Biomedical subjects
Publications and source records attributed to K Krøner.
We investigated the diagnostic value of two different ultrasound scanning methods for the early diagnosis of acute scaphoid fractures. Fifty-seven patients with ten scaphoid fractures were assessed within a week of injury. The accuracy of the ultrasound assessment was 84% and its specificity was 91%. However, its sensitivity was only 50%. We conclude that ultrasound examination is unreliable for the diagnosis of acute scaphoid fractures.
Accidental laser-induced profound burns are rare, and they generally affect the eyes. We present a case in which an industrial worker was hit by an invisible laserbeam (1.5 KW) on his right index finger. The lesion was a cavity (3 x 3 x 12 mm) affecting cutis and subcutis. Further, there was transitory affection of the vola-ulnar nerve. The wound healed in 10 days with a stringformed scar, but without any loss of function. A visible frequency added to the cutting laserbeam could supplement the existing extensive safeguards.
This randomized double-blind study compared the analgesic efficacy and tolerability of intramuscular lornoxicam and tramadol in 76 patients with moderate to unbearable pain following arthroscopic reconstruction of the anterior cruciate ligament using the patella bone-tendon-bone technique. Patients receiving a single dose of lornoxicam 16 mg experienced significantly greater total pain relief than patients receiving tramadol 100 mg over the following 8 hours. Lornoxicam had greater analgesic efficacy than tramadol in patients with moderate baseline pain but was of equivalent efficacy in those with severe/unbearable baseline pain. Fewer patients in the lornoxicam group required rescue medication (58% vs. 77%, respectively). Patients' global impression of efficacy showed lornoxicam to be superior to tramadol with 82% and 49% of patients, respectively, rating treatment as good, very good, or excellent. Following multiple-dose administration of lornoxicam (8 mg tid) or tramadol (100 mg tid) for 3 days, efficacy profiles similar to those following a single dose were obtained. Thus, slightly fewer patients in the lornoxicam group required rescue medication, and patients' global impression of efficacy again favored lornoxicam. Adverse events were reported by 38 of the 76 patients and were mainly mild to moderate in severity. Significantly fewer patients reported one or more adverse events with lornoxicam than with tramadol (14 vs. 24, respectively). Thus, intramuscular lornoxicam offers a useful alternative to tramadol for the treatment of moderate to severe postoperative pain.
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BACKGROUND: Epidural analgesia before limb amputation is commonly used to reduce postamputation pain. But there have been no controlled studies with large numbers of patients to prove such a pre-emptive effect. We investigated whether postamputation stump and phantom pain in the first year is reduced by preoperative epidural blockade with bupivacaine and morphine. METHODS: In a randomised, double-blind trial, 60 patients scheduled for lower-limb amputation were randomly assigned epidural bupivacaine (0.25% 4-7 mL/h) and morphine (0.16-0.28 mg/h) for 18 h before and during the operation (29 patients; blockade group) or epidural saline (4-7 mL/h) and oral or intramuscular morphine (31 patients; control group). All patients had general anaesthesia for the amputation and were asked about stump and phantom pain after 1 week and then after 3, 6, and 12 months by two independent examiners. Study endpoints were rate of stump and phantom pain, intensity of stump and phantom pain, and consumption of opioids. FINDINGS: Two patients in each group were withdrawn before amputation. The groups were well matched in baseline characteristics. Median duration of preoperative saline treatment was 18.5 h (IQR 17-20). Median duration of preoperative epidural blockade in the blockade group was 18 h (15-20.3). The combined median duration of postoperative epidural pain treatment in both groups was 166 h (89.3-308.3). After 1 week, 14 (52%) patients in the blockade group and 15 (56%) in the control group had phantom pain (95% CI - 30.6 to 22.7, p = 0.9). The figures for blockade versus control group were: 14 (82%) vs ten (50%; 4.0 to 60.8, p = 0.09) at 3 months; 13 (81%) vs 11 (55%; -2.7 to 55.3, p = 0.2) at 6 months; and nine (75%) vs 11 (69%; -27.0 to 39.6, p = 1.0) at 12 months. Intensity of stump and phantom pain and consumption of opioids were similar in both groups at all four postoperative interviews. INTERPRETATION: Perioperative epidural blockade started a median of 18 h (15-20.3) before the amputation and continued into the postoperative period does not prevent phantom or stump pain.
