Mismatch 'never events' in hip and knee arthroplasty: a cohort and intervention study.

AIMS: The aim of this study was to give estimates of the incidence of component incompatibility in hip and knee arthroplasty and to test the effect of an online, real-time compatibility check. MATERIALS AND METHODS: Intraoperative barcode registration of arthroplasty implants was introduced in Denmark in 2013. We developed a compatibility database and, from May 2017, real-time compatibility checking was implemented and became part of the registration. We defined four classes of component incompatibility: A-I, A-II, B-I, and B-II, depending on an assessment of the level of risk to the patient (A/B), and on whether incompatibility was knowingly accepted (I/II). RESULTS: A total of 26 524 arthroplasties were analyzed. From 12 307 procedures that were undertaken before implementation of the compatibility check, 21 class A incompatibilities were identified (real- or high-risk combinations; 0.17%; 95% confidence interval (CI) 0.11 to 0.26). From 5692 hip and 6615 knee procedures prior to implementation of the compatibility check, we found rates of class A-I incompatibility (real- or high-risk combinations unknowingly inserted) of 0.14% (95% CI 0.06 to 0.28) and 0.17% (95% CI 0.08 to 0.30), respectively. From 14 217 procedures after the introduction of compatibility checking (7187 hips and 7030 knees), eight class A incompatibilities (0.06%; 95% CI 0.02 to 0.11) were identified. This difference was statistically significant (p = 0.008). CONCLUSION: Our data presents validated estimates of the baseline incidence of incompatibility events for hip and knee arthroplasty procedures and shows that a significant reduction in class A incompatibility events is possible using a web-based recording system. Cite this article: Bone Joint J 2019;101-B:960-969.

Postpartum depression and child growth in Tanzania: a cohort study.

OBJECTIVE: To examine the association between postpartum depression and child growth in a Tanzanian birth cohort. DESIGN: Prospective cohort study. SETTING: Moshi, Tanzania. POPULATION: Pregnant women over the age of 18 who sought antenatal care at two health clinics in Moshi, and the children they were pregnant with, were assessed for inclusion in this study. METHODS: The women were interviewed twice during pregnancy and three times after birth, the final follow up taking place 2-3 years postpartum. Signs of postpartum depression were assessed approximately 40 days postpartum with the Edinburgh Postnatal Depression Scale. MAIN OUTCOME MEASURES: Child growth was assessed with anthropometric measurements at 2-3 years of age and expressed as mean z-scores. RESULTS: In all, 1128 mother-child pairs were followed throughout the duration of the study. In total, 12.2% of the mothers showed signs of postpartum depression. Adjusted mean height-for-age z-score (HAZ) was significantly lower at 2-3 years follow up for children of mothers with postpartum depression than for children of mothers without (difference in HAZ: -0.32, 95% CI-0.49 to -0.15). Adjusted mean weight-for-height z-score (WHZ) was significantly increased for the children exposed to postpartum depression (difference in WHZ: 0.21, 95% CI 0.02-0.40), whereas there was no significant difference in adjusted weight-for-age z-score (WAZ; difference in WAZ: -0.04, 95% CI -0.20 to 0.12). CONCLUSIONS: We found that postpartum depressive symptoms predicted decreased linear height in children at 2-3 years of age and slightly increased weight-for-height. TWEETABLE ABSTRACT: Postpartum depression in Tanzanian mothers is associated with impaired child growth at 2-3 years of age.

Intraoperative hyperventilation vs remifentanil during electrocorticography for epilepsy surgery - a case report.

BACKGROUND: Traditionally, intraoperative intracranial electroen-cephalography-recordings are limited to the detection of the irritative zone defined by interictal spikes. However, seizure patterns revealing the seizure onset zone are thought to give better localizing information, but are impractical due to the waiting time for spontaneous seizures. Therefore, provocation by seizure precipitants may be used with the precaution that spontaneous and provoked seizures may not be identical. OBJECTIVE: We present evidence that hyperventilation induced and drug induced focal seizures may arise from different brain regions in the same patient. METHODS: Hyperventilation and ultra short acting opioid remifentanil were used separately as intraoperative precipitatants of seizure patterns, while recording from subdural and intraventricular electrodes in a patient with temporal lobe epilepsy. Two different ictal onset zones appeared in response to hyperventilation and remifentanil. Both zones were resected and the patient has remained essentially seizure free for 1 year. Furthermore, this is the first description of hyperventilation used as an intraoperative seizure precipitant in human focal epilepsy.

