Identification and Characterization of a Nationwide Danish Adult Common Variable Immunodeficiency Cohort.

In this study, we identified all adults living in Denmark diagnosed with common variable immunodeficiency (CVID) and characterized them according to clinical presentation and EUROclass classification. Using a retrospective, cross-sectional design, possible CVID patients were identified in the Danish National Patient Register and Centers in Denmark treating patients with primary immunodeficiencies. The CVID diagnosis was verified by review of medical records. One-hundred-seventy-nine adults with CVID were identified. This corresponds to a prevalence of 1:26,000. The median age at onset of symptoms was 29 years with no sex difference. The median age at diagnosis was 40 years. Males were diagnosed earlier with a peak in the fourth decade of life, whereas females were diagnosed later with a peak in the sixth decade. The median diagnostic delay was seven years. Recurrent sinopulmonary infections were seen in 92.7% of the patients. The prevalence of non-infectious complications was similar to that of previously reported cohorts: bronchiectasis (35.8%), splenomegaly (22.4%), lymphadenopathy (26.3%), granulomatous inflammation (3.9%) and idiopathic thrombocytopenic purpura (14.5%). Non-infectious complications were strongly associated with B cell phenotype, with all having a reduced number of isotype-switched memory B cells. One-hundred-seventy (95%) were treated with immunoglobulin replacement therapy, primarily administered subcutaneously. According to international guidelines, diagnostic evaluation was inadequate in most cases. This study emphasizes the need for improved diagnostic criteria and more awareness of CVID as a differential diagnosis. Diagnosis and management of CVID patients is a challenge requiring specialists with experience in the field of PID.

Zygomatic fracture. I. A simplified classification for practical use.

A review of classifications of zygomatic fractures demonstrates an increasing complexity in the choice of proper treatment. To facilitate the choice of treatment a proposal is made of a simplified classification with prediction of post-reductive fracture stability. The author's material, comprising 137 patients, has been accordingly divided and the proposed classification justified by the peroperative findings and by the follow-up results.

Zygomatic fractures. II. A follow-up study of 137 patients.

Out of a total of 137 patients with zygomatic fractures, 87 with post-reductively stable fractures were treated solely with Gillies' procedure. Twenty-eight patients with unstable fractures were treated with transosseous wiring. In 22 patients, in whom the fracture was considered undisplaced, no fracture treatment was given. At the follow-up only 2 of the patients treated by Gillies' procedure presented malunited fractures, and these only minor ones,this reductive method thus being satisfactory in 64% of all cases. Malunion was seen in one-third of the patients treated with transosseous wiring, this treatment thus appearing frequently insufficient. Consequently, accomplishment with Kirschner-pin fixation is proposed. Finally, a schedule for treatment of zygomatic fractures is given.

Mandibular fractures. II. A follow-up study of 229 patients.

During the period 1964-73, 286 patients were treated for mandibular fractures. 229 patients (80%) attended the follow-up examination. The length of observation was from 1 to 9 years. The treatment and the follow-up evaluations in the 229 patients are described. Early fracture treatment has been the objective, also in patients who have undergone severe cerebral traumas. Antibiotic prophylaxis was implemented in cases of compound fractures. Preservation of teeth and tooth buds in the line of fracture was attempted. Clinical infection occurred in 0.4% of the patients. At the follow-up examination 1 patient presented with a fracture displacement outside the condylar process. Neither malocclusion nor pseudarthrosis following fracture or after treatment were seen. Permanent sensory disturbances in the innervation area of the mental nerve following fracture occurred in 8%. Radiological examination of the teeth in the line of fracture revealed unnoticed apical bone lesions in 17% of 118 patients. In a further 23% there was a negative response to the vitality test. Follow-up control of mandibular fractures is advised at 12 to 18 months after treatment.

Mandibular fractures. I. An analysis of their etiology and location in 286 patients.

Case histories were studied of 286 patients treated for mandibular fractures by the Department of Plastic Surgery in conjunction with the Dental Department at Odense University Hospital between 1964 and 1973. 46.5% of the patients were aged 18-30 years; and 73.4% were male. Mandibular fractures associated with mid-face fractures were most frequently caused by traffic accidents (81%). When the mandible alone was fractured traffic accidents accounted for 50%, while assaults were responsible for 20%. Accidents at work only occurred among the men. Of the 487 mandibular fractures the most frequent site was the condylar process (36%) where half of the fractures in women were localized. Assaults most frequently caused fracture of the angle of the mandible; while falls were most frequently responsible for fracture of the condylar process. The fracture distribution in dentulous and edentulous mandibles differed despite the aetiology being the same.