Svend Erik Østgaard

Perforated gastric ulcer

A retrospective study is presented of 297 patients operated upon for perforated benign gastric ulcer in Denmark from 1975 to 1984. Male:female ratio was 0.9:1, mean age 64.2 years. The numbers of gastric and prepyloric perforations were almost equal (156:141), but gastric perforations were more frequent in elderly women and prepyloric perforations in younger men. Simple closure was performed in 83 per cent of the patients, gastric resection in 14 per cent and simple closure and vagotomy in 3 per cent. The postoperative mortality rate was 21 per cent and was related to the high proportion of elderly patients with concurrent diseases and delayed treatment.

ROENTGEN STEREOPHOTOGRAMMETRIC ANALYSIS USING COMPUTER-BASED IMAGE-ANALYSIS

The two-dimensional position of markers in radiographs for Roentgen Stereophotogrammetric Analysis (RSA) is usually determined using a measuring table. The purpose of this study was to evaluate the reproducibility and the accuracy of a new RSA system using digitized radiographs and image-processing algorithms to determine the marker position in the radiographs. Four double-RSA examinations of a phantom and 18 RSA examinations from six patients included in different RSA-studies of knee prostheses were used to test the reproducibility and the accuracy of the system. The radiographs were scanned at 600 dpi resolution and 256 gray levels. The center of each of the tantalum-markers in the radiographs was calculated by the computer program from the contour of the marker with the use of an edge-detection software algorithm after the marker was identified on a PC monitor. The study showed that computer-based image analysis can be used in RSA-examinations. The advantages of using image-processing software in RSA are that the marker positions are determined in an objective manner, and that there is no need for a systematic manual identification of all the markers on the radiograph before the actual measurement.

Glenohumeral movement patterns after puncture of the joint capsule: An experimental study

In on experimental series comprising 22 shoulder specimens obtained at autopsy, we investigated the influence of an intact capsule on glenohumeral stability. Puncture of the capsule resulted in significant glenohumeral translation in unloaded and loaded specimens during shoulder abduction. A maximum of 16.6 mm of distal translation was observed at 20° of abduction. Concomitant with this translation the humerus spontaneously rotated externally, with a maximum rotation of 15.8° at 50° of abduction. After venting the capsule, anterior and posterior translation and external rotation were increased significantly. Maximum total increase in anteroposterior translation was 14 mm at 30° of abduction. The external rotation was increased up to 7.1° at 40° of abduction. These findings indicate that studies evaluating glenohumeral instability are compromised unless the translations resulting from capsular venting ore corrected. Evaluation of shoulder stability should be performed before violation of the intraarticular pressure mechanisms.

Population-Based Epidemiology of Tibial Plateau Fractures

Although epidemiologic studies of tibial plateau fractures have been conducted, none have included geographically defined populations or a validated fracture classification based on computed tomography (CT). The goals of this study were to provide up-to-date information on the incidence and basic epidemiology of tibial plateau fractures in a large unselected patient population and to report the mechanisms of injury involved and the distribution of fractures according to a validated CT-based fracture classification. The authors conducted a population-based epidemiologic study of all patients treated for tibial plateau fracture over a 6-year period from 2005 to 2010. The study was based on an average background population of 576,364 citizens. A retrospective review of hospital records was performed. During this time, a total of 355 patients were treated for tibial plateau fracture. This group included 166 men and 189 women, and mean age was 52.6 years (SD, 18.3). The most common fracture type was AO type 41-B3, representing 35% of all tibial plateau fractures. The second most common fracture type was AO type 41-C3, representing 17% of all tibial plateau fractures. The incidence of tibial plateau fractures was 10.3 per 100,000 annually. Compared with women, men younger than 50 years had a higher incidence of fractures. The incidence of fractures increased markedly in women older than 50 years but decreased in men older than 50 years. In both sexes, the highest frequency was between the ages of 40 and 60 years.

Resection arthroplasty of the proximal interphalangeal joint

Palmar plate resection arthroplasty of the PIP joint, a new technique for operative treatment of destroyed PIP joints, is presented. By combining palmar plate arthroplasty with a flexor tenodesis a stable arthroplasty with adequate active motion can be performed. It can be used even in severely destroyed joints and still provide adequate post-operative stability and motion. Exercise can be started early.