Quality assurance ofallergen-specific immunotherapy during a national outbreak of anaphylaxis: results of a continuous sentinel event surveillance system.

BACKGROUND AND OBJECTIVE: Subcutaneous allergen-specific immunotherapy (SCIT) is an effective treatment for patients with allergic asthma and rhinitis. SCIT may be performed in many different ways and good safety profiles have been published. Other studies, however, have reported high frequencies of severe adverse events (SAEs) but without identifying the causes. After an increase in SCIT-related SAEs in Denmark between 2003 and 2004, strict performance regulations were imposed by the authorities. Because safety data from national databases were not available, we implemented a surveillance system aimed at identifying the causes of SAEs. METHODS: We prospectively registered the number of injections and SAEs during SCIT. A slow up-dosing regimen was used and adherence to international standards was optimized. RESULTS: No SAEs were observed with 28 992 injections. The maximal risk per injection was calculated at < 1.3 per 10 000 injections. DISCUSSION: Our results confirm the good safety profile of SCIT. We applied a sentinel SCIT surveillance system that may offer a means of guaranteeing safety by providing online feedback to all participating clinics when SAEs occur in order to explore their causes by root course analyses performed by all participants. Furthermore, such quality assurance documentation may facilitate wider acceptance of SCIT by health care administrators, clinicians, and patients.

Remifentanil-induced spike activity as a diagnostic tool in epilepsy surgery.

OBJECTIVES: To assess the value of remifentanil in intraoperative evaluation of spike activity in patients undergoing surgery for mesial temporal lobe epilepsy (MTLE). MATERIALS AND METHODS: Twenty-five patients undergoing temporal lobectomy for medically intractable MTLE were enrolled in the study. Electrocorticography (ECoG) recordings were performed on the intraventricular hippocampus and from the anterior inferior temporal and lateral neocortex before and after a 300 microg intravenous bolus of remifentanil. Spike activity was quantified as spike-count per minute. RESULTS: A significant increase (P < 0.005) in spike activity was observed after administration of remifentanil in 23 of 25 patients (92%). Furthermore, two patients who did not have any spike activity on the baseline ECoG developed spikes after administration of remifentanil. CONCLUSIONS: The results suggest that remifentanil can enhance spike activity in the epileptogenic zone and reveal otherwise concealed epileptogenic tissue in patients with MTLE. Thus, remifentanil may prove to be an important diagnostic tool during surgical treatment for intractable focal epilepsy.

Interactions between carrageenans and milk proteins: a microstructural and rheological study.

Gels were produced using kappa-, iota-, or hybrid-carrageenan at a low (0.2-0.25%) and a high (0.7-1.0%) dosage in skim milk. The microstructure of carrageenan and protein was observed by confocal laser scanning microscopy using direct immunostaining. Additionally, rheology was used to characterize the gels. The low kappa- and iota-carrageenan dosages resulted in gels with a fine stranded carrageenan-protein microstructure and emulsion-like inclusions, while the high dosages resulted in strongly flocculated microstructures. Hybrid-carrageenan exhibited flocculation at both dosages. When using iota- and hybrid-carrageenan at a high dosage and kappa-carrageenan at both dosages, the gel characteristics were dominated by carrageenan-carrageenan interactions. On the other hand, the gel with a low dosage of iota-carrageenan in milk was barely fusible, indicating the presence of a true coupled network. We suggest that kappa-, iota-, and hybrid-carrageenan all interact with casein micelles but that the impact of this interaction on the total gel properties varied.

Dopamine transporter imaging and the effects of deep brain stimulation in patients with Parkinson's disease.

PURPOSE: Single-photon emission computed tomography (SPECT) with [123I]FP-CIT is a marker for loss of presynaptic dopamine transporters in the striatum in Parkinson's disease (PD). We used [123I]FP-CIT SPECT in order to evaluate binding to the dopamine transporter before and after neurosurgical treatment with bilateral stimulation in the subthalamic nucleus (STN). METHODS: Thirty-five patients with levodopa-responsive PD were examined with [123I]FP-CIT SPECT pre-operatively (baseline scan: mean 3 months before surgery), and 3 and 12 months after surgery. RESULTS: Pre-operatively, all patients already had substantial signs of severe nigrostriatal neuronal loss as determined from the [123I]FP-CIT SPECT scans. One year after surgery the specific [123I]FP-CIT binding to the striatum was significantly reduced by 10.3% compared with the pre-operative baseline scan. The mean time span from the baseline scan before surgery to the follow-up scan 1 year after surgery was 16.2 months. Hence, the rate of reduction equals a mean annual reduction of 7.7%. A comparable control group of patients with PD who did not undergo surgery was also examined longitudinally. In this group the specific binding of [123I]FP-CIT was reduced by 6.7% per year. CONCLUSION: The specific binding of [123I]FP-CIT was reduced equally in the STN-stimulated patients and a group of non-operated PD patients with advanced disease. Our study does not support the notion that electrode implantation and STN stimulation exert a neuroprotective effect by themselves.

