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Wikeroy A.K.B.,University of Oslo | Hoiness P.R.,Rikshospitalet | Andreassen G.S.,University of Oslo | Hellund J.C.,University of Oslo | Madsen J.E.,University of Oslo
Journal of Orthopaedic Trauma | Year: 2010

Objective: To assess long-term functional and radiologic results after two types of syndesmosis fixation, comparing one quadricortical syndesmotic screw fixation with two tricortical screw fixation in ankle fractures. Design: Follow up of a previously conducted prospective, randomized clinical study. Setting: University clinic, Level I trauma center. Patients: Forty-eight patients with closed ankle fractures and concomitant syndesmotic rupture were operated on with quadricortical (n = 23) or tricortical (n = 25) syndesmotic fixation. Results: Follow-up time was 8.4 years (range, 7.7-8.9 years). There were no statistical differences in the two groups regarding Olerud-Molander Ankle score, Orthopaedic Trauma Association score, or degree of osteoarthritis. Patients with a difference in the syndesmotic width between the operated and the nonoperated ankle of 1.5 mm or more showed a tendency toward poorer functional results (P = 0.056). Twenty-one patients showed synostosis on plain radiographs. Of these, only seven patients had synostosis verified on computed tomography, all of whom had significantly worse function. Patients with a posterior fracture fragment at time of operation had poorer Olerud-Molander Ankle score (73.1 versus 85, P = 0.05) and all had osteoarthritis as compared with 55% of those without a posterior fragment. Obese patients (body mass index greater than 30 kg/m) also had poorer Orthopaedic Trauma Association score, but neither obesity nor being overweight predicted late arthritis. Conclusions: Follow up 8.4 years after surgery of ankle fractures with syndesmotic injury showed satisfactory functional results with only minor differences between the two groups of syndesmotic fixation. Obese patients had significantly poorer functional results. The presence of a posterior fracture fragment was an important negative prognostic factor regarding functional results. Plain radiographs overestimated tibiofibular synostosis. Synostosis on computed tomography, however, predicted impaired ankle function. A difference in syndesmotic width 1.5 mm or greater between the two ankles seemed to be associated with an inferior clinical result. © 2009 by Lippincott Williams & Wilkins.


Norum H.M.,Rikshospitalet | Breivik H.,Rikshospitalet | Breivik H.,University of Oslo
Scandinavian Journal of Pain | Year: 2010

Background: The "gold standard" for pain relief after thoracotomy has been thoracic epidural analgesia (TEA). The studies comparing TEA with paravertebral block (PVB) and recent reviews recommend PVB as a novel, safer method than TEA. Methods: A systematic search of the Cochrane and PubMed databases for prospective, randomized trials (RCTs) comparing TEA and PVB for post-thoracotomy analgesia was done. We assessed how TEA and PVB were performed, methods of randomization, assessment of pain relief, and complications. Abstracts only were excluded. Results: Ten studies were included, comprising 224 patients randomized to TEA, 243 to PVB. The studies were heterogeneous. Therefore, a systematic narrative review with our evaluations is presented. Only 3/10 trials reported the method of randomization. Pain during coughing was reported in only 5/10, pain assessment not specified in 5/10. Only 1/10 trials found PVB superior to TEA, but placed TEA catheters too low (


Opdal S.H.,University of Oslo | Opdal S.H.,Rikshospitalet | Rognum T.O.,University of Oslo
Forensic Science, Medicine, and Pathology | Year: 2011

Genetic risk factors play a role in sudden unexpected infant death; either as a cause of death, such as in cases with medium-chain acyl-coenzyme A dehydrogenase deficiency and cardiac arrest due to long QT syndrome, or as predisposing factors for sudden infant death syndrome (SIDS). Most likely genetic predisposition to SIDS represent a polygenic inheritance pattern leading to sudden death when combined with other risk factors, such as a vulnerable developmental stage of the central nervous system and/or the immune system, in addition to environmental risk factors, such as a common cold or prone sleeping position. Genes involved in the regulation of the immune system, cardiac function, the serotonergic network and brain function and development have so far emerged as the most important with respect to SIDS. The purpose of the present paper is to survey current knowledge on SIDS and possible genetic contributions. © 2010 Springer Science+Business Media, LLC.


