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Biomedical subjects

O Sneppen

Publications and source records attributed to O Sneppen.

At least 19 recordsLinked to original sources
PubMed1992

[Primary aneurysmal bone cyst. Evaluation of the symptomatology, treatment and prognosis based on 21 patients].

PABC is a rather rare, non-malignant osteolytic bone disease, affecting children and young people. Most frequently, it is localized to the metaphyses of the long bones. The present material consists of 21 cases, treated in the Orthopaedic Hospital in Aarhus between 1973 and 1991. Nineteen patients were treated with curettage of the cyst followed by bone grafting to the cavity. Six (31%) had recurrences. Five were operated again without any recurrence. The last patient has not yet received any further treatment. Two patients were initially treated by bone resection. No postoperative complications occurred. Curettage of PABC followed by bone grafting is recommended as the treatment of choice, in spite of the recurrence rate mentioned above. Because of the risk of recurrence after this treatment, regular follow-up examinations are necessary until healing has occurred i order to treat a possible local recurrence in time.

Adolescent↗
PubMed1991

[Thoraco-scapular amputation in sarcomas of the shoulder girdle].

A total of 121 patients with sarcomas localized to the shoulder girdle were referred to the Sarcoma Centre in Arhus. Of these, 17 (14%) underwent interscapulothoracic amputation. At the time of treatment, the average age was 51 years (17-82 years). Eleven of these patients had sarcomas of bone and six had soft tissue sarcomas. Late diagnosis or previous surgical interventions contributed to the indication for the mutilating procedure. At the time of referral, six of the 11 cases of bone sarcomas were complicated by a pathological fracture and all six soft tissue sarcomas had been submitted to incisional biopsy or non-radical treatment. The soft tissue sarcomas were usually large with an average maximum diameter of 10 cm (4-15 cm). Postoperative recovery was uncomplicated in all cases. Local recurrence occurred in three patients (18%). Eight patients (47%) developed metastases and died from the tumour on an average of 32 months (7-94 months) after operation. Two patients died from other causes without tumour. Seven patients (41%) were tumourfree and alive for an average of 69 months (21-128 months) after operation. Only three of these seven patients wore their shoulder-arm prosthesis regularly while the remainder preferred to be either without a prosthesis or to use a lightweight shoulder prosthesis. None of the seven patients still experienced phantom pain necessitating analgetics. All of the patients were self-reliant in everyday life and the five patients who had been occupationally active until the time of operation had returned to work. The prognosis after interscapulothoracic amputation depends upon the primary malignant disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Radiation induced sarcoma of the shoulder girdle].

A well-known complication after irradiation of tissue is development of postradiation sarcomas, and the shoulder girdle is in this connexion a frequent location, because it relatively often is exposured to x-rays. During the period 1956 to 1989 121 patients with sarcomas located to the shoulder girdle were referred to the Sarcoma centre in Arhus. Of these, six were postradiation sarcomas. The indication for the initial irradiation was in two cases cancer of the breast, in one malignant lymfogranulomatosis, in one a metastasis from malignant melanoma and finally two cases of peritendinitis humeroscapularis. In average 15 years (7-26 years) elapsed from irradiation to the diagnosis of the sarcomas. There were four bone sarcomas, two located in the clavicles and 2 in the humeri. Of these, three were osteogenic sarcomas and one a malignant fibrous histiocytoma. There were two soft tissue sarcomas, both located subcutaneously with involvement of deep fascia and muscle. Both tumors were extraskeletal osteogenic sarcomas. Three patients died of tumor on an average after 11 months. Two died without tumor from other causes, and one patient is alive without tumor 11 years after the treatment. If a patients presents with pain at the side of prior radiation, the diagnosis postradiation sarcoma must be considered and the patient referred to the Sarcoma centre. Radiation therapy should not be used in patients with benign lesions.

Adult↗
PubMed1991

Histopathological grading of soft tissue tumours. Prognostic significance in a prospective study of 278 consecutive cases.

A consecutive 10-year series of 278 soft tissue sarcomas was prospectively graded, using a system based on the number of mitoses and taking into account parameters such as cellularity, anaplasia, necrosis, and histogenetic type and subtype of tumour. Prognostic factors in relation to metastasis-free survival were studied by uni- and multivariate analysis. Fifty-seven (20.5 per cent) were low-grade tumours, 43 (15.5 per cent) were intermediate, and 178 (64 per cent) were high grade. High-grade tumours were divided into two groups; 80 (29 per cent) grade 3A (= 5-20 mitoses per 10 high power fields (HPF)) and 78 grade 3B (28 per cent) (= more than 20 mitoses/10 HPF); 10 HPF corresponds to 2.5 mm2. Twenty (7.2 per cent) high-grade tumours could not be further subdivided. Grading was found to be the prognostic factor associated with the strongest predictive value. Five-year survival in low-grade and intermediate tumours (95 and 86 percent, respectively) differed significantly (P less than 0.0001) from high grade (50 per cent) and (p = 0.0018) between grade 3A (64 per cent) and grade 3B (41 per cent). Other prognostic indicators of importance in high-grade tumours were age, local recurrence at presentation (primary operation outside the Centre), and localization (superficial vs. deep).

