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Viral haemorrhagic septicaemia ( VHS) is a notifiable fish disease, whose causative agent is a rhabdovirus isolated from a wide range of fish species, not only in fresh but also in marine and brackish waters. Phylogenetic studies have identified four major genotypes, with a strong geographical relationship. In this study, we have designed and validated a new procedure - named binary multiplex RT- qPCR (bm RT- qPCR) - for simultaneous detection and typing of all four genotypes of VHSV by real-time RT- PCR based on dual-labelled probes and composed by two multiplex systems designed for European and American/Asiatic isolates, respectively, using a combination of three different fluorophores. The specificity of the procedure was assessed by including a panel of 81 VHSV isolates covering all known genotypes and subtypes of the virus, and tissue material from experimentally infected rainbow trout, resulting in a correct detection and typing of all strains. The analytical sensitivity was evaluated in a comparative assay with titration in cell culture, observing that both methods provided similar limits of detection. The proposed method can be a powerful tool for epidemiological analysis of VHSV by genotyping unknown samples within a few hours. [ABSTRACT FROM AUTHOR]

Cardiac rupture following blunt trauma is usually fatal. Patients arriving alive at the hospital may be saved with prompt diagnosis and treatment. We report a case where a haemopericardium was diagnosed by ultrasonography in a 28-year-old man involved in a motor vehicle accident. A tear in the right atrial appendage was successfully repaired in the operating room at the Emergency Department without the use of a cardiopulmonary bypass.

This consecutive study comprised 86 patients who were available for follow up 5-51 months after sustaining a Colles' fracture--Older type IV. A total of 42 patients were treated with Kirschner (K) wires of whom one had bilateral fracture. Forty-four patients (of whom two had bilateral fractures) were treated with Rush nails. A functional assessment of the patients was made using both a questionnaire and a clinical examination. The end-results of residual deformity, subjective and objective findings, and complications were evaluated according to the Lucas' modification of the Sarmiento demerit point-rating system. At follow-up, the ulnar/radial deviation was significantly better in the patients operated on with K-wires (37 degrees compared with 27 degrees, p < 0.02, range in both groups 0-80 degrees), but no differences were found in the other directions of movement. A total of three patients (7%) developed complications. The final result showed that 40 (93%) of the fractures treated with K-wires were excellent or good compared with 38 (86%) of those operated on with a Rush nail. One fracture in each group (2%) had a poor outcome. Comparison of the final results showed no significant difference between the two groups.

A qualitative systematic review of randomized controlled trials (RCT) of incisional local anaesthesia for the control of postoperative pain after open abdominal operations was performed. Twenty-six studies with data from 1211 patients were considered appropriate for analysis. RCT considered inguinal herniotomy, hysterectomy, cholecystectomy and a variety of surgical procedures. Outcome measures were pain scores, supplementary analgesics and time to first analgesic request. Efficacy was estimated by significant difference (p < 0.05) as reported in the original investigation. All trials of herniotomy showed a 2-7 hour lasting, clinically relevant, improved pain relief. Five of eight cholecystectomy trials showed significant differences but in three studies of questionable clinical importance and validity. In other procedures results were inconsistent and in some cases of minor clinical importance. Except for herniotomy there is a lack of evidence for effect of incisional local anaesthesia on postoperative pain and further standardized studies are needed before recommendations can be made.

Controversies continue concerning the treatment of the posttraumatic caput ulna syndrome. We have treated 12 patients, mean age 42 (23-77) years, with arthrodesis ad modum Sauvé-Kapandji of the distal articulation between the radius and ulna, combined with resection of the ulnar neck. Before the operation, all patients had persistent ulnar wrist pain and restricted pronation-supination movement. At follow-up, after a mean of 2 (1.5-4) years, 8 patients had an excellent outcome, 3 a good, and 1 patient had a fair outcome. 10 patients had no wrist pain. The average grip-score improved from 53% preoperatively to 76% at the follow-up.

We compared wound infiltration with small-dose tenoxicam (7.5 mg) to intramuscular (IM) administration of the same dose to treat pain after herniorrhaphy. In a randomized, double-blind study, 50 patients received either preoperative wound infiltration with tenoxicam, 7.5 mg in 40 mL of 0.9% saline (WI group; n = 25) or IM tenoxicam 7.5 mg (IM group; n = 25). In each group a saline placebo of equal volume was given by the alternate route, i.e., those who received wound infiltration with tenoxicam received 0.75 mL of 0.9% saline IM; those who received IM tenoxicam received 40 mL of 0.9% saline for wound infiltration. Postoperative pain was assessed with a verbal pain scale and a visual analog scale (VAS) at rest and during movement and cough, 1, 2, 4, 6, and 24 h postoperatively. Wound tenderness was assessed with an electronic algometer preoperatively, and 2, 4, and 6 h postoperatively. The need for supplementary analgesics (acetaminophen and morphine) was registered. No differences were observed between groups in VAS pain scores, verbal rating pain scores, pain pressure thresholds, or in need for supplementary analgesics. We conclude that tenoxicam 7.5 mg has no local analgesic effect on postoperative pain after herniorrhaphy.

