had experienced severe life events. CONCLUSION: Factors predictive of hospital admission were identified as pregnancy complications, adverse reproductive health history, and severe life events.

Health consequences of severe life events for pregnancy.

OBJECTIVE: To investigate the relationship between severe life events and disorders in pregnancy. DESIGN: Cohort study of pregnant women with and without life events. SETTING: Three Scandinavian cities, Uppsala (Sweden), Bergen and Trondheim (Norway). SUBJECTS: 451 parous women (para 1 and para 2) attending antenatal care. 107 women did and 344 did not experience severe life events just prior to or during pregnancy. MAIN OUTCOME MEASURES: Pregnancy disorders, frequency of sick leave and admission to hospital. RESULTS: There were no significant differences in pregnancy disorders between pregnant women with and without severe life events. However, women with life events were relatively more on sick leave and significantly more often admitted to hospital than pregnant women without this kind of distress in pregnancy. CONCLUSION: Severe life events seem largely unrelated to the incidence of specific pregnancy disorders, but seem to have an adverse influence on the pregnant women's general health, as indicated by the use of sick leave and hospitalization.

[Computer tomography in the detection of hemochromatosis]. / Computertomografi til påvisning av hemokromatose.

Computed tomography (CT) was performed to estimate the density of the hepatic and splenic parenchyma in 18 patients with hemochromatosis. The mean CT density was 79 +/- 21 Hounsfield units compared with 61 +/- 9 (p < 0.01) in 31 controls without hepatic disease. Increased density above 79 Hounsfield units was found in eight patients out of 18 (44%). The highest density (125 Hounsfield units) was found in a patient with a serum ferritin of 6500 micrograms/l. There was an association between CT density and serum ferritin (r = 0.72, p < 0.01). The difference in density between liver and spleen gave better discrimination between patients and controls: 12 of 18 (67%) showed an increased difference in density between liver and spleen. We conclude that CT represents a non-invasive alternative to liver biopsy in cases where the latter is contraindicated. However, CT is not sensitive when serum ferritin is below 1,000 micrograms/l.

[Clinical experience with early hemochromatosis]. / Klinisk erfaring med tidlig hemokromatose.

During the period 1986-93 22 patients were diagnosed as having primary hemochromatosis. Only 11 of them had elevated aminotransferases. Transferrin saturation was higher > 63% in 17 (77%) and serum-ferritin was higher in all the patients. (257 mumol/l to 6,500 mumol/l). A percutaneous liver biopsy was performed in 20 patients, all of whom showed a characteristic grading from 2 + to 4+ using Perls' stain. Two males had cirrhosis with simultaneous hepatocellular carcinoma, and another two had cirrhosis. One patient had diabetes mellitus type I. We conclude that fasting serum-iron and transferrin should be determined in all subjects over 40 years of age and in patients with chronic elevation of liver enzymes. If transferrin saturation is higher than 50% in females and 60% in males, serum ferritin should be determined. A percutaneous liver biopsy should be performed if both values are higher than normal. Screening of siblings is important because of the autosomal recessive pattern of inheritance.

A double-blind and randomized placebo-controlled trial of low molecular weight heparin once daily to prevent deep-vein thrombosis in acute ischemic stroke.

The effect of LMW heparin (Kabi 2165, Fragmin) was compared with placebo for the prevention of DVT in 103 patients with acute ischemic stroke using a prospective, double-blind, randomized trial design. Treatment was started within 72 hours, and LMW heparin was administered subcutaneously once daily according to body weight classes, which corresponded to about 55 to 65 Factor-Xa inhibitory U/kg, for 14 days, or until discharge from the hospital, if earlier. All patients underwent thrombosis surveillance with unilateral venography of the paretic limb. Evaluation of venography could be performed in 42 of 52 patients randomized to LMW heparin and in 50 of 51 patients randomized to placebo. The frequency of DVT was 15 of 42 patients or 36% (95% confidence interval 22 to 52%) in the LMW heparin group and 17 of 50 patients or 34% (21 to 49%) in the placebo group. The frequency of proximal thrombi was 5 of 42 (12%) and 8 of 50 (16%), respectively. There was one fatal pulmonary embolism in the placebo group. The mortality rate (28 days follow-up) was 5 of 52 in the LMW heparin group and 1 of 51 in the placebo group (p = 0.24). None of the deaths was related to treatment. No major hemorrhagic complications were observed. The mean Factor Xa inhibitory activity levels at peak concentration were 0.34 U/ml on day 2 and 0.42 U/ml on day 12 (p = 0.02). We conclude that LMW heparin in the dose range studied did not provide efficient prophylaxis against DVT in patients with acute ischemic stroke.

An inexpensive electronic counting system for step tests.

A simple electronic counter was designed to count step test cadence. Foot pads, a controller and a counter were used to record the number of times the subject placed both feet on the top step. The electronics insured accurate counting by preventing double counts on one ascent and requiring weight to be put on both feet on the top step.

Fatal stroke in migraine: a case report with autopsy findings.

A 50-year-old woman with migraine was admitted to hospital shortly after having abruptly developed hemiparesis. CT scan revealed infarction in the territory of the right middle cerebral artery. Death ensued after three days due to cerebral edema with herniation. Autopsy revealed no pathologic findings in the heart or in the extra- or intracranial arteries. It is suggested that the fatal stroke may have resulted from arterial spasm caused by ergotamine overdosage and possibly complicated by thrombosis.

Fatalities in a stroke unit.

During the first 4 years of the CV unit the mortality rate among 464 patients was 5.2 per cent. The records of the 24 fatalities were reviewed. In the 10 patients submitted to autopsy the clinician's opinion of the cause of death was confirmed in 6 cases. In 4 cases autopsy revealed brain abscess, pulmonary embolism, acute myocardial infarction and pneumonia, respectively. Other significant findings not registered clinically were made in 4 cases. Twenty-three patients underwent a cerebral CT scan which showed positive findings in 19 cases. In one patient a brain abscess was misinterpreted as a brain infarction and in 2 other patients with a negative CT scan, autopsy revealed a small pontine and hemispheric infarction, respectively. Apart from the misdiagnosis of the brain abscess the accuracy of the CT scan was acceptable. Extracranial complications as a cause of or contributing to death in stroke patients are common. Prevention, early detection and treatment of these complications are important. The findings underscore the importance of autopsy in the evaluation of stroke patients.

Bypass to the tibial and peroneal arteries using the great saphenous vein in situ.

In 22 patients with extensive atherosclerotic disease of the lower extremities 24 long bypasses have been performed. The main indications for surgery were rest pain and imminent or manifest gangrene. The semiclosed in situ vein technique was used in all except one case. Five grafts thrombosed within 2 weeks postoperatively, one of them was successfully reopened. At discharge 20 grafts were patent, and most of the patients had relief of their ischemic symptoms. After 5 years 26% of the long vein grafts were patent. In comparison, almost 70% of in situ femoro-popliteal vein grafts were patent. One patient is still living with an open long vein graft 14 years after surgery. The in situ vein technique is especially suited for long bypasses. The poorer results in the present series is probably due to an extremely advanced atherosclerotic disease and a high percent of small fibrotic veins with a diameter of 3 mm or less.