Clinical consequences of different exsanguination methods in hand surgery. a double-blind randomised study.

A randomised trial was performed in 100 patients in order to evaluate the effectiveness of three commonly used methods of exsanguination (simple elevation, squeeze method and Esmarch bandage) in a clinical setting. The quality and quantity of the exsanguination was evaluated every 5 min by the surgeon and the amount of oozing was observed. Although there was no significant difference between squeezing the arm and Esmarch bandaging, both resulted in significantly better exsanguination than simple elevation. In 22 out of the 100 patients, a small amount of ooze was observed. The oozing was observed significantly more frequently in the patients exsanguinated by simple elevation.

Observer variation in the radiographic classification of fractures of the neck of the femur using Garden's system.

By means of Kappa statistics, we calculated the inter- and intra-observer variation in the classification of fractures of the neck of the femur according to Garden's system. Radiographs of 96 consecutive patients were assessed independently by six observers who agreed on classification for only 14 fractures (15%). The level of agreement was poor for the overall classification (Kappa = 0.39). When reducing Garden's system into non-displaced (Stage I and II) and displaced fractures (Stage III and IV) the level of agreement became acceptable (Kappa = 0.68). However, problems remain in distinguishing Stage II and Stage III fractures, and further improvements in the classification system are necessary.

Release of trigger finger in children. Long term results.

During a 10 year period 58 patients had 80 trigger fingers operated on at this hospital. The male/female ratio was 32:26 and most children were operated on at between the ages of 2 and 4 years, and 15 months (range 2-99) after the lesion had been noticed. The operation was quick and effective with no complications. Only one patient was re-operated on, with a good result. Thirteen patients had bilateral lesions. Both hands were examined and in 11 patients (19%) we found that the thickening corresponding to the trigger finger was also present on the opposite side but giving no symptoms. There seems to be a predisposition to bilateral affections.

[Quality assurance in amputation of the lower extremities due to vascular insufficiency]. / Kvalitetssikring ved amputationer på underekstremiteterne grundet vasculaer insufficiens.

In this retrospective study we reviewed the clinical charts for 82 patients who underwent lower limb amputation at our department during 1990 and 1991. Our results are compared with the literature, and different aspects of the treatment are discussed. Subsequently a model for future quality assurance is presented.

[Gynecomastia treated by subcutaneous mastectomy using Webster's method]. / Gynaekomasti behandlet med subkutan mastektomi a.m. Webster.

Gynecomastia was treated surgically by Webster's method in 23 patients during the period from 1983 to 1989. This surgical procedure was used if gynecomastia was classified from stage 1 to stage 2B. Cosmetic reasons were the major reasons for operation in 70% of the patients. The most common late postoperative sequelae were inverted areolae and hypaesthesiae of the areolar region. When operation was carried out, half of the patients were overweight. The remainder were of normal weight. Among the patients, who were overweight time of operation, 2/3 found that the cosmetic correction was unsatisfactory. In the "normal weight group" 2/3 were satisfied with the cosmetic result. The patients in the dissatisfied group found that too little tissue had been removed from the area. The operation is carried out through a little infraareolar incision. Because of this, it is technically difficult, especially in patients with considerable subcutaneous tissue. On this background, we find that Webster's method alone, not should be used as surgical treatment of gynecomastia in overweight patients.