Danish translation and validation of the Self-reported foot and ankle score (SEFAS) in patients with ankle related fractures.

BACKGROUND: The Self-reported Foot and Ankle Score (SEFAS) is a patient-reported outcome measure used to evaluate foot and ankle disorders. The purpose of this study was to translate, cross-culturally adapt and validate the Danish language version of the SEFAS in patients with ankle-related fractures. METHODS: Forward-backward translation, cross-cultural adaption and validation were performed. In total, 125 patients completed the SEFAS-DK and the Danish version of American Orthopaedic Foot and Ankle Score (AOFAS-DK) at three time points after the date of fracture. The evaluation was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. RESULTS: The intra-class correlation coefficient (ICC) level of the SEFAS-DK total score was 0.93 (95% confidence interval [CI]: 0.88-0.96). Cronbach's alpha (CA) for the SEFAS-DK was 0.93, while the floor and ceiling effect at week 6 post-injury was 22.4%. Construct validity was correlated with the AOFAS, and >75% of the pre-defined hypotheses could be confirmed. Responsiveness was analysed using longitudinal data. The minimal clinical important change (MCIC) showed that the SEFAS-DK detects changes in physical function over time. CONCLUSION: The Danish version of the SEFAS showed overall good reliability, validity and responsiveness. SEFAS-DK can be used to evaluate physical function in patients with ankle-related fractures. LEVEL OF EVIDENCE: level II, prospective cohort study.

T cells isolated from patients with checkpoint inhibitor-resistant melanoma are functional and can mediate tumor regression.

Background: Almost half of the patients with metastatic melanoma obtain only short-term or no benefit at all from checkpoint inhibitor (CPI) immunotherapy. In this study, we investigated whether the immune system of patients progressing following CPI treatment was able to generate functional tumor-specific immune responses. Materials and methods: Tumor-infiltrating lymphocytes (TILs) were isolated and expanded from metastatic melanoma lesions which progressed during or after anti-programmed cell death protein 1 (PD)-1 and anti-Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) treatment. Tumor-specific immune responses were assessed with co-culture assays of TILs and autologous tumor cells. Results: TILs from 23 metastases of individual patients could be assessed for T cells recognition of autologous tumor cells. All metastases were progressive on or following anti-PD-1 (23/23, 100%), and the majority also after anti-CTLA-4 (17/23, 74%). Functional antitumor immune responses were detected in 19/23 patients (83%). Both CD8+ (in 18/23 patients, 78%) and CD4+ (in 16/23 patients, 70%) TILs were able to recognize autologous tumors. A large fraction of CD8+ TILs (median 23%, range 1.0%-84%) recognized tumor cells. This is similar to the cohorts of unselected patient populations with metastatic melanoma presented in previous studies. The localization of intratumoral immune infiltrates was heterogeneous among samples. In a phase I/II clinical trial, TILs were administered with lymphodepleting chemotherapy, pegIFNα2b and interleukin-2 to 12 patients with CPI-resistant melanoma. Out of 12 patients who previously failed CPI therapy, treatment with TILs resulted in two partial responses, of which one is ongoing. Conclusions: Tumor-reactive T cells appear to heavily infiltrate the tumor microenvironment of patients who failed previous CPI treatment. These patients can still respond to an infusion of unselected autologous TILs. Our results warrant further testing of novel immune re-activation strategies in melanoma patients who failed multiple CPI therapy.

Hydration shells exchange charge with their protein.

Investigation of the interaction between a protein and its hydration shells is an experimental and theoretical challenge. Here, we used ultrasonic pressure waves in aqueous solutions of a protein to explore the conformational states of the protein and its interaction with its hydration shells. In our experiments, the amplitude of an ultrasonic pressure wave is gradually increased (0-20 atm) while we simultaneously measure the Raman spectra from the hydrated protein (ß-lactoglobulin and lysozyme). We detected two types of spectral changes: first, up to 70% increase in the intensity of the fluorescence background of the Raman spectrum with a typical relaxation time of 30-45 min. Second, we detect changes in the vibrational Raman spectra. To clarify these results we conducted similar experiments with aqueous solutions of amino acids and ethanol. These experiments led us to conclude that, without the presence of an ultrasonic pressure, a protein and its hydration shells are in thermodynamic and charge equilibrium, i.e. a protein and its hydration shells exchange charges. The ultrasonic wave disrupts these equilibria which are regained within 30-45 min after the ultrasonic pressure is shut off.