A review of different ways of injecting drugs during cardiopulmonary resuscitation (CPR) and during states of shock is presented. On the basis of this review, central or peripheral intravenous injection is recommended as first choice. If a peripheral vein is used, the drug injection should be followed by infusion of a large volume of normal saline to facilitate the entry of the drug into the central circulation. In case of endotracheal intubation, several drugs can be injected into the tracheal tube. Atropine, lidocaine and naloxone are shown to be effective when given by this route. Adrenalin is probably not effective when injected endotracheally. Intraosseous injection of drugs, crystalloids and colloids is an alternative in all states except for hypovolaemic shock due to lower infusion rates. Intracardiac injection of drugs during CPR is recommended as a last resort.

A case of phantom limb pain, which had not successfully responded to a long list of medical therapy or neurosurgery, is presented. After oral ketamine treatment was instituted the patient became free of pain. A possible mode of action is described.

In order to compare the epidemiology of burns and predisposing factors to burns at two burn centres representing the cities of Aarhus and Copenhagen, Denmark, a prospective study was set up at the University Department of Orthopedic Surgery and Traumatology, Aarhus and the Centre of Plastic Surgery and Burns Unit, Hvidovre Hospital, Denmark. Several significant differences in the epidemiology of burns in the two populations were found. Considering the social circumstances, the situation in Aarhus was characterized by the fact that most patients lived in their own houses, had a larger family and a larger family income. At the Hvidovre Hospital, the patients more often lived in a flat, had a smaller family and a lower family income than the average.

In a well-defined community, 144 cases of femoral shaft fracture in children (< 15 years old) were registered over a ten-year period. The cases were analysed epidemiologically. The variables taken into consideration were age, sex, aetiology of the fracture, and yearly and seasonal changes of the incidence rates of the fracture. The boy/girl ratio was found to be 2.8:1. The incidence rate was 28 per 100,000 child-years. Young children (< three years) had the highest incidence rates. The most common aetiology was traffic trauma (43.1%), fall trauma (41.7%) coming next. Falling off bicycles contributed with 41.9%, direct trauma with 3.5%, and jamming with 5.6%. An incidence peak was found in the summer months April through August. Involvement of children in traffic accidents and the number of femoral shaft fractures due to traffic trauma fell significantly over the ten-year period.

Twenty-one patients with hydronephrosis mean age 37 years (11-72) were operated using Anderson-Hynes pyeloplasty, without routine use of a nephrostomy catheter. One patient developed urinary leakage postoperatively, which ceased after insertion of a ureteric catheter. Follow-up assessment was performed after a mean observation time of 85 months (44-142). Clinical examination, laboratory investigations, urography and renography were performed preoperatively and at follow-up. No signs of stones or stenosis in the pelvis were found. The patients operated upon before the age of 30 showed improved postoperative renal function. All patients had symptoms preoperatively, but only one had symptoms postoperatively. It can be concluded that the results of surgical intervention in hydronephrosis are excellent, especially in patients below 30 years.

A series of 13 patients is reported in which a Sauvè-Kapandji procedure consisting of arthrodesis of the articulation between the radius and ulna combined with resection of the collum ulnae was used to treat posttraumatic caput ulnae syndrome. Among the nine female and four male patients whose median age was 42 years (range: 23 to 77 years), nine sustained a distal fracture that had healed with shortening of the radius or with subluxation of the caput ulnae. Median postoperative observation time was 16 months (range: six to 27 months). Preoperatively, all patients had persistent medial wrist pain and restricted pronation-supination. At follow-up, ten patients were without symptoms and three others had improved significantly. No patient suffered from pain from the site of the resection. A significant improvement in pronation-supination of 45 degrees and flexion-extension of 25 degrees were found. Hand grip strength improved significantly during rehabilitation. At follow-up, the average hand grip strength on the operated wrists was 69% compared to the uninjured side.

Fifty-seven patients treated for an acute rupture of the Achilles tendon were studied. The patients were randomized into a Mason suture technique or a reinforced continuous six-strand suture technique, and markers were attached to each tendon end perioperatively. The postoperative separation of the markers was studied by repeat radiographic examination. Despite immobilization, separation developed after a biphasic course, and after 7 weeks the mean separation was 10.5 mm. No difference was found between the two techniques. We attempt to correlate the separation to the clinical outcome, examined at 1 year follow up.

We report 144 femoral shaft fractures (FSF) in 138 children less than 15 years old. The boy/girl ratio was 2.8:1. The incidence rate was 28 per 100,000 child-years. Young children (less than 3 years) had the highest incidence rates. The most common etiology was trauma due to traffic accidents (43.1%) and falls (42.2%). Falling off bicycles contributed to 4.9%, direct trauma to 3.5%, and jamming to 5.6% of fractures. Involvement of children in traffic accidents and the number of FSFs due to traffic trauma fell significantly during the study period. The resource consumption of FSF was very high compared to other childhood fractures. The mean length of stay for FSF was almost three times that of all other patients seen in the emergency unit.

The value of late remanipulation followed by fixation with a Rush rod was studied in 14 patients with Older type 4 Colles' fractures. At follow-up, the dorsal angulation was improved in 13 of 14 patients, and the radial shortening was unchanged. Subjectively, six patients were fully satisfied, five were partially satisfied, and three were unsatisfied with the final result. It is concluded that operative management is successful and patients have good benefit from this form of treatment.

The aim of this study was to determine the incidence rate and to determine the etiology and the severity of accidents caused by playground equipment during the period 1.1.1989-31.12.1989 and to compare the results with the study made by Christensen et al (1-3). The number of children aged below 15 years was 42,635. A total of 270 playground accidents were registered, which resulted in an incidence rate of 6.3 per 1,000 children per year. This is a reduction from 9.3 per 1,000 children per year in 1981. The incidence rates between boys and girls were 7.0 and 5.6 per 1,000 children per year, as compared with respectively. The sex ratio for the population studied was 1.31 to 1 as compared with 1.44 to 1 in 1981. The sex ratio in the background population was 1.05 both in 1981 and 1989. The greatest number of accidents were seen in spring, especially in April and May. Swings, climbing frames, slides, playhouses and playcastles were responsible for 80% of the accidents. The etiologies were fall accidents in 211 cases, being caught between two objects in 17 cases, being kit by an object in 21 cases and different causes in 21 cases. The underlying surfaces were sufficiently soft in 24% of the cases. The severity of the injury was classified according to the Abbreviated Injury Scale and was found to be: no lesions 1.1%, minor lesions 70%, moderate lesions 25.1% and severe lesions 3.7%. A total of 17 patients were admitted and of these 13 patients had fractures. The possibilities of reducing the number of injuries resulting from playground equipment are discussed.

In order to illustrate the severity of accidents with playground equipment, two cases of fractures in the hip region in children are presented. Both accidents occurred when the children fell on hard surface without the necessary shock absorbing properties as recommended by the Danish Standards. It should be impossible for a child falling accidentally from playground equipment to attain deceleration levels exceeding 50 G at the impact with the underlying surface.

Sixty-two (11 women and 51 men) of 76 consecutive patients treated between January 1960 and December 1979 with percutaneous pinning, traction, and ambulation in Thomas splints for slipped capital femoral epiphyses (physiolysis colli femoris; PCF) were re-examined radiologically and clinically to evaluate long-term results of an abandoned technique. Median follow-up time was 21 years (range: 8 to 28). The average age at symptom start was 14 years (range: 9 to 17). Fourteen patients were operated bilaterally, while 15 were operated on the right side only and 33 on the left side only. No additional hip surgery for coxarthrosis as adults had been performed. At the clinical examination the mean hip-movement-sum was 220 degrees (range: 30 degrees to 300 degrees). Pain occurred in 31 hips. A limp was found in 23 patients, and 56 had no impairment of working ability. At radiologic examination, 30 patients showed sequelae of PCF, and 30 (48%) had bilateral signs of PCF at follow up.

The frequency of bilateral physiolysis colli femoris was evaluated in 62 patients. At first admission, 5 patients had a bilateral slipping. Further, 9 patients had slipping diagnosed in the contralateral hip during adolescence 1-3 years after the primary operation. At the follow-up examination 22 years after the primary operation, radiographs showed bilateral sequelae of slipping in 30 of 62 patients. Of the nine slips diagnosed later during adolescence, one showed mild and two severe arthrosis. Among the 16 slips diagnosed at follow-up, mild arthrosis was found in four hips. We recommend bilateral pinning at first admission in all patients with a slipped capital femoral epiphysis.

A life-threatening case of accidental strangulation caused by play-ground equipment (in this case a play house) is described. The new standardized recommendation about playground equipment had not been observed. Attention is drawn to this case in order to improve the safety of playground equipment.

Of 37 patients who were treated for a Colles' fracture (Older type 4) by fixation with either a Kirschner wire or a Rush pin, 29 (78%) subsequently developed osteoarthritis. There were no significant correlations between the subjective or objective end results and the development of osteoarthritis. We conclude that osteoarthritis in patients who have suffered from a Colles' fracture (Older type 4) develops soon after the fracture, but it seldom gives rise to symptoms or influences the function of the wrist.

Twenty-five wrist joints treated with immobilization for Kienböck's disease were reexamined after 8 (1-11) years. Six patients had no pain, but 14 had daily problems with the wrist, and of these, 7 had to change their occupation. Five wrist joints were arthrodesed during the follow-up period. We conclude that nonoperative treatment of Kienböck's disease is ineffective.