Revision risk after pediatric spinal deformity surgery: a nationwide study with 2-year follow-up

BACKGROUND CONTEXTRevision risk after pediatric spine surgery is not well established and varies between deformity etiologies.PURPOSETo report the 2-year revision risk following surgery for primary pediatric spinal deformity in a nationwide cohort and to evaluate potential risk factors and reasons for revision surgery.DESIGNRetrospective nationwide cohort study.PATIENT SAMPLEA national registry study of all pediatric spinal deformity patients undergoing surgery during 2006–2015 (n=1310).OUTCOME MEASURESTwo-year revision risk.METHODSAll patients ≤21 years of age undergoing spinal deformity surgery in Denmark during 2006–2015 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Data on revision surgery were retrieved from the DNPR. Patients were categorized in six groups according to etiology. Medical records were reviewed for reason for revision in all patients. Potential risk factors for revision were assessed with multiple logistic regression analyses and included age, etiology, sex, Charlson comorbidity index (CCI), and growth-preserving treatment.RESULTSPatients were categorized according to etiology: idiopathic deformity (53%), neuromuscular deformity (23%), congenital/structural deformity (9%), spondylolisthesis (7%), Scheuermann's kyphosis (5%), and syndromic deformity (3%). Of 1,310 included patients, 9.2% underwent revision surgery within 2 years and 1.5% was revised more than once. Median time to revision was 203 (interquartile range 35–485) days. The multivariable logistic regression found significantly higher odds ratio (OR) for revision in patients with growth-preserving treatment (OR=5.1, 95% confidence interval [CI] 2.6–10.1), congenital deformity (OR=2.7, 95% CI 1.3–5.3), spondylolisthesis (OR=3.5, 95% CI 1.9–6.7), Scheuermann kyphosis (OR=3.9, 95% CI 1.9–8.3), and CCI score ≥3 (OR=2.5 95% CI 1.1–5.6). The most common reason for revision was implant failure (32.5%) followed by residual deformity and/or curve progression (15.8%).CONCLUSIONSIn this nationwide study, the 2-year revision risk after primary pediatric spinal deformity surgery is 9.2%. Risk factors for revision are etiology of congenital deformity, spondylolisthesis, Scheuermann kyphosis as well as patients with growth-preserving treatment and higher CCI. The most common reason for revision is implant failure.     

Being in transit and in transition The experience of time at the place,when living with severe incurable disease ‐ a phenomenological study

The aim of this study is to describe the experience of time as it presents itself at the place being situated when living with severe incurable disease and receiving palliative care. The empirical data consist of 26 open‐ended interviews with 23 patients receiving palliative care at home, at a palliative day care, in a palliative bed unit in hospital or in a nursing home in Norway. A common meaning of a shifting space for living emerged from the analysis and was revealed through three different aspects: (i) Transition from a predictable to an unpredictable time: To live with severe incurable disease marks a transition to a changed life involving an ongoing weakened and altered body with bothersome symptoms making experience of time different and unpredictable. (ii) Transition between a safe and unsafe time: When time is unpredictable, feeling safe is revealed as essential to how time is experienced at the place being situated. (iii) To be in transition from a homely to a homeless existence: In a time of increased bodily weakness, unpredictable ailments and displacements, the sense of belonging to the place is revealed as significant to the experience of time. Not knowing where to be in a time of change is like an existential cry of distress where the foothold in existence is lost. The findings are discussed and interpreted as an embodied experience originating from the passage of time continually affecting life sometimes so fundamentally that it marks a transition to a changed space of life that is reflected in the experience of time.     

Failing Masculinity at the Club: A Poststructural Alternative to Intoxication Feminism

With a starting point in women's studies, this article moves on to approach the nightclub as a place of embodiment for both genders by introducing neo-Lacanian insights combined with Baudrillardian concepts. We look at three young drug-experienced men interviewed for a Danish club study (2008–09). The article examines how the risks of losing masculinity, losing sexual opportunities, and losing friends are managed in nightlife. Since masculinity becomes invested in the fantasy of the drug and the utopian party, these young men can be perceived as risking their male position when the party does not work out as planned.     

1- and 7-year risk of cardiac events in relation to Holter monitoring in patients admitted with chest pain in whom AMI is not confirmed