[Admission, initial examination and care of severely injured in Denmark]. / Modtagelse, initial undersøgelse og behandling af svaert tilskadekomne i Danmark.

INTRODUCTION: The aim of this study was to describe the initial care and management of trauma patients in Denmark. MATERIAL AND METHODS: A questionnaire was sent to all 64 hospitals in Denmark in July 1999. All responded. The questionnaire covered 81 questions. RESULTS: The number of severely injured patients received by the hospitals was evenly distributed. Nine hospitals received more than 50 severely injured patients/year. Protocols for trauma care were available in 46 hospitals. Monitoring with ECG and pulse oximetry in the emergency room was possible in most hospitals. Most hospitals were also equipped to perform endotracheal intubation, chest tube drainage, surgical airway, and peritoneal lavage. Radiological and clinical laboratory services were available round the clock in most hospitals. Ultrasonography could be performed in 41 and CT in 36 hospitals. Three hospitals did not transfer patients to other facilities. An estimated quarter of the severely traumatised patients are transferred to a hospital with a higher level of trauma treatment. CONCLUSION: Many Danish hospitals receive trauma patients. However, a number of hospitals do not have the necessary organisation, clinical capabilities, or resources for trauma care. There is a need for regional and national guidelines for trauma care with recommendations ensuring early recognition of patients who may be sufficiently cared for in the local hospital, and those who require transfer to trauma centres for definitive care.

[Ultrasonographic scanning of patients with severe abdominal injuries]. / UL-scanning af abdomen hos hårdt kvaestede patienter.

INTRODUCTION: The aim of this study was to describe our experiences with ultrasonography (US) of severely traumatised patients, and to show whether it is a safe and fast procedure when screening for intra-abdominal lesions. MATERIAL AND METHODS: In a period from 1996 to 1999, 876 patients were received by the trauma team. The number of patients with an injury severity score (ISS) > 15, was constant during the period. Seventy-five per cent of the patients were men. One hundred and fifty-five patients (18%) died, 111 before US was carried out. RESULTS: Over the four-year period, the number of patients received by the trauma team increased from 150 in 1996 to 365 in 1999. The number of US examinations increased from 61 (1996) till 303 (1999). The number of pathological US scans was constantly about 20 per year, where as the number of pathological CT scans was between ten and 20 per year. The number of patients that went on to explorative laparotomy was between seven and 17 per year and 49 in the whole period. The sensitivity of US to detect abdominal lesions is 0.74 and the specificity 0.97, whereas that to detect free abdominal fluid is 0.88 and the specificity 0.99. DISCUSSION: US of the abdomen is a fast and safe procedure to carry out on the severely traumatised patient. An algorithm for diagnosis is suggested.

The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures.

We present a study of the pattern of elbow fractures in children under 15 years of age, during a 5-year period, with special reference to supracondylar humerus fractures. The incidence was 308/100 000 per year; 58% of the children had a fracture in the supracondylar area of the humerus. There were 355 elbow fractures, and there were 164 boys (46%) and 191 girls (54%). The mean age for the entire group was 7.9 years (for boys, 7.2 years; for girls, 8.5 years). Of 209 supracondylar fractures (including 5 combination fractures), 134 were type I, 40 were type II, and 35 were type III (as classified by Gartland). Associated temporary nerve injuries involving the median, radial, and ulnar nerves were seen in 15 patients with type III supracondylar fractures. Associated brachial artery injuries were seen in 6 patients, 5 of whom had type III fractures.

