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1.
Burns ; 45(6): 1283-1290, 2019 09.
Article in English | MEDLINE | ID: mdl-31176509

ABSTRACT

OBJECTIVE: This study aimed to provide insight into the patterns and factors that predict burn scar outcomes at 3, 6 and 12 months after burn. METHODS: The Patient and Observer Scar Assessment Scale (POSAS) was used to assess the scar formation of each patient. Structural equation modelling was used. The predictor variables used in this study were sex, three age categories, TBSA, depth of the wound and cause of the burn. RESULTS: The POSAS patient total and individual item scores demonstrated a statistically significant decrease in the first 12 months after burn, except for the relief item. Male patients had a lower total and items scores (better scar quality) for pain and pruritus compared with female patients. Full thickness burns had a higher scores for pruritus, pliability, thickness and relief compared to the partial-thickness burns. Ages younger than 5 years, higher TBSA values and flame burns were predictors of various POSAS items at 3 and 6 months after burn. CONCLUSION: The POSAS patient total and individual item scores demonstrated a statistically significant improvement in the scar quality in the first 12 months after burn, except for the relief. Sex, age, depth of the wound, the percentage of TBSA and flame burns were predictors of various POSAS patient items at 3, 6 and 12 months after burn.


Subject(s)
Burns/complications , Cicatrix/physiopathology , Pain/physiopathology , Pruritus/physiopathology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Body Surface Area , Child , Child, Preschool , Cicatrix/etiology , Cicatrix/pathology , Elasticity , Female , Humans , Infant , Male , Middle Aged , Pain/etiology , Patient Reported Outcome Measures , Pigmentation , Prognosis , Pruritus/etiology , Sex Factors , Young Adult
2.
Knee Surg Sports Traumatol Arthrosc ; 26(6): 1823-1830, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29282486

ABSTRACT

PURPOSE: Patient-specific instrumentation (PSI) is a technique to plan and position the prosthesis components in unicompartmental knee arthroplasty (UKA) surgery. This study assesses whether the definitive component position in the frontal, sagittal and axial plane is according to the preoperative plan, based on the hypothesis that PSI is accurate. METHODS: Twenty-six patients who had PSI Oxford UKA surgery were included prospectively. The component position in vivo was determined with a postoperative CT-scan and compared with the planned component position using MRI-based digital 3D imaging. Adjustments to the preoperative plan and implanted component sizes during surgery were recorded. RESULTS: Intraoperatively, no femoral adjustments were performed; 12 tibial re-resections were necessary. The median absolute deviation from the plan in degrees (range) in the frontal, sagittal and axial plane was 1.8° (- 1.5°-6.5°), 2.0° (- 6.5°-8.0°) and 1.0° (- 1.5°-5.0°) for the femoral component, and 2.5° (- 1.0°-6.0°), 3.0° (- 1.0°-5.0°) and 5.0° (- 6.5°-12.5°) for the tibial component. The femoral component is positioned 0.5 (- 1°-2.5°) mm more lateral and 0.8 (- 1.0°-2.5°) mm more anterior. The tibial component is positioned 2.0 (- 5.0-0.0) mm more lateral and 1.3 (- 3.0-6.0) mm more distal. The femoral and tibial default plans were changed four times (15.4%) and nine times (34.6%), respectively, before approval by the surgeon. CONCLUSION: PSI in Oxford UKA surgery is reliable and accurately translates the preoperative plan into the in vivo situation, except for the tibial rotational position. The preoperative planning is a crucial step in avoiding re-resections that can cause angular deviations in prosthesis position, especially in tibial component rotational position. It is advised to avoid re-resections and to consider this while planning the PSI procedure. LEVEL OF EVIDENCE: Prospective comparative study Level II.


