Minor amputations on the feet after revascularization for gangrene. A consecutive series of 95 limbs.

A consecutive series of 89 patients (95 limbs) with gangrene were operated on with amputation of toes or some distal part of the foot after arterial reconstruction. 43 patients had diabetes. Healing was achieved in 81/82 feet when the reconstruction was open. Amputation below or above the knee was required in 4/5 limbs when the reconstruction failed. 8 patients died before healing. The median time to healing was 30 (17-452) days, after a single amputation, and 115 (36-466) days, when more than one procedure had been necessary. We concluded that amputations on the feet for gangrene usually heal after arterial reconstruction, in patients with diabetes as well as in those with arteriosclerosis. No weight bearing and control of infection are important during the early postoperative period.

External appearance of forensic autopsy material of alcoholics.

Forensic material of alcoholics was compared with controls with regard to the height, weight, state of nutrition, stature, the ageing process and the presence of traumatic lesions. Surprisingly, it was found that alcoholic women were taller than controls. Alcoholics were significantly more often slightly undernourished, while the extremes, severe obesity or severe undernourishment, did not show any differences. Alcoholics looked older than their age more often than controls. Not unexpectedly, traumatic lesions were more frequent in alcoholics. The lesions were, however, only rarely the result of deliberate violence, but were usually suffered when the alcoholic fell whilst under the influence of alcohol.

Soft tissue infections from drug abuse. A clinical and microbiological review of 145 cases.

We evaluated clinical and microbiological aspects in 145 hospitalizations of 89 intravenous drug abusers with acute soft tissue infections at the injection site. There were 58 superficial abscesses, 27 deep abscesses, 57 cellulitis with or without concomitant ulcer, 1 purulent arthritis, 1 tenosynovitis and 1 incompletely categorized abscess. The commonest location was the groin. Serious complications occurred in 17 cases, including 4 lower-extremity amputations due to arterial lesions. There was a predominance of polybacterial infections (53 percent polybacterial, 38 percent monobacterial, 9 percent sterile). The commonest bacteria isolates were Streptococcus species with a preponderance of oropharyngeal bacteria, Staphylococcus aureus, and anaerobes, especially Bacteroides species. Typical intestinal bacteria were rare. In addition to surgical treatment we recommend that aerobic and anaerobic culturing with susceptibility tests always are carried out, that primary antibacterial therapy should consist of an antistaphylococcal agent, such as dicloxacillin plus metronidazole, and that free injection paraphernalia with disinfection swabs are easily available.

Fatal agricultural accidents.

During the period 1969-1988, 33 victims (30 males and 3 females) of agricultural accidents were autopsied at the University Institute of Forensic Medicine in Copenhagen. Five were under the age of 15 years. The median age was 51 years. The most frequent types of accident were machinery accidents (45%), falling from a height (30%) and suffocation, including drowning, (12%). The place of the accident was meadow/field (36%), stable/barn (24%), farmyard (24%) and public road (12%). Severe lesions in all body regions dominated the picture with a preponderance of skull/brain and chest lesions. Skull/brain lesions were found in 80% of the cases of falling from a height, while 87% of the machinery accident cases had severe chest lesions. More effective control of machinery and a data collection system for these accidents are proposed.

An investigation of the pattern of firearms fatalities before and after the introduction of new legislation in Denmark.

All firearms fatalities in East Denmark during the period 1984-1987 were examined. There were 276 cases or 3.0 per 100,000 living inhabitants. The majority were suicides (80%) and by far the majority of these were men. There were only four accidents, two of which were the results of 'Russian roulette'. There were no hunting accidents. No specific decrease could be demonstrated in the number of fatal cases with shot guns, but possibly a general preventive effect. When compared with previous Danish investigations an increase in the total number of suicides with firearms was found in the period examined, whereas an increase was found in the total as well as the relative number of homicides. More information and further endeavours to limit the number of firearms in the population is recommended.

The natural history of chondromalacia patellae. A 12-year follow-up.

A series of 45 patients with chondromalacia patellae demonstrated clinically and by arthrotomy, but without demonstrable biomechanical misalignment, was investigated retrospectively. Thirty-one of the patients had only been treated conservatively while partial chondrectomy was performed in 14. All of the patients underwent an intensive rehabilitation program. After 12 years the patients were interviewed. Eighty-one percent of the patients who were treated conservatively and 57 percent of the patients in whom partial chondrectomy was performed had mild or no pain and no other knee complaints. The results were better for patients aged 20 years or younger. Two patients received disability pensions on account of poor knee function and 6 had changed to less strenuous occupations. Restraint is advised as regards operative treatment of chondromalacia patellae.