The significance of preamputation pain for the development of postamputation stump and phantom pain has been discussed over the years and is still a matter of dispute. It has been argued that preamputation pain increases the risk of phantom pain and that phantom pain is a revivification of pain experienced before the amputation. The purpose of this prospective study was to clarify the relation between preamputation pain and phantom pain. Fifty-six patients scheduled for amputation of a lower limb were interviewed the day before the amputation about preamputation pain and about stump and phantom pain 1 week, 3 and 6 months after the amputation. Pain was quantitated and described using a visual analogue scale (VAS), 10 different word descriptors, the McGill Pain Questionnaire (MPQ) and the patients' own words. If phantom pain was present patients were asked if the pain was similar to any pain experienced before the amputation. At each postoperative interview patients were asked to recall preamputation pain intensity. Location of pain and analgesic requirements were registered. Preamputation pain significantly increased the incidence of stump pain (P = 0.04) and phantom pain (P = 0.04) after 1 week and the incidence of phantom pain after 3 months (P = 0.03). About 42% of the patients reported that their phantom pain resembled the pain they had experienced at the time of the amputation. However, there was no relation between the patients' own opinion about similarity between preamputation pain and phantom pain and the actual similarity found when comparing pre- and postoperative recordings of pain. Patients significantly overestimated preamputation pain intensity after 6 months.
A 17 year old man presented with a five-month history of swelling of the distal phalanx and a small ulcer on the pulp of the right fifth finger. Despite biopsy the diagnosis was missed until more than six months after onset, when the lesion was excised and histological examination showed a dermal leiomyosarcoma.
Phantom breast syndrome following mastectomy has been reported by other authors. However, the temporal course, character and extent of this phenomena have not been elucidated. In a prospective study we have investigated the incidence, clinical picture and temporal course of phantom breast syndrome. One hundred and twenty women who started postoperative control or treatment at the Oncology Department over a one-year period were interviewed by a standard questionnaire three weeks after the operation. One year later 110 patients and six years later 68 patients were interviewed again. The incidence of phantom pain and non-painful phantom sensations was respectively 13.3% and 15.0%, respectively three weeks after the mastectomy. 12.7% and 11.8% after one year, and 17.4% and 11.8% after six years. A significant relationship between preoperative pain and phantom breast syndrome was found, but neither age, cancer treatment or postoperative sequelae seemed to affect the occurrence of phantom breast syndrome. Scar pain was found to persist in 30.9% of the patients six years after the operation. The present incidence of phantom-related phenomena is close to the incidence reported by others. However, persistent phantom pain after mastectomy may be more common than usually expected. Also, the persistence of scar pain seems to be more common than generally expected.
The possibility of reducing the incidence of injuries in long-distance runners was investigated in 41 recreational long-distance runners. They were divided into two matched groups according to age, sex, weight, height, experience, training and incidence of injury during the previous year. The runners in the study group were clinically investigated before the season started, and individual training programmes were drawn up. The other group served as controls. The runners receiving prevention and training programmes improved in training technique and had increased training mileage, race participation and racing mileage. In 1 year a total of 50 injuries were recorded, 29 in the study group and 21 in the controls. The injury incidence per 1000 hours of competition was significantly lower in the study group with a preventive training regimen than in the controls (30.7 versus 62.5).