Subject(s)
Arthroplasty, Replacement, Knee/instrumentation , Bone Malalignment/diagnostic imaging , Knee Prosthesis , Osteoarthritis, Knee/surgery , Surgery, Computer-Assisted/instrumentation , Tibia/surgery , Aged , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/methods , Bone Malalignment/physiopathology , Bone Malalignment/surgery , Female , Femur/physiopathology , Femur/surgery , Humans , Knee Joint/diagnostic imaging , Knee Joint/physiopathology , Knee Joint/surgery , Knee Prosthesis/adverse effects , Male , Middle Aged , Osteoarthritis, Knee/diagnostic imaging , Osteoarthritis, Knee/physiopathology , Prospective Studies , Reproducibility of Results , Rotation , Surgery, Computer-Assisted/adverse effects , Surgery, Computer-Assisted/methods , Tibia/physiopathology
3.
Burns ; 43(4): 715-723, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28040371

ABSTRACT

BACKGROUND: The aim of this study was to assess the predictive validity of the Patient and Observer Assessment Scale (POSAS), in order to determine whether it can be used to predict final scar quality. METHODS: Patients with a maximum TBSA burned of 20% who were treated in a Dutch burn center and participated in two scar assessments at 3 months and >18 months post-burn were included. Scar quality assessment consisted of the POSAS, Dermaspectrometer® (color) and Cutometer® (elasticity). Predictive validity was determined in three ways: (1) the discriminative ability to distinguish good from reduced long term scar quality, (2) correlations between POSAS items score at the two subsequent assessments and (3) linear regression was conducted to identify POSAS items as independent predictors. Additionally, reliability, construct validity and interpretability were assessed. RESULTS: A total of 141 patients were included with a mean TBSA burned of 5.2% (±4.5). The ability of the Patient scale to discriminate between good and reduced long term scar quality was adequate with an area under the curve (AUC) of 0.728 (CI 0.640-0.804), the ability of the Observer scale was good with an AUC of 0.854 (CI 0.781-0.911). Correlations between items scored T3 and T>18 were at least adequate. On item level, pain and stiffness (Patient) and pliability and relief (Observer) were identified as significant predictors for reduced long term scar quality. The POSAS was reliable, construct validity was adequate at three months but declined at >18 months. CONCLUSION: This study found that final scar quality can be adequately predicted by an early POSAS assessment at three months.


Subject(s)
Burns/complications , Cicatrix/etiology , Elasticity , Skin/physiopathology , Adolescent , Adult , Aged , Aged, 80 and over , Area Under Curve , Body Surface Area , Child , Child, Preschool , Cicatrix/pathology , Cicatrix/physiopathology , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Linear Models , Male , Middle Aged , Netherlands , Outcome Assessment, Health Care , Pain/etiology , Reproducibility of Results , Skin/pathology , Trauma Severity Indices , Young Adult
4.
Knee ; 22(2): 111-6, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25662474

ABSTRACT

BACKGROUND: Arthroscopic reconstruction of the anterior cruciate ligament (ACL) has traditionally been performed in an inpatient setting. Outpatient treatment may offer the advantages of cost reduction and higher patient satisfaction. HYPOTHESIS/PURPOSE: We investigated whether ACL reconstruction in an outpatient setting is equally safe as in an inpatient setting and whether comparable functional outcomes can be achieved. We hypothesized that the outcomes of outpatient ACL reconstruction result in similar outcomes as inpatient ACL reconstruction. STUDY DESIGN: A prospective randomized controlled trial was conducted at one centre. METHODS: Forty-six patients were randomized to outpatient treatment or a 2-day admission after ACL reconstruction. The functional outcome was evaluated with the Lysholm, Tegner and International Knee Documentation Committee scores. Safety of the procedures was judged according to pain experience and readmission rate. The duration of follow-up was 1 year after ACL reconstruction. The patients were provided with a simple postoperative analgesic protocol. The linear mixed effect model for repeated measures was used for testing the differences between the study groups. RESULTS: No significant differences were found between the study groups in all the outcome measures. No readmissions were recorded related to pain. One complication was recorded in the outpatient group versus three in the inpatient group. CONCLUSION: This study indicates that outpatient care after ACL reconstruction yields comparable functional results and postoperative pain experience as inpatient care and is a safe option. A simple analgesic protocol provides adequate pain relief during the postoperative phase. LEVEL OF EVIDENCE: I.