Screening for allergic respiratory disease in the general population with the ADVIA Centaur Allergy Screen Assay.

BACKGROUND: In patients in whom the clinical indication for immunoglobulin E (IgE)-mediated allergic respiratory disease is weak, a single qualitative multiallergen-screening assay for IgE antibody to multiple allergen specificities may support the absence of IgE-mediated allergic respiratory disease. The aim was to investigate the diagnostic efficacy of a new multiallergen-screening assay in relation to skin prick test (SPT) reactivity and objective diagnoses of allergic respiratory disease in a general population setting. METHODS: A total of 709 participants in a population-based study were examined by questionnaire and SPT. Serum was analysed by using a multiallergen-screening assay: the ADVIA Centaur Allergy Screen (AS) assay. The dichotomized result of the AS assay was compared with SPT reactivity, specific IgE positivity, and a clinical diagnosis of allergic rhinitis or allergic asthma defined by the presence of relevant symptoms and positive SPTs. RESULTS: Sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of the AS against SPT reactivity were 86%, 96%, 94%, and 89%, respectively. A negative AS assay test was able to exclude allergic rhinitis and allergic asthma with a probability of more than 96% and 98% (NPV), respectively. The AS assay was able to identify more than 92% and 92% (sensitivity) of cases of allergic rhinitis and allergic asthma, respectively. CONCLUSIONS: The AS assay proved to be a valid measure of allergic respiratory disease and may be used as a screening tool to rule out allergic respiratory disease, and as an objective measure of allergic respiratory disease in epidemiological studies.

Airborne chemicals cause respiratory symptoms in individuals with contact allergy.

Exposure to fragrance chemicals causes various eye and airway symptoms. Individuals with perfume contact allergy report these symptoms more frequently than individuals with nickel allergy or no contact allergies. However, the associations between contact allergy and respiratory symptoms elicited by airborne chemicals other than perfumes are unclear. The study aimed to investigate the association between eye and airway symptoms elicited by airborne chemicals (other than perfumes) and contact allergy in a population-based sample. A questionnaire on respiratory symptoms was posted, in 2002, to 1189 individuals who participated in 1997/1998 in a Danish population-based study of allergic diseases. Questions about eye and airway symptoms elicited by different airborne chemicals and airborne proteins were included in the questionnaire. Data from the questionnaire were compared with data on patch testing and prick testing. Having at least 1 positive patch test (adjusted odds ratio 1.7, 95% CI 1.2-2.5) was associated with the symptoms, and the odds ratio increased with the number of positive patch tests (P-value for test for trend <0.05). Bronchial hyperreactivity, female sex and psychological vulnerability were independently associated with symptoms, but no association was found between prick test reactivity to proteins and the symptoms elicited by airborne chemicals.

Mucosal symptoms elicited by fragrance products in a population-based sample in relation to atopy and bronchial hyper-reactivity.

BACKGROUND: Exposure to perfume and fragrance products may, in some individuals, cause symptoms from the eyes and airways. The localization, character and risk factors of such symptoms in the general population are unknown. OBJECTIVE: To investigate both the localization and character of symptoms from the eyes and airways elicited by fragrance products, and the associations between such symptoms and skin prick test reactivity (atopy), methacholine bronchial hyper-reactivity (BHR), allergic rhinitis and asthma. METHODS: A questionnaire on mucosal symptoms elicited by fragrance products was posted to 1189 persons who had participated in a Danish population-based study of allergic diseases in 1997/1998. The study included measurement of BHR, atopy, forced expiratory volume in 1 s (FEV1), and serum eosinophilic cationic protein (serum ECP). RESULTS: The response rate was 79.6%. Symptoms from the eyes or airways elicited by fragrance products were reported by 42%. BHR (adjusted odds ratio 2.3, 95% confidence interval 1.5-3.5) was independently associated with symptoms from the eyes and airways elicited by fragrance products. There were no significant associations between these symptoms and atopy, FEV1 or serum ECP. CONCLUSIONS: Mucosal symptoms from the eyes and airways were common in this population. BHR was a significant and independent predictor of these symptoms. The lack of association with atopy suggested that IgE-mediated allergic mechanisms do not play a major role in the development of these symptoms.