We compared the efficacy and safety of low-molecular-weight heparin with that of low-dose unfractionated heparin in the prevention of venous thromboembolism after total knee arthroplasty in a prospective, randomized, multicenter trial. One hundred and eighty-five patients were randomly assigned to two groups: ninety-two received low-molecular-weight heparin (forty milligrams of enoxaparin the evening before the operation and once a day subsequently) and ninety-three received unfractionated heparin (5000 international units the evening before the operation and three times a day thereafter). The prophylaxis was continued until bilateral ascending venography was performed six to nine days after the operation or, if venography was not done, until the eighth postoperative day. Venography revealed a prevalence of deep-vein thrombosis of 27 per cent (twenty-five of ninety-three patients) in the group that received unfractionated heparin and 23 per cent (twenty-one of ninety-two patients) in the group that received low-molecular-weight heparin. The difference was not significant (p = 0.6). Five patients (5 per cent) who received unfractionated heparin and 3 patients (3 per cent) who received low-molecular-weight heparin had a deep-vein thrombosis in the proximal veins. Two patients who received unfractionated heparin and one who received low-molecular-weight heparin had clinical symptoms suggestive of a pulmonary embolism. None of these three patients had a positive ventilation-perfusion scan. There were no deaths, major bleeding episodes, or wound hematomas necessitating operative intervention or discontinuation of the anticoagulation in the series.(ABSTRACT TRUNCATED AT 250 WORDS)
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UNLABELLED: Phantom breast syndrome after mastectomy has already been reported by us and other authors. The temporal course, character, and extent of these phenomena, however, have not yet been elucidated. OBJECTIVE: To investigate in a prospective study the incidence, clinical picture, and temporal course of phantom breast syndrome during a 6-year period. DESIGN: One-hundred twenty women who embarked on consecutive postoperative control or treatment at our department during a 1-year period were interviewed by a standard questionnaire 3 weeks after the operation. Of these, 110 patients were interviewed 1 year later and 69 were interviewed again 6 years later. PATIENTS: The median age at the first interview was 54 years (Quartile (Q)1 = 45 years; Q3 = 62 years) and at the third interview 6 years later, 60 years (Q1 = 51 years; Q3 = 68 years). RESULTS: The incidence of phantom pain and nonpainful phantom sensations was 13.3% and 15.0%, respectively, 3 weeks after mastectomy, 12.7% and 11.8%, respectively, after a year, and 17.4% and 11.8%, respectively, after 6 years. We found significant relationships between preoperative pain and phantom breast syndrome, but no significant relationship between age and the occurrence of this syndrome. Neither postoperative sequelae nor cancer treatment including radiotherapy seemed to affect the occurrence of phantom breast syndrome. Pain in the scar, which was clearly distinguishable from phantom pain, was present in 35.0% of the patients 3 weeks postoperatively, in 22.7% after 1 year, and persisted in 30.9% 6 years later. CONCLUSIONS: The present incidence of phantom-related phenomena is close to the incidence reported by others. However, persistent phantom pain after mastectomy may be more common than usually expected. Also, the persistence of pain in the scar seems to be more common than generally expected.
60 patients were examined 5 (2-9) years after simple suture of acute rupture of the anterior cruciate ligament. In the follow-up the patients were examined clinically and by instrumental testing of stability (Acufex Knee Signature System). 10 knees had had a ligament reconstruction during the follow-up period, 28 knees were stable, and 22 unstable. By the Lysholm knee-score, function was rated excellent or good in both stable and unstable knees and the Tegner activity score dropped insignificantly. A positive correlation was found between the measured laxity and the clinical tests. Instrumental stability testing seems to be a reliable supplementary tool in the diagnosis of anterior cruciate ligament insufficiency. Ligament repair by simple suture was not better than reported results on conservative treatment.
The TPR total ankle joint replacement system (Smith & Nephew Richards) was implanted in 30 ankles in 25 patients. Twenty-three ankles in 18 patients were followed; 21 had rheumatoid arthritis and two had osteoarthritis. The average age at surgery was 62 years (range: 37 to 77), and the average follow up was 59 months (range: 37 to 89). The improvement was especially obvious with respect to pain and function. The average walking distance improved from 260 m preoperatively to 975 m postoperatively. Even though there was some improvement with respect to pain and function, the results of the study are disappointing in comparison to studies of ankle arthrodesis.