Subject(s)
Ambulatory Surgical Procedures/methods , Anterior Cruciate Ligament Reconstruction/methods , Anterior Cruciate Ligament/surgery , Inpatients , Pain, Postoperative , Adolescent , Adult , Anterior Cruciate Ligament/physiology , Anterior Cruciate Ligament Injuries , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pain, Postoperative/diagnosis , Patient Satisfaction , Prospective Studies , Treatment Outcome , Young Adult
5.
Burns ; 40(7): 1406-14, 2014 Nov.
Article in English | MEDLINE | ID: mdl-24703338

ABSTRACT

INTRODUCTION: The aim of this study was to characterize the epidemiology of severe burns in the Netherlands, including trends in burn centre admissions, non burn centre admissions and differences by age. METHODS: Patients with burn-related primary admission in a Dutch centre from 1995 to 2011 were included. Nationwide prospectively collected data were used from three separate historical databases and the uniform Dutch Burn Repository R3 (2009 onwards). General hospital data were derived from the National Hospital Discharge Register. Age and gender-adjusted rates were calculated by direct standardization, using the 2005 population as the reference standard. RESULTS: The annual number of admitted patients increased from 430 in 1995 to 747 in 2011, incidence rates increased from 2.72 to 4.66 per 100,000. Incidence rates were high in young children, aged 0-4 years and doubled from 10.26 to 22.96 per 100,000. Incidence rates in persons from 5 up to 59 increased as well, in older adults (60 years and older) admission rates were stable. Overall burn centre mortality rate was 4.1%, and significantly decreased over time. There was a trend towards admissions of less extensive burns, median total burned surface area (TBSA) decreased from 8% to 4%. Length of stay and length of stay per percent TBSA decreased over time as well. CONCLUSIONS: Data on 9031 patients admitted in a 17-year period showed an increasing incidence rate of burn-related burn centre admissions, with a decreasing TBSA and decreasing in-burn centre mortality. These data are important for prevention and establishment of required burn care capacity.


Subject(s)
Burn Units/trends , Burns/epidemiology , Hospitalization/trends , Adolescent , Adult , Age Distribution , Body Surface Area , Child , Child, Preschool , Databases, Factual , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Middle Aged , Netherlands/epidemiology , Severity of Illness Index , Young Adult
6.
Burns ; 40(8): 1570-4, 2014 Dec.
Article in English | MEDLINE | ID: mdl-24685351

ABSTRACT

BACKGROUND: Staphylococcus aureus wound colonization frequently occurs in patients with burns and can cause impaired wound healing. Nasal mupirocin application may contribute to the reduction of burn wound colonization of endogenous origin, whereas colonization by the exogenous route can be reduced by blocking cross-infection from other sources. In this study we evaluated whether the implementation of routine treatment of patients and burn center personnel using nasal mupirocin ointment reduces S. aureus burn wound colonization. METHODS: We composed three study groups, consisting of a control period (Control), a mupirocin period (MUP), in which patients with burns were all receiving nasal mupirocin at admission, and a mupirocin+personnel period (MUP+P), in which we also screened the burn center personnel and decolonized S. aureus carriers by nasal mupirocin. RESULTS: The patients who carried S. aureus in their nose and did not have S. aureus burn wound colonization at admission were considered as patients susceptible for the use of nasal mupirocin. In these patients, the S. aureus burn wound colonization rate was the same in all study groups. S. aureus nasal carriage was a significant independent risk factor for burn wound colonization (OR: 3.3; 95% CI: 1.4-7.6) when analyzed within the three study groups. CONCLUSION: Although S. aureus carriage is a significant risk factor for developing burn wound colonization, the routine use of nasal mupirocin did not contribute to a reduction of burn wound colonization.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Burns/drug therapy , Carrier State/drug therapy , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Mupirocin/therapeutic use , Staphylococcal Infections/prevention & control , Wound Infection/prevention & control , Administration, Intranasal , Adolescent , Adult , Burn Units , Child , Child, Preschool , Humans , Infant , Middle Aged , Staphylococcal Infections/transmission , Wound Infection/transmission , Young Adult
7.
Open Orthop J ; 5: 168-76, 2011.
Article in English | MEDLINE | ID: mdl-21633722

ABSTRACT

The aim of this literature review is to describe the clinical anatomy of the elbow joint based on information from in vitro biomechanical studies. The clinical consequences of this literature review are described and recommendations are given for the treatment of elbow joint dislocation.The PubMed and EMBASE electronic databases and the Cochrane Central Register of Controlled Trials were searched. Studies were eligible for inclusion if they included observations of the anatomy and biomechanics of the elbow joint in human anatomic specimens.Numerous studies of the kinematics, kinesiology and anatomy of the elbow joint in human anatomic specimens yielded important and interesting implications for trauma and orthopaedic surgeons.

