Does hysterectomy with ovarian conservation affect bone metabolism and density?

We evaluated whether hysterectomy with ovarian conservation (HYX) has an effect on bone metabolism and density in 176 healthy Caucasian postmenopausal women aged 48-59 years. Bone properties of the hip, spine, radius, tibia, and calcaneus were measured using different bone assessment modalities. In addition, bone turnover was assessed using serum bone-specific alkaline phosphatase (BAP), osteocalcin (OC), and tartrate-resistant acid phosphatase (TRAP) 5b as biomarkers. Our results showed that women having HYX had a significantly lower level of OC ( P = 0.017) and a marginally lower level of TRAP 5b ( P = 0.051) and higher bone mineral density (BMD) of the femoral neck ( P = 0.037) and lumbar spine ( P= 0.001) than women with no history of HYX. In addition, the cortical BMD and bone strength index (I(polar)) of the tibia also showed higher values at different sections in women having HYX than women with no history of HYX ( P = 0.055 to P< 0.005). These results suggest that the uterus may have a role in regulating bone metabolism that has not been detected previously.     

Bioabsorbable miniplating versus metallic fixation for metacarpal fractures

Bioabsorbable implants offer an attractive alternative to metallic implants to stabilize small bone fractures in the hand. Self-reinforced bioabsorbable miniplating for metacarpal fractures was studied in bones from cadavers and compared with standard metallic fixation methods. One hundred twelve fresh-frozen metacarpals from humans had three-point bending and torsional loading after transverse osteotomy followed by fixation using seven methods: (1) dorsal and (2) dorsolateral 2-mm self-reinforced polylactide-polyglycolide 80/20 plating, (3) dorsal and (4) dorsolateral 2-mm self-reinforced poly-L/DL-lactide 70/30 plating, (5) dorsal 1.7-mm titanium plating, (6) dorsal 2.3-mm titanium plating, and (7) crossed 1.25-mm Kirschner wires. In apex dorsal and palmar bending, dorsal self-reinforced polylactide-polyglycolide and poly-L/DL-lactide plates provided stability comparable with dorsal titanium 1.7-mm plating. When the bioabsorbable plates were applied dorsolaterally, apex palmar rigidity was increased and apex dorsal rigidity was decreased. Bioabsorbable platings resulted in higher torsional rigidity than 1.7-mm titanium plating and in failure torque comparable with 2.3-mm titanium plating. Low-profile selfreinforced polylactide-polyglycolide and poly-L/DL-lactide miniplates provide satisfactory biomechanical stability for metacarpal fixation. These findings suggest that bioabsorbable miniplating can be used safely in the clinical stabilization of metacarpal and phalangeal fractures.     

Sound exposure among the Finnish National Opera personnel

The purpose of the study was to determine how and when the personnel of the Finnish National Opera are exposed to noise and whether exposure depends on musical selection of repertoire. Additionally, an evaluation of sound exposure level due to individual rehearsals was included. The measurements were done using individual noise dosimeters and fixed-point measurements. From the measurements, annual noise exposure in the Opera was evaluated. The conductors, dancers, and double bass players were exposed to levels below 85 decibels, A-weighted, dB(A), which is the national action level. The choir members were exposed to sound levels of 92 and 94 dB(A). Within the orchestra, the highest sound exposure levels were found among percussionists, 95 dB(A); flute/piccolo players, 95 dB(A); and brass players, 92-94 dB(A). Other sound exposure levels among orchestra members varied from 83 to 89 dB(A). Soloists and rehearsal pianists are likely to be exposed to sound levels exceeding the national action level. From an exposure perspective, the individual rehearsals, 79-100 dB(A), proved to be as important as performances and group rehearsals, 82-99 dB(A), among orchestra musicians and choir singers. The ambient sound level for the lighting crew was 76 +/- 4 dB(A). However, the measured sound levels at the ear varied from 77 to 92 dB(A) due to the communication via headphones that had individual volume control. For the majority of personnel of the Finnish National Opera, sound exposure level exceeded the national action level value of 85 dB(A). Artists exceeded the action level during both individual and group rehearsals, as well as during performances. Hearing protection has been designed for musicians. Education/reinforcement is required to ensure it is worn.     

Invasive group B streptococcal infections in Finland: a population-based study

We analyzed surveillance data on group B streptococcus (GBS) infection in Finland from 1995 to 2000 and reviewed neonatal cases of early-onset GBS infection in selected hospitals in 1999 to 2000. From 1995 to 2000, 853 cases were reported (annual incidence 2.2-3.0/100,000 population). We found 32-38 neonatal cases of early-onset GBS disease per year (annual incidence 0.6-0.7/1,000 live births). In five hospitals, 35% of 26 neonatal cases of early-onset GBS infection had at least one risk factor: prolonged rupture of membranes, preterm delivery, or intrapartum fever. Five of eight mothers screened for GBS were colonized. In one case, disease developed despite intrapartum chemoprophylaxis. Although the incidence of early-onset GBS disease in Finland is relatively low, some geographic variation exists, and current prevention practices are suboptimal. Establishing national guidelines to prevent perinatal GBS is likely to reduce the incidence of the disease.     