A link between skin and airways regarding sensitivity to fragrance products?

BACKGROUND: Exposure to volatile fragrances is commonplace and may be related to various eye and airway symptoms. Skin exposure to fragrances is known to cause perfume contact allergy and eczema, but it is unknown whether eye or airway symptoms elicited by fragrance products are associated with contact allergy or eczema. OBJECTIVES: To investigate if eye and airway symptoms elicited by fragrance products are associated with perfume contact allergy or hand eczema in a population-based sample. METHODS: A questionnaire on eye and airway symptoms elicited by fragrance products was mailed to 1189 individuals who had recently participated in a Danish population-based study of allergic diseases. Results from the questionnaire about localization and character of the symptoms were compared with data on patch testing and 1-year prevalence of hand eczema collected during the health examination. RESULTS: Positive, independent and significant (P < 0.05) associations were found between eye and airway symptoms elicited by fragrance products and perfume contact allergy (adjusted odds ratios 2.0-3.7) and hand eczema (adjusted odds ratios 1.6-2.6). In further analysis, similar and consistent results were found regarding severity of the symptoms. No associations were found between nickel contact allergy and the symptoms. Female sex and psychological vulnerability were independently associated with eye and airway symptoms elicited by fragrance products, but adjustment in multivariate analysis did not change the results regarding perfume contact allergy and hand eczema. CONCLUSIONS: Individuals with perfume contact allergy and/or hand eczema, as opposed to those without, have more frequent and more severe eye or airway symptoms after exposure to volatile fragrance products. Having hand eczema has the greatest impact on reporting eye and airway symptoms elicited by fragrance products.

Pets in the home and the development of pet allergy in adulthood. The Copenhagen Allergy Study.

BACKGROUND: The aim of the study was to investigate the association between exposure to cat and dog in the home and the development (incidence) of IgE sensitization to cat and dog. METHODS: Participants in a population-based study of 15-69-year-olds in 1990 were invited to a follow-up in 1998. Serum IgE antibodies against common inhalant allergens was assessed in 734 subjects (participation rate 69.0%) on two occasions 8 years apart. Information about current or previous keeping of cats and dogs in the home was obtained in a questionnaire at baseline. RESULTS: A cat in the home currently was significantly associated with the development of IgE sentisization to cat (adjusted odds ratio 8.4, 95% confidence interval (CI) 1.7-42.7). Moreover, an atopic predisposition in terms of IgE sensitization to allergens other than cat at baseline was an independent risk factor for the development of IgE sensitization to cat. A dog in the home was not significantly associated with the development of IgE sensitization to dog. CONCLUSIONS: In this adult population, exposure to a cat in the home increased the risk of developing IgE sensitization to cat. More prospective data are needed on this issue.

The relationship of alcohol consumption to total immunoglobulin E and the development of immunoglobulin E sensitization: the Copenhagen Allergy Study.

BACKGROUND: Several studies in patient populations have reported a positive association between alcohol consumption and serum total IgE. Furthermore, we have previously reported a positive association between alcohol consumption and the prevalence of skin prick test (SPT positivity) to inhalant allergens in a population-based cross-sectional study. OBJECTIVE: To investigate the relationship of alcohol consumption to levels of serum total IgE and the development of IgE sensitization to inhalant allergens. METHODS: In 1990, self-reported consumption of alcohol, serum total IgE, SPT positivity and specific IgE positivity to inhalant allergens were assessed in 1112 subjects, aged 15-69 years, participating in a population-based cross-sectional study in Copenhagen, Denmark. In 1998, they were invited to a follow-up and 734 were re-examined (participation rate 69.0%). Adjustment for potential confounders was performed by using multivariable regression analyses. RESULTS: In non-atopic (specific IgE negative) subjects there was a positive association between alcohol consumption and the concentration of total IgE (P = 0.001). During the follow-up period, 45 and 33 subjects developed SPT positivity and specific IgE positivity, respectively. There was no significant association between alcohol consumption and the development of SPT positivity or specific IgE positivity. However, the risk of developing SPT positivity tended to increase with increasing consumption of alcohol (P = 0.055). CONCLUSIONS: This epidemiological study confirms that alcohol consumption has an influence on levels of serum total IgE. A significant association between alcohol consumption and the development of IgE sensitization was not established. However, there seems to be a lack epidemiological data on this issue.

