Instrumented cervical spinal fusions in children: indications and outcomes.

PURPOSE: To report indications, outcomes and complications of instrumented cervical spinal fusion in a consecutive series of children at major university hospitals. METHODS: A retrospective, single surgeon series identified 35 consecutive children with a mean follow-up (FU) of 2.5 years undergoing instrumented cervical spinal fusion between 2005 and 2015. RESULTS: The main indications were skeletal dysplasia and trauma associated cervical instability. Surgical complications were observed in 12 (34%) patients with multiple complications in four (11%). Four (11%) children required at least one revision surgery, three for nonunion and one for graft dislodgement. All were fused at FU. Surgical complications were more common in children undergoing occipitocervical (OC) fusion than in those avoiding fusion of the OC junction (60% versus 24%) (p = 0.043). Complications were found significantly more in children operated on under the age of ten years than above (50% versus 18%) (p = 0.004). The risk of complications was not dependent on the indications for surgery (skeletal dysplasia versus trauma) (p = 0.177). CONCLUSION: Skeletal dysplasia associated cervical instability and cervical spine injuries represented the most common indications for instrumented cervical spinal fusion in children. Complications were observed in one-third of these children and 11% required revision surgery for complications. OC spinal fusion and spinal fusion before the age of ten years are associated with higher risk of surgical complications and increased mortality than non-OC fusions and cervical spinal fusions at an older age. We urge surgeons to employ caution to the patient, timing and procedure selection when treating paediatric cervical spine.

Diagnostic performance of knee ultrasonography for detecting degenerative changes of articular cartilage.

OBJECTIVE: To investigate the diagnostic performance of non-invasive knee ultrasonography (US) to detect degenerative changes of articular cartilage using arthroscopic grading as the gold standard. DESIGN: Forty adult patients referred to a knee arthroscopy because of knee pain were randomly selected for the study. Before the arthroscopy, knee US was performed and cartilage surfaces at medial and lateral femoral condyles as well as at intercondylar notch area (sulcus) were semi-quantitatively graded from US. Ultrasonographic grading was compared with the arthroscopic Noyes' grading for cartilage degeneration. RESULTS: Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic odds ratio for detecting arthroscopic cartilage changes in US varied between 52 and 83%, 50-100%, 88-100%, 24-46%, and 5.0-13.0, respectively, depending on the site. Correlation of severity of cartilage changes (grades) between US and arthroscopy varied from insignificant to significant depending on the site: at the sulcus area the correlation was highest (r(s)=0.593, P<0.001), at the medial condyle also significant (r(s)=0.465, P=0.003), and at the lateral condyle non-significant (r(s)=0.262, P=0.103). The sum of cartilage grades in all three sites of the femoral cartilage between US and arthroscopy had the highest correlation (r(s)=0.655, P<0.001). CONCLUSIONS: Positive finding in US is a strong indicator of arthroscopic degenerative changes of cartilage, but negative finding does not rule out degenerative changes. Non-invasive knee US is a promising technique for screening of degenerative changes of articular cartilage, e.g., during osteoarthritis.

Hepatitis A, B, C and HIV infections among Finnish female prisoners--young females a risk group.

OBJECTIVES: Previous prison studies have shown that the female gender is associated with higher hepatitis C prevalence. However, there are few prison studies of gender differences concerning the risk factors of hepatitis C infections. We studied the prevalence of hepatitis and HIV infections and the risk factors among Finnish female prisoners. METHODS: The material consisted of 88 females and 300 male prisoners as controls. RESULTS: The prevalence of hepatitis C virus antibodies was 52%, hepatitis B surface antigen 0%, hepatitis A virus antibodies 38% and HIV antibodies 1% among women, and 44%, 0.7%, 4% and 0.7% respectively among men. Among women, 71% of the age group 16-24 had HCV. There was no significant association between gender and HCV. Women were more commonly sharing syringes/needles and had unsafe sexual habits. Among women, HCV was associated only with IDU and syringe/needle sharing whereas among men also with tattoos, cumulative years in prison and age. CONCLUSIONS: Especially young females had a high prevalence of HCV. The study showed that the risk factors are differentiated by gender. This should be taken into account when assessing earlier studies which mainly concentrate on men.

Comprehensive optimization process of paranasal sinus radiography.

BACKGROUND: The optimization of radiological examinations is important in order to reduce unnecessary patient radiation exposure. PURPOSE: To perform a comprehensive optimization process for paranasal sinus radiography at Mikkeli Central Hospital, Finland. MATERIAL AND METHODS: Patients with suspicion of acute sinusitis were imaged with a Kodak computed radiography (CR) system (n=20) and with a Philips digital radiography (DR) system (n=30) using focus-detector distances (FDDs) of 110 cm, 150 cm, or 200 cm. Patients' radiation exposure was determined in terms of entrance surface dose and dose-area product. Furthermore, an anatomical phantom was used for the estimation of point doses inside the head. Clinical image quality was evaluated by an experienced radiologist, and physical image quality was evaluated from the digital radiography phantom. RESULTS: Patient doses were significantly lower and image quality better with the DR system compared to the CR system. The differences in patient dose and physical image quality were small with varying FDD. Clinical image quality of the DR system was lowest with FDD of 200 cm. Further, imaging with FDD of 150 cm was technically easier for the technologist to perform than with FDD of 110 cm. CONCLUSION: After optimization, it was recommended that the DR system with FDD of 150 cm should always be used at Mikkeli Central Hospital. We recommend this kind of comprehensive approach in all optimization processes of radiological examinations.

Changing injury pattern of acute anterior cruciate ligament tears treated at Tampere University Hospital in the 1980s.

During the years 1980-1989, 450 patients with an acute anterior cruciate ligament (ACL) rupture were treated at the University Hospital of Tampere, Finland. ACL ruptures were diagnosed by arthroscopy or open surgery. The data were analyzed in terms of patient age, sex, injury etiology, injury type and sports activity to determine the trends in the 1980s. The number of ACL tears seen in the Hospital increased by 247% over this period. Sixty-three percent of the patients were male (mean age 33 years) and 37% female (mean age 39 years), and there were no changes in the sex and age distribution in 1980s. The most common injury type was the isolated ACL rupture (51%), followed by a combination injury of the ACL and medial collateral ligament (38%). Isolated ACL ruptures in the 1980s increased 6.5 times. Sports accounted for 54% of all injuries without any sign of change in their relative proportion in 1980s. The most common sports causing the rupture were soccer (29%), downhill skiing (20%), cross-country skiing (12%) and volleyball (12%). From 1980 to 1989, there was a decrease (2 times) in ACL injuries sustained in cross-country skiing and a substantial (30 times) increase in ACL injuries sustained in downhill skiing.