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Seventy-eight patients with unstable, one-level fracture of the thoracolumbar spine and no neurological impairment were treated with short segment fixation, transpedicular autologous bone transplantation and posterolateral fusion. Kyphotic deformity and anterior column height improved significantly. Complications consisted of one case of late deep infection, three cases of seroma, four cases with 5 mm schantz screw breakage and two cases with screw loosening. Mild to moderate pain was present in 79% of the patients at follow-up, median 32 (13-72) months. Sixty-seven percent of the patients had returned to previous activity levels of employment. Short posterior internal fixation, transpedicular transplantation and posterolateral fusion allowed neurologically intact patients to be mobilized early, to spend median 12 days in hospital, and carried no risk of deterioration in neurological function.

The aim was to evaluate the effect of supplementary pedicle screw fixation (Cotrel-Dubousset [CD]) in posterolateral lumbar spinal fusion. The study comprises 130 patients undergoing lumbar or lumbosacral fusion for spondyloisthesis grades I-II or degenerative segmental instability conditions. The patients were randomly allocated for no instrumentation (n = 66) or CD instrumentation (n = 64) in posterolateral lumbar fusion. A 97.7% follow-up was achieved. There were no significant differences between the two groups concerning fusion rates assessed by X-ray or functional outcomes assessed by Dallas Pain Questionnaire. The global patient satisfaction was 82% in the instrumented group versus 74% in the noninstrumented group. Instrumentation increased both operation time, blood loss, and early re-operation rates significantly. A high patient satisfaction was found in both groups. However, the results from this study do not justify the general use of pedicle screw fixation alone as an adjunct to posterolateral lumbar fusion.

Epilepsy and asthma, especially non-severe asthmatic bronchitis, were the most frequent genuinely paediatric diagnoses among children referred to paediatric specialist examination. Atopic dermatitis was a substantial problem. A number of patients were probably suffering from sequelae of diseases, which can be prevented or treated. Among potential etiological factors may be mentioned perinatal asphyxia, infections, and neonatal hyperbilirubinemia including kernicterus. Postneonatally meningitis may be mentioned. Cerebral palsy and epilepsy were possible sequelae. Otitis media cannot be considered as genuine paediatric diseases, but nevertheless this was the most frequent diagnosis among children referred to paediatric examination. A few cases of rare diseases were seen, among these some specifically Greenlandic diseases, for instance familial Greenlandic cholestasis and familial hypoplasia of the adrenal cortex. Other health problems than diseases (Z-diagnoses) represented 24% of diagnoses made, among these fear of disease.

The purpose of this investigation was to identify risk factors in relation to non-union following lumbar intercorporal spondylodesis and to correlate this result with the functional outcome as assessed by the Dallas Pain Questionnaire (DPQ). This comprises questions concerning daily activities, work-leisure activities, anxiety-depression and social interest, measured on visual analog scales. During the period 1979-87 a total of 132 patients were operated with spondylodesis, diagnosed as suffering from spondylolisthesis or disc degeneration. Minimal follow-up was one year. Radiological graft incorporation was complete in 52% of the cases, partial in 24% and lacking in 24%. The rate of functional outcome follow-up was 72%. Seventy percent claimed an improvement in three out of four categories. Thirty percent claimed no improvement or worsened condition. The DPQ showed signs of poor prognosis for age groups above 45 (p < 0.04) and those with former spine surgery (p < 0.02). The questionnaire showed significantly better results for the group with perfect or doubtful union compared to the group with non-union (p < 0.006). In conclusion this investigation demonstrates a success rate of 70% for anterior lumbar interbody fusion. There is a tendency to poorer prognosis for patients with previous spine surgery and age above 45 years. The Dallas Pain Questionnaire correlates significantly to X-ray analysis and seems to be a useful tool for the description of individual biopsychosocial changes following spine surgery.

In the district of Maniitsoq/Sukkertoppen, Greenland, an investigation was carried out to evaluate the extent of major surgical diseases seen in an epidemiological context. The number of patients submitted to major emergency surgery was 63, of which 61 were operated at the hospital of Sukkertoppen. The three main diagnostic entities were appendicitis, ectopic pregnancy and complicated delivery leading to cesarean section. Operative outcome was described, and the results were evaluated as satisfactory in the light of a very modest amount of per- and postoperative complications. The need for surgical preparedness must be taken into consideration by the authorities responsible for the recruitment of doctors and medical staff for district hospitals in Greenland.

In addition to the well known paraplegia or tetraplegia, lesions of the spinal cord frequently cause a series of disturbances of sensation in the segments around or distal to the lesion. Disturbances of sensation in spinal cord lesions are painful or non-painful. The painful and also the non-painful sensations may represent irritative and withdrawal phenomena. A series of central neurogenic pains seem to be best explained by spontaneous neuronal activity in sensory spinal cord neurones which have lost the peripheral, segmental and descending neuronal control from the nervous system. Surgical treatment of pain in cases of spinal cord lesions is rarely considered apart from root-avulsion where surgical lesion in the superficial part of the posterior horn is effective. No specific treatment is as yet available for pain and disturbances of sensation in cases of spinal cord injury. However, on the basis of our limited knowledge of the pathogenesis of these symptoms, future therapeutic strategy will be directed towards not only the peripheral but also the central points of attack. Treatment of painful conditions in patients with spinal cord injuries, as in other states of chronic pain, should also include social and psychological support.

Eighty-one women suffering from occluded Fallopian tubes and 29 women with unexplained infertility were treated with in vitro fertilization and embryo transfer (IVF-ET). All procedures were carried out on outpatients. A total of 24 pregnancies were achieved in the group of patients with occluded tubes whereas eight became pregnant in the group of patients treated for unexplained infertility. From these results, it is expected that 30% of women suffering from occluded tubes or unexplained infertility can achieve pregnancy following two IVF-ET treatment cycles.

The incidence of tuberculosis is greatest among elderly individuals. The clinical features may be atypical, non-specific and may be confused with coexistent or age-related diseases. The risk factors predisposing to tuberculosis are related to underlying chronic or acute disease and malnutrition which disrupt integumental barriers, impair clearance mechanisms or compromise cellular responses to infecting agents. It is essential to provide optimal treatment of chronic disease, to avoid invasive procedures, to limit unnecessary medication and to ensure adequate nutrition.