[Life expectancy together with good health are health indicators of the public health status].
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Aged↗
Biomedical subjects
H Pettersson
Publications and source records attributed to H Pettersson.
Twenty-five years' experience of prophylactic treatment in severe haemophilia A and B.
In Sweden, prophylactic treatment of boys with severe haemophilia has been practised since 1958 in an attempt to convert the disease from a severe to a milder form. The present study population consisted of 60 severe haemophiliacs (52 A, 8 B), aged 3-32 years. Treatment is started when the boys are 1-2 years of age, the regimens used being 24-40 IU F VIII kg-1 three times weekly in haemophilia-A cases (i.e. greater than 2000 IU kg-1 annually) and 25-40 IU F IX kg-1 twice weekly in haemophilia-B cases. The orthopaedic and radiological joint scores (maximum scores of 90 and 78, respectively) are evaluated as recommended by the World Federation of Haemophilia. Of those subjects aged 3-17 years, 29 out of 35 individuals had joint scores of zero. The oldest group had only minor joint defects. The VIII:C and IX:C concentrations had usually not fallen below 1% of normal. All 60 patients are able to lead normal lives. In conclusion, it appears to be possible to prevent haemophilic arthropathy by giving effective continuous prophylaxis from an early age, and preventing the VIII:C or IX:C concentration from falling below 1% of normal.
Adolescent↗
Comparison of two surgical methods for treatment of crib-biting in horses.
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Aerophagy↗
Diagnostic imaging.
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Diagnostic Imaging↗
Early rheumatoid arthritis--onset, course, and outcome over 2 years.
Eighty-nine patients, 33 men and 56 women, with early definite rheumatoid arthritis were followed for 2 years. Two-thirds were seropositive. About 1/3 were eventually treated with second line drugs. The disease mostly had an insidious onset initially involving the finger joints. Early remission occurred in 16%. Patient relevant measures such as pain, patient's overall assessment of disease activity and anxiety decreased significantly. Disability evaluated by the HAQ disability index remained at a low level. The joint damage score (JDS) in hands and feet increased steadily and only 18% were nonerosive after 2 years. One-third developed hand deformities which was associated with higher JDS. A joint function index (SOFI) correlated significantly with JDS. Twenty-eight percent had a slower rate of joint damage progression the second year. There was no significant correlation between JDS and disease duration. Six patients developed rapidly progressive damage in larger joints, five in the hip joints and one in the shoulder joint, all requiring joint replacement. The ability to predict outcomes with clinical and laboratory variable obtained at entry was of limited clinical usefulness. By applying discriminant analyses 67%-80% of the cases who fared worst regarding clinical, functional, and radiological features could be correctly classified.
Adult↗
Disease activity and joint damage progression in early rheumatoid arthritis: relation to IgG, IgA, and IgM rheumatoid factor.
The clinical and biochemical correlations with joint damage progression over two years in a consecutive group of 68 patients with rheumatoid arthritis with disease duration of less than two years are reported. Joint damage was assessed with Larsen's severity scale and a measure of change in progression rate constructed. Initial haemoglobin concentration, Ritchie index, and Waaler-Rose titre in combination accounted for one third of the variance in joint damage progression. Rheumatoid factor (RF) concentrations were followed with enzyme linked immunosorbent assays (ELISAs) for IgG RF, IgA RF, and IgM RF. The RF concentrations, except IgG RF, decreased with time; significant correlations between RFs and disease activity were few and barely clinically useful. After two years IgG RF correlated significantly with a radiological score if early non-erosive changes were omitted. All RFs tended to correlate better with this radiological score at all three observation points. Analyses of the change in progression rate indicated a time delay between development of radiographic changes and increase of IgG RF. These results suggest an indirect relation between RFs and joint damage. Clinical and biochemical improvements in early RA occur despite joint damage progression, and conventional markers have insufficient predictive value.
Arthritis, Rheumatoid↗
CT scans and lipohaemarthrosis in hip fractures.
Computed tomography was performed on 40 patients with recent hip trauma. Radiographs of 25 showed a fracture of the femoral neck with slight displacement; 24 of these had intra-articular fluid and 20 had a lipohaemarthrosis on the CT scan. In 15 patients, radiographs at the time of admission were normal but suspicion of fracture remained. A fracture was later verified in five patients, four of whom had lipohaemarthrosis on admission. In the remaining 10 patients no fracture could be detected; only one patient had a hip joint effusion but no free fat. Thus all 24 patients with lipohaemarthrosis had an intracapsular fracture of the hip. We suggest CT for patients with hip trauma and negative radiographs. The presence of a lipohaemarthrosis of the hip strongly suggests an intra-articular fracture of either the femoral neck or the acetabulum.
