The Risk of Revision After TKA Is Affected by Previous HTO or UKA.

High tibial osteotomy (HTO) and unicompartmental arthroplasty (UKA) are reconstructive surgeries advocated for younger patients. In case of failure or progression of osteoarthritis, they can both be converted to a total knee arthroplasty (TKA)

Undisturbed theatre dressing during the first postoperative week. A benefit in the treatment by external fixation: a cohort study

In the literature, there are several different suggestions as to when the first postoperative pin-site care should be carried out to best prevent pin-site infections during the treatment by external fixation. In a cohort study, we compared the use of antibiotics and complications in patients where the theatre dressing was changed during the first postoperative week with patients where the theatre dressings were left undisturbed for the first postoperative week. Sterile compresses moistened with chlorhexidine 5 mg/ml in alcohol (70%), draped around each pin site and fixed by a bandage, were used as theatre dressing. In all patients, cultures were taken 1 week postoperatively from each pin site; use of antibiotics and complications during the treatment was documented. In 101 consecutive patients (118 knees) (73% men, mean age 50, mean BMI 27.5 kg/m2) operated on by high tibial osteotomy for knee deformity using the hemicallotasis technique, during 2005–2006, the theatre dressings were left undisturbed during the first postoperative week in 90 patients (104 knees) of group 1, and in 11 patients (14 knees) of group 2, the theatre dressings were changed during the first postoperative week. Eight of 11 patients in group 2 were treated with antibiotics compared to 32 of 90 patients in group 1 (RR 2.0, 95% CI 1.6–2.7, p = 0.02) during the treatment period by external fixation. Patients with a disturbed theatre dressing during the first postoperative week had an increased use of antibiotics by 18.6 days (95% CI 10.6–26.5, p < 0.0001, adjusted analysis). Four of 11 patients in group 2 had complications and 11 of 90 in group 1, adjusted analysis (RR 2.7, 95% CI 0.4–16.2, p = 0.3). Bilateral surgery simultaneously showed increased use of antibiotics by 10.4 days (4.4, 16.4, p = 0.0009) and increased risk of complications (RR 5.8, 95% CI 1.2–27.5, p = 0.03). In conclusion, the increased use of antibiotics indicates that leaving the theatre dressing undisturbed during the first postoperative week is beneficial to the treatment by external fixation and is probably of importance in the prophylactic pin-site care

Tafl emk ôrr at efla ... : brettspill i vikingtid og middelalder

Med utgangspunkt i skriftlige, arkeologiske og kunsthistoriske kilder har jeg undersøkt hvilken betydning brettspill hadde for guder og mennesker i vikingtid og middelalder. Tidsmessig ligger hovedtyngden i perioden 750 e. Kr. – 1350 e. Kr. Kildene belyser i hovedsak norske og islandske forhold. Undersøkelsen viser at brettspill har vært et forbausende stabilt element i kulturen. Allerede Tacitus var bestyrtet over germanernes hang til spill, selv når de var edrue. Menneskene tilla brettspillet stor vekt også i forhold til gudene. I den første delen fant jeg at brettspillet har hatt en viktig plass i menneskenes religiøse forestillinger, dette kommer tydelig frem ved hjelp av Völuspá alene. I Völuspá er det bare de gylne spillebrikkene som er tilbake etter Ragnarök. Det er videre indisier som peker mot en symbolsk handling, hvor brettspill var en rekvisitt. Brettspillet har vært nært knyttet til menneskenes kjærlighetsliv og jeg fant en mulig sammenheng mