Increased frequency of multiple sclerosis among patients with bullous pemphigoid: a population-based cohort study on comorbidities anchored around the diagnosis of bullous pemphigoid.

BACKGROUND: Bullous pemphigoid (BP) is a disease of the elderly and may be associated with neurological and cardiovascular diseases and diabetes. Mortality rates strongly exceed those of the background population. OBJECTIVES: To investigate the frequency of comorbidities and their temporal relation to BP. METHODS: A register-based matched-cohort study on all Danish patients with a hospital-based diagnosis of BP (n = 3281). The main outcomes were multiple sclerosis (MS), Parkinson disease (PD), Alzheimer disease (AD), stroke, diabetes types 1 and 2, malignancies, ischaemic heart disease (IHD), hypertension and eventually death. RESULTS: At baseline, patients with BP had increased prevalences of MS [odds ratio (OR) 9·7, 95% confidence interval (CI) 6·0-15·6], PD (OR 4·2, 95% CI 3·1-5·8), AD (OR 2·6, 95% CI 1·8-3·5) and stroke (OR 2·7, 95% CI 2·4-2·9). Furthermore, malignancies, cardiovascular disease and diabetes were over-represented among patients with BP: type 1 diabetes (OR 3·1, 95% CI 2·5-3·8), type 2 diabetes (OR 2·3, 95% CI 2·0-2·6), malignancies (OR 1·3, 95% CI 1·1-1·4), IHD (OR 1·7, 95% CI 1·5-1·9) and hypertension (OR 2·0, 95% CI 1·8-2·2). During follow-up, the risk of MS was significantly higher among patients with BP [hazard ratio (HR) 9·4, 95% CI 4·9-18·0], even if events during the first year after diagnosis of BP were excluded (HR 5·1, 95% CI 2·3-11·3). Patients with BP had an average increased mortality rate of 2·04 (95% CI 1·96-2·13). CONCLUSIONS: We discovered a significantly increased frequency of MS among patients with BP. At the time of diagnosis, patients with BP had an excessive number of comorbidities and an increased mortality rate over the following years.

Effects of medullary reaming on fracture healing. Tibial osteotomies in rabbits.

Unilateral, midshaft tibial osteotomy was made in 16 rabbits. Reaming of the medullary canal was performed in half the animals, while the other half were operated on without reaming. Intramedullary fixation was accomplished with multiple Kirschner pins in both groups. Bone healing occurred with abundant peripheral callus in both groups. Mechanical testing after 6 weeks revealed higher strength of the osteotomized bones where reaming had not been performed compared with bones with reaming. We conclude that bone healing is delayed by medullary reaming, whereas the pattern of healing is similar in bones with and without reaming.

Early postoperative weight-bearing and muscle activity in patients who have a fracture of the ankle.

Fifty-six patients who had a displaced fracture of the ankle necessitating surgical fixation were randomly assigned to one of three postoperative treatment regimens: no plaster cast or weight-bearing, and active exercises of the ankle; a non-weight-bearing plaster cast; or a plaster walking cast for the first six postoperative weeks. At follow-up with a duration of as much as two years, there were no consistent differences in the clinical results between the three groups. The time lost from work and the proportion of excellent and good clinical results were also uninfluenced by the postoperative regimen. No adverse effects could be detected as a result of the patient's having walked before the syndesmosis screw had been removed. It was concluded that none of the three postoperative regimens has any advantage over the others in a patient who has a stable osteosynthesis of a fracture of the ankle.