Aged↗
Spontaneous osteonecrosis of the knee: value of MR imaging in determining prognosis.
Sixteen patients with early and late stages of spontaneous osteonecrosis of the knee were studied to evaluate if MR imaging can be used to determine the prognosis of the disease. All patients had sequential conventional radiographs and clinical examinations, one or more 99mTc-methylene diphosphonate bone scintigrams, and an MR examination. The duration of the disease at the time of the MR examination ranged from 1 to 58 months (mean, 18 months). A relationship was identified between the pattern of bone marrow alteration noted on long TR/TE MR sequences and the scintigraphic stage and clinical course of the disease. The dimensions of the osteonecrotic region could be identified as well or better on the short TR/TE MR images than on the radiographs in all patients. MR imaging also afforded evaluation of the hyaline cartilage overlying the osteonecrotic lesion, revealing secondary osteoarthrosis in seven patients. We conclude that MR imaging in patients with spontaneous osteonecrosis of the knee may provide information of value for determining the prognosis of the disease.
Adult↗
Wrist synovectomy in juvenile chronic arthritis (JCA).
Synovectomy of 20 wrist joints in 15 patients with juvenile chronic arthritis (JCA) was performed and results were evaluated 3 (0.5-5) years after surgery. The surgical procedure consisted of synovectomy of the radiocarpal joint, around the ulnar head and in all intercarpal joints. Resection of the ulnar head was not performed. Results at follow-up showed that four wrist joints had been re-operated by arthrodesis because of persistent pain. In one case a spontaneous ankylosis had developed. These cases were not included in the re-examination. Of the remaining 15 cases, 12 were improved and 7 of these were totally pain-free. At follow-up, clinical examination revealed a mean improved grip strength (0.2 kp/cm2) and a mean decreased range of motion (10 degrees of flexion and extension, 16 degrees of pronation, supination unchanged). All wrist joints showed some radiographic changes preoperatively and at follow-up about half showed some further deterioration. This study indicates that the results of wrist synovectomy in patients with juvenile chronic arthritis do not differ significantly from results of wrist synovectomy in adult arthritic patients.
Adolescent↗
[The new medical imaging technics].
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Costs and Cost Analysis↗
A long-term follow-up study of total meniscectomy in children.
The long-term effects of single meniscectomy in 89 children have been analyzed at an average of 16.8 years after surgery. Seventy-four percent were pleased with the outcome, but only 52% or 58% had objectively satisfactory results according to the two scoring systems used. Significantly poorer results were achieved with lateral meniscectomies. The range of movement was significantly decreased after lateral meniscectomy. Minor instabilities were recorded in 45% of the patients and major instabilities in 15%. Anteroposterior and rotatory instabilities were objectively measured, and a significant increase was noted in knees that had lateral meniscectomy. Grade I gonarthrosis was recorded in 39% of the surgically treated knees and Grades II and III gonarthroses in 9%. The joint space was significantly reduced in all knees irrespective of the injured compartment.
Adolescent↗
Gadolinium-DTPA enhancement of soft tissue tumors in magnetic resonance imaging.
In a clinical study of 13 patients, gadolinium-DTPA (Gd-DTPA) was used for enhancement of soft tissue tumors at magnetic resonance imaging. Gd-enhanced T1 sequences were found to give additional information concerning tumor vascularity in 11 cases, tumor necrosis in 2 cases and tumor delineation in one case, compared with conventional T1 and T2 weighted spin echo sequences. If Gd-enhanced sequences were to be used as the only source of information, accurate assessment of tissue composition of the tumor would not have been possible. Furthermore, valuable information regarding tumor delineation towards surrounding fat may be lost.
Adult↗
Trochanteric fractures--a clinical and radiologic evaluation of McLaughlin, Ender, and Richard's osteosynthesis.
Four hundred and thirty femoral trochanteric fractures operated with nail-plate (McLaughlin), Ender, or sliding screw-plate (Richard) osteosynthesis were followed up radiographically and clinically. For each method of osteosynthesis the initial nail position was correlated to the occurrence of late mechanical complications. Unstable fractures were associated with a higher incidence of one or more clinical complications such as repeated surgery, post-operative death, or increased pain. For Ender osteosynthesis correlations were found between several mechanical and clinical complications, while for Richard's osteosynthesis mechanical complications were significantly correlated to repeated surgery only. McLaughlin and Ender osteosyntheses had a higher incidence of reoperations than Richard's osteosynthesis, whereas the mobility and ADL function were the same at 4 months.
