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This is a case report of a 26-year-old healthy female who sustained an isolated posterior malleolar fracture; diagnosed by X-ray, confirmed by CT and treated with an orthosis and full weightbearing. Subsequent weightbearing X-rays showed no displacement or concomitant injury. However rare, isolated posterior malleolar fracture may indicate a complex ankle injury and therefore warrant extra attention when diagnosed. The diagnosis is difficult due to diffuse symptoms and limited visualization on plain X-rays. Missed diagnoses might lead to persistent pain and arthrosis.

Appendicitis is a common condition, which is often seen by the general practitioners as well as in the emergency departments. It is normally treated with laparoscopic appendectomy. This review gives an overview of the long-term surgical complications ileus and incisional hernia and of the impact of appendicitis and appendectomy on female fertility. The literature shows, that there is a low risk of ileus and incisional hernia after appendectomy, and that there is no change in female fertility after appendectomy, not even in cases where the appendix was perforated.

Cardiovascular disease is the leading cause of death in the western countries. Conventional risk evaluation of asymptomatic individuals is unfortunately inaccurate. There is a need for better diagnostic tools to identify persons, who will benefit from intensified preventive treatment. Coronary artery calcium score (CACS) measured by multi-slice CT scan contributes significantly to risk stratification especially in persons with intermediate risk assessed by conventional risk analysis. A CACS-guided preventive intervention strategy seems appealing to reduce mortality due to cardiovascular disease.

Introduction: Iatrogenic dural tear with cerebrospinal fluid leakage is a known complication of lumbar surgery of the columna. In the literature, the incidence is 3-16%., Material and Methods: The study was a retrospective, consecutive review of electronic patient records after spinal surgery at the Private Hospital Hamlet. The study covers cases from the 10-month period from September 1, 2007 to June 30, 2008. Data was collected after this period and consists of surgeon-documented dural tears. At the time of surgery, the surgeon was unaware that there would be a subsequent registration. A total of 634 patients had lumbar neural decompressive surgery - 479 patients were treated for spinal stenosis and 155 for prolapsed disc., Results: The incidence of dural tear was 3.9% (25 dural tears in 634 operations). The risk of a dural tear after secondary surgery was 7.9% versus 3.3% for primary (p = 0.02) and the mean age was 65.9 years for patients with dural tear compared with 58.1 years for patients without (p = 0.00). The difference in the mean duration of surgery was significant being 72 minutes in the group suffering a dural tear compared with 56 minutes (p = 0.03) among the remaining patients, and in the former group length of stay was increased by 1.1 day (p = 0.00)., Conclusion: The incidence of iatrogenic dural tear was 3.9%. The incidence of dural tear was doubled in secondary surgery. The duration of surgery increased by 16 minutes and the patients with dural tear were also hospitalized one day longer.

Introduction: Introduction of principles for postoperative multimodal rehabilitation (fast track surgery) has decreased hospital stay from about 8-10 days to 2-4 days after colonic resection. The aim of this study was to investigate the effect of a similar fast track regimen in patients operated for ovarian cancer., Method: 72 consecutive patients operated with a conventional perioperative treatment regimen (group 1) were compared with the initial 69 consecutive patients (group 2) with a multimodal rehabilitation regimen and the next 50 consecutive patients (group 3) where the fast track regimen was implemented as a routine., Results: Patients demographics and surgical characteristics were comparable between groups. Median postoperative hospital stay was reduced from six days in group 1, to five days in group 2, and four days in group 3 (p < 0,05). Surgical complications were similar while medical complications were reduced from 12% to 1% (p < 0,05) and readmissions from 10% to 2% (p < 0,05) with the fast track regimen., Conclusion: Principles for postoperative multimodal rehabilitation from colonic surgery lead to faster rehabilitation, decreased risk of medical complications and hospital stay in patients operated for ovarian cancer.

In acute heart failure the myocardial function is acutely reduced and the oxygenation of the tissues becomes inadequate. Traditional inotropic drugs improve the haemodynamics and give symptomatic relief, but the evidence of injurious effects on morbidity and mortality restricts their use. The need for new inotropic drugs which can also reduce morbidity and mortality is for that reason obvious. Levosimendan is such a new drug in a new class (Ca2+ sensitizers) of positive inotropic drugs with favourable effects compared to existing treatment possibilities.