Adolescent↗
PubMed1991

Shoulder arthroplasty in complex acute and chronic proximal humeral fractures.

From 1983 to 1988, 42 shoulder arthroplasties were performed on comminuted acute or chronic proximal humeral fractures. Patients were categorized according to the post-fracture operative delay; there were 15 four-part fractures, with median post-fracture delay of 13 days (range: 7 to 21), and 27 chronic fractures, including 11 four-part fractures, 9 three-part fractures, and 7 two-part fractures, with median post-fracture delay of 14 months (range: 4 to 72). Follow up was approximately 2 years in both groups (range: 1 to 5). All patients were evaluated according to a modified Neer score-system and classified into four groups. Pain relief was satisfactory in the acute group, but was unpredictable in the chronic group. The results in the acute group were significantly superior (P less than .05). In the acute group, 3 (20%) patients had an excellent result and 6 patients (40%) had a good result, compared to a good result obtained by 6 patients (22%) in the chronic group. Two patients (13%) in the acute group and 11 patients (40%) in the chronic group had a poor result. There were no statistical differences between two-part, three-part, or four-part fractures in the chronic group. Five cases of persistent instability were seen in shoulders formerly treated with osteosynthesis (one acute and four chronic cases). Two of these cases developed an infection. Good results can be expected after prosthetic replacement in acute proximal humeral fractures. Failed primary treatment reduces the possibility of a good result with revision arthroplasty.

Adult↗
PubMed1990

[Sarcoma treatment in Denmark].

Approximately 240 sarcomas are registered annually in Denmark. Of these, 5/6 are soft-tissue sarcomas while the remainder consist of various types of sarcomas of bone. Determination of the histogenetic type, the degree of aplasia and the anatomical spread of the primary tumour is decisive for optimal prognostic assessment and for planning of the primary local treatment. The surgical treatment is aimed at radical treatment and, where tumours in extremities are concerned, this frequently involves reconstruction with endoprostheses with the object of salvaging the limb. Irradiation is indicated in cases of soft-tissue sarcoma which are not amenable to radical operation and as palliative treatment. In cases of soft-tissue sarcoma, cytostatic therapy with adriamycin alone or combined with iphosphamide in metastasizing disease can result in response in 30-50% of the patients. On the other hand, the value of adjuvant treatment is not yet elucidated. In cases of osteogenic sarcoma, the data available at present suggest that prolongation of the survival rate may be obtained by means of intensive adjuvant cytostatic treatment, but the optimal regimen is not yet defined. In other situations, cytostatic therapy must be considered as experimental and not indicated outside the fields of controlled investigations. Optimal diagnosis and treatment of sarcoma requires extensive multidisciplinary contributions which should be centralized in the fewest possible centres. Intimate national and international cooperation is also essential.

Antineoplastic Agents↗
PubMed1990

Total knee arthroplasty in classic hemophilia.

Thirteen semiconstrained total knee arthroplasties (TKA) were performed in nine men with classic hemophilia. The average age at surgery was 38 years, the average Factor VIII administration during hospitalization was 84.222 units, and the average hospitalization time was 33 days. Four patients (44%) died during the observation period, three from acquired immunodeficiency syndrome (AIDS) contracted through contaminated Factor VIII plasma concentrates and one from sudden cardiac arrest. One of the patients who died from AIDS had a positive test for human immunodeficiency virus (HIV) at surgery. He died three months after the arthroplasty. The remaining two patients contracted AIDS one year and four years after the arthroplasty. All but one patient were followed for at least one year, with an average follow-up period of 43 months. Using The Hospital for Special Surgery Knee Rating Scale, the overall result was excellent in nine knees and good in three knees. All patients were completely relieved of pain. TKA in hemophiliacs is an effective treatment for otherwise intractable chronic knee pain due to severe joint degeneration. However, caution should be taken in HIV-positive patients owing to the challenge of the patient's immune system and the risk of transmitting the virus to the hospital staff.

Acquired Immunodeficiency Syndrome↗
PubMed1978

Synovectomy as a prophylactic measure in recurrent haemophilic haemarthrosis. Follow-up of 23 cases.

