[Bilateral rupture of the quadriceps tendon in a healthy individual]. / Bilateral quadricepsseneruptur hos et rask individ.

A case of bilateral rupture of the quadriceps tendons in a 59 year-old man without any known systemic disease is presented. The ruptures occurred while he was descending a staircase, after which he fell. Repetitive microtrauma was suspected as the etiological reason for rupture.

[Training on a wobble board following lateral ankle joint sprains]. / Traening med vippebraet efter laterale ankelledsdistorsioner.

The aim of this study was to investigate whether the number of patients with residual symptoms following ankle sprains could be reduced by training on a wobble board during a 12-week training recovery period. The effect of a 12-week training program was compared to no training. Forty-eight patients completed the study. In the follow-up period (mean 230 days) we found significantly fewer recurrent distorsions and fewer patients had functional instability in the study group compared to controls. There were no differences between the two groups concerning subjective complaints during the recovery period. Volumetric measurements revealed no difference in the speed of reduction of haematoma and oedema in the two groups. We conclude that training on a wobble board is effective in reducing residual symptoms following ankle sprains.

Prospectively measured red cell folate levels in methotrexate treated patients with rheumatoid arthritis: relation to withdrawal and side effects.

OBJECTIVE: To investigate whether red cell folate (RCF) levels relate to side effects, withdrawals, or disease activity during treatment with the folic acid antagonist methotrexate (MTX) for rheumatoid arthritis (RA). METHODS: Side effects were recorded monthly, RCF levels were measured by lactoglobulin binding radioassays, and 8 variables for disease activity were measured in a placebo controlled double blind trial of 28 weeks' duration comparing efficacy of MTX (n = 23) and D-penicillamine (n = 23). RESULTS: From Week 20 RCF levels decreased only in the MTX group (p < 0.02), and 5 MTX treated patients withdrew due to side effects. Withdrawals had lower RCF values at Weeks 0 and 9 compared to the remaining patients (p < 0.05). Folate deficiency evolved in 5 patients; 2 of these developed cytopenia. Aberrations in the scheduled dosage increase were related to lower pretreatment values of RCF (p = 0.007). Side effect scores were inversely correlated to RCF values at Weeks 0, 9, and 28 (p < 0.05). RCF levels measured concomitantly with liver enzyme elevation were lower than the remaining values (p < 0.001). When side effects were reported, 96% of concomitantly measured RCF values were below 800 nmol/l. RCF values at entry did not correlate to improvement in any variable for disease activity, or a graded overall improvement. CONCLUSION: RCF levels decrease during MTX treatment and relate to side effects, withdrawals, liver enzyme elevations and aberrant MTX dosage increase, but not to the therapeutic effect. RCF above 800 nmol/l protects against side effects.

Wobble board training after partial sprains of the lateral ligaments of the ankle: a prospective randomized study.

Ankle sprains are often complicated by functional instability and repeated sprains. Rehabilitation with wobble boards in patients with functional instability has been tested, and significant improvement has been found compared to no training. The aim of this study was to investigate whether the number of patients with residual symptoms following ankle sprains could be reduced by training on a wobble board during 12-week recovery period. In addition, the influence of training in the time course reduction of edema was investigated. We performed a prospective study including 61 patients, all active in sports for more than 2 hours a week with primary ankle sprains. The effect of a 12-week training program with wobble board was compared with no training. Forty-eight patients completed the study. In the follow-up period (mean X = 230 days), we found significantly fewer recurrent sprains, and significantly fewer patients in the training group had functional instability of the ankle compared with the no training group. There were no differences in the two groups in the time which elapsed before patients were painless at walking, during running, or at sports. Volumetric measurements revealed no difference in the speed of reduction of hematoma and edema of the ankle and foot between the two groups. We conclude that training on a wobble board early after primary stage 2 ankle sprains is effective in reducing residual symptoms following this lesion and that training does not seem to affect the time course reduction in edema.

External tissue stretching for closing skin defects in 22 patients.

In this prospective study, we treated 12 women and 10 men with a newly developed skin-stretching system. The stretching device was used for the closure of 9 fasciotomies and for preoperative skin extension before excision of 6 tattooes, 7 splitskin transplants, 4 giant naevi, and 3 scars. The stretching device was placed under the skin, using local anesthesia. The patient stretched the skin. The mean stretching time was 4 (2-11) days. 20 patients completed the expansion successfully, with no pain or only slight discomfort. In 2 cases, we observed minor complications during the expansion. The external skin-stretching system can be used to obtain primary closure of defects where splitskin transplants otherwise would be necessary. The method can be applied in out-patients, using local anesthesia.

Prognosis of fracture of the talus in children. 21 (7-34)-year follow-up of 14 cases.

