Time trends in pediatric fracture incidence in Sweden during the period 1950–2006

Background and purpose — Pediatric fracture incidence may not be stable. We describe recent pediatric fracture epidemiology and etiology and compare this to earlier data.

Patients and methods — The city of Malmö (population 271,271 in 2005) in Sweden is served by 1 hospital. Using the hospital diagnosis registry, medical charts, and the radiographic archive, we identified fractures in individuals <16 years that had occurred during 2005 and 2006. We also retrieved previously collected fracture data from between 1950 and 1994, from the hospital’s pediatric fracture database. We used official population data to estimate period-specific fracture incidence (the number of fractures per 10⁵ person-years) and also age- and sex-adjusted incidence. Differences are reported as rate ratios (RRs) with 95% confidence intervals.

Results — The pediatric fracture incidence during the period 2005–2006 was 1,832 per 10⁵ person-years (2,359 in boys and 1,276 in girls), with an age-adjusted boy-to-girl ratio of 1.8 (1.6–2.1). Compared to the period 1993–1994, age-adjusted rates were unchanged (RR =0.9, 95% CI: 0.8–1.03) in 2005–2006, with lower rates in girls (RR =0.8, 95% CI: 0.7–0.99) but not in boys (RR =1.0, 95% CI: 0.9–1.1). We also found that the previously reported decrease in unadjusted incidence in Malmö from 1976–1979 to 1993–1994 was based on changes in demography, as the age-adjusted incidences were similar in the 2 periods (RR =1.0, 95% CI: 0.9–1.1).

Interpretation — In Malmö, pediatric fracture incidence decreased from 1993–1994 to 2005–2006 in girls but not in boys. Changes in demography, and also other factors, influence the recent time trends.     

Minimizing atelectasis formation during general anaesthesia—oxygen washout is a non-essential supplement to PEEP

Background: Following preoxygenation and induction of anaesthesia, most patients develop atelectasis. We hypothesized that an immediate restoration to a low oxygen level in the alveoli would prevent atelectasis formation and improve oxygenation during the ensuing anaesthesia.

Methods: We randomly assigned 24 patients to either a control group (n?=?12) or an intervention group (n?=?12) receiving an oxygen washout procedure directly after intubation. Both groups were, depending on body mass index, ventilated with a positive end-expiratory pressure (PEEP) of 6–8 cmH₂O during surgery. The atelectasis area was studied by computed tomography before emergence. Oxygenation levels were evaluated by measuring blood gases and calculating estimated venous admixture (EVA).

Results: The atelectasis areas expressed as percentages of the total lung area were 2.0 (1.5–2.7) (median [interquartile range]) and 1.8 (1.4–3.3) in the intervention and control groups, respectively. The difference was non-significant, and also oxygenation was similar between the two groups. Compared to oxygenation before the start of anaesthesia, oxygenation at the end of surgery was improved in the intervention group, mean (SD) EVA from 7.6% (6.6%) to 3.9% (2.9%) (P?=?.019) and preserved in the control group, mean (SD) EVA from 5.0% (5.3%) to 5.6% (7.1%) (P?=?.59).

Conclusion: Although the oxygen washout restored a low pulmonary oxygen level within minutes, it did not further reduce atelectasis size. Both study groups had small atelectasis and good oxygenation. These results suggest that a moderate PEEP alone is sufficient to minimize atelectasis and maintain oxygenation in healthy patients.     

High prevalence of an active cytomegalovirus infection in the appendix of immunocompetent patients with acute appendicitis

BACKGROUND: Appendicitis is a very common surgical diagnosis with unclear pathology. Human cytomegalovirus (HCMV) can modulate our immune system and has been associated with inflammatory bowel disease (IBD) and various other inflammatory diseases. METHODS: We investigated the association between HCMV and acute appendicitis in 14 immunocompetent patients. Tissue sections from 10 AIDS patients with verified HCMV infection were used as positive controls, and uninflamed intestinal tissue sections from 12 patients were used as negative controls. RESULTS: Cells double positive for HCMV early antigens and IL-6/IL-8 were observed in the appendices of 64.3% of appendicitis patients (9 of 14) by immunohistochemical analysis. HCMV late antigen was found in the appendices of 42.9% of the acute appendicitis patients (6 of 14). Latent HCMV appendix infection, as verified by in situ hybridization, as well as HCMV IgG, was observed in 78.6% of patients (11 of 14). The study samples from all 6 healthy appendices were negative for HCMV early and late antigens, although 50% (3 of 6) were HCMV IgG and HCMV DNA positive. CONCLUSIONS: We have shown that HCMV infection of the appendix is associated with acute appendicitis (P = 0.002) and possibly with the severity of the disease. Our study identified HCMV as a pathogen to be sought for in the appendicitis patient group, possibly allowing further medical treatment of these patients.     

Dishevelled proteins are significantly upregulated in chronic lymphocytic leukaemia

Tumor Biology - Dishevelled (DVL) proteins are components of the Wnt signalling pathways, and increased expression is associated with various malignancies. Information on DVLs in chronic lymphatic...     

Epidemiology of cutaneous melanoma in Sweden—Stage‐specific survival and rate of recurrence

Cutaneous malignant melanoma (CMM) incidence is increasing globally, making a thorough understanding of the disease and its outcomes essential for optimizing care even more urgent. In this population‐based, retrospective study, we investigated stage‐specific survival and recurrence/progression rates of CMM among patients diagnosed in Stockholm County Council during 2005–2012, before the wide introduction of targeted therapy. A total of 3,554 CMM patients from the Stockholm Melanoma Register were included. Information on comorbidities, progression, death, and treatments was obtained from nationwide registers and hospital electronic medical records. Unadjusted 5‐year survival varied from 91.4% for stage I to 24.6% for stage IV patients. Stage, age and gender were predictors of survival, with gender an independent predictor of survival for stages IA and IIA. 74.6% of patients remained recurrence/progression‐free during follow‐up, with 5‐year recurrence/progression‐free survival rates varying from 85.3% to 12.9% among stages I and IV patients, respectively. In addition to stage, male gender, and age, circulatory system comorbidities increased the risk for recurrence/progression. No statistically significant differences in progression rate for operated and non‐operated patients could be detected, possibly due to high rate (98.9%) of surgery. Our estimates of survival and recurrence rates are consistent with historical and global expectations and can serve as a baseline to gauge population‐level improvements with use of novel melanoma treatments.