Exercises may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4-8-years' follow-up in a prospective, randomized study.

OBJECTIVES: To compare the prognosis of subacromial impingement (SAI) stage II treated conservatively or with subacromial decompression. METHODS: A follow-up study after 4-8 years in a randomized controlled trial (RCT) with 90 adult cases with SAI treated in a Danish hospital from 1996 to 2000 with graded physiotherapy and exercises or arthroscopic subacromial decompression. Outcomes were proportion of time per year with income transfers (indexed 0-1), including total transfers (marginalization), sick leave and disability pension obtained from the registry at the Ministry of Work. Self-reported function, working capability, employment status and global improvement were obtained by questionnaire in September 2004. The main outcomes are given as differences in development from baseline. RESULTS: Seventy-nine (88%) responded to the questionnaire and registry data were obtained from 81. After 1 year the marginalization index increased by 0.45 [95% confidence interval (CI) 0.35-0.56] for surgery and 0.25 (0.16-0.34) for physiotherapy. Cases undergoing surgery also tended to have more sick payments during the first year, but the difference was not significant. Four years after inclusion, changes in indices did not differ between treatment groups. Self-reported outcomes after 4-8 years did not differ between treatment groups. CONCLUSION: The results of surgical decompression were equal to those of conservative treatment, and the surgery group had more income transferrals during the first year of follow-up.

Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up.

OBJECTIVES: To compare the effect of graded physiotherapeutic training of the rotator cuff versus arthroscopic subacromial decompression in patients with subacromial impingement. METHODS: Randomised controlled trial with 12 months' follow up in a hospital setting. Ninety consecutive patients aged 18 to 55 years were enrolled. Symptom duration was between six months and three years. All fulfilled a set of diagnostic criteria for rotator cuff disease, including a positive impingement sign. Patients were randomised either to arthroscopic subacromial decompression, or to physiotherapy with exercises aiming at strengthening the stabilisers and decompressors of the shoulder. Outcome was shoulder function as measured by the Constant score and a pain and dysfunction score. "Intention to treat" analysis was used, with comparison of means and control of confounding variables by general equation estimation analysis. RESULTS: Of 90 patients enrolled, 84 completed follow up (41 in the surgery group, 43 in the training group). The mean Constant score at baseline was 34.8 in the training group and 33.7 in the surgery group. After 12 months the mean scores improved to 57.0 and 52.7, respectively, the difference being non-significant. No group differences in mean pain and dysfunction score improvement were found. CONCLUSIONS: Surgical treatment of rotator cuff syndrome with subacromial impingement was not superior to physiotherapy with training. Further studies are needed to qualify treatment choice decisions, and it is recommended that samples are stratified according to disability level.

Prognostic factors in lateral epicondylitis: a randomized trial with one-year follow-up in 266 new cases treated with minimal occupational intervention or the usual approach in general practice.

OBJECTIVES: To determine whether minimal intervention by occupational specialists involving information about the disorder, encouragement to stay active and instruction in graded self-performed exercises could enhance the prognosis of lateral epicondylitis compared with the treatment usually given in general practice, to quantify workplace factors associated with the prognosis, and to consider treatments given in general practice. METHODS: A randomized controlled trial was performed in a cohort of 266 consecutive new cases of lateral epicondylitis diagnosed in general practice. Workplace factors were assessed with questionnaires at the time of inclusion, and patients completed follow-ups at 3, 6 and 12 months. Status at 1 yr was assessed as overall improvement and pain reduction compared with the time of diagnosis. General practitioners (GPs) registered the treatments given for both cases and controls during follow-up. Numbers of contacts with GPs and physiotherapists were obtained from the National Health Insurance registry. Prognostic factors were analysed by multiple logistic regression analysis. RESULTS: After 1 yr, 83% of cases showed improvement in the condition, but the intervention was found to have had no advantage. Poor overall improvement was associated with employment in manual jobs [odds ratio (OR) 3.0, 95% confidence interval (CI) 1.0-8.7], a high level of physical strain at work (OR 8.5, CI 1.0-74.7) and a high level of pain at baseline (OR 2.3, CI 1.0-5.3). Pain reduction less than 50% was associated with manual jobs (OR 2.3, CI 1.1-5.1), high physical strain at work (OR 3.6, CI 1.0-12.9), high baseline distress (OR 1.9, CI 1.0-4.0) and tennis elbow on the dominant side (OR 3.1, CI 1.4-6.8). The intervention group received less treatment and fewer treatment modalities, but the intervention was not followed by a reduction in the number of visits to GPs and physiotherapist clinics during 12 months of follow-up. CONCLUSIONS: Poor prognosis at 1 yr of follow-up for lateral epicondylitis was related to manual work and high baseline pain, whilst no relation was found between the type of medical treatment given/chosen and prognosis. This may have implications for the future management of lateral epicondylitis in terms of a greater focus on interaction with the workplace regarding job modification to reduce physical demands during recovery.