The prognostic value of ventricular premature beats (VPBs) was evaluated in 198 patients with chest pain (non-AMI patients) in whom the diagnosis of acute myocardial infarction was ruled out after admission to hospital. VPBs were registered at the time of discharge during a 24-hour Holter monitoring. The amount of cardiac events (CEs) were analyzed after 1 and 7 years follow-up. After 1 year, CEs were seen in 9% of the non-acute myocardial infarction (AMI) patients. After 7 years, 51 CEs (20 nonfatal AMIs and 31 cardiac deaths) had occurred (25%). After 1 year, only pairs of VPBs were associated with an increased risk of CEs. CEs were seen in 25% of the patients with pairs of VPBs and in 6% of the patients without pairs (p<0.01). The occurrence of CEs after 7 years was related to the presence of pairs of VPBs and multiform VPBs. Fifty-five percent of the patients with pairs of VPBs had CEs during the long-term follow-up, compared with 22.5% without pairs (p<0.0005). CE was seen in 48.9% of the patients with multiform VPBs, compared with 19.0% without multiform VPBs (p< 0.0001). Thus, Holter monitoring seems to be of better value for predicting long-term prognosis than for predicting short-term prognosis in non-AMI patients. The presence of multiform VPBs or pairs of VPBs is strongly associated with an increased risk of CE after 7 years. Non-AMI patients with pairs of VPBs or multiform VPBs should be considered as high-risk patients.Presented at The 35th World Congress, International College of Angiology, Copenhagen, Denmark, July 1993     

Three-year mortality in patients suspected of acute myocardial infarction with and without confirmed diagnosis. The Danish Study Group on Verapamil in Myocardial Infarction

The 3-year mortality from day 15 after admission was evaluated prospectively in 11,345 consecutive patients with chest pain suspected of myocardial infarction--4,265 patients with confirmed diagnosis (AMI) and 7,080 patients without confirmed diagnosis (non-AMI), respectively. The mortality rates per year in the first 3 years in the patients with AMI were 14.2%, 6.9%, and 7.6%, and in the non-AMI patients were 8.8%, 5.8%, and 5.5%. The standardized mortality ratio (SMR) correcting for age and sex differences was calculated. SMR is the ratio between the observed mortality in the study population and the expected mortality in an age- and sex-matched subgroup of the general background population. SMR in the first year was 6.7 (95% confidence limits: 6.2 to 7.2) in AMI and 4.7 (4.4 to 5.1) in non-AMI patients. In the second and third years of follow-up, SMR was 3.0 (2.6 to 3.4) and 2.9 (2.5 to 3.4) in AMI and 2.8 (2.5 to 3.1) and 2.4 (2.1 to 2.8) in the non-AMI patients. It is concluded that in the first 3 years the mortality of non-AMI patients is approximately three times higher than in the general population and very close to the late mortality of AMI patients, suggesting that the majority of non-AMI patients are suffering from ischemic heart disease also. Non-AMI patients should consequently be evaluated carefully prior to discharge.     

Auscultatory versus oscillometric measurement of blood pressure in octogenarians

Abstract Background. Auscultatory measurement using a sphygmomanometer has been the predominant method for clinical estimation of blood pressure, but it is now rapidly being replaced by oscillometric measurement. Objective. To compare blood pressure by auscultatory and oscillometric measurements in patients ≥?80 years. Method. 100 patients had blood pressure measured by auscultation with a sphygmomanometer and by an electronic device using the oscillometric method. For each patient the mean of two blood pressures with each method measured within 15 min were compared. Results. The mean age of participants was 85.8 years; 55.8% were women. The correlation coefficient for systolic blood pressure was 0.88 and for diastolic 0.79. Differences between auscultatory and oscillometric values were less than 10 mmHg in 70.6% of systolic blood pressures and in 83.2% for diastolic. Arrhythmia and hypertension did not influence the results, and there was no correlation between the magnitude of the differences and the level of blood pressure. Conclusion. Agreement between oscillometric and auscultatory measurements of blood pressure in octogenarians was found to be less than required by validation protocols. However, semi-automatic equipment, which is observer-independent, may be used even in the very elderly, particularly if multiple readings are performed.     

Evaluation of a new sagittal classification system in adolescent idiopathic scoliosis

European Spine Journal - The purpose of the present study was to validate a new spinal sagittal classification. We retrospectively included 105 consecutive AIS patients who underwent posterior...     

Independent Origin of Plasmodium falciparum Antifolate Super-Resistance,Uganda, Tanzania,and Ethiopia

Super-resistant Plasmodium falciparum threatens the effectiveness of sulfadoxine–pyrimethamine in intermittent preventive treatment for malaria during pregnancy. It is characterized by the A581G Pfdhps mutation on a background of the double-mutant Pfdhps and the triple-mutant Pfdhfr. Using samples collected during 2004–2008, we investigated the evolutionary origin of the A581G mutation by characterizing microsatellite diversity flanking Pfdhps triple-mutant (437G+540E+581G) alleles from 3 locations in eastern Africa and comparing it with double-mutant (437G+540E) alleles from the same area. In Ethiopia, both alleles derived from 1 lineage that was distinct from those in Uganda and Tanzania. Uganda and Tanzania triple mutants derived from the previously characterized southeastern Africa double-mutant lineage. The A581G mutation has occurred multiple times on local Pfdhps double-mutant backgrounds; however, a novel microsatellite allele incorporated into the Tanzania lineage since 2004 illustrates the local expansion of emergent triple-mutant lineages.