[Ectopic thyroid gland in the submandibular region]. / Ektopisk thyreoidea i submandibulaerlogen.

A case of an ectopic thyroid gland in the submandibular region is presented. The embryological aspects are discussed.

Hallux valgus correction using a modified Hohmann technique.

In 181 patients presenting with hallux valgus (247 toes), we performed a modified Hohmann procedure with Kirschner wire fixation of the osteotomy. Follow-up by a questionnaire was possible in 159 patients representing 217 operated toes (21 reoperations), and roentgenograms of bony healing were assessed in all these patients. The questionnaire was returned by 91% (145/159) of the patients. The average observation time was 52 months (25-97 months). The average correction of the hallux valgus angle was 10 degrees, ranging from 31.4 degrees before surgery to 21.4 degrees after surgery. Eighty-eight percent of the patients stated that they had an excellent or good/fair result, and 12% had pain or problems with footwear. We found a positive correlation among the correction of the valgus angle, the lateral displacement, shortening of the first metatarsal, and the overall result. No correlation was found among the plantar displacement, correction of the intermetatarsal angle and the result. The modified Hohmann procedure is, in our opinion, a safe and reliable procedure for treating hallux valgus deformity of the foot.

[Agricultural injuries in Ringkjøbing County]. / Landbrugsulykker i Ringkjøbing Amt.

The aim of the study was to investigate agricultural injuries in Ringkjøbing County in the period 1.1-31.12.1992. At the five local hospitals, all persons treated after accidents on farms were registered prospectively and classified according to activity and injury severity (AIS-90). A total of 294 injured persons were registered. Of those, 257 (87%) accidents were due to working activities. Four persons (1%) were killed in the accident. The mean age was 42 years (2-81). Fractures were seen in 32% of the patients and open wounds in 21%. Only 6% had lesions with an AIS-score > 2, and only six patients (2%) had lesions with an AIS-score > 3. In spite of that, 30% were unable to work for more than four weeks because of the injury. An injury prevention programme towards agricultural injuries is therefore suggested.

[Are ambulances manned by physicians used in a sufficient extent for trauma patients?]. / Anvendes laegeambulancer i tilstraekkeligt omfang til traumepatienter?

The aim of the study was to investigate, how often a hospital-based ambulance manned by medical doctors from the intensive care unit took part in prehospital treatment and transportation of severely injured patients in the Holstebro area. The design was a retrospective investigation based on reports concerning all trauma patients admitted by ambulance to Holstebro Central Hospital during the period 1.1.1990 to 31.12.1990 (171 admissions). All cases were classified according to the AIS-scale (1990 version) and the ISS-score was calculated for all patients. Of a total of 198 calls where the hospital based ambulance was activated, only 18 (9.1%) were for trauma patients. Five of the trauma patients were dead when the ambulance arrived, and 13 were admitted to hospital. Median ISS in the group of patients that was transported by a standard ambulance was 8.6 (1-18), and 12.7 (1-43) in the group of patients that was transported by the special ambulance manned by medical doctors. Fifteen patients (68.2%) out of the group of patients with an ISS-score > 12 were transported by standard ambulance. We thus conclude that the activation of the hospital-based ambulance manned with medical doctors to trauma patients has to be improved, so that all severely traumatised patients are transported by this kind of ambulance instead of by a standard ambulance.

Abscess of the submandibular gland caused by Salmonella typhimurium biotype 10.

From an abscess of the submandibular gland, Salmonella typhimurium biotype 10 was isolated in pure culture. The patient had no history of gastroenteritis, and Salmonella could not be isolated from faeces.

[Removal of foreign bodies (needles) by aspiration]. / Fjernelse af overfladiske fremmedlegemer (nåle) ved aspiration.

A new method by which foreign bodies in the form of needles or parts of these can be removed from the skin and subcutis is presented. Accidentally implanted needles is a common problem presenting in the casualty ward. Instead of applying the traditional method, incision and subsequent instrumentation with forceps, we have in two cases successfully removed needlepoints by way of aspiration. Guided by radioscopy, a syringe with a needle for intravenous injection is inserted near the foreign body, which is then introduced into the injection needle and subsequently aspirated into the syringe. Since the aspiration method is simple and safe, and is less traumatic than other methods, we recommend this as first choice in treating patients with superficially implanted needles.

[Self-help groups--how? Experiences with families of patients with apoplexy]. / Selvhjaelpsgrupper--hvordan? Erfaringer med apopleksiramte familier.

The object of this investigation was to establish self-help groups for apoplectics and their spouses and to gain basic experience for establishing future self-help groups. Twenty-four participants took part in the investigation and two qualitative methods for collection of data were employed: observation by participants and interview observation. In the first instance, the apoplectic individual and spouses participated in separate groups on a total of nine occasions. In the second instance, a group was established with the apoplectic persons and their spouses on seven occasions. Two separate meetings were held. The compositions of the groups influenced the choice of subjects discussed. In the group of apoplectic persons, the main subjects were problems of identity, the condition involved and dependence upon the spouse. In the group of spouses, the subjects were distribution of power, interchange and fellowship in the group concerning the individual everyday situations. The mixed group was the forum for acceptance and solidarity e.g. concerning the tensions which apoplexy involves in the partnership but also for amusement. The model with the mixed group was found to fulfill the requirements of the families best. The time of discharge and cessation of training were vulnerable. The need for information about apoplexy and its sequelae for the apoplectic person and the spouse had not been covered. Neither the apoplectic persons nor their spouses considered that they could establish self-help groups for others on their own.

Epidermoid carcinoma of the pharynx. Therapeutic results in a series of 221 patients.