Anterolateral instability in the anterior cruciate ligament deficient knee. A cadaver study

Knee instability was evaluated in 13 normal osteoligamentous knee preparations after transection of the anterior cruciate ligament. Abduction-adduction rotation, coupled tibial translatory movement, and coupled tibial axial rotation were recorded continuously and simultaneously during flexion or extension while applying a well defined valgus directed moment and during extension while applying an anterior tibial force. As a result of the valgus-directed moment, an increase was found in abduction rotation, in coupled anterior tibial translation, and in coupled internal tibial axial rotation. Coupled rotatory and translatory instabilities were larger, and maximum instability was observed at a smaller knee angle during the extension movement than during the flexion movement. The pattern of the instability, excited as a result of the valgus moment, was different from the instability excited as a result of an anterior tibial force.

The influence of Po2, pH, and albumin on the in vitro contraction of vascular smooth muscle

A method by which gases can be added to a tissue bath containing proteins in solution is described and utilized in a study of the importance of O2, CO2 and albumin for the contraction of rings of rabbit pulmonary artery. In electrolyte solutions without protein, reduction of the oxygen tension from 700 to 150 mm Hg caused a shortening of the period during which contractions could be elicited by nerve specific electrical field stimulation before a significant decrease in the contractile response occurred. The addition of albumin (45 g/l) to the bath caused a significant increase in contractile response during the first hour and furthermore a prolongation of the period during which the following gradual decrease remained at an insignificant level. A reduction in oxygen tension in the albumin solution from 700 to 150 mm Hg caused a more abrupt and pronounced reduction in contractile response than the one seen in the protein free solution. The response increased when the pH in the saline solution was raised early during an experiment but not if the pH was raised later. Decreased responses were seen when the pH was reduced regardless of the length of the period prior to the pH change. It is emphasized that the method improves the possibilities for in vitro studies of the activity of protein bound drugs in the presence of dissolved proteins.

Population-based epidemiology of 9767 ankle fractures

BACKGROUND The purpose was to provide up-to-date information concerning the incidence of ankle fractures in a large and complete population including all age groups, spanning a decade, and report the distribution of fractures, trauma mechanism and patient baseline demographics. METHODS Population-based epidemiological study of all patients treated for an ankle fracture in a 10-year period from 2005 to 2014. RESULTS A total of 9767 patients with ankle fractures were treated between 2005 and 2014. The mean age at time of fracture was 41.4 (24.3 SD) years. The mean incidence of ankle fractures between 2005 and 2014 was 168.7/100,000/year. Years with cold winters showed increased incidences compared with years with normal winters. For males, the incidence was 157.1/100,000/year, and for females, 179.5/100,000/year. The incidence shows a peak incidence among adolescents in both genders with a male predominance. After the age of 19 the male incidence declines with age, which is in contrast to females, who experience an increasing incidence. The most common fracture type in all age groups was a fracture of the lateral malleolus representing 55% of all fractures. The predominant mode of injury was falls (61%) followed by sports (22%). CONCLUSION This study shows an incidence of 168.7/100,000/year spanning a decade. The most common fracture type in all age groups was a fracture of the lateral malleolus representing 55% of all fractures. The predominant mode of injury was falls (61%) followed by sports (22%).

EOS® Micro-Dose Protocol: First Full-Spine Radiation Dose Measurements in Anthropomorphic Phantoms and Comparisons with EOS Standard-Dose and Conventional Digital Radiology (CR)