14 children suffering from a fracture of the talar neck or body were examined after 21 (7-34) years. The talar neck was fractured in 10 children and the talar body in 4.3 fractures were displaced and primarily treated with reduction and immobilization. Nondisplaced fractures were treated conservatively. All fractures healed. All patients with displaced fractures had exercise-induced pain at follow-up. Of 11 patients with nondisplaced fractures only 1 had minor complaints. CT and conventional radiographs showed arthrosis in the talocrural joint and normal subtalar joints in those with displaced fractures. The radiographic findings were normal after nondisplaced fractures.

Osteochondral lesions of the talar dome in children. A 24 (7-36) year follow-up of 13 cases.

13 patients who in childhood had had osteochondral lesions (OCL) of the talar dome participated in a long-term follow-up including physical examination, computed tomography (CT) and conventional radiographs. Most of the cases were caused by trauma. Conventional radiographs showed abnormal findings in 4 cases and CT in a further one. In 3 cases the primary lesion could still be seen as an osteochondral defect, and 2 had a loose body in the joint. 3 of these 5 patients had mild symptoms. We conclude that arthrosis following OCL in childhood is infrequent and recommend conservative treatment initially. In those with persisting symptoms, additional imaging evaluation with CT and MRI is recommended.

The shoulder impingement syndrome: The results of surgical decompression.

Forty patients (41 operated shoulders) with subacromial impingement resistant to conservative therapy underwent acomioplasty and were evaluated 6 to 142 months after surgery. Patients requiring rotator cuff repair were excluded from the study. With the UCLA scoring system, results were excellent or good in 28 (68%), fair in five (12%), and poor in eight (20%). Thirty-three (80%) were satisfied with their result. There was a trend toward poorer results in women and in the elderly (aged 60 to 69 years). A striking finding was the statistically significant relationship between result rating and duration of symptoms. Ninety-three percent had an excellent or good result, if they had been symptomatic for greater than 3 years, whereas only 56% reached those ratings with symptom duration less than 3 years. The only complication was a superficial infection. Three patients required manipulation after the procedure. Two required subsequent surgery because of continuing pain. This procedure seems safe and reasonably effective. Careful patient selection must be stressed. Results will be better with a longer preoperative duration of symptoms.

[Microvascular reimplantation of the penis]. / Mikrovaskulaer penisreimplantation.

A case of autoamputation of the penis is presented. Although the unique vascular properties of the penis have permitted good results in a number of cases of amputation of the penis, it is certain that the use of microreimplantation gives better results with a minimum of postoperative complications.

[Naproxen versus indomethacin as night-time medication for patients with rheumatoid arthritis]. / Naproxen versus indometacin som natlig behandling til patienter med reumatoid arthritis.

The investigation consisted of a double-blind cross-over study of the effect of 75 mg indometacin, 500 mg naproxen or a placebo in 63 patients with rheumatoid arthritis accompanied by night pain and morning stiffness. All the patients received day treatment with 250 mg naproxen b.i.d. Only a few patients benefitted from the treatment at night and no differences in the effect of indometacin and naproxen were observed. Naproxen was better tolerated than indometacin. Day treatment with naproxen, which has a relatively long half life time decrease the need for supplementary treatment at night.

[Festival injuries. Injury patterns at the Midtfyn Music Festival in 1988]. / Festivalskader. Skademønstret på Midtfynsfestivalen 1988.

A first-aid station was established at the Midtfyn Music Festival in 1988. A total of 174 patients were treated. The diseases and casualties are described according to numbers, distribution, course and causes. Orthopaedic casualties constituted approximately 60%, sprains, infections, contusions and open wounds being the commonest. Respiratory diseases were the commonest conditions among the non-orthopaedic conditions. Treatment could be completed in approximately 60% of the cases. Most of the casualties were caused by broken glass, deliberate violence or failure to comply with maintenance medication. Various suggestions are made to reduce the number of casualties.

[Treatment methods of keloid and hypertrophic scar formation]. / Behandlingsformer ved keloid og hypertrofisk arvaevsdannelse.

Hypertrophic scar and keloid are diagnoses based on clinical symptoms. Hypertrophic scar is an unacceptably enlarged scar, within the boundaries of the original wound; whereas keloid is an unacceptably enlarged scar infiltrating the surrounding tissue. Hypertrophic scar and keloid belong to the same category of diseases, characterized by increased collagen development. The treatments employed are compression, excision, corticosteroid injections and irradiation. New medical treatments affecting the collagen metabolism such as colchicin, beta-amino-proprionitrite (BAPN), D-penicillamine, cytostatics and prostaglandin-inhibitors have been introduced with promising results and fewer side effects.