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Sundsvall, Sweden

Sayed-Noor A.S.,Sundsvall Hospital
Journal of surgical orthopaedic advances

The technical description of a new surgical method (Pedersen-Noor operation) to treat refractory external snapping hip [coxa saltans externa (CSE)] is presented. The method consists of distal lengthening of the iliotibial band by Z-plasty under local anesthesia and on an outpatient basis. Five patients with refractory CSE were treated with the new method. Postoperatively, the outcome was evaluated by phone interview and physical examination, 3 to 4 months and 1 year postoperatively, respectively. The snapping disappeared in all five patients. No postoperative complications were reported. Three patients were very satisfied and two patients were satisfied with the result of the operation. All five patients would recommend the operation to another patient with similar symptoms. The described method is simple, economic, and effective and can be recommended in the treatment of refractory CSE. Source

Israelsson L.A.,Umea University | Millbourn D.,Sundsvall Hospital
Langenbeck's Archives of Surgery

Background: The most important wound complications are surgical site infection, wound dehiscence and incisional hernia. Experimental and clinical evidences support that the development of wound complications is closely related to the surgical technique at wound closure. Results: The suture technique monitored through the suture length-to-wound length ratio is of major importance for the development of wound complications. The risk of wound dehiscence is low with a high ratio. The ratio must be higher than 4; otherwise, the risk of developing an incisional hernia is increased four times. With a ratio higher than 4, both the rate of wound infection and incisional hernia are significantly lower if closure is done with small stitches placed 5 to 8 mm from the wound edge than with larger stitches placed more than 10 mm from the wound edge. Conclusions: Midline incisions should be closed in one layer by a continuous suture technique. A monofilament suture material should be used and be tied with self-locking knots. Excessive tension should not be placed on the suture. Wounds must always be closed with a suture length-to-wound length ratio higher than 4. The only way to ascertain this is to measure, calculate and document the ratio at every wound closure. A high ratio should be accomplished with many small stitches placed 5 to 8 mm from the wound edge at very short intervals. © 2012 Springer-Verlag Berlin Heidelberg. Source

Vogt H.,Linkoping University | Braback L.,Sundsvall Hospital | Kling A.-M.,Unit for Statistics and Surveillance | Grunewald M.,Public Health Agency of Sweden | Nilsson L.,Linkoping University

BACKGROUND AND OBJECTIVES: Childhood immunization may influence the development of asthma, possibly due to lack of infections or a shift in the T-helper cell type 1/T-helper cell type 2/regulatory T cells balance. We therefore investigated whether pertussis immunization in infancy is associated with asthma medication in adolescence.METHODS: After 14 years of no general pertussis vaccination, almost 82,000 Swedish children were immunized for pertussis in a vaccination trial between June 1, 1993, and June 30, 1994. In a follow-up analysis of almost 80,000 children, their data were compared with those of ∼100,000 nonvaccinated children, born during a 5-month period before and a 7-month period after the vaccination trial. Data for the main outcome variable (ie, dispensed prescribed asthma medication for each individual in the cohort during 2008-2010) were obtained from the national prescription database. Multivariate regression models were used to calculate the effect size of vaccination on dispensed asthma medication (odds ratios [OR], 95% confidence intervals [CI]). Approaches similar to intention-to-treat and per-protocol methods were used.RESULTS: The prevalence rates of various asthma medications for study patients at 15 years of age differed between 4.6% and 7.0%. The crude ORs for any asthma medication and antiinflammatory treatment in pertussis-vaccinated children after intention-to-treat analysis were 0.97 (95% CI: 0.93-1.00) and 0.94 (95% CI: 0.90-0.98), respectively. Corresponding adjusted ORs were 0.99 (95% CI: 0.95-1.03) and 0.97 (95% CI: 0.92-1.01). Similar ORs were found after per-protocol analysis.CONCLUSIONS: Pertussis immunization in infancy does not increase the risk of asthma medication use in adolescents. Our study presents evidence that pertussis immunization in early childhood can be considered safe with respect to long-term development of asthma. Copyright © 2014 by the American Academy of Pediatrics. Source

Israelsson L.A.,Umea University | Millbourn D.,Sundsvall Hospital
Surgical Clinics of North America

The development of wound complications is closely related to the surgical technique at wound closure. The risk of the suture technique affecting the development of wound dehiscence and incisional hernia can be monitored through the suture length to wound length ratio. Midline incisions should be closed in one layer by a continuous-suture technique using a monofilament suture material tied with self-locking knots. Excessive tension should not be placed on the suture. Closure must always be with a suture length to wound length ratio higher than 4. © 2013 Elsevier Inc. Source

Wadsten M.A.,Umea University | Sayed-Noor A.S.,Umea University | Englund E.,Sundsvall Hospital | Buttazzoni G.G.,Umea University | Sjoden G.O.,Umea University
Bone and Joint Journal

This paper investigates whether cortical comminution and intra-articular involvement can predict displacement in distal radius fractures by using a classification that includes volar comminution as a separate parameter. A prospective multicentre study involving non-operative treatment of distal radius fractures in 387 patients aged between 15 and 74 years (398 fractures) was conducted. The presence of cortical comminution and intra-articular involvement according to the Buttazzoni classification is described. Minimally displaced fractures were treated with immobilisation in a cast while displaced fractures underwent closed reduction with subsequent immobilisation. Radiographs were obtained after reduction, at 10 to 14 days and after union. The outcome measure was re-displacement or union. In fractures with volar comminution (Buttazzoni type 4), 96% (53 of 55) displaced. In intraarticular fractures without volar comminution (Buttazzoni 3), 72% (84 of 117) displaced. In extra-articular fractures with isolated dorsal comminution (Buttazzoni 2), 73% (106 of 145) displaced while in non-comminuted fractures (Buttazzoni 1), 16 % (13 of 81 ) displaced. A total of 32% (53 of 165) of initially minimally displaced fractures later displaced. All of the initially displaced volarly comminuted fractures re-displaced. Displacement occurred in 31% (63 of 205) of fractures that were still in good alignment after 10 to 14 days. Regression analysis showed that volar and dorsal comminution predicted later displacement, while intra-articular involvement did not predict displacement. Volar comminution was the strongest predictor of displacement. © 2014 The British Editorial Society of Bone & Joint Surgery. Source

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