8.
Eur J Trauma Emerg Surg ; 37(3): 269-75, 2011 Jun.
Article in English | MEDLINE | ID: mdl-26815109

ABSTRACT

AIMS: The aims of this study were to determine if the severity of injury is related to the prevalence of posttraumatic stress disorder (PTSD) in polytrauma patients and to review the personality traits of patients with PTSD. METHODS: During 2006 and 2007, 252 polytrauma patients were treated at the Medical Centre Haaglanden in The Hague, The Netherlands. Of the 174 survivors, 53 adult patients were traced and sent questionnaires. They were screened for PTSD and personality traits, coping styles, and negative cognitions, and their level of social support were assessed. RESULTS: PTSD was demonstrated in 22.6% of the patients. CONCLUSIONS: An increased level of neuroticism, negative cognitions regarding themselves, and active dealing were found to be significant predictors of PTSD. However, we found no relation between the injury severity score and the prevalence of PTSD.

9.
Hernia ; 15(4): 443-5, 2011 Aug.
Article in English | MEDLINE | ID: mdl-20440527

ABSTRACT

Although blunt abdominal trauma is frequent, traumatic abdominal wall hernias (TAWH) are rare. We describe a large TAWH with associated intra-abdominal lesions that were caused by high-energy trauma. The diagnosis was missed by clinical examination but was subsequently revealed by a computed tomography (CT) scan. Repair consisted of an open anatomical reconstruction of the abdominal wall layers with reinforcement by an intraperitoneal composite mesh. The patient recovered well and the results of a post-operative CT scan are presented.


Subject(s)
Abdominal Injuries/complications , Hernia, Abdominal/diagnostic imaging , Hernia, Abdominal/surgery , Abdominal Wall , Accidental Falls , Hernia, Abdominal/etiology , Humans , Male , Middle Aged , Rupture , Tomography, X-Ray Computed
10.
Open Orthop J ; 4: 115-9, 2010 Feb 17.
Article in English | MEDLINE | ID: mdl-20383289

ABSTRACT

Three patients, two adults and one child, developed an acute compartment syndrome of the lower leg. Due to delay in diagnosis, severe complications developed, resulting in two transfemoral amputations. In the youngest patient, the lower leg was able to be saved after extensive reconstructive surgery. In most cases, acute compartment syndrome of the lower leg is seen in combination with a fracture (40%), although other causes (minor trauma or vascular surgery) are also known. Moreover, patient history (pain out of proportion to the associated injury) and physical examination are central to the diagnosis. In some cases, however, a reliable diagnosis cannot be made clinically, as in the case of unconscious, intoxicated or intubated patients, as well as small children. Under these circumstances, intra-compartmental pressure measurement can be of great assistance. After confirmation of the diagnosis, immediate fasciotomy of all lower leg compartments should be performed. The eventual outcome of this syndrome is directly related to the time elapsed between diagnosis and definitive treatment. Although the diagnosis can be difficult, delays in treatment should be avoided at all costs. The acute compartment syndrome of the lower leg is a surgical emergency and should be dealt with immediately.

11.
Hernia ; 14(3): 243-7, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20091329

ABSTRACT

PURPOSE: The repair of incisional hernias can be accomplished by open or laparoscopic techniques. The Biodex dynamometer measures muscle strength during isokinetic movement. The objectives of this study are to compare the strength of the trunk flexors between patients who underwent repair for incisional hernia and a control group, and to compare trunk flexion after two kinds of operative techniques for incisional hernias with and without approximation of the rectus abdominis muscles. METHODS: The trunk flexion of 30 patients after different operative techniques for midline incisional hernias and of 12 healthy subjects was studied with the Biodex isokinetic dynamometer. RESULTS: The mean torque/weight (N m/kg) for trunk flexion was significantly higher in the control group compared to the patient group after incisional hernia repair. A significantly higher peak torque/weight [coefficient 24.45, 95% confidence interval (CI) -0.05; 48.94, P = 0.05] was found in the two-layered suture technique without mesh compared to the laparoscopic technique after adjusting for gender. CONCLUSIONS: The isokinetic strength of the trunk flexor muscles is reduced after an operation for incisional hernia. There is some evidence that a two-layered suture repair with approximation of the rectus abdominis muscles results in higher isokinetic strength of the trunk flexor muscles compared to the laparoscopic technique.


