Long-term follow-up of patients >or=60 yr old with acute myeloid leukaemia treated with intensive chemotherapy.

It is still controversial how to treat elderly patients with acute myeloid leukaemia (AML), and results have been poor with most regimens. We report the long-term results of a randomised study performed by the Leukaemia Group of Middle Sweden during 1984-88 comparing two intensive chemotherapeutic drug combinations. Ninety patients >or=60-yr old with untreated AML were randomly allocated to treatment with daunorubicin, cytosine arabinoside (ara-C), and thioguanine (TAD) (43 patients) or a combination in which aclarubicin was substituted for daunorubicin (TAA) (47 patients). Forty-four patients (49%) entered complete remission (CR), 22/43 (51%) in the TAD group and 22/47 (47%) in the TAA group (ns). The CR rate in patients 70 yr 14/48 (29%) (P<0.0001). Early death within 30 d after treatment initiation was more often seen in patients >70 yr than in patients or=10 yr after inclusion of the last patient, 5/90 patients (one in the TAD group and four in the TAA group, respectively) were still alive, four in continuous complete remission and one in second complete remission. Thus, both treatment regimens appear to have similar efficacy, with a relatively high complete remission rate, and a reasonable survival as compared to other studies including some long-term survivors. However, early deaths are still numerous, particularly in patients above 70 yr of age, and the relapse rate is substantial.

A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test.

STUDY DESIGN: The standing hip flexion test was evaluated by using a radiostereometric analysis. OBJECTIVES: To evaluate whether the commonly used standing hip flexion test reflects movement in the sacroiliac joints, or whether the increased load of one sacroiliac joint also reduces the mobility of the other sacroiliac joint according to the theory of form and form closure in the sacroiliac joints. SUMMARY OF BACKGROUND DATA: The standing hip flexion test, used frequently to analyze sacroiliac joint mobility, is advocated as a test for study of normal or impaired motion in the sacroiliac joint. METHODS: In this study, 22 patients considered to have sacroiliac pain were analyzed with radiostereometric analysis when standing and when performing the standing hip flexion test on the right and left sides. RESULTS: Very small movements were registered in the sacroiliac joints. When provoking one side, the rotations were small on both sides. CONCLUSIONS: The small movements registered support the theory of form and force closure in the sacroiliac joints. The self-locking mechanism that goes into effect when the pelvis is loaded in a one-leg standing position probably obstructs the movements in the sacroiliac joints. Therefore, the standing hip flexion test cannot be recommended as a diagnostic tool for evaluating joint motion in the sacroiliac joints.

A radiostereometric analysis of the movements of the sacroiliac joints in the reciprocal straddle position.

STUDY DESIGN: A Radiostereometric analysis of the reciprocal straddle position. OBJECTIVES: To evaluate the magnitude of rotation in the sacroiliac joints in the reciprocal straddle position. SUMMARY OF BACKGROUND DATA: The reciprocal straddle position has been objectified in different studies, using different techniques, to show a sacroiliac motion between 5 degrees and 36 degrees. Previous studies with radiostereometric analysis during different provocations reported much smaller movements. METHODS: Six women with posterior pelvic pain of long duration after pregnancy (n = 5) and sacroiliitis (n = 1) underwent radiostereometric analysis in the sustained reciprocal straddle position. RESULTS: A reciprocal movement could be demonstrated in the sacroiliac joints in the reciprocal straddle position. However, the movements were 10 times smaller than reported in earlier studies of the reciprocal straddle position. CONCLUSIONS: It was possible to demonstrate reciprocal movements of the sacroiliac joints in the straddle position. However, the radiostereometric analysis technique showed the movements to be small, as reported in other mobility studies.

Can an external frame fixation reduce the movements in the sacroiliac joint? A radiostereometric analysis of 10 patients.