Bone Plates↗
Metabolism of aflatoxin B1 in the bovine olfactory mucosa.
Carcinomas of the ethmoidal region of the nose are observed relatively frequently in cattle in several countries in tropical and subtropical latitudes. Viruses have been implicated as causative agents, but it has been observed that affected animals sometimes suffer from aflatoxicosis, and a role of aflatoxin B1 (AFB1) in the aetiology has also been proposed. We have examined whether the bovine nasal olfactory mucosa has a capacity to metabolize AFB1. The contents of cytochrome P-450 and cytochrome b5, and the NADPH cytochrome c reductase activity in the nasal olfactory mucosa have also been determined. Comparative experiments have been performed with the liver. Incubations with 3H-labelled AFB1 showed that the nasal olfactory mucosa has a much higher capacity than the liver to form lipid-soluble, water-soluble and tissue-bound AFB1-metabolites. High-resolution microautoradiography showed a strong localization of tissue-bound metabolites in the sustentacular cells in the apical portion of the olfactory surface epithelium and in Bowman's glands in the olfactory lamina propria mucosae. Especially in the sustentacular cells the labelling was preferentially located in the nuclei of the cells. Liquid chromatography of chloroform extracts of the nasal olfactory mucosa and the liver incubated with 3H-AFB1 showed formation of several metabolites. The dominating peak in both tissues was aflatoxin M1 (AFM1). However, the amount of AFM1 was higher in the nasal olfactory mucosa than in the liver, and the amounts and proportions of several other metabolites also differed markedly between the two tissues. The level of cytochrome P-450 in the nasal olfactory mucosa was found to be about one quarter of that in the liver, but the NADPH cytochrome c reductase activity was much higher in the nasal olfactory mucosa than in the liver. In addition, the cytochrome b5: cytochrome P-450 ratio was higher in the nasal olfactory mucosa than in the liver. The higher metabolism of AFB1 in the nasal olfactory mucosa than in the liver may be related to differences in the cytochrome P-450 isoenzyme profile. In addition, the microsomal electron transport to cytochrome P-450 may be facilitated by the high reductase: cytochrome P-450 ratio and the high cytochrome b5: cytochrome P-450 ratio in the nasal olfactory mucosa.(ABSTRACT TRUNCATED AT 400 WORDS)
Aflatoxin B1↗
Computerized assessment of radiological changes of the hand in rheumatic diseases.
Evaluations of radiological changes in rheumatic diseases are subject to great inconsistency. In this study, digital image analysis is shown to be a promising tool in the evaluation of joint space narrowing. The repeatability of the measurements is shown to be better than that of manual methods and is also less dependent on the observer.
Aged↗
Femoral head necrosis in juvenile chronic arthritis.
Radiographic signs of ischemic necrosis of the femoral head in terms of abnormal epiphysis and caput indices were found in 30/72 hips in 36 children with hip pain or limitation of motion among 206 children, consecutively admitted during 15 months because of juvenile chronic arthritis. Nine out of 10 hips with obvious signs of femoral head necrosis showed a sclerotic rim at the base of the femoral neck, confirming an earlier episode of ischemic damage to the epiphysis and growth plate. Femoral head necrosis in children with juvenile chronic arthritis seems to be more common than previously reported, and may be caused by circulatory disturbance secondary to increased intraarticular pressure due to synovitis and/or effusion, or to treatment with passive extension of the hip. This should be considered in the treatment and the follow-up of these children.
Adolescent↗
Lateral meniscal lesions in patients with clinically suspected medial lesions.
Double-contrast arthrography and arthroscopy were performed in a prospective study on 46 consecutive patients clinically suspected of having a medial meniscal tear only. At arthrography, 38 torn medial menisci were found; four of them were, however, false-positive and another false-negative as compared with arthroscopic examination. Moreover, seven unsuspected lateral meniscal tears were diagnosed at both arthrography and arthroscopy. The diagnostic accuracy of the double-contrast arthrography was well above the clinical accuracy, and we conclude that arthrography is a reliable method for diagnosing both medial and lateral tears.
Arthrography↗
A case of bilateral duplication of the patella.
A boy with bilateral duplication of his patellae was radiographically examined between 8 and 11 years of age. The duplication was probably caused by a disrupted fusion of two ossification centra.
Child↗