Subject(s)
Hernia, Ventral/surgery , Muscle Contraction/physiology , Muscle Strength/physiology , Rectus Abdominis/physiopathology , Aged , Female , Humans , Male , Middle Aged , Muscle Strength Dynamometer , Postoperative Period , Torque
12.
Arch Orthop Trauma Surg ; 130(2): 241-9, 2010 Feb.
Article in English | MEDLINE | ID: mdl-19340433

ABSTRACT

OBJECTIVE: To identify if functional treatment is the best available treatment for simple elbow dislocations. SEARCH STRATEGY: Electronic databases MEDLINE, EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials. SELECTION CRITERIA: Studies were eligible for inclusion if they were trials comparing different techniques for the treatment of simple elbow dislocations. DATA ANALYSIS: Results were expressed as relative risk for dichotomous outcomes and weighted mean difference for continuous outcomes with 95% confidence intervals. MAIN RESULTS: This review has included data from two trials and three observational comparative studies. Important data were missing from three observational comparative studies and the results from these studies were extracted for this review. No difference was found between surgical treatment of the collateral ligaments and plaster immobilisation of the elbow joint. Better range of movement, less pain, better functional scores, shorter disability and shorter treatment time were seen after functional treatment versus plaster immobilisation.


Subject(s)
Elbow Joint , Joint Dislocations/therapy , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult
13.
Hernia ; 13(4): 421-6, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19296196

ABSTRACT

BACKGROUND: Incisional hernia is a serious complication after abdominal surgery and occurs in 11-23% of laparotomies. Repair can be done, for instance, with a direct suture technique, but recurrence rates are high. Recent literature advises the use of mesh repair. In contrast to this development, we studied the use of a direct suture repair in a separate layer technique. The objective of this retrospective observational study is to assess the outcomes (recurrences and complications) of a two-layered open closure repair for primary and recurrent midline incisional hernia without the use of mesh. METHODS: In an observational retrospective cohort study, we analysed the hospital and outpatient records of 77 consecutive patients who underwent surgery for a primary or recurrent incisional hernia between 1st May 2002 and 8th November 2006. The repair consisted of separate continuous suturing of the anterior and posterior fascia, including the rectus muscle, after extensive intra-abdominal adhesiolysis. RESULTS: Forty-one men (53.2%) and 36 women (46.8%) underwent surgery. Sixty-three operations (81.8%) were primary repairs and 14 (18.2%) were repairs for a recurrent incisional hernia. Of the 66 patients, on physical examination, three had a recurrence (4.5%) after an average follow-up of 2.6 years. The 30-day postoperative mortality was 1.1%. Wound infection was seen in five patients (6.5%). CONCLUSIONS: A two-layered suture repair for primary and recurrent incisional hernia repair without mesh with extensive adhesiolysis was associated with a recurrence rate comparable to mesh repair and had an acceptable complication rate.


Subject(s)
Hernia, Ventral/diagnosis , Hernia, Ventral/surgery , Surgical Procedures, Operative/methods , Suture Techniques , Aged , Chi-Square Distribution , Cohort Studies , Female , Follow-Up Studies , Hernia, Ventral/etiology , Humans , Incidence , Laparotomy/adverse effects , Male , Middle Aged , Probability , Recurrence , Reoperation , Retrospective Studies , Risk Assessment , Severity of Illness Index , Surgical Mesh , Surgical Procedures, Operative/adverse effects , Surgical Wound Infection/epidemiology , Tensile Strength , Time Factors , Treatment Outcome , Wound Healing/physiology
14.
Hernia ; 13(1): 45-8, 2009 Feb.
Article in English | MEDLINE | ID: mdl-18688566