Two hundred and twenty-one cases of epidermoid carcinoma of the pharynx diagnosed between 1965 and 1984 were analysed. Fifty-seven per cent of the carcinomas were poorly differentiated and 57% of the patients had stage IV disease; 65% had lymph node metastases at the time of diagnosis. Radiotherapy was the primary treatment. Between 1977 and 1979, preirradiation chemotherapy was used and from 1979 the effect of the radiosensitizer misonidazole was investigated in split-course radiotherapy. Loco-regional failure occurred in 60% after primary treatment. No changes in treatment results were observed during four consecutive 5-year periods. The five-year corrected actuarial survival rate in the whole series was 33%. It is concluded that the treatment results are still unsatisfactory, and that chemotherapy, optimized radiotherapy, and radiosensitizers as used in the present series did not seem to improve the results. Alcohol and tobacco restriction is emphasized for prevention.

Monitoring middle ear pressure by tympanometry. A study of middle ear pressure variation through seven hours.

The aim of this investigation was to monitor fluctuations in middle ear pressure, to study tympanometric signs of Eustachian tube functioning and to assess the validity of the tympanometric readings. In 20 patients with a low initial middle ear pressure (-150 daPa or lower) and 5 normals, impedance tympanometry was performed every 3 min through 7 h. Median pressure for the patients was -150 daPa (range 100 to -400 daPa) and for the normals 0 daPa (range 50 to -50 daPa). A remarkable pressure increase was seen after changing the body position to the supine. The patients were arranged into three groups according to the lowest middle ear pressure registered. Median pressures for the groups were running at a rather constant level. However, the individual pressure fluctuations in many patients were so great that a single tympanometric reading has to be considered unreliable when selecting patients for insertion of ventilation tubes. Thirteen patients never equalized their negative middle ear pressure, indicating that their Eustachian tube did not open during the test period. In spite of this the pressure did not decrease to lower values, indicating that maintaining a relative constant middle ear pressure is independent of opening of the Eustachian tube.

Hyperfrequency of pulmonary cancer in a population of 415 patients treated for laryngeal cancer.

Four hundred fifteen patients with laryngeal cancer were treated mainly by primary irradiation from 1965 to 1983, at the Radium Centre of Odense. By December 31, 1983, a total of 32 patients had developed pulmonary cancer. The Danish Cancer Registry calculated the expected number of pulmonary cancer in a population of the same composition from the same period of time and the same geographical locale. A statistically significant hyperfrequency of pulmonary cancer among males was found, most pronounced among supraglottic cases: 6.73. Furthermore, a cumulative estimation of the risk of developing pulmonary cancer as a function of follow-up revealed a risk of 26% during the first 14 years of follow-up. The only effective way to solve the problem is to stop smoking.

Chronic headache related to nasal obstruction.

A study of the occurrence of chronic headache in 444 patients suffering from nasal obstruction is presented. The localization, frequency, severity of the headache and differences between men and women are described. All the patients were treated with rhinoplastic surgery and examined just prior to surgery and 12 months post-operatively, applying exactly the same scheme of questioning and examination on the two occasions. The investigation shows a very strong association between the establishment of a normal nasal passage and the cure of headache. The study stresses the viewpoint that a negative sinus X-ray cannot rule out the possibility that a headache is of nasal origin, and that careful rhinologic examination is essential.

Impedance pneumography for long-term monitoring of respiration during sleep in adult males.

Impedance pneumography is based on the relationship between respired volume (delta V) and changes of transthoracic impedance (delta/Z/) during breathing. The impedance signal, the relationship between delta V and delta/Z/ and the success rate during long-term recording was studied in 11 healthy adult males, aged 21-46, by a portable tape recorder (Oxford Medilog 4-24). The signals from the tape recorder (delta/Z/), and from a spirometer (delta V) were recorded simultaneously on a mingograph during normal breathing, apnoea, deep sighs, and coughs. The relationship between delta V and delta/Z/ was also analysed on an X-Y recorder. Delta/Z/ was delayed in relation to delta V and during one respiratory cycle the relationship was not linear. The time constant of delta/Z/ was 6 s. A significant correlation was found between peak values of delta V and delta/Z/ for 0 less than delta V less than 2.5 litres. Long-term recording of delta/Z/ during one night's sleep resulted in a success rate of 63-100%, mean 90%. Invalidation of the impedance signal was caused by overloading (81%) and interference (19%). It is concluded that the Medilog respiratory recorder enables determination of respiratory frequency, periods of apnoea and a semiquantitative estimate of volume, but artifacts may invalidate the signal.

Unilateral immediate tonsillectomy as the treatment of peritonsillar abscess: results, with special attention to pharyngitis.

The results of unilateral immediate tonsillectomy, as the routine treatment of peritonsillar abscess, were studied in 47 patients with no previous history of serious tonsillitis. The follow-up was carried out between three and four years after operation. The incidence of tonsillitis in the contralateral tonsil remained unchanged and peritonsillar abscess did not occur in that tonsil. Symptoms of pharyngitis, periodic or chronic, were present in three patients only. This was found to be significantly lower than that found in the literature in a similar group of patients in whom bilateral immediate tonsillectomy had been performed. The results are discussed and the authors recommend unilateral immediate tonsillectomy in cases of peritonsillar abscess in all patients with no previous history of serious tonsillitis, as this apparently prevents the troublesome side-effects of chronic pharyngitis.

Distribution of ABO blood groups in secretory otitis media and cholesteatoma.

The ABO blood groups of 610 patients with documented secretory otitis media (SOM) and of 361 patients with cholesteatoma were compared with those of a control group. In cholesteatoma a normal distribution appeared while in SOM a preponderance of group A or shortage of group O was statistically significant and the incidence ratio was 1.49. In both disease entities a preponderance of males was found. The blood group abnormalities of SOM may indicate hereditary trends and they oppose the theories of SOM being the 'missing link' in the development of cholesteatoma.