Hip fractures in Finland and Great Britain – a comparison of patient characteristics and outcomes

All hip fracture patients (age <50 years, pathological and subtrochanteric fractures excluded) were registered at admission to hospital and at 4 months (mortality up to 1 year) between 1989 and 1997 in Peterborough District Hospital (2083 patients) and Oulu University Hospital (1702 patients). The mean age at fracture was 80.3 years in Peterborough and 78.3 years in Oulu. Respectively, 69% and 62% of the patients had been living in their own homes, 50% and 54% had been able to walk alone unassisted. In Oulu, the patients were discharged after a mean stay of 7.1 days, most of them to health care centre hospitals (71%) and only 21% to their original place of residence. In Peterborough 81% were discharged to their original place of residence after a mean stay of 15.6 days. At 4 months, 54% were living at their own homes in Peterborough and 44% in Oulu. The overall mortality at 1 year was 27.1% in Peterborough and 24.9% in Oulu.     

The effect of age and density of the breast on the sensitivity of breast cancer diagnostic by mammography and ultasonography

Purpose. We studied which, age of the patient or density of the breast accounts for the sensitivity of mammography and ultrasonography (US). Furthermore we studied whether the overall impression on the density of the breast or the density in tumour area accounts for the sensitivity of mammography and ultrasonography. Materials and methods. The material consisted of 572 consecutive histologically and 5 cytologically verified breast cancer cases. Mammography and US examinations were performed immediately before breast cancer operations and information on the findings were received from the original patient files and classified as malignant or benign. The density of breast parenchyma to fatty, mixed or dense in total breast and separately in tumour area was defined by a radiologist group from the original mammograms by comparing to model mammograms. The sensitivity (Se) of mammography and US was compared in 3 age groups (26–49, 50–59 and 60–92) and in the different density classes. Results. Sensitivity of mammography increased by age (density-adjusted OR=0.2, 95%, CI 0.1–0.5) in age group 26–49 compared to age group 60–92) and with fattiness of the breast (age-adjusted OR=0.4, 95%, CI 0.1–1.0 for dense breast parenchyma in tumour area compared to fatty breast). Sensitivity of US was inversely related to age (density-adjusted OR=2.3, 95%, CI 1.0–5.2 in age group 26–49 compared to age group 60–92) and directly related with fattiness of breast (age-adjusted OR=0.5, 95%, CI 0.2–0.9 by dense breast parenchyma in tumour area compared to fatty breast). Density in the tumour area compared to total breast density was related only mariginally better sensitivity both of mammography (0.4 vs. 0.6) and of US (0.5 vs. 0.6). itConclusion. Sensitivity of both mammography and sensitivity of US are independently related both to the age of the patient and to the density of the breast. The effect of age is inverse and that of density parallel between mammography and US on sensitivity. The effect of overall breast density was close to the effect of density at the site of the tumour on the sensitivity of both mammography and US.     

Is a dissection balloon beneficial in totally extraperitoneal endoscopic hernioplasty (TEP)?

apd: 27 February 2001     

The 12-month prevalence and risk factors for major depressive episode in Finland: representative sample of 5993 adults

OBJECTIVE: This study reports the 12-month prevalence of major depressive episode and its risk factors in a representative nationwide sample. METHOD: A random sample of non-institutionalized Finnish individuals aged 15-75 years (N = 5993) was interviewed in 1996. Major depressive episode during the last 12 months was assessed using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). RESULTS: The population prevalence of major depressive episode was 9.3% [95% CI 8.5,10.0], and the age-adjusted prevalences for females and males were 10.9% [95% CI 9.7,12.0] and 7.2 [95% CI 6.2,8.2], respectively. In logistic regression analyses the factors associated with major depressive episode after adjustment for age were urban residency, smoking, alcohol intoxication and chronic medical conditions. In addition, being single and obese were found to be risk factors for males. CONCLUSION: The female to male risk ratio for major depressive episode was smaller than in many previous studies. The sex-specific risk factor associations warrant further investigation into sex differences in depression.     

Breastfeeding and childhood asthma: a six-year population-based cohort study

Background  

The question of the protective effect of breastfeeding on development of asthma has raised substantial interest, but the scientific evidence of the optimal duration of breastfeeding is controversial.     