ABSTRACT

BACKGROUND: The objective of this study is to determine the reliability and validity of ultrasonography (US) in diagnosing incisional hernias in comparison with computed tomography (CT). The CT scans were assessed by two radiologists in order to estimate the inter-observer variation and twice by one radiologist to estimate the intra-observer variation. Patients were evaluated after reconstruction for an abdominal aortic aneurysm or an aortoiliac occlusion. METHODS: Patients with a midline incision after undergoing reconstruction of an abdominal aortic aneurysm or aortoiliac occlusion were examined by CT scanning and US. Two radiologists evaluated the CT scans independently. One radiologist examined the CT scans twice. Discrepancies between the CT observations were resolved in a common evaluation session between the two radiologists. RESULTS: After a mean follow-up of 3.4 years, 40 patients were imaged after a reconstructed abdominal aortic aneurysm (80% of the patients) or aortoiliac occlusion. The prevalence of incisional hernias was 24/40 = 60.0% with CT scanning as the diagnostic modality and 17/40 = 42.5% with US. The measure of agreement between CT scanning and US expressed as a Kappa statistic was 0.66 (95% confidence interval [CI] 0.45-0.88). The sensitivity of US examination when using CT as a comparison was 70.8%, the specificity was 100%, the predictive value of a positive US was 100%, and the predictive value of a negative US was 69.6%. The likelihood ratio of a positive US was infinite and that of a negative US was 0.29. The inter- and intra-observer Kappa statistics were 0.74 (CI 0.54-0.95) and 0.80 (CI 0.62-0.99), respectively. CONCLUSIONS: US imaging has a moderate sensitivity and negative predictive value, and a very good specificity and positive predictive value. Consistency of diagnosis, as determined by calculating the inter- and intra-observer Kappa statistics, was good. The incidence of incisional hernias is high after aortic reconstructions.


Subject(s)
Endosonography/methods , Hernia, Abdominal/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Female , Follow-Up Studies , Hernia, Abdominal/epidemiology , Humans , Incidence , Male , Netherlands/epidemiology , Postoperative Complications , Reproducibility of Results , Retrospective Studies
15.
J Bone Joint Surg Am ; 89(7): 1424-31, 2007 Jul.
Article in English | MEDLINE | ID: mdl-17606778

ABSTRACT

BACKGROUND: Complex regional pain syndrome type I is treated symptomatically. A protective effect of vitamin C (ascorbic acid) has been reported previously. A dose-response study was designed to evaluate its effect in patients with wrist fractures. METHODS: In a double-blind, prospective, multicenter trial, 416 patients with 427 wrist fractures were randomly allocated to treatment with placebo or treatment with 200, 500, or 1500 mg of vitamin C daily for fifty days. The effect of gender, age, fracture type, and cast-related complaints on the occurrence of complex regional pain syndrome was analyzed. RESULTS: Three hundred and seventeen patients with 328 fractures were randomized to receive vitamin C, and ninety-nine patients with ninety-nine fractures were randomized to receive a placebo. The prevalence of complex regional pain syndrome was 2.4% (eight of 328) in the vitamin C group and 10.1% (ten of ninety-nine) in the placebo group (p=0.002); all of the affected patients were elderly women. Analysis of the different doses of vitamin C showed that the prevalence of complex regional pain syndrome was 4.2% (four of ninety-six) in the 200-mg group (relative risk, 0.41; 95% confidence interval, 0.13 to 1.27), 1.8% (two of 114) in the 500-mg group (relative risk, 0.17; 95% confidence interval, 0.04 to 0.77), and 1.7% (two of 118) in the 1500-mg group (relative risk, 0.17; 95% confidence interval, 0.04 to 0.75). Early cast-related complaints predicted the development of complex regional pain syndrome (relative risk, 5.35; 95% confidence interval, 2.13 to 13.42). CONCLUSIONS: Vitamin C reduces the prevalence of complex regional pain syndrome after wrist fractures. A daily dose of 500 mg for fifty days is recommended.