To evaluate whether a Hoffmann-Slätis frame can reduce movements in the sacroiliac joints, 10 patients (7 women) with severe posterior pelvic pain of long duration were externally stabilized. The movements were analyzed with radiostereometric analysis (RSA) in supine and standing positions, preoperatively and postoperatively with the frame applied. In 2 patients, there was no reduction in the movements with the frame, perhaps because it was not properly tightened. In the remaining 8 patients, the median reduction in rotation was 55% on the left side and 63% on the right side around the helical axes, and 74% around the x-axes on the left side and 66% on the right side. Our data suggest that external fixation using the Hoffmann-Slätis frame, substantially reduces sacroiliac joint mobility in some patients, which must be considered when using the frame as a diagnostic tool. Pre-stressing the frame by tightening the vertical bars before the compression bar is applied is recommended to reduce the risk of this shortcoming.

Pain pattern in pregnancy and "catching" of the leg in pregnant women with posterior pelvic pain.

STUDY DESIGN: A cross-sectional study of symptoms and signs in pregnant women. OBJECTIVES: To describe the clinical appearance of back pain in pregnancy and the relation between pain distribution and symptoms in women with posterior pelvic pain, in order to shed light on etiologic factors. SUMMARY OF BACKGROUND DATA: Back pain is common in the general population. During pregnancy, it is even more common, and back pain is experienced by about 50% of pregnant women. In the pregnant woman, differentiation between common low back pain and posterior pelvic pain is believed to be essential because these symptoms should be treated in different ways. METHODS: The women were interviewed with a questionnaire. Those with back symptoms completed a pain drawing and were examined by an orthopedic surgeon. Based on the symptoms and findings, the women were divided into three groups: thoracic pain, lumbar pain, and posterior pelvic pain. RESULTS: Of 335 pregnant women, 51% had back pain at the time of examination. The pain was more widespread compared with common low back pain. Seventy-one percent of the 171 patients examined by the orthopedic surgeon had a positive posterior pelvic pain test. These women more often had pain in the gluteal and posterior thigh regions. A "catching" feeling of the leg was described when walking by 44 of 122 these women, whereas only 1 of 49 women without a posterior pelvic pain test had such symptoms. CONCLUSIONS: The higher prevalence of back pain in pregnancy may be due to several factors. In women with posterior pelvic pain, there is a specific symptom-a catching of the leg when walking. The most probable explanation for the catching is that local nociception disturbs muscular function in women with posterior pelvic pain because changes in the sacroiliac joint range of motion, which is very small, cannot cause this symptom.

Intensive treatment in order to minimize the Ph-positive clone in CML. Danish-Swedish CML Group.

With the rationale that a significant reduction of the malignant clone in CML might prolong time to metamorphosis, intensive treatment was given to patients < or = 55 years. Six months of hydroxyurea and high dose interferon-alpha (IFN-alpha) was followed by one to three courses of intensive chemotherapy. Patients who had a donor were allotransplanted and patients who became Ph-negative in bone marrow were autotransplanted. On 1 May 1995, 160 patients were registered in the study. Fifty-one percent of the patients who received six months IFN-alpha and hydroxyurea had a significant Ph-reduction and 5% became Ph-negative. The corresponding figures after two intensive chemotherapy courses were 47 and 28%, respectively. Twenty-seven of 30 autotransplanted patients have been analysed for Ph. Seventeen have relapsed cytogenetically, while ten are Ph-negative 1-64 + months after ABMT. BMT was performed in 59 patients. The actuarial 6-year survival from diagnosis of all 160 registered patients is 68%, which seems to be better than for age-matched historical controls.

Specified diagnosis in 532 cases of back pain.

In the city of Malmö, Sweden, a project was started to improve the rehabilitation of patients with back pain. Among 532 patients with back pain who were on sick leave for an average of 98 days the year preceding the consultation, very few specific diagnoses were made in spite of a thorough clinical and radiological examination. Only five of the patients were cured by surgery. During the same period 103 patients were operated on for disc herniation or nerve root stenosis at the Orthopaedic Department at Malmö General Hospital. Thus the routines for somatic diagnosis of the medical service in Malmö are adequate and an improvement would have very little effect on the expenditures for sick leave and early retirement. As suggested in this paper social and psychological factors are of greater importance in the rehabilitation and we should focus less on the physical problems of the patient.

The impact of intra-uterine factors on neonatal hip instability. An analysis of 1,059,479 children in Norway.

