Long term results of operative treatment of knee osteochondritis dissecans.

PURPOSE: This retrospective study was designed to evaluate the hypothesis that open reduction internal fixation (ORIF) of an unstable osteochondritis dissecans (OCD) lesion results in a high percentage of acceptable outcomes at long-term follow-up. METHODS: Eight patients who had been treated with ORIF for unstable knee OCD lesions were identified. Long-term outcomes were assessed with a Subjective Knee Evaluation Form and Knee Examination Form of the International Knee Documentation Committee (IKDC 2000) and an OCD specific Hughston rating scale. RESULTS: All lesions were healed and stable to arthroscopic probing at 3 months. At the average follow-up of 14.8 years (range 12-21 years), the mean IKDC subjective score was 80.9. In IKDC examination form, six patients reached group A (normal) and two patients reached groups B (near normal) and C (abnormal), respectively. According to Hughston criteria, three patients were rated excellent, three good, one fair, and one poor. CONCLUSIONS: We recommend aggressive attempts to preserve articular cartilage in OCD.

The role of genital pathogens in morbidity following diathermy loop excision of the transformation zone of the uterine cervix.

OBJECTIVE: To evaluate the role of genital pathogens in postoperative morbidity following diathermy loop excision of the transformation zone (LETZ) of the uterine cervix. METHODS: Patients with cervical intraepithelial neoplasia (CIN) who underwent diathermy LETZ were included in a prospective study. Cervical swabs for genital pathogens were collected before the diathermy procedure. After surgery, women were followed-up regarding the occurrence and severity of postoperative pain, bleeding, and discharge. RESULTS: Genital pathogens were present in 463 of 788 (58.8%) cases. The most frequently isolated groups of microorganisms were group B ß-hemolytic Streptococcus, α-hemolytic Streptococcus, Enterococcus species, and coliforms. In patients with genital pathogens, postoperative pain was present in 298 (37.8%), discharge in 262 (33.2%), and bleeding in 236 (29.9%) cases. In patients without genital pathogens, 199 (25.3%) experienced pain, 181 (23.0%) discharge, and 143 (18.1%) bleeding. The differences between the 2 groups were not statistically significant (χ(2) for pain=0.675; χ(2) for discharge=0.031; χ(2) for bleeding=3.444; P>0.05). CONCLUSION: Genital pathogens are very common among patients with CIN and do not affect the occurrence or severity of pain, discharge, or postoperative bleeding after diathermy LETZ.

Potential drug-drug interactions and admissions due to drug-drug interactions in patients treated in medical departments.

PURPOSE: Adverse drug reactions due to drug-drug interactions (DDIs) are important in drug safety. The aim of this study was to check potential DDIs (pDDIs) on hospital admission and discharge and to evaluate admissions due to DDIs in medical departments of a primary city and tertiary referral hospital. METHODS: Age, sex, presence of renal and liver failure, drug information, diagnosis, and urgency and reason for admission were retrospectively recorded in 520 randomly selected patients in medical departments of the University Medical Center Ljubljana. The screening program Drug-Reax was used to check for pDDIs in patients with drug information on both admission and discharge home, and the proportion of patients admitted as the consequence of a DDI was estimated. RESULTS: Overall, 14.6% (76/520) of patients had incomplete information on drug names in their medical documentation on admission; at the end of treatment 12.5% (52/416) of patients were discharged home with incomplete information on drug names in their discharge letters. A total of 323 patients had complete information on drug names on both admission and discharge and were included in the analysis of pDDIs: 51% (166/323) of patients on admission and 63% (204/323) on discharge had at least one pDDI (P = 0.001). Major pDDIs were found in 13% (41/323) of patients on admission and 18% (59/323) on discharge (P = 0.001). An ACE inhibitor combined with spironolactone was the most common major pDDI, representing 20.0% of all pDDIs on admission and 25.6% on discharge. Among patients with pDDI on admission, 2.4% (4/166) of were admitted because of an ADR caused by a DDI. Overall, 1.2% (4/323) of patients were admitted as the consequence of a DDI. CONCLUSIONS: The information on patient medication on hospital admission and discharge is incomplete. Half of patients on admission and almost two-thirds on discharge had pDDIs. ADRs due to DDIs caused 1.2% of admissions to medical departments in Ljubljana's primary city and tertiary referral hospital.

The frequency of adverse drug reaction related admissions according to method of detection, admission urgency and medical department specialty.

BACKGROUND: Adverse Drug Reactions (ADRs) have been regarded as a major public health problem since they represent a sizable percentage of admissions. Unfortunately, there is a wide variation of ADR related admissions among different studies. The aim of this study was to evaluate the frequency of ADR related admissions and its dependency on reporting and method of detection, urgency of admissions and included medical departments reflecting department/hospital type within one study. METHODS: The study team of internal medicine specialists retrospectively reviewed 520 randomly selected medical records (3%) of patients treated in the medical departments of the primary city and tertiary referral governmental hospital for certain ADRs causing admissions regarding WHO causality criteria. All medical records were checked for whether the treating physicians recognised and documented ADRs causing admissions. The hospital information system was checked to ensure ADR related diagnoses were properly coded and the database of a national spontaneous reporting system was searched for patients with ADRs included in this study. RESULTS: The established frequency of admissions due to certain ADRs recognised by the study team and documented in medical records by the treating physicians was the same and represented 5.8% of all patients (30/520). The frequency of ADR causing admissions detected by employing a computer-assisted approach using an ICD-10 coding system was 0.2% (1/520), and no patient admitted due to ADRs was reported to the national reporting system (0/520). The recognized frequency of ADR related admissions also depends on the department's specialty (p = 0.001) and acceptance of urgently admitted patients (p = 0.001). Patients admitted due to ADRs were significantly older compared to patients without ADRs (p = 0.025). Gastrointestinal bleeding due to NSAID, acetylsalicylic acid and warfarin was the most common ADR that resulted in admission and represented 40% of all certain ADRs (12/30) according to WHO causality criteria. CONCLUSION: ADRs cause 5.8% of admissions in medical departments in the primary city and tertiary referral hospital. The physicians recognise certain ADR related admissions according to WHO causality criteria and note them in medical records, but they rarely code and report ADRs. The established frequency of ADR related admissions depends on the detection method, department specialty and frequency of urgently admitted patients.