Subject(s)
Antioxidants/administration & dosage , Ascorbic Acid/administration & dosage , Fractures, Bone/complications , Reflex Sympathetic Dystrophy/prevention & control , Wrist Injuries/complications , Analysis of Variance , Chi-Square Distribution , Dose-Response Relationship, Drug , Double-Blind Method , Female , Humans , Male , Middle Aged , Reflex Sympathetic Dystrophy/etiology , Treatment Outcome
16.
Burns ; 31(2): 198-204, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15683693

ABSTRACT

The aim of this study was to assess if the pain observation scale for young children (POCIS) and the visual analogue scale (VAS) are reliable and valid instruments to measure procedural and background pain in burned children aged 0-4 years. Burn care nurses (n=73) rated pain from 24 fragments of videotaped children during wound care procedures and during periods of rest using the POCIS and the VAS. Intraclass correlations were used to assess inter-rater and intra-rater reliability for the POCIS and the VAS. Internal consistency for POCIS was assessed by Cronbach's alpha. The POCIS has shown poor to moderate inter-rater reliability, moderate to good intra-rater reliability and an acceptable internal consistency. The VAS turned out to have poor inter-rater reliability and poor to moderate intra-rater reliability. Due to poor results of inter-rater reliability in both scales, construct validation is left undone until more acceptable results are obtained. Factors explaining the results are the large number of raters, the manner they were trained and a lack of variation between pain classes in video fragments. Although not all results were satisfying, an easy to use scale as POCIS has promising qualities and deserves further reliability research.


Subject(s)
Burns/physiopathology , Pain Measurement/methods , Adolescent , Adult , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Observer Variation , Pain/epidemiology , Reproducibility of Results
17.
J Trauma ; 57(4): 851-4, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15514541

ABSTRACT

BACKGROUND: Rapid diagnosis of scaphoid bone fracture in the wrist is important so that appropriate treatment can be started. If a fracture is clinically suspected without being visible on radiography, further investigation has to be conducted to reveal a fracture or to rule it out. The objective of this study was to investigate the validity of computed tomographic (CT) scanning and bone scintigraphy compared with the clinical fracture rate during follow-up of 1 year for examining patients with a suspected scaphoid fracture. METHODS: Bone scintigraphy and CT scanning were performed in 29 patients with persistent clinical suspicion of a scaphoid bone fracture 5 to 10 days after trauma. RESULTS: The sensitivity, specificity, and positive and negative predictive values of the CT scan were 100%. The sensitivity, specificity, and positive and negative predictive values of bone scintigraphy were 78%, 90%, 78%, and 90%, respectively. Seven patients showed a fracture on both CT scanning and bone scintigraphy. Eighteen patients showed no fracture on both CT scanning and bone scintigraphy. A false-positive bone scintigram showed up in two patients and a false-negative bone scintigram in another two patients. CONCLUSION: CT scanning is a rapid, simple, valid method for demonstrating or ruling out a scaphoid fracture and is superior to bone scintigraphy.


Subject(s)
Radionuclide Imaging/methods , Scaphoid Bone/injuries , Tomography, X-Ray Computed/methods , Wrist Injuries/diagnostic imaging , Adult , Aged , Casts, Surgical , Cohort Studies , Female , Follow-Up Studies , Fracture Fixation/methods , Fracture Healing/physiology , Humans , Injury Severity Score , Male , Middle Aged , Sensitivity and Specificity , Treatment Outcome , Wrist Injuries/therapy
18.
Eur J Surg ; 165(9): 855-60, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10533761

ABSTRACT

OBJECTIVE: To evaluate the long term results of Mason's vertical banded gastroplasty (VBG) using accepted criteria, and to find out which factors predicted success. DESIGN: Retrospective survey of a cohort of 40 severely obese patients (mean initial body mass index (BMI in kg/m2): 43, range 34-62). SETTING: General teaching hospital, The Netherlands. MAIN OUTCOME MEASURES: Success according to three definitions: weight loss of more than 25%; percentage of excess weight 50% or less; and BMI < 30. RESULTS: Mean follow-up was 7.4 years (range 0.5-10) or 85%. The distribution over MacLean and Reinhold criteria shows a shift towards unfavourable categories. The consecutive percentages of success at five years were 35%, 62%, and 35%. Logistic regression analysis of success at 5 years shows that the following factors significantly predicted success: Definition I: age odds ratio (95% confidence interval): 0.88 (0.78 to 0.99). Definition II: age: 0.84 (0.69-1.01), outlet > or = 5 cm: 176 (2.4 to 12774), percentage of ideal weight > or = 100%: 0.03 (0.002 to 0.48). Definition III: age: 0.86 (0.75 to 0.99), pouch size > or = 15 ml: 10.64 (1.48 to 76.6). CONCLUSION: The long term results of VBG are disappointing when assessed by the standard criteria.