Metastatic spinal cord compression (MSCC) is a disabling complication to cancer for which the optimal treatment of choice is not settled. An analysis was performed in patients with MSCC secondary to lung cancer in order to elucidate clinical symptoms and treatment results according to regression of neurological deficits and survival. The total series consisted of 102 retrospectively evaluated patients referred for treatment, in the Eastern part of Denmark in the period 1979-1988. Patients included 40% cases with Small Cell Carcinoma (SCLC), Adeno-carcinoma (ACL) (26%), Squamous Cell Carcinoma (SQLC) (18%) and Large Cell Carcinoma (LCC) (9%). Symptoms, clinical presentations and therapeutic results are described. The outcome of treatment depended fundamentally on the patient's neurological condition at the time of the diagnosis. All patients with SCLC who were able to walk at the time of MSCC remained ambulatory while 15% of the non-ambulatory SCLC patients regained walking ability; in non-SCLC, 95% of patients retained walking ability while 22% regained the ability to walk. No major differences in the immediate outcome of treatment between the various histological types of lung cancer as to the different treatment modalities were observed, however, 82% of the patients with non-SCLC had benefit from treatment with laminectomy followed by radiotherapy compared with either laminectomy (47%) or radiotherapy (39%) alone (p = .03, Chi-square test). The group of patients treated with laminectomy followed by radiotherapy had a better survival (median value 3.5 months, range 0-132 months) than patients treated with either laminectomy (median value 1.5 months, range 0-32 months) or radiotherapy (median value 1 month, range 0-59 months) alone (p = .03, Log-Rank test). No significant difference was observed in survival between the various histological types of lung cancer (p = .18, Log-Rank test). Despite a short survival, early diagnosis and immediate treatment is crucial, since it may preserve the gait function in 97% of lung cancer patients developing malignant spinal cord compression.

Potential toxic effects of prolonged NO2 exposure below the current threshold limit value (TLV) were examined in 14 healthy, non-smoking adults. The subjects were exposed to 2,3 ppm NO2 and to clean air for five hours with a one week interval between exposures. Physiological and biochemical measurements were obtained during exposure and the following 24 hours after. A 14% decrease in serum glutathione peroxidase activity (GSH-Px) was observed 24 hours after the start of the NO2 exposure while indications of a 22% decrease in alveolar permeability were found 11 hours after the start. There were no indications of mucous membrane irritation or of decreased lung function during or after NO2 exposures. The results support the assumption that a delayed response is a feature of the human reaction to NO2 even below the current TLV of three ppm, and they stress the importance of an extended period of observation in future NO2 exposure studies.

Failure of the testes to descend is probably mostly due to dysfunction of the hypothalamo-pituitary-testis axis. The primary treatment of testicular non descent should therefore be pharmacological in the form of HCG injections or LH-RH intranasally. Contraindications for hormonal therapy are coexistent inguinal hernia or hydrocele testis or previous inguinal operations. HCG and LH-RH treatment lead to testicular descent with about the same frequency, 20-50% in boys above five years of age, whereas HCG therapy before this age results in 10-20% success only. Reversible androgenic side effects are described in approximately 30% following HCG treatment, but only limited side effects are seen in less than 10% after LH-RH therapy. Because of the non-invasive mode of administration, the good response to treatment in the age of 2-5 years and the very limited side effects, LH-RH is recommended as the primary treatment of testicular nondescent.

In a double-blind, placebo-controlled study, 118 boys, aged 2-12 years, with 161 undescended testes were treated with luteinising-hormone releasing-hormone (LH-RH), 1.2 mg daily intranasally for four weeks. According to randomization, 60 boys with 85 undescended testes received LH-RH and 58 boys with 76 undescended testes received the placebo. 17 testes (20%) in 12 boys (20%) descended in the LH-RH group and 2 testes (3%) in 2 boys (3%) descended in the placebo group. This difference is statistically significant (chi 2, 0.01 greater than p greater than 0.001). A second LH-RH course, offered three months later to the boys who did not respond to the first LH-RH course, increased the success rate to 35%. The primary location of the testis was a significant factor for the effect of treatment. The highest success rate (63%) was registered in testes located in a high scrotal position. There was no significant difference in success of treatment between unilateral and bilateral cryptorchidism, nor between age groups. No serious adverse effects of treatment were noted. It is concluded, that LH-RH administered intranasally can be used in the treatment of boys with unilateral and bilateral cryptorchidism.

A retrospective study of 398 patients suffering from metastatic compression of the spinal cord or cauda equina is presented. The study comprised almost all relevant medical records of patients admitted to hospital in the eastern part of Denmark in the period 1979 through 1985. Carcinoma of the lung, prostate, breast and kidney were the most frequent primary malignancies causing spinal compression. Most patients were treated with laminectomy, or radiotherapy or with laminectomy and radiotherapy combined. The effect of the treatment was estimated by evaluation of motor function and sphincter control. Treatment with laminectomy followed by radiotherapy was significantly superior to treatment with laminectomy or radiotherapy alone. But if the patients' motor function and primary tumour were taken into account, no significant difference between the treatments was observed. The efficacy of treatment depended upon the symptoms when the diagnosis was established, and accordingly early diagnosis is of the utmost importance. The incidence of metastatic compression increased during the period covered by the study, and since this condition must not go untreated, awareness of the symptoms, primarily pain, is essential.