The aim of this study was to determine the incidence rate and to determine the etiology and the severity of accidents caused by playground equipment during the period 1.1.1989-31.12.1989 and to compare the results with the study made by Christensen et al (1-3). The number of children aged below 15 years was 42,635. A total of 270 playground accidents were registered, which resulted in an incidence rate of 6.3 per 1,000 children per year. This is a reduction from 9.3 per 1,000 children per year in 1981. The incidence rates between boys and girls were 7.0 and 5.6 per 1,000 children per year, as compared with respectively. The sex ratio for the population studied was 1.31 to 1 as compared with 1.44 to 1 in 1981. The sex ratio in the background population was 1.05 both in 1981 and 1989. The greatest number of accidents were seen in spring, especially in April and May. Swings, climbing frames, slides, playhouses and playcastles were responsible for 80% of the accidents. The etiologies were fall accidents in 211 cases, being caught between two objects in 17 cases, being kit by an object in 21 cases and different causes in 21 cases. The underlying surfaces were sufficiently soft in 24% of the cases. The severity of the injury was classified according to the Abbreviated Injury Scale and was found to be: no lesions 1.1%, minor lesions 70%, moderate lesions 25.1% and severe lesions 3.7%. A total of 17 patients were admitted and of these 13 patients had fractures. The possibilities of reducing the number of injuries resulting from playground equipment are discussed.
With the object of investigating the occurrence of pain and dysaesthesiae in the scar following mastectomy, 120 were interviewed by a standard questionnaire in a prospective study. These women had commenced postoperative control or treatment in the Department of Oncology in the University Hospital of Aarhus consecutively during a one-year period. One hundred and ten of these women were interviewed again one year later. In 92% of the patients with scar pain and dysaesthesiae, these appeared within the first three months postoperatively. At the first interview, 42 patients (35%) had scar pain and 15 of these (13%) experienced constant scar pain. One year later, 25 patients (23%) still had scar pain and 13 patients (12%) had experienced persistent scar pain throughout the entire year. Two of the patients (8%) with scar pain had constant pain while, at the second interview, 14 patients (56%) reported that the scar pain lasted for seconds. Twenty-seven patients (23%) had dysaesthesiae at the first interview while 29 patients experienced these continually one year after operation. Both the intensity and the duration of the scar pain diminished with the elapse of time. This held also true where dysaesthesiae were concerned but was not so marked.
In a one year period, from 1 January 1986 to 31 December 1986, 4303 patients with sports injuries were treated at Aarhus Amtssygehus and Aarhus Kommunehospital. The mean age was 21.6 years (range 7-72 years) and 2830 were men. Two hundred and seventeen badminton injuries occurred in 208 patients (136 men) with a mean age of 29.6 years (range 7-57 years), constituting 4.1 percent of all sport injuries in Aarhus. Joints and ligaments were injured in 58.5 percent of the patients, most frequently located in the lower limb and significantly more often among patients younger than 30 years of age. Muscle injury occurred in 19.8 percent of the patients. This type of injury was significantly more frequent among patients older than 30 years of age. Most injuries were minor. However, 6.8 percent of the patients were hospitalized and 30.9 percent received additional treatment by a physician. As the risk of injury varies with age, attempts to plan training individually and to institute prophylactic measures should be made.
A questionnaire investigation was undertaken in connection with the Arhus Marathon Race in 1986, with the object of registering experience, previous running injuries, amount of training, running injuries, treatment and causes. A total of 831 replies were obtained (90%). Of these, there were 731 men and 100 women with an average age of 34.6 (11-77) years, duration og training 5.5 months, training distance 47.5 km/week and tempo 10.8 km/hour. Among these, 193 injuries were registered in 161 runners (19%). Eighty-nine had to stop sports for more than one week and 26 still had injuries which limited participation in sport after eight weeks. The injuries consisted of blisters (25%) and stress injuries (66%) particularly in the knee (37%) and leg (23%). Runners who sustained injuries were found to be significantly younger than non-injured runners, their training distance was less and training tempo lower. The causes of the injuries were mainly overexertion. The significance for the types of shoes for stress injuries was investigated and a tendency to increased risk of overexertion injuries was demonstrated on employing competition shoes and cheap jogging shoes.