A portable diagnostic workstation based on a Webpad: implementation and evaluation

A wireless hand-held Webpad device was used to review a sample set of cranial computerized tomography (CT) studies to assess its diagnostic capabilities and its feasibility as a portable diagnostic workstation for radiology. The data-set consisted of 30 head CT studies of emergency cases. Two neuroradiologists and a senior radiologist participated in the evaluation of the portable workstation. They used a Web-based viewer that we developed, which provided all the major functionalities required for radiological image review. The reported radiological findings and diagnoses were compared with a gold standard, comprising a set of diagnoses previously formulated by a consensus panel of radiologists who had reviewed the original studies. The diagnoses made using the Webpad were correct (no major discrepancies) in 82 out of 90 interpretations (91%), which is comparable to the accuracy reported in image review with a conventional radiological workstation. The average total working time per diagnosis was 5 min 25 s (range 2-12 min). The simplicity of use of the system and its low cost make it suitable for distributing radiological studies within hospital facilities.     

Effect of upper gastrointestinal endoscopy on cardiopulmonary changes in very old patients

Although routine gastroscopy is regarded as a safe examination, it is sometimes associated, especially in elderly patients, with serious arrhythmias. We studied the influence of gastroscopy in very old patients on the occurrence and number of ECG changes and on oxygen saturation. Electrocardiographic (ECG) changes on a 24 h Holter recording and arterial oxygen saturation (SaO2) changes measured by pulse oximetry were observed in 37 hospitalized patients aged 80 years or more undergoing gastroscopy without premedication or conscious sedation and with supplementary oxygen (2 l/min). Gastroscopy did not induce significant arterial oxygen desaturation. ST changes were greatest or equal to that during gastroscopy in 16 (48%) patients. The number of VES increased during the 1-h period after gastroscopy, especially in those patients with an ST level change of over 1 mm h after gastroscopy (P=0.01) and in patients suffering from heart disease (P=0.007). In other arrhythmias no significant change was observed and no fatal complications occurred. Gastroscopy is a safe procedure also in very old patients. However, it induces increased number of VES after endoscopy in patients suffering from heart disease. In those patients a close follow-up of adverse symptoms is advisable, also for a short period after gastroscopy.     

Growth hormone-insulin-like growth factor-1 axis,leptin and sleep in anorexia nervosa patients

The present study characterizes the relationships between severe malnutrition, sleep, growth hormone-insulin-like growth factor-1 (GH-IGF-1) axis, and leptin levels in anorexia nervosa (AN) patients before and after weight gain. Eleven restricting-type anorectic females (mean age = 19.7 years) with severe starvation state [mean body mass index (BMI) = 13.3] were studied using polysomnography and spectral power analysis. The hormone levels were measured in the morning after sleep recording. Eleven normal-weight, age- and gender-matched healthy volunteers without a history of any eating disorder served as controls. After nutritional treatment for about 2 months (65.7 +/- 6.4 days), sleep examinations and blood tests were repeated. At this stage, the study group consisted of 5 patients (mean BMI = 15.6). Higher IGF-1 and leptin levels were associated with longer and deeper sleep among anorectics. The sleep parameters including the percentages of stage 1 sleep and SWS as well as IGF-1 tended to normalize after only limited weight gain. Sleep disturbances in anorectics may be mediated through changes in the levels of the GH-IGF-1 axis hormones, as well as the levels of leptin.     

Day-case tonsillectomy in children: parental attitudes and consultation rates

OBJECTIVE: In Europe, the day-case tonsillectomy rate in children is slowly increasing, but whether parents really want this rapid discharge of their child is questionable. The fear is that aftercare might fall solely on community care. The aim of this prospective study was to introduce pediatric day-case tonsillectomy to our hospital and to determine parents' attitudes to this procedure. The other interest centered on consultation rates within the 2-week recovery period. METHODS: One hundred children aged 3-16 years had day-case tonsillectomy (38) or adenotonsillectomy (62). Peri-operative and post-operative complications were recorded. Parents were phoned the next day and 1-4 months after the operation. Parents' opinions of day-case surgery and consultations with healthcare professionals during the 2-week recovery period were recorded. RESULTS: Ninety children went home the day of the operation. Vomiting was the most frequent complication. No primary hemorrhages occurred. Called the next day, 100% of parents felt that their children were better served spending their first night at home as compared with staying in hospital. Called 1-4 months later, 94.5% of parents still thought this way. In the 2-week recovery period following the tonsillectomy, 13% of patients visited a physician and 17% called for information. These numbers include patients with secondary hemorrhage. If these are excluded, 5% of patients visited a physician and 13% called for advice. Children were taken back to hospital only due to secondary hemorrhage. CONCLUSIONS: Most parents considered day-case tonsillectomy to be suitable for their family. Consultation rates were low. Careful patient selection and adequate pre-operative information are prerequisites for day-case tonsillectomy.