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Rosner A.,University of Tromso | Avenarius D.,University of Tromso | Malm S.,University Hospital North Norway | Malm S.,University of Tromso | And 4 more authors.
European Heart Journal Cardiovascular Imaging | Year: 2015

Aims: Detection and correct localization of transmural lesions can be important for optimal treatment of patients with chronic coronary artery disease(CAD). The aim of the studywas to investigate the ability of peak longitudinal ejection strain (PLS) to detect the presence and extent of scar-tissue in CAD patients with normal or near normal ejection fraction, in comparison to cardiac magnetic resonance (CMR). Methods and results: Before coronary artery bypass grafting, 57 patients underwent late gadolinium enhancement (LGE) CMR and echocardiography at rest and dobutamine stress (DS). According to the degree of LGE, segments were allocated to groups of none, subendocardial (1-50%), subtotal (51-75%), and total transmural scars (>75%). Dysfunctional segments were identified by PLS or wall motion scores (WMS). The finding of normal/near normal resting WMS and PLS, excellently identified segments without transmural LGE (AUC 94.0 CI 90.6-97.3 and AUC 85.7 CI 79.0-92.3, respectively). However, the finding of akinesia did not necessarily indicate transmural scarring. The negative predictive value was high (99%, CI 98-100%) while the positive predictive value was low. Detection-rates for subendocardial LGE were low. Conclusion: Normo- and slightly hypokinetic myocardium by resting WMS or strain detects the absence of transmural scars. However, the finding of severe hypo- and akinesia does not reliably predict transmural scarring, with no improvement by the addition of DS. Detection of predominant akinesia with less than two normo- or hypokinetic segments in the territory of a high-grade coronary stenosis or occlusion, warrants further examination by LGE-CMR. © The Author 2015. Source


Murad M.K.,Foundation Medicine | Husum H.,University Hospital North Norway
Prehospital and Disaster Medicine | Year: 2010

Introduction: Recent studies demonstrate that early, in-field, basic life support by paramedics improves trauma survival where prehospital transport times are long. So far, no case-control studies of the effect of layperson trauma first responders have been reported. It was hypothesized that trained layperson first responders improve trauma outcomes where prehospital transit times are long.Methods: A rural prehospital trauma system was established in the mine and war zones in Iraq, consisting of 135 paramedics and 7,000 layperson trauma first responders in the villages. In a non-randomized clinical study, the outcomes of patients initially managed in-field by first-responders were compared to patients not receiving first-responder support.Results: The mortality rate was significantly lower among patients initially managed in-field by first responders (n = 325) compared to patients without first-responder support (n = 1,016), 9.8% versus 15.6%, 95% CI = 1.3-10.0%.Conclusions: Trained layperson first responders improve trauma outcomes where prehospital evacuation times are long. This finding demonstrates that simple interventions done early - by any type of trained care provider - are crucial for trauma survival. Where the prevalence of severe trauma is high, trauma first-responders should be an integral element of the trauma system. © World Association for Disaster and Emergency Medicine 2010. Source


Damasio M.B.,Istituto Giannina Gaslini | De Horatio L.T.,Bambino Gesu Childrens Hospital | Boavida P.,Great Ormond Street Hospital for Children | Lambot-Juhan K.,Hopital Necker Enfants Malades | And 3 more authors.
Acta Radiologica | Year: 2013

Juvenile idiopathic arthritis (JIA) is a heterogeneous condition encompassing all forms of chronic arthritis of unknown origin and with onset before 16 years of age. During the last decade new, potent therapeutic agents have become available, underscoring the need for accurate monitoring of therapeutic response on both disease activity and structural damage to the joint. However, so far, treatment efficacy is based on clinical ground only, although clinical parameters are poor markers for disease activity and progression of structural damage. Not so for rheumatoid arthritis patients where the inclusion of radiographic assessment has been required by FDA to test the disease-modifying potential of new anti-rheumatic drugs. In imaging of children with JIA there has been a shift from traditional radiography towards newer techniques such as ultrasound and MRI, however without proper evaluation of their accuracy and validity. We here summarize present knowledge and discuss future challenges in imaging children with JIA. Source


Nenad T.,University of Tromso | Reiner W.,Berufsgenossenschaftliche Unfallklinik | Michael S.,Berufsgenossenschaftliche Unfallklinik | Reinhard H.,Berufsgenossenschaftliche Unfallklinik | Hans H.,University Hospital North Norway
Journal of Trauma - Injury, Infection and Critical Care | Year: 2010

Background: The management strategies for reconstruction of soft-tissue defects of the lower leg and the foot remain disputed. To date, no comprehensive studies have been reported on the saphenous perforator flaps in reconstructive surgery in patients with posttraumatic osteomyelitis. MATERIAL:: Fifty patients with lower leg postinjury chronic osteomyelitis were included in a retrospective, noncontrolled clinical study conducted from 1995 to 2006. All study patients were managed by distally based saphenous neurofasciocutaneous perforator flaps, the feeding perforators originating from the tibial artery. An endpoint survey was conducted after flap surgery, mean follow-up period 4 years, response rate 60%. Results: Six patients had short-term flap failure (12%, 95% confidence interval: 5-24). An additional six patients had flap necrosis of <1/4 that healed without surgical revision. Based on the endpoint data, the long-term success rate was 70% (95% confidence interval: 51-85). Three variables had impact on flap failure rates: the number of previous reconstructive operations, the identity of the performing surgeon, and the area of the primary defect. Other assumed risk factors had no statistically significant impact on short- or long-term results. The anatomic localization of the perforating arteries is described. Conclusion: The saphenous perforator flap is a sturdy flap with low short-term failure rates, also in high-risk patients. The success rate compares well with results of free flap transfers in the management of posttraumatic osteomyelitis. The saphenous flap is a feasible option for posttraumatic reconstructions of osteomyelitis, especially in low-resource settings. © 2010 Lippincott Williams & Wilkins. Source


Viet L.,Dong - A University | Husum H.,University Hospital North Norway
Southeast Asian Journal of Tropical Medicine and Public Health | Year: 2012

The study examines the epidemiology of cluster weapon and land mine accidents in Quang Tri Province since the end of the Vietnam War. The province is located just south of the demarcation line and was the province most affected during the war. In 2009, a cross sectional household study was conducted in all nine districts of the province. During the study period of 1975-2009, 7,030 persons in the study area were exposed to unexploded ordnances (UXO) or land mine accidents, or 1.1% of the provincial population. There were 2,620 fatalities and 4,410 accident survivors. The study documents that the main problem is cluster weapons and other unexploded ordnances; only 4.3% of casualties were caused by land mines. The legacy of the war affects poor people the most; the accident rate was highest among villagers living in mountainous areas, ethnic minorities, and low-income families. The most common activities leading to the accidents were farming (38.6%), collecting scrap metal (11.2%), and herding of cattle (8.3%). The study documents that the people of the Quang Tri Province until this day have suffered heavily due to the legacy of war. Mine risk education programs should account for the epidemiological findings when future accident prevention programs are designed to target high-risk areas and activities. Source

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