The records of the Medical Birth Registry of Norway from 1970 through 1988 contain information on maternal health, course of delivery and health of 1,059,479 newborns. The overall prevalence at birth of neonatal hip instability (NHI) was 0.9 percent: 0.6 percent in boys and 1.4 percent in girls. In breech presentation, the rate was 4.4 percent. In vaginally delivered children, the rate was only marginally higher compared to those delivered by cesarean section. In children with a birthweight less than 2,500 g, the rate was 0.3 percent. In vertex presentation, the duration of pregnancy had no influence in boys whilst, in breech presentation, the prevalence increased up to the 39th week of gestation. In girls, the NHI rate increased with the duration of gestation, particularly in breech presentation. In first-born children, these patterns were even more obvious. The data are consistent with a hypothesis that intra-uterine mechanical factors, in combination with hormonal factors, are of importance rather than the actual trauma of vaginal delivery.

Direct ultrasonographic measurement of femoral anteversion in newborns.

A direct method of ultrasonographic measurement of the anteversion angle of the femoral neck is presented. Normal values based on measurements in 30 random newborns with vertex presentation correspond well with figures from previous autopsy series. The femoral anteversion in breech presentation was found to be on average 10 degrees greater than in vertex presentation (p < 0.0001).

Intensive treatment in order to minimize the Ph-positive clone in chronic myelogenic leukemia.

Several studies indicate that interferon (IFN) treatment, intensive chemotherapy and autologous bone marrow transplantation (ABMT) effectively reduce the Ph-positive clone in Chronic Myelogenic Leukemia (CML). In the present study on patients < or = 55 years, we have combined these three treatment modalities. The aim of the study was to eliminate or minimize the Ph-positive clone to see whether a status of minimal residual or Ph-negative disease could be maintained for a longer period of time. After diagnosis, patients received interferon (IFN-a-2b) and hydroxyurea (HU) to keep the white blood cell (WBC) and platelet count below 2-4 and 100-150 x 10(9)/l, respectively. After six months of treatment, Ph-analysis was performed. Patients with Ph-positive cells in bone marrow then received 1-3 courses of intensive chemotherapy. In patients Ph-negative after two courses, bone marrow was harvested and used for ABMT. After a third course, patients with up to 50% Ph-positive metaphases were accepted for ABMT. As of January 1, 1993, 97 patients were registered in the study. Six months of IFN+HU reduced the percentage of Ph-positive metaphases in 57% of the patients (7% became Ph-negative). The corresponding figures after two intensive cytotherapies were 70% (40% Ph-negative). Eighteen patients were autotransplanted. Seven have relapsed with Ph-positivity 3-22 months after ABMT, while nine are Ph-negative at 1-32+ months after ABMT (two not yet analyzed). Seventeen patients are alive and well, while one died one month after ABMT due to interstitial pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of effusion on hip joint stability in the newborn. A postmortal study.

In a postmortal study we found that 1 mL fluid injected through the triradiate cartilage into the hip joint of a newborn child was enough to cause instability. This instability persisted even after aspiration of the fluid. The findings were confirmed by ultrasonography.

The von Rosen splint compared with the Frejka pillow. A study of 408 neonatally unstable hips.

101 children in Tromsö, Norway, treated with the Frejka pillow for 4.5 months because of neonatal hip instability (NHI) were compared with 307 children in Malmö, Sweden, treated with the von Rosen splint for 3 months. The pelvic radiographs, taken when the treatment was terminated, were assessed by the acetabular index (AI) and the cases of failure were evaluated. The AI showed no difference between the two groups. The Frejka group had 4 patients who received further treatment because of remaining acetabular dysplasia and/or subluxation while the von Rosen group had none. The difference in risk of failure might partly be explained by different criteria for failure.

The natural course of lumbar spinal stenosis.

The course of 32 untreated patients with spinal stenosis was studied. The mean patient age was 60 years, and the mean period of observation was 49 months. About 75% of the patients had spinal claudication. In the follow-up survey, the same number of patients had claudication, but the symptoms were milder. In estimation by visual analog scale, symptoms in 70% of the cases were unchanged, 15% showed improvement, and 15% worsened. No proof of severe deterioration was found after four years, and expectant observation may be an alternative to surgical treatment.