Detection of injuries in traumatic deaths. The significance of medico-legal autopsy.

A material of 218 medico-legal autopsies on persons with traumatic injuries was analysed. All these persons had been admitted to hospital. In 75 (34%) injuries had been missed in hospital. In 11 (5%) the overlooked injuries were the sole cause of death, while in 51 (23%) they were contributory. The missed injuries were found in all regions: 27% were moderate (AIS 2), 28% serious (AIS 3), 40% severe (AIS 4), and 5% critical (AIS 5). It is concluded that medico-legal autopsies are necessary for an exhaustive evaluation of traumatic deaths. They are of significance not only to legal security, but also to the social need for analysing injury mechanisms and the consequent possibility of preventive efforts.

[Fatal gunshot injuries in East Denmark]. / Dødelige skudlaesioner i Ostdanmark.

All of the fatal gunshot lesions in East Denmark during the period 1984-1987 were investigated. A total of 276 cases were found corresponding to an annual frequency of approximately 3.0 per 100,000 live population. The majority were cases of suicide (86%) and the majority of these were men. Only four accidents were found. Two of these were due to "Russian roulette"). No hunting accidents were encountered. In the middle of the period investigated, new and more restrictive legislation concerning firearms was introduced in Denmark. No specific effect in the form of reduction in the number of cases with smooth barrelled shot guns resulting from this could be demonstrated but there was, possibly, a general prophylactic effect. As compared with previous Danish investigations, the absolute number of cases of suicide with firearms has increased during the period investigated here while not only the absolute but also the relative number of homicides have increased. Increased information and further attempts to limit the number of firearms in the population are recommended.

[Metastasizing squamous cell carcinoma in patients with psoriasis treated with immunosuppressive agents]. / Metastaserende spinocellulaert karcinom hos immunsupprimerede psoriasispatienter.

Immunosuppressive agents are imployed increasingly frequently in treatment of nonfatal disorders. We report two cases of metastasizing squamous cell carcinoma after treatment for psoriasis with methotrexate. Additional cases must be reported, but we consider that: 1) methotrexate medication, when possible, should be withdrawn when a localized squamous cell carcinoma is diagnosed and 2) when this diagnosis is confirmed the patient should be referred for radical treatment.

Injuries due to deliberate violence in areas of Denmark. V. Violence against women and children. Copenhagen Study Group.

As part of an European-South American study of deliberate violence cases of violence against women greater than or equal to 15 years of age and violence against and among children under the age of 15 years were registered at 3 Danish emergency wards and at the Institute of Forensic Medicine in Copenhagen. 352 cases of violence against women and 46 cases of violence against children were registered in the three emergency wards corresponding to rates of about 1.6/1000 per year for women, 0.6/1000 per year for boys and 0.7/1000 per year for girls in a provincial/rural district, the catchment region of Holbaek County Hospital, 3.4/1000 per year for women, 2.8/1000 per year for boys and 0.6/1000 per year for girls in a mainly middle income area of the metropolis Copenhagen, the catchment region of Frederiksberg Hospital, and 4.0/1000 per year for women, 4.0/1000 per year for boys and 0.9/1000 per year for girls in a mainly low income area of Copenhagen, the catchment region of the Rigshospital. Nineteen live adult female victims and 17 dead adult female victims of violence were registered in the Institute of Forensic Medicine in Copenhagen, where also one was registered as a victim of homicide. Nearly half of the adult live female victims of violence had been injured at home while this was the case for approximately three fourth of the dead victims. In 35% of the live cases the husband was the aggressor and in 12% a former cohabitant. In 71% of the homicide cases the husband was the aggressor. The live women appeared to have fewer but more serious lesions than men. The pattern of deliberate violence against women appears to be associated with socio-economic and cultural factors. In cases with a preceding quarrel there is statistically a link to alcohol intoxication. In half of the cases of violence against children the aggressor was known to the victim, in 15% the aggressor was one of the parents, while 42% of the cases were violence among children. The pattern of violence according to sex, and the distribution and severity of lesions for 10-14 years old children showed resemblance to the situation for adults. The lesions were more serious in young infant victims, especially boys, than in adult victims.