Subject(s)
Gastroplasty , Adult , Body Mass Index , Body Weight , Cohort Studies , Female , Follow-Up Studies , Gastroplasty/methods , Gastroplasty/statistics & numerical data , Humans , Male , Retrospective Studies , Time Factors , Treatment Outcome , Weight Loss
19.
Dig Surg ; 16(2): 107-10, 1999.
Article in English | MEDLINE | ID: mdl-10207235

ABSTRACT

BACKGROUND: Kuzmak developed a horizontal gastroplasty for morbid obesity using his adjustable silicone gastric banding (ASGB). The aim of this study was to evaluate the efficiency at weight loss, early and late morbidity and mortality. METHOD: The records of 44 patients (mean age 36 years) were reviewed. The indication for ASGB was a BMI >40 (group A = 37 patients) or a BMI between 35 and 40 with obesity-related morbidity (group B = 7 patients). The mean preoperative BMI was 44 (+/-5). The paired t test was used to evaluate the BMI. RESULTS: Early complications occurred in 5 patients: splenic injury (n = 1), aspiration pneumonia (n = 1), wound infection (n = 1), gastric perforation (n = 2); mortality was 2%. Late complications occurred in 19 patients: 17 patients (39%) had a functional stenosis with pouch dilatation (FSPD) and 6 patients had an injection port leakage (14%). At the 1-year follow-up, the mean BMI (of the 39 patients available) was 30 (+/-5) and remained stable. At 36 months, 54% of group A and 100% of group B had a BMI <30. CONCLUSION: The original technique of Kuzmak is effective to lose weight. However the technique must be adjusted in order to decrease the unacceptable high incidence of FSPD.


Subject(s)
Gastroplasty/methods , Obesity, Morbid/surgery , Silicones , Adult , Female , Follow-Up Studies , Gastroplasty/adverse effects , Humans , Male , Middle Aged , Obesity, Morbid/diagnosis , Patient Satisfaction , Treatment Outcome , Weight Loss
20.
Lancet ; 354(9195): 2025-8, 1999 Dec 11.
Article in English | MEDLINE | ID: mdl-10636366

ABSTRACT

BACKGROUND: The pathogenesis of reflex sympathetic dystrophy (RSD) is not clear, nor is there a definitive treatment for this syndrome. The morbidity, costs in health care, and loss of work time justify the search for a means to prevent post-traumatic dystrophy. Although the role of toxic oxygen radicals has not yet been clarified, we investigated vitamin C (ascorbic acid) as a prophylactic antioxidant drug. METHODS: 123 adults with 127 conservatively treated wrist fractures were randomly allocated in a double-blind trial to take a capsule of 500 mg vitamin C or placebo daily for 50 days. Each participant's sex, age, side of fracture, dominance, fracture type, dislocation, reduction, and complaints with the plaster cast were recorded, and they were clinically scored for RSD. The follow-up lasted 1 year. FINDINGS: Eight patients were withdrawn after randomisation. 52 patients with 54 fractures (male 22%, female 78%; mean age 57 years) received vitamin C and 63 patients with 65 fractures (male 20%, female 80%; mean age 60 years) received placebo. RSD occurred in four (7%) wrists in the vitamin C group and 14 (22%) in the placebo group 15% (95% CI for differences 2-26). Other significant prognostic variables for the occurrence of RSD were complaints while wearing the cast (relative risk 0.17 [0.07-0.41]) and fracture type (0.37 [0.16-0.89]). INTERPRETATION: This prospective, double-blind study shows that vitamin C was associated with a lower risk of RSD after wrist fractures. Our hypothesis is that this beneficial effect of prophylaxis would be useful in other forms of trauma.


Subject(s)
Antioxidants/administration & dosage , Ascorbic Acid/administration & dosage , Fractures, Bone/complications , Reflex Sympathetic Dystrophy/prevention & control , Wrist Injuries/complications , Adult , Aged , Aged, 80 and over , Antioxidants/adverse effects , Ascorbic Acid/adverse effects , Casts, Surgical , Female , Fracture Healing/drug effects , Fractures, Bone/therapy , Humans , Male , Middle Aged , Reflex Sympathetic Dystrophy/etiology , Wrist Injuries/therapy
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