Clinical results and recurrences 1-4 years after parietal cell vagotomy in duodenal ulcer patients

168 patients with duodenal or prepyloric ulcer, treated with parietal cell vagotomy (PCV), were followed up one to four years after operation. 67% of the patients had more than 5 years' history of ulcer disease and in 44% preoperative bleeding or perforation could be confirmed. According to the modified Visick classification the clinical results were considered excellent or very good in 71%, with a marked tendency to better results for those surgeons with the greatest experience in performing parietal cell vagotomy. The result was considered unsatisfactory in 25 patients (15%) and this was in all cases due to reoperation and/or recurrent ulcer. There was no postoperative mortality and a low frequency of postoperative complications. Dumping was found in only one patient and mild diarrhoea in two. At follow-up, 16 patients (9.5%) had had a proven and 8 (4.5%) a suspected recurrent ulcer and 3 had gastric retention without recurrence. The recurrence rate was very high for those patients operated during the first year after the introduction of PCV, but then decreased significantly. 18 patients required reoperation. Antrectomy or truncal vagotomy with drainage is considered the method of choice for patients with an incomplete PCV and recurrent ulcer.     

Asthenopia in Schoolchildren,Orthoptic and Ophthalmological Findings and Treatment

The aim of this study was to describe the orthoptic and ophthalmological findings in schoolchildren with asthenopia, to correlate them with asthenopic symptoms and to evaluate the effect of treatment. One hundred and twenty schoolchildren, aged 6–16 years, were included in the study. They were all referred by school nurses, for asthenopic symptoms. An orthoptic and ophthalmological assessment was performed. The main diagnoses were accommodative insufficiency, convergence insufficiency, refractive errors, and latent strabismus. Reading glasses could help 98% of the schoolchildren with reduced accommodation, and 94% of the children with refractive errors and heterophorias were helped with appropriate spherical, cylindrical and prism correction. Convergence exercise reduced the symptoms in all patients with convergence insufficiency. Ninety-three percent of all 120 schoolchildren were symptom free 3–6 month after treatment had started. By an orthoptic and ophthalmological examination abnormalities in schoolchildren with asthenopia related to visual problems can be identified. Most of the children were relieved from their symptoms by giving adequate glasses, convergence exercises and surgery.     

Does the Covid-19 pandemic affect ankle fracture incidence? Moderate decrease in Sweden

Background and purpose — While many other countries implemented strict regulations and restrictions for their citizens during the 1st wave of the Covid-19 pandemic, Sweden maintained a more restrained approach. The Swedish Public Health Agency emphasized individual responsibility and pushed for behavioral changes. With strict lockdown a 77% decrease in ankle fracture incidence has been reported. We investigated whether there was a change in the incidence of ankle fractures seen at 7 selected hospitals during the Covid-19 pandemic 2020.Patients and methods — Data on all ankle fractures treated at 7 selected departments during March 15 through June 15, 2020, and for the same period in the preceding 3 years (2017–2019), was retrieved from the Swedish Fracture Register. The number of fractures during the whole period and subsequent 30-day periods were compared between 2020 and 2017–2019, including subgroup analyses of age and sex.Results — The monthly rate of ankle fractures was reduced by 14% in 2020 (139 fractures) compared with 2017–2019 (161 fractures). Women had a 16% decrease and patients aged > 70 years had a 29% decrease. During the 1st 30-day period, a 26% decrease in fractures was seen.Interpretation — During the 1st wave of the Covid-19 pandemic, a moderate decline in the number of ankle fractures was seen. Women and patients aged > 70 years displayed the greatest reduction. The greatest reduction in incidence of fractures was seen during the 1st 30-day period. This indicates greater adherence to government recommendations regarding social distancing in these subgroups and during the 1st month of the pandemic. Changes in ankle fracture incidence may be a measure of lockdown extent.

While many other countries implemented strict regulations and restrictions for their citizens during the 1st wave of the Covid-19 pandemic, imposing quarantine and entry bans and closing restaurants, schools, and preschools to prevent the spread, Sweden maintained a more restrained approach. The Public Health Agency of Sweden (SPHA) emphasized individual responsibility and pushed for behavioral changes instead of imposing regulations, with the aim of reducing the pace of viral transmission (Public Health Agency of Sweden 2020). From mid-March, 2020, Swedes were advised to stay at home if they had symptoms, to keep their distance and take personal responsibility (Government Offices of Sweden 2020). The only ban imposed in Sweden during the 1st months of the pandemic during the spring of 2020 was a ban on public gatherings of 50 or more people on March 27.Ankle fractures are common in all age groups and both sexes and most often sustained after a simple same-level fall (Bergh et al. 2020, Rydberg et al. 2020). Following the recommendations imposed by the SPHA, people worked more from home, thereby eliminating travelling to work. Sports activities and competitions were cancelled on a widespread scale. A reduction in the number of ankle fractures could be expected.Haskel et al. (2020) reported a 77% reduction in ankle fractures in New York and Lubbe et al. (2020) reported a reduction in the number of orthopedic trauma and foot injuries in Las Vegas during a 45-day period in March–April. Kuitunen et al. (2020) described a substantial decrease in Finland in the number of visits to A&E due to orthopedic conditions during the 1st wave of the pandemic.The Swedish Fracture Register (SFR) is a national quality register that has been collecting information on fractures of all types for almost 10 years (Wennergren et al. 2015). The SFR collects data on patient characteristics, injury mechanism, fracture type, and subsequent treatment methods for fractures of all types, treated surgically as well as non-surgically. As data are entered in the register by the treating physician at the time of the injury, they can be extracted from the register without delay.We investigated whether there was a change in the incidence of ankle fractures seen in some selected hospitals during the Covid-19 pandemic compared with the same time period during the previous 3 years. We also investigated whether a reduction in the incidence of ankle fractures was seen in sub-groups defined by age and sex, or during certain 30-day periods.     

Exercise training in heart failure improves quality of life and exercise capacity

Aims Benefit from exercise training in heart failure has mainly beenshown in men with ischaemic disease. We aimed to examine theeffects of exercise training in heart failure patients 75 yearsold of both sexes and with various aetiology. Methods and Results Fifty-four patients with stable mild-to-moderate heart failurewere randomized to exercise or control, and 49 completed thestudy (49% 65 years; 29% women; 24% non-ischaemic aetiology;training, n=22; controls, n=27). The exercise programme consistedof bicycle training at 80% of maximal intensity over a periodof 4 months.Improvements vs controls were found regarding maximalexercise capacity (6±12 vs –4±12% [mean±SD],P<0·01)and global quality-of-life (2 [1] vs 0 [1] units [median {inter-quartilerange}],P<0·01), but not regarding maximal oxygenconsumption or the dyspnoea–fatigue index. All of thesefour variables significantly improved in men with ischaemicaetiology compared with controls (n=11). However, none of thesevariables improved in women with ischaemic aetiology (n=5),or in patients with non-ischaemic aetiology (n=6). The trainingresponse was independent of age, left ventricular systolic function,and maximal oxygen consumption. No training-related adverseeffects were reported. Conclusion Supervised exercise training was safe and beneficial in heartfailure patients 75 years, especially in men with ischaemicaetiology. The effects of exercise training in women and patientswith non-ischaemic aetiology should be further examined.