Injuries due to deliberate violence in areas of Denmark. IV. Alcohol intoxication in victims of violence. The Copenhagen Study Group.

A material of 1316 victims of deliberate violence was collected prospectively during a one year period in three Danish emergency wards covering a provincial/rural area and two metropolitan areas. The frequency of alcohol intoxication was determined. Forty-one percent of the patients were intoxicated. The highest frequency was found in male victims, in the provincial/rural area, in restaurants or their vicinity, in the age group 35-49, during evenings and nights and in May. It is difficult to indicate specific preventive measures. However, a more restrictive attitude is suggested with regard to serving alcohol to intoxicated persons in restaurants.

Injuries due to deliberate violence in areas of Denmark. III. Lesions. The Copenhagen Study Group.

As part of a transcultural investigation of violent behavior in Denmark and South America, the lesions from accidents involving deliberate violence registered in three Danish emergency wards during a 1-year period were studied. A quantity of 2211 lesions were diagnosed in 1316 patients (953 male and 363 female patients). Sixty-five percent of the lesions were in the head/neck region, 13% in truncus, 18% in the upper extremities and 5% in the lower extremities. The most frequent diagnosis was an open wound in the head/neck region. Adding contusions and fractures in the same region this amounted to more than half of the total number of lesions. In the upper extremities 62% of the lesions were contusions or open wounds. Serious lesions of internal arteries were few, however always caused by sharp instruments (knives). Serious lesions due to firearms were not recorded/reported. Strangulation had been used against 1.1% of the victims, the male/female ratio being 1:6. The main part of the lesions were of minor severity when assessed on the basis of the scores in the Abbreviated Injury Scale (AIS). The lesions were, however, more serious compared to other recent studies, and it appeared that the female victims had fewer but more serious lesions than the male victims. The need for treatment and hospitalization was in the range of other recent studies.

Injuries due to deliberate violence in areas of Denmark. II. Victims of homicide in the Copenhagen area.

As part of a transcultural investigation of injuries due to deliberate violence in Denmark and South America, homicides in the Copenhagen area were studied for a 1-year period. Forty-five cases corresponding to a rate of approximately 2/10(5) per year were recorded. The rate seems to be increasing and the pattern changing with a higher frequency of stabbing and with an increasing frequency of high blood-alcohol concentrations in the victims. The highest number were killed at home. In the majority of cases the aggressor and the victim knew each other. A reduction in alcohol consumption is indicated as a possible preventive measure.

Injuries due to deliberate violence in areas of Denmark. I. The extent of violence.

As part of a transcultural investigation of violent behavior in Denmark and South America an analysis was made during a one year period of the incidents involving deliberate violence as registered at 3 Danish emergency wards, and at the Institute of Forensic Medicine in Copenhagen. In the three emergency wards a total of 1316 victims of deliberate violence were observed corresponding to a rate of about 3.3/1000 per year in a provincial/rural district, the catchment region of Holbaek County Hospital, 5.5/1000 per year in a mainly middle income area of the metropolis Copenhagen, the catchment region of Frederiksberg Hospital, and 7.6/1000 per year in a mainly low income area of Copenhagen, the catchment region of the Rigshospital. The highest risk, 28/1000 per year, was found for young men between 15 and 19 years of age living in the low income area of Copenhagen. The risk was low for people greater than or equal to 60 years of age in all three areas investigated, ranging from 0 (men) to 1.3/1000 per year (women). Skilled and unskilled workers were greatly over represented as victims of violence, considering their share of the background population. Seventy percent of the victims were men. At least 44% of the men and 32% of the women were alcohol intoxicated when arriving in the emergency ward. The incidents took place in restaurants or in the vicinity of restaurants for 30% of the male and 11% of female victims respectively, while 45% of the women had been subject to deliberate violence at home. The rate of fatal cases of deliberate violence in the Eastern part of Denmark, the catchment area for the Institute of Forensic Medicine in Copenhagen, was found to be 0.02/1000 per year. The risk of becoming a victim of deliberate violence has not increased during the last 4 years comparing with similar investigations from other parts of Denmark. However, the rate of homicide seems to have increased, and so has the severity of the injuries caused by deliberate violence. The pattern of deliberate violence appears to be associated with socio-economic and cultural factors, and to be closely linked with alcohol intoxication.