Tranexamic acid given intraoperatively reduces blood loss after total knee replacement: a randomized, controlled study.

BACKGROUND: Extensive blood loss in total knee replacement (TKR) surgery is well known and is associated with a high transfusion rate of allogenic blood. Tranexamic acid (TXA) has been shown to reduce blood loss by 50% in this patient group, but only in cases with a perioperative loss of 1400-1800 ml. This study was performed to see if TXA offers any advantages in knee replacement surgery with blood loss at 800 ml. METHODS: Thirty consecutive patients scheduled for TKR in spinal anesthesia with the use of a tourniquet, were randomized to TXA or non-TXA. Tranexamic acid 10 mg kg-1 was given at conclusion of surgery and again 3 h later. Blood loss was registered. RESULTS: Total blood loss was at all times significantly lower in the TXA group compared to the non-TXA group (409.7+/-174.9 ml vs. 761.7+/-313.1 ml; P<0.001). There were no differences in coagulation parameters. No patients in the TXA group had a blood transfusion vs. 13% in the non-TXA group (NS). No complications were registered in the two groups. CONCLUSION: We conclude that TXA significantly reduces blood loss after total knee replacement surgery.

The link between allergic rhinitis and allergic asthma: a prospective population-based study. The Copenhagen Allergy Study.

BACKGROUND: It has been hypothesized that allergic rhinitis and allergic asthma are manifestations of the same disease entity. We aimed to investigate the relationship between allergic rhinitis and allergic asthma. METHODS: Participants in a population-based study of 15-69-year-olds in 1990 were invited to a follow-up in 1998. A total of 734 subjects were examined on two occasions eight years apart. Allergic rhinitis to pollen was defined as a history of nasal symptoms on exposure to pollens and IgE specific to pollen. Allergic asthma to pollen was defined as a history of lower airway symptoms on exposure to pollens and IgE specific to pollen. Similarly, diagnoses of allergic rhinitis and allergic asthma to animals or mite were defined. RESULTS: At follow-up, all subjects with allergic asthma to pollen (n = 52) had in addition allergic rhinitis to pollen. In the longitudinal analysis, there were a total of 28 new (incident) cases of allergic asthma to pollen. They all had allergic rhinitis to pollen at baseline, or had developed allergic rhinitis to pollen at follow-up. Accordingly, allergic rhinitis to animals and mite were ubiquitous in subjects with allergic asthma to animals and mite, respectively. CONCLUSIONS: The results support the hypothesis that allergic rhinitis and allergic asthma are manifestations of the same disease entity.

Incidence of allergic contact sensitization in Danish adults between 1990 and 1998; the Copenhagen Allergy Study, Denmark.

BACKGROUND: Studies of incidence of contact allergy in a general population have not been reported. Data from incidence studies may support and direct strategies for prevention of contact allergy and allergic contact dermatitis. OBJECTIVE: To study the incidence of contact allergy and evaluate risk factors for developing contact allergy in an adult general population sample. PATIENTS AND METHODS: In 1990 a random sample of 567 persons of the 15-69-year-old population living in the western part of Copenhagen County (Denmark) was patch tested in a cross-sectional study. In 1998 a follow-up study was performed. Of 540 invited, 365 (68%) were patch tested again. RESULTS: In the follow-up study, 37 persons (12%) of the 313 patch-test-negative persons in 1990 had developed one or more positive patch tests (incident contact allergy). Twenty cases (6%) of incident nickel allergy and 25 cases (8%) of incident contact allergy to one or more haptens other than nickel were found. The data indicate that female sex, young age and ear piercing (before 1990) were risk factors for developing nickel allergy. Between 1990 and 1998 metal contact dermatitis was reported in seven women with incident nickel allergy. Six of these women had bought the eliciting item in Denmark before 1995, when vigorous control of the Danish nickel legislation was introduced. CONCLUSIONS: We found a considerable number of incident cases of contact allergy in the adult population. The results of the study support the actions taken to restrict the use of the allergens most frequently encountered, and to increase the labelling demands to products intended for prolonged contact with the skin or a combined action.