Treatment of femoral shaft fractures with Grosse-Kempf intramedullary nail.

Ninety consecutive femoral shaft fractures in 87 patients treated by reamed Grosse-Kempf intramedullary nailing were reviewed. The median observation time was 45 months. The functional results were excellent or good in 82% of the fractures, fair in 16%, and poor in 2%. Four non-unions and two superficial infections were observed. Leg shortening of more than 2 cm was recorded in 2 patients. Rotatory malalignment exceeded more than 15 degrees in 2 patients. We conclude that reamed Grosse-Kempf intramedullary nailing is an excellent treatment for femoral shaft fractures. Although this study represents the first period during which we used the nail, the number of complications was acceptable.

[Roller skating accidents. A registry and questionnaire study]. / Rulleskøjteulykker. En register- og spørgeskemaundersøgelse.

At the University Hospital of Odense DK an increasing number of roller skating injuries has been observed, and a total of 283 injuries were registered in 1996. They all received a questionnaire in order to obtain information about: The differences between users of conventional and in-line roller skaters in pattern of injury, to what extent safety gear was used and occurrence of "splint-top" fractures. Eighty-seven percent were returned. It showed that "in-liners" and conventional roller skaters showed no statistical differences in pattern of injury. Accidents occurred at low speed. Twenty-nine percent used protective gear. There was a significantly lower rate of injuries to the hand and wrist when wrist guards were used. Splint-top fractures were not observed. Increasing experience seems to lower the incidence of fractures. An increase in the use of protective gear seems to occur following an injury.

Osteosynthesis of intra-articular fractures in the proximal interphalangeal joint with Kirschner wires.

Twenty-eight consecutive patients, aged 4-68 years, who had had an intra-articular fracture of the proximal interphalangeal (PIP) joint were reviewed retrospectively in 1996. All patients were operated on within a median of three days (range 0-26). Only three patients had open injuries while 11 had fracture-dislocations. A median of half the articular surfaces were involved, and dislocations ranged from 1-4 mm. Twelve patients had their fractures anatomically reduced and 13 had postoperative dislocations of less than 1 mm. Eighteen patients were reviewed after 10-49 months, and four were interviewed by telephone. The median reduction in range of movement in the PIP joint at follow-up was 15 degrees (range 0-90 degrees). Nine patients had subjectively slightly reduced movements, and only three of 17 patients stated that they had limited movement. Ten patients had occasional pain, which eight described as mild and two as moderate. Two patients had ulnar instability less than 5 degrees, and the remainder were stable. Twelve patients had a cold sensation in the affected finger joint in cold weather. No patients had changed occupation as a result of their injury, and only two patients said that they were limited in any way in any activity at work or at home. Open and precise reduction and osteosynthesis with Kirschner (K) wires seems to be an effective treatment for most intra-articular fractures of PIP joints.

[Indication for radiological examination in acute ankle distorsion]. / Indikation for røntgenundersøgelse ved akut ankeldistorsion.

Inversion injuries of the ankle are a common cause of presentation to accident and emergency units. They impose a major load on radiological services. A prospective study was carried out to test the hypothesis that a thorough physical examination can eliminate the need for a large number of radiographs obtained in patients with acute ankle trauma. Two hundred and one patients were seen in the emergency department for acute ankle trauma. All patients were assessed clinically, then examined radiographically. Sensitivity and specificity of various clinical signs were calculated. Swelling, focal bony tenderness on the lateral malleollus, and decreased ability to bear weight were found to be the most important predictors, especially if present simultaneously. According to this material bimalleolar distance ratio cannot be used as predictor.

[Mortality among victims of traffic accidents with multiple injuries. A descriptive study 1986-1990]. / Mortaliteten hos multitraumatiserede trafiktilskadekomne. Deskriptiv undersøgelse 1986-1990.