STUDY DESIGN A comparative study of radiation dose measured in anthropomorphic phantoms. OBJECTIVES The aim of this study was to first report the first organ dose and effective dose measurements in anthropomorphic phantoms using the new EOS imaging micro-dose protocol in full-spine examinations, and to compare these measurements of radiation dose to measurements in the EOS standard-dose protocol and conventional digital radiology (CR). SUMMARY OF BACKGROUND DATA Few studies evaluating organ dose and effective dose for the EOS low-dose scanner exist, and mainly for the standard-dose protocol. To the best of our knowledge, no studies of effective dose based on anthropomorphic phantom measurements exist for the new micro-dose protocol. METHODS Two anthropomorphic phantoms, representing a 5-year-old (pediatric) and a 15-year-old (adolescent). The phantoms were exposed to EOS micro-dose and standard-dose protocols during full-spine imaging. Additionally, CR in scoliosis settings was performed. For all modalities, organ doses were measured and effective doses were calculated using thermoluminescent dosimeters. RESULTS We found a 17-fold reduction (94%) of effective dose in micro-dose protocol compared with our CR system in the adolescent phantom. Micro-dose versus standard-dose protocol, showed a 6-fold reduction (83%), and for standard-dose versus our CR system a 2.8-fold reduction (64%) reduction of effective dose was observed.For the pediatric phantom, a 5-fold reduction (81%) of effective dose in micro-dose protocol compared to our CR system was observed. Micro-dose versus standard-dose protocol, showed a seven-fold (86%) reduction. However, we observed an increase in absorbed dose of 38% when comparing the EOS standard-dose protocol with our CR system. CONCLUSION The EOS imaging micro-dose option exposes patients to lower radiation doses than any currently available modality for full-spine examination. Expected reduction of dose was established for the adolescent phantom when comparing CR and standard-dose protocol. However, no reduction of effective dose with EOS standard-dose protocol compared to our reference CR system was observed in the pediatric phantom. LEVEL OF EVIDENCE N/A.Study Design. A comparative study of radiation dose measured in anthropomorphic phantoms. Objectives. The aim of this study was to first report the first organ dose and effective dose measurements in anthropomorphic phantoms using the new EOS imaging micro-dose protocol in full-spine examinations, and to compare these measurements of radiation dose to measurements in the EOS standard-dose protocol and conventional digital radiology (CR). Summary of Background Data. Few studies evaluating organ dose and effective dose for the EOS low-dose scanner exist, and mainly for the standard-dose protocol. To the best of our knowledge, no studies of effective dose based on anthropomorphic phantom measurements exist for the new micro-dose protocol. Methods. Two anthropomorphic phantoms, representing a 5-year-old (pediatric) and a 15-year-old (adolescent). The phantoms were exposed to EOS micro-dose and standard-dose protocols during full-spine imaging. Additionally, CR in scoliosis settings was performed. For all modalities, organ doses were measured and effective doses were calculated using thermoluminescent dosimeters. Results. We found a 17-fold reduction (94%) of effective dose in micro-dose protocol compared with our CR system in the adolescent phantom. Micro-dose versus standard-dose protocol, showed a 6-fold reduction (83%), and for standard-dose versus our CR system a 2.8-fold reduction (64%) reduction of effective dose was observed. For the pediatric phantom, a 5-fold reduction (81%) of effective dose in micro-dose protocol compared to our CR system was observed. Micro-dose versus standard-dose protocol, showed a seven-fold (86%) reduction. However, we observed an increase in absorbed dose of 38% when comparing the EOS standard-dose protocol with our CR system. Conclusion. The EOS imaging micro-dose option exposes patients to lower radiation doses than any currently available modality for full-spine examination. Expected reduction of dose was established for the adolescent phantom when comparing CR and standard-dose protocol. However, no reduction of effective dose with EOS standard-dose protocol compared to our reference CR system was observed in the pediatric phantom. Level of Evidence: N/A

Dissatisfaction and persistent post-operative pain following total knee replacement – A 5 year follow-up of all patients from a whole region

Abstract Introduction Total knee replacement (TKR) is the treatment of choice for the millions of individuals whose osteoarthritis related pain can no longer be managed through non-invasive methods. Although most patients report improvement in pain and functioning following TKR, up to 30% report after 1–2 years persistent pain that interferes with their daily function. Further knowledge on long term results are highly demanded. The present study is the first 5 year follow-up of all patients from a whole region. Methods Patients were interviewed by letter concerning pain, overall satisfaction and forgotten joint score (FJS). In 2011, 607 patients in the region of North Denmark had a primary TKR, of which 20 was bilateral. Still alive are 546 patients. A total of 498 answered by letter (91%) of which 13 were not able to answer detailed due to psychological reasons. Results A total of 290 (59%) patients were very satisfied with their TKR, 140 (30%) were satisfied and 58 (12%) dissatisfied. Pain free were 269 (55%). 163 patients (33%) experienced moderate pain and 55 (11%) had strong pain. Dissatisfaction and pain were highly correlated, especially pain at walking: Among patients reporting strong pain, 35 (64%) scored higher than 6 on the VAS-average pain last 24 h versus 46 (84%) that scored higher than 6 on the VAS-pain after 30 min’s walk. Conclusions Among an unselected series of patients having TKR, 12% were dissatisfied and 11% still had strong pain 5 years later. Dissatisfaction was especially correlated with pain when walking. Thus, the association between dissatisfaction, pain at activity and the individual expectations should be further focused.