Because of frequently recurring haemarthrosis which could not be controlled by conservative management 19 haemophiliacs were subjected to synovectomy on a total of 23 joints--17 knees, 5 elbows, and 1 hip. The patients were followed for an average of 23 months. Primary postoperative complications occurred, in the form of recurrent bleeding, in 8 joints. Rehabilitation was often difficult and long-lasting, and the range of joint motion was essentially restricted in 4 cases. After a follow-up period exceeding 6 months the findings in the remaining, mobile 19 synovectomized joints were: 12 had been relieved of haemorrhage, 5 had rare and two frequent haemorrhages. The reduction in the number of haemorrhages was significant (p is less than 0.01). In the light of the complicated postoperative course it is concluded that synovectomy should be used only on strict indications, viz. only in otherwise intractable cases of progressing haemophilic arthropathy.

Adolescent↗
PubMed1978

Hemipelvectomy. Postoperative rehabilitation assessed on the basis of 41 cases.

Rehabilitation was evaluated on the basis of 41 consecutive hemipelvectomies for malignant tumours. Owing to early metastasization and death, 11 patients were not supplied with prostheses, while prosthetic fitting was attempted in the remaining 30. Of this number 27 completed prosthetic training, with the result that 15 used their prosthesis, while 12 discarded it after some time, six because of poor general health owing to recurrence of the tumours and six because they felt that the prosthesis was too heavy and difficult to wear. Twenty-three returned to work. After elimination of the most severely tumour-affected patients, there were 19 one-year survivors without recurrence. Thirteen of them were using their prosthesis every day, and thirteen had gone back to work. Serious mental sequelae were found in five patients, including four with long-lasting exogenous depressions and one with anxiety neurosis.

Adult↗
PubMed1978

Osteosarcoma of the metatarsal bones. Review of the literature and report of a case.

A case of osteosarcoma affecting the third metatarsal bone is submitted. Below-knee amputation was performed, but the patient developed pulmonary metastases and died 1 year after the operation. The six cases of osteosarcoma in the metarsal bones published so far are reviewed. The prognosis for cases with this localization does not appear to differ from that for osteosarcoma in general.

Adult↗
PubMed1978

Lateral dislocation of the patella following Marmor and Guepar arthroplasty of the knee.

The follow-up of 50 knees treated with the modular Marmor prosthesis and 50 with the Guepar hinge joint included tangential radiography of the femoro-patellar joint. After Marmor arthroplasty lateral patellar dislocation was found in seven knees, in six causing pain. After Guepar arthroplasty lateral patellar dislocation was found in 32 knees, but pain was present in only three. There was only a questionable correlation between pre-existing valgus deformity and postoperative lateral patellar dislocation, and an external rotation deformity of the lower leg was found in only five cases after Guepar arthroplasty. Thus, neither phenomenon could explain the high incidence of lateral patellar dislocation in the Guepar series. These dislocations must be assumed to be due to the unphysiological strain on the extensor apparatus inherent in this type of prosthesis.

Adolescent↗
PubMed1978

Numerical assessment of bone scintigraphy in primary bone tumors and tumor-like conditions.

Fifty-four tumors or tumor-like conditions in bone were studied by numerically assessed 99m-technetium polyphosphate scintigraphy. The uptake was expressed as a ratio of the uptake in the tumor region to the uptake in a corresponding region in the contralateral part of the body. In the malignant tumors there was marked variation in the uptake within each individual tumor group, a variation that rendered a differential diagnosis impossible. In general, the uptake was fairly high in malignant tumors and lower in benign ones. A ratio below 1.5 suggested the likelihood that the lesion was benign. The ratios also varied considerably with the site of the tumor and the patients' ages. Relatively low ratios were found for tumors of the trunk and for juxta-articular tumors in children, whereas higher and more varied ratios were observed in tumors of the peripheral skeleton in adults. It is concluded that numerically assessed scintigraphy is not a useful supplement to other methods used for diagnosing bone tumors.

Adolescent↗
PubMed1977

Fractures of the neck of the talus.

One hundred and twenty-three patients with fracture of the neck of the talus were followed up over an average of 22 months. Ffity-four fractures were undisplaced, 53 associated with subtaler dislocation, and 16 associated with dislocation of the talus in both ankle joint and subtalar joint. Of the total 123 patients, 21% (26/123) developed avascular necrosis, 31% (38/123) developed talo-crural and 47% (58/123) subtalar osteoarthrosis. Fifteen per cent (18/123) of the fractures united with considerable deformity, and four per cent (5/123) exhibited non-union of the neck. Out of 63 patients with isolated fracture of the neck of the talus, 65% (41/63) reported moderate or severe complaints, and 52% (33/63) complained of functional disability often resulting in a change to lighter work. Even among the 54 undisplaced cases there were unexpected numbers of late sequelae, such as osteoarthrosis, subjective complaints and disablement.

Adolescent↗