Efficacy and safety of prolonged thromboprophylaxis with a low molecular weight heparin (dalteparin) after total hip arthroplasty--the Danish Prolonged Prophylaxis (DaPP) Study.

The aim of this study was to compare the efficacy and safety of prolonged (35 days) thromboprophylaxis with a standard length (7 days) regimen of a low molecular weight heparin in patients undergoing total hip arthroplasty. The study was multicentre, randomised, double-blind, and prospective with two groups. Following seven days on a standard length regimen of dalteparin (5000 antifactor Xa units subcutaneously once daily starting 12 h before surgery), patients were randomized to continue the prophylaxis with either subcutaneous injections of dalteparin or placebo injections for a further 28 days. Efficacy was evaluated at the end of the study (day 35) in all patients with bilateral ascending phlebography to detect deep vein thrombosis. Bleeding complications and other adverse events were registered throughout the study period. Three hundred consecutive patients agreed to participate before the operation: 281 were finally randomised and 215 completed the study; two patients died before randomisation; 17 developed deep vein thrombosis; none developed pulmonary embolism; and five of 113 patients (4.4%, 95% CI 1-10%) developed deep vein thrombosis in the dalteparin group, compared with 12 of 102 (11.8%; 95% CI 6-20%) in the placebo group (p=0.039). Deep vein thrombosis in the proximal veins was diagnosed in one patient (0.9%; 95% CI 0-5%) in the dalteparin group, and in five (5.0%; 95% CI 2-11%) in the placebo group (p=0.076). Major bleeding was observed in one patient in the placebo group; minor bleeding complications and adverse events were equally distributed between the groups. We concluded that prolonged (35 days) thrombo prophylaxis with dalteparin is more effective than a standard length (7 days) regimen without increased risk of bleeding complications or other adverse events.

[Referrals to an emergency unit before and after changes in the practitioner-on-call system]. / Skadestuehenvendelser før og efter aendring af vagtlaegeordningen.

Attendance at the casualty department of the Central Hospital in Naestved was investigated during two similar periods before and after changes were made in the practitioner-on-call system. The total number of patients admitted (either via casualty or referred from a practitioner) were registered. A total of 4454 attendances took place during the two periods, 2330 of these being before the changes and 2123 after the changes in the practitioner-on-call system. In the present material there were 1673 orthopaedic and 136 medical patients before and 1552 orthopaedic and 133 medical patients after the reorganization. No changes in medical specialities of the attendances in the two periods could be pointed out. 2110 patients were admitted to hospital in the first period, 2299 in the second period. The study concludes that no changes in the pattern of attendance at the casualty department could be shown after the reorganization in general practice.

[Overlooked posterior shoulder dislocation]. / Overset posterior skulderluksation.

Posterior dislocation of the shoulder is frequently overlooked. Early diagnosis is a prerequisite for successful treatment. Supplementary axillary or apical oblique projections should be included in the routine radiograms to confirm the diagnosis.

Intra-articular bupivacaine plus adrenaline for arthroscopic surgery of the knee.

The purpose of the study was to evaluate three different doses of intra-articular bupivacaine plus adrenaline in relation to per- and postoperative pain relief following arthroscopy. Sixty patients were allocated to three groups of 20 patients each scheduled for arthroscopy. They were randomized prospectively to receive bupivacaine plus adrenaline 25 mg + 50 micrograms, 50 mg + 100 micrograms, 75 mg + 150 micrograms, respectively, diluted to a volume of 30 ml. Four patients were excluded because the operation could not be carried out under intra-articular analgesia, 18 patients had a diagnostic arthroscopy and 38 patients had different arthroscopic operations performed. The number of patients scoring pain in the knee as moderate or severe was less in Group 3 than in the other two groups, i.e. the highest dose had a better pain relief. No adverse effects were registered. With respect to per- or postoperative administration of analgesics, postoperative pain occurrence, and the surgeon's acceptance of the method, there were no statistically significant differences. Ninety-two percent of the patients would prefer intraarticular analgesia if they should need to have another arthroscopy performed.

[Conservative treatment of the knee with stable hemarthrosis]. / Konservativ behandling af det stabile haemarthronknae.

Follow-up examination of 27 patients nine years after conservative treatment for traumatic haemarthromatous knees with stable ligaments revealed that the injuries which should have been anticipated very frequently, according to other authors, were only found in one patient, viz lesion of the anterior cruciate ligament. Two patients had undergone operative treatment for menicsal lesions which may have been related to the primary injury. The delayed treatment had not resulted in arthrosis or other permanent sequelae. Expectant treatment with arthroscopy appears to be justified in cases of traumatic haemarthroma of the knee in patients in whom the ligaments have been demonstrated to be stable at repeated clinical examinations.

[Evaluation of clinical tests in meniscal injuries]. / Evaluering af kliniske menisktest.

The values of clinical tests in general use were calculated in a group of patients who were not selected in advance as suffering from meniscal damage. Arthroscopic examination was employed to control the diagnosis. Employing Smillie's, Bragard's and McMurrays's tests, it was possible to exclude meniscal lesions with 75-95% probability and these could be demonstrated with 25-60% probability. Böhler's test was not correlated significantly with meniscal lesions and the true positive nosographic frequency of Apley's and Jones' tests were so low that their value was limited.

Cribriform diaphragm: a variant of congenital diaphragmatic herniation. A case report.

Herniation through a "cribriform" diaphragm was incidentally detected in a 65-year-old woman. Liver tissue protruding into the right hemithorax showed signs of strangulation. The defects were surgically corrected. The condition presumably was an extremely rare variant of congenital diaphragmatic hernia.