Haug J.B.,University of Oslo | Reikvam A.,Rikshospitalet
Journal of Antimicrobial Chemotherapy | Year: 2013

Objectives: To investigate effects on surveillance results of hospital antibiotic use when WHO defined daily doses (WHO DDDs) are adjusted to doses recommended for hospitalized patients [hospital-adjusted defined daily doses (haDDDs)]. Methods: Datafor antibiotic use in 2006-11 for all 22 Norwegian Health Enterpriseswere analysed with bothWHO DDDs and haDDDs as numerators. The haDDDswere determined fromrecommendations given in regional and national guidelines on antibiotic use in hospitals. The twoways of calculating the amount of antibiotic use were compared, with either the number of bed days (BDs) or the number of discharges as the denominator. The drug utilization 90% methodology was applied for ranking the use of the various antibiotics. Results: DDD adjustments altered the figures for total antibiotic use from 67.1 WHO DDDs/100 BDs to 49.3 haDDDs/100 BDs (226.4%). The most marked difference was found for penicillins: 31.1 WHO DDDs/100 BDs versus 13.4 haDDDs/100 BDs (256.8%). The corresponding figures for broad-spectrum antibiotics were 17.3 and 15.5 (210.4%), respectively; for these antibiotics, the conversion changes varied significantly between institutions, from 216.7% to 23.3%. Ranking antibiotic use based on haDDDs resulted in higher positions for metronidazole, cefuroxime, cefotaxime and cefalotin/cefalexin compared with the WHO DDD-based ranking, where the penicillins dominated. Conclusions: The low-set WHO DDDs for penicillins caused skewed surveillance results that concealed the real magnitude of broad-spectrumantibiotic use and distorted interhospital comparisons. For surveillance of antibiotic use in hospitals, WHO DDDs should be supplemented with haDDDs. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Toft M.,University of Oslo | Toft M.,Rikshospitalet
Movement Disorders | Year: 2011

Action tremor was for a long time considered to be a defining symptom of multiple sclerosis. The Wilson films include a short segment showing a female patient suffering from relatively severe action tremor. Tremor is the most common movement disorder in multiple sclerosis, and can be very disabling in some patients. Insights into the frequency and treatment of tremor in multiple sclerosis have changed since the Wilson films were taken, and are reviewed herein. © 2011 Movement Disorder Society.


Kreukels B.P.C.,VU University Amsterdam | Haraldsen I.R.,Rikshospitalet | De Cuypere G.,Ghent University | Richter-Appelt H.,University of Hamburg | And 2 more authors.
European Psychiatry | Year: 2012

Studies on diagnostic subtypes of gender identity disorder (GID) or gender incongruence (GI), comorbidity and treatment outcome show considerable variability in results. Clinic/country specific factors may account for the contradictory results, but these factors have never been studied. This article is the first of a series reporting on a unique collaborative study of four European gender identity clinics (the European network for the investigation of gender incongruence [ENIGI]). Here, we present the diagnostic procedures of the four clinics (Amsterdam, Ghent, Hamburg, and Oslo), the standard battery of instruments, and the first results regarding applicants with GI who seek treatment. Applicants in the four clinics did not differ in living situation, employment status, sexual orientation, and age of onset of GI feelings. However, the Amsterdam and Ghent clinic were visited by a majority of natal males, whereas Hamburg and Oslo see more natal females. Male applicants were older than female applicants within each country, but female applicants in one country were sometimes older than male applicants in another country. Also, educational level differed between applicants of the four clinics. These data indicate that certain sociodemographic and/or cultural characteristics of applicants have to be taken into account in future studies. © 2010 Elsevier Masson SAS.


Heylens G.,Ghent University | Elaut E.,Ghent University | Kreukels B.P.C.,VU University Amsterdam | Paap M.C.S.,University of Hamburg | And 5 more authors.
British Journal of Psychiatry | Year: 2014

Background: Research into the relationship between gender identity disorder and psychiatric problems has shown contradictory results. Aims: To investigate psychiatric problems in adults fulfilling DSM-IV-TR criteria for a diagnosis of gender identity disorder. Method: Data were collected within the European Network for the Investigation of Gender Incongruence using the Mini International Neuropsychiatric Interview - Plus and the Structured Clinical Interview for DSM-IV Axis II Disorders (n = 305). Results: In 38% of the individuals with gender identity disorder a current DSM-IV-TR Axis I diagnosis was found, mainly affective disorders and anxiety disorders. Furthermore, almost 70% had a current and lifetime diagnosis. All four countries showed a similar prevalence, except for affective and anxiety disorders, and no difference was found between individuals with early-onset and late-onset disorder. An Axis II diagnosis was found in 15% of all individuals with gender identity disorder, which is comparable to the general population. Conclusions: People with gender identity disorder show more psychiatric problems than the general population; mostly affective and anxiety problems are found.