In the period 1986-1990, 16,307 patients were injured in road traffic accidents in the city of Odense, Denmark. 251 had multiple injuries according to the definition: AIS > or = 3 in at least two body regions. Overall mortality was 41%, while the mortality in hospital was 20%. 19 patients died within the first 24 hours after admission mainly due to brain damage, while 18 patients died later than 24 hours mainly from complications. These patients also had a higher average age (55 years) than the rest (34 years). The median Injury Sverity Score (ISS) was 26 for the whole series, and 19 for survivors. Median ISS was 59 for patients who were dead on arrival, whereafter it fell to 43 for patients who died within the first 24 hours after admission, with a further decrease to 29 for patients who died after 24 hours. 50% of all serious injuries were located in the thorax, 27% in the brain and 22% in the abdomen. The litterature on the subject is reviewed.

[Diagnosis and treatment of injuries to the lateral ligaments of the ankle joint]. / Diagnose og behandling af laterale ligamentlaesioner i fodleddet.

Injury to the lateral ligaments of the ankle joint is one of commonest injuries seen in the casualty department. The diagnostic routines and treatment vary considerably from one hospital to another. The methods for precise diagnosis and treatment are reviewed and discussed and the main emphasis is placed on major prospective investigations. The authors suggest that the diagnosis should be made on the basis of the clinical examination and that, regardless of the degree of ligamental injury, treatment should consist of adhesive strapping. Primary identification of patients with prolonged symptoms is an unsolved problem since the degree of ligamental injury is not a reliable predictor.

Risk of acute nonlymphocytic leukemia and preleukemia in patients treated with cyclophosphamide for non-Hodgkin's lymphomas. Comparison with results obtained in patients treated for Hodgkin's disease and ovarian carcinoma with other alkylating agents.

Of 602 patients treated for non-Hodgkin's lymphomas, 9 developed overt acute nonlymphocytic leukemia or preleukemia with refractory cytopenia and cytogenetic abnormalities of the bone marrow. A Kaplan-Meier estimate of the cumulative probability of leukemic complications was 6.3 +/- 2.6% (mean +/- SE) 7 years after start of treatment. All 9 patients with leukemic complications belong to a major subgroup of 498 patients treated with alkylating agents, predominantly cyclophosphamide. The risk of leukemic complications in this subgroup was compared with the risk in 312 patients treated with other alkylating agents for Hodgkin's disease, and with the risk in 553 patients treated with dihydroxybusulfan for ovarian carcinoma. Cumulative 9-year risks were 8.0 +/- 3.3%, 12.8 +/- 3.5%, and 7.1 +/- 1.9%, respectively. The general risk of secondary leukemia after long-term treatment with alkylating agents ranges from 1% to 1.5% per year from 2 to at least 9 years after start of treatment.

Acute non-lymphocytic leukemia in patients with ovarian carcinoma following long-term treatment with Treosulfan (= dihydroxybusulfan).

Acute non-lymphocytic leukemia occurred in eight women following long-term treatment with Treosulfan (= dihydroxybusulfan) for ovarian carcinoma. The leukemia developed from 21 to 58 months (median 50 months) after the institution of chemotherapy. At the time when the leukemia appeared seven of the patients were in complete, and one in partial, remission as regards the ovarian carcinoma. Seven of the eight cases of acute leukemia occurred in a series of 553 patients treated with Treosulfan for ovarian cancer in the period from 1970 to 1977 and followed closely for a total of 1159 patient-years up to February 1978. As compared with an expected number of 0.04 cases of acute myeloblastic leukemia based on patient-years, the observed seven cases correspond to a 175-times increased risk. Although the cumulative probability of acute non-lymphocytic leukemia among surviving patients at five years using life-table statistics was 7.6%, the survival curve for the 553 patients with ovarian carcinoma was only slightly affected by death from leukemia. The probability of developing acute leukemia in this study was not significantly correlated to the total cumulative dosage of Treosulfan. Cytogenetic studies of the bone marrow performed after the development of acute leukemia showed chromosome abnormalities in all five patients examined, with hypodiploidy and loss of B and C group chromosomes.