Physical and psychosocial risk factors for lateral epicondylitis: a population based case-referent study.

AIMS: To assess the importance of physical and psychosocial risk factors for lateral epicondylitis (tennis elbow). METHODS: Case-referent study of 267 new cases of tennis elbow and 388 referents from the background population enrolled from general practices in Ringkjoebing County, Denmark. RESULTS: Manual job tasks were associated with tennis elbow (odds ratio (OR) 3.1, 95% confidence interval (CI) 1.9 to 5.1). The self reported physical risk factors "posture" and "forceful work" were related to tennis elbow. Among women, work involving performing repeated movements of the arms was related to tennis elbow (OR 3.7, CI 1.7 to 8.3). Among men, work with precision demanding movements was related to tennis elbow (OR 5.2, CI 1.5 to 17.9). Among both males and females, the results for work with hand held vibrating tools were inconsistent, partly because of few exposed subjects. A physical strain index was established based on posture, repetition, and force. The adjusted ORs for tennis elbow at low, medium, and high strain were 1.4 (CI 0.8 to 2.7), 2.0 (CI 1.1 to 3.7), and 4.4 (CI 2.3 to 8.7). Low social support at work, adjusted for physical strain, was a risk factor among women (OR 2.4, CI 1.3 to 4.6). CONCLUSION: Results indicate that being a new case of tennis elbow is associated with non-neutral postures of hands and arms, use of heavy hand held tools, and high physical strain measured as a combination of forceful work, non-neutral posture of hands and arms, and repetition. Furthermore, tennis elbow among women was associated with low social support at work. The results for precision demanding movements and for vibration were less consistent.

[Infantile hypertrophic pyloric stenosis. Decreasing incidence]. / Infantil hypertrofisk pylorusstenose. Faldende incidens.

The aim of this study was to confirm a clinical suspicion that the frequency of this disease is in decline. A retrospective review of case notes of all children admitted and operated in all hospitals in Viborg County during the period of 1.1.1973 to 31.12.1997 was performed. The local survey was supplemented with a national survey. One hundred and forty-seven patients from Viborg County were operated for infantile hypertrophic pyloric stenosis during the period described. Divided into five year periods the number per 1000 living births was consecutively 1.6, 2.4, 2.0, 2.8 and 0.9. The same tendency was found nationally, Table 1. The decrease started in 1993 and has since strengthened. The reason is unknown, but there is a relation regarding to the timing of a change in recommendations concerning positioning of infants during sleep. However, a causal relation is unknown.

Infantile hypertrophic pyloric stenosis. Decreasing incidence.

INTRODUCTION: The study aimed to prove or disprove a clinical suspicion of a decreasing frequency of pyloric stenosis. METHOD: Retrospective review of hospital records of all children operated for pyloric stenosis in the hospitals of the County of Viborg from 1 January 1973 to 31 December 1997. This regional review was supplemented by a nationwide study, in which the National Registry of Patients was searched for the diagnosis number and the operation code of pyloric stenosis during the period 1 January 1977 to 31 December 1997. RESULTS: One hundred and forty-seven children were operated for infantile hypertrophic pyloric stenosis in Viborg County during the period in question. When calculated in five-year periods, the respective numbers per 1000 liveborn children were: 1.6, 2.4, 2.0, 2.8, and 0.9. Only one child was operated per year during 1996 and 1997, compared with an average of seven children annually during the preceding 20 years. The same tendency was found in the nationwide study. Until 1993 an average of 160 children were operated per year, i.e. 2.2 to 3.2 per 1000 liveborn children. From 1993-1997 inclusive the number decreased to 1.4. In 1996 and 1997, respectively, 75 and 76 children were operated, i.e. 1.1 per 1000 liveborn children. CONCLUSION: There has been a significant decrease in the incidence of children with infantile hypertrophic pyloric stenosis, both in the County of Viborg and in the whole of Denmark. The decrease, which started in 1993, has for unknown reasons continued to accelerate ever since. The decrease coincides with changing recommendations concerning the positioning of infants during sleep, but a causal connection is uncertain.

[Epoxy in occupational environment--an old acquaintance in a new dress]. / Epoxy i arbejdsmiljøet--en gammel kending i nye klae'r.

This article describes a cluster of epoxy related contact dermatitis in a glassfibre reinforcement plant, using mostly preimpregnated epoxylaminate (Pre-Preg), but also fluid epoxy-products. An occupational medical and dermatological examination revealed nine of 26 cases as allergic contact eczema, 14 as toxic epoxyrelated eczema and three cases of other non-occupationally related skin diseases. The plant uses seven different epoxyresins with 15 epoxyhardeners. Preventive measures were gradually improved, but even then it was difficult to rule the production into safe procedures with this potent allergen used in large scale production of windmill wings.

[Prognosis of children with very low birth weight in the county of Viborg. A follow-up of an unselected patient group]. / Prognosen for børn med meget lav fødselsvaegt i Viborg amt. Efterundersøgelse af en uselekteret patientgruppe.

Neonatal mortality and follow-up examination among children with birthweight < or = 1500 g born in the period 1983-1987 inclusive has been recorded in an unselected material from a Danish county (Viborg County). There were 100 with birthweight < or = 1500 g and the low-birthweight rate was 7/1000. The neonatal survival was 72% dispersed with 32% for children with birthweight < or = 1000 g and 90% for children with birthweight 1001-1500 g. Four children died before follow-up examination. Of the surviving 68 children 66 were examined between the ages 21 months to six and a half years, the average age being about three years. The test-results were based on a questionnaire to the parents, an objective examination including neuropaediatric assessment and a Denver developmental screening test. Seven children were found to have moderate to severe handicaps, equal to 10% of surviving children. Of these seven children, three (4.5%) have cerebral paresis. Five other children were found to have small "handicaps". In conclusion 12 children or 18% had varying degrees of disability while 54 children were without demonstrable disability at follow up examination.

Thyroxine-binding globulin deficiency in early childhood. Postnatal changes in serum concentrations of thyroid hormones and thyroid hormone-binding proteins.

Serial determinations of serum thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH), thyroid hormone-binding globulin (TBG), prealbumin (TBPA) and albumin were performed in a euthyroid girl with TBG deficiency and in her mother for a period of 22 months after delivery. At 8 days old the child had a serum TBG concentration around 50% of normal level which remained essentially unchanged during infancy. Total serum T4 and T3 concentrations were low, the free serum T4, free serum T3 and serum TSH concentrations were normal. The mother had received thyroid hormone from the age of 15 years. Her serum TBG level at 6 weeks post partum was similar to that of non-pregnant adults but decreased to about 50% of normal level, indicating a TBG deficiency. She remained euthyroid after withdrawal of T4 therapy. Serum TBPA and albumin concentration were normal in mother and child. An X-linked inheritance of the TBG deficiency was suggested from a study of the family.

Chromosome variants in children referred for cytogenetic examination from two paediatric departments during a 12-year-period.

The present study deals with frequency and clinical signs of children with chromosome variants. Previous studies of the possible effect of different chromosome variants on phenotype and risk of congenital abnormalities are controversial.

Fragile site long arm chromosome 16.

A fragile site at the long arms (q21) of chromosome 16 was found in two persons, each of whom became the parent of a child with a de novo structural chromosome abnormality--a balanced autosomal translocation and an autosomal deletion. The question of an increased risk of structural chromosome abnormalities in the offspring of persons with fragile site long arm 16 is discussed.

Prevalence of Edwards' syndrome. Clustering and seasonal variation?

The incidence of Edwards' syndrome was found to be 1 per 4857 newborn children of 34000 consecutively newborn children in two Danish counties. Six of the 7 cases were born during the months of February through April. The incidence was high compared with the expected incidence of Edwards' syndrome of approximately 1 per 10000. This might be due to clustering in the area studied during the period 1967 to 1973. The finding of variations in incidence of children with Edwards' syndrome in different parts of the world, as well as the finding of seasonal variation in birth of such children, indicates that some of the etiological factors of nondisjunction of chromosome 18 are of an environmental nature.