General lymphangiomatosis in a child

The lymphographic findings in a 4 year old girl with general lymphangiomatosis are presented. The number of iliac and lumbar lymphatics had increased markedly and the lymph nodes were enlarged with very loose structure and with contrast medium distributed in scattered droplets and filiform channels.     

Cerebrospinal fluid concentration and urinary excretion of cyclic adenosine-3′, 5′-monophosphate in various diseases of children

Cerebrospinal fluid (CSF) concentration and urinary excretion of cyclic adenosine-3′,5′-monophosphate (cAMP) were measured in children aged from 3 days to 15 years by the protein-binding method of Gilman (1970). The mean CSF cAMP concentration (22.4±0.6 (S.E.) nmol/l) of 24 “healthy” children tended to be lower (P<0.2) than that of adult patients who revealed no pathological findings on clinical examination. No difference in the results was found between the sexes. High cAMP concentrations were found in CSF of children suffering from cerebellar glioma, hypothalamic precocious puberty, bacterial meningitis, or Cushing's disease. The urinary excretion of cAMP varied from 0.2 to 5.3 in “healthy” and from 1.3 to 7.6 μmol/24 hrs in diseased children. Two children with pheochromocytoma showed a striking decrease in the rate of urinary excretion of the nucleotide after surgical treatment.     

Angiographic 20-year follow-up of 61 consecutive patients with internal thoracic artery grafts.

OBJECTIVE: To assess the behavior of internal thoracic artery (ITA) grafts versus venous grafts in repeated angiograms up to 20 years. SUMMARY BACKGROUND DATA: Use of ITA grafts to bypass left anterior descending artery stenosis has been shown to be associated with improved survival in patients undergoing coronary artery bypass grafting. METHODS: Sixty-one consecutive patients who received one or two ITA grafts and who underwent surgery from Oct. 5, 1971, to Dec. 18, 1973, in Helsinki University Central Hospital, Finland, were included in this prospective follow-up series. Fifty-six of the patients (92%) also received at least one venous graft. The number of distal anastomoses was 157, of which 47.7% (75) were performed with ITA grafts. The median age of the patients was 47.7 years (range 30.0 to 63.1), and 85% (52) were men. RESULTS: After 20 years of follow-up, 18/20 (90%) of the survivors underwent angiography; the patency rate was 88.9% for ITA grafts and 47.8% for venous grafts. Cumulative graft patency at 20 years, using all the information obtained from repeated angiographic examinations and autopsies, was also calculated to eliminate selection bias. The cumulative 20-year patency rate was 81% for ITA-left anterior descending artery anastomoses, 53.8% for venous graft-right coronary artery anastomoses, and 48.5% for venous graft-left circumflex artery anastomoses. In paired comparisons between anastomoses, the patency time of the ITA-left anterior descending artery anastomoses was on average 2.8 years longer than the venous graft-left circumflex artery patency time and 2.6 years longer than the venous graft-right coronary artery. CONCLUSIONS: Internal thoracic artery grafts, especially in left anterior descending artery anastomoses, should be considered as a primary solution in coronary artery bypass grafting surgery in patients with >10 years of life expectancy; if venous grafting is preferred, further evidence is needed.     

Nosocomial Legionella pneumophila serogroup 5 outbreak associated with persistent colonization of a hospital water system

An outbreak of infections caused by Legionella pneumophila serogroup 5 was detected in a university hospital, and nosocomial reservoirs of the legionella epidemic were examined. Clinical isolates from two patients who had been affected by the L. pneumophila serogroup 5 outbreak, and from another patient with a legionella infection caused by the same serogroup 3 years later, were compared to L. pneumophila serogroup 5 isolates from the hospital water supply by two molecular methods, amplified fragment length polymorphism (AFLP) analysis and random amplified polymorphic DNA analysis (RAPD). Genotyping confirmed the epidemiological linkage of the first two patients, and linked their infections with the hospital water supply. The third clinical strain, which was also linked to the hospital water, was very similar to the epidemic strain. Even though the water distribution system was sanitized (superheat and flush sanitation), the epidemic strain was shown to be persisting in the hospital water outlets several years after its initial discovery.