Forsdahl S.H.,University of Tromsø | Solberg S.,Rikshospitalet | Singh K.,University of Tromsø | Jacobsen B.K.,University of Tromsø
International Journal of Epidemiology | Year: 2010

Background: In a population-based study in Tromsø, Norway, the authors assessed whether an abdominal aortic aneurysm (AAA) or the maximal infrarenal aortic diameter in a non-aneurismal aorta influence total and cardiovascular disease (CVD) mortality. Methods: A total of 6640 men and women, aged 25-84 years, were included in a 10-year mortality follow-up: 345 subjects with a diagnosed AAA and 6295 subjects with a non-aneurismal aorta. Non-aneurismal aortic diameter and prevalent AAAs were categorized into seven groups. Results: In subjects without an AAA, an aortic diameter ≥30 mm increased age- and sex-adjusted total mortality [mortality rate ratio (MRR) = 3.73, 95% confidence interval (CI) 1.77-7.89] and CVD mortality (MRR = 9.24, 95% CI 4.07-20.97) compared with subjects with aortic diameter of 21-23 mm. An AAA at screening was strongly associated with deaths from aortic aneurysm and was associated with total (MRR = 1.60, 95% CI 1.31-1.96) and CVD mortality (MRR = 2.41, 95% CI 1.81-3.21). This was not explained by deaths due to an AAA. Adjustments for CVD risk factors could fully explain the increased total, but not CVD mortality in subjects with an AAA. Conclusions: An AAA increases total and CVD mortality. In the large majority of subjects with a non-aneurysmal aorta, the diameter does not influence total or CVD mortality. However, in individuals with a maximal diameter >26 mm (2% of the population), a positive relationship is found. © The Author 2009; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.


Crowley S.,Rikshospitalet | Matthews I.,Rikshospitalet
Pediatric Pulmonology | Year: 2010

Bronchiectasis is, by definition, an irreversible condition. Following recent reports of reversible bronchiectasis in children, it has been suggested that the definition be broadened to include pre-bronchiectasis and transitional reversible states. We describe the case of a young infant who had extensive, severe bronchiectasis of unknown etiology that resolved following prolonged treatment with antibiotics and a tapering course of oral steroids. We suggest that the prolonged treatment may have played a role, perhaps by eradicating infection and thus enabling regeneration of bronchial anatomy. © 2010 Wiley-Liss, Inc.


Paulsen A.H.,Rikshospitalet | Lundar T.,Rikshospitalet | Lindegaard K.-F.,Rikshospitalet
Journal of Neurosurgery: Pediatrics | Year: 2015

Object Treatment for hydrocephalus has not advanced appreciably since the advent of CSF shunts more than 50 years ago. The outcome for pediatric patients with hydrocephalus has been the object for several studies; however, much uncertainty remains regarding the very long term outcome for these patients. Shunting became the standard treatment for hydrocephalus in Norway during the 1960s, and the first cohorts from this era have now reached middle age. Therefore, the objective of this study was to review surgical outcome, mortality, social outcome, and health-related quality of life in middle-aged patients treated for hydrocephalus during childhood. Methods Data were collected in all patients, age 14 years or less, who required a CSF shunt during the years 1967-1970. Descriptive statistics were assessed regarding patient characteristics, surgical features, social functioning, and work participation. The time and cause of death, if applicable, were also determined. Kaplan-Meier survival estimates were used to determine the overall survival of patients. Information regarding self-perceived health and functional status was assessed using the 36-Item Short Form Health Survey (SF-36) and the Barthel Index score. Results A total of 128 patients were included in the study, with no patient lost to follow-up. Of the 128 patients in the study, 61 (47.6%) patients died during the 42-45 years of observation. The patients who died belonged to the tumor group (22 patients) and the myelomeningocele group (13 patients). The mortality rate was lowered to 39% if the patients with tumors were excluded. The overall mortality rates at 1, 2, 10, 20, and 40 years from time of initial shunt insertion were 16%, 24%, 31%, 40%, and 48% respectively. The incidence of shunt-related mortality was 8%. The majority of children graduated from a normal school (67%) or from a school specializing in education for physically handicapped children (20%). Self-perceived health was significantly poorer in 6 out of 8 domains assessed by SF-36 as compared with the background population. Functional status among the survivors varied greatly during the follow-up period, but the majority of patients were self-dependent. A total of 56% of the patients were socially independent, and 42% of the patients were employed. Conclusions Approximately half of the patients are still alive. During the 42-45 year follow-up period, the mortality rate was 48%. Two deaths were due to acute shunt failure, and at least 8% of the deaths were shunt related (probable or late onset). The morbidity in middle-aged individuals treated for pediatric hydrocephalus is considerable. The late mortality rate was low, but not negligible. Twelve patients died during the last 2 decades, 1 of whom died because of acute shunt failure. Although the shunt revision rate was decreasing during the study period, many patients required shunt surgery during adulthood. Forty-one revisions in 21 patients were performed during the last decade. Thus, there is an obvious need for life-long follow-up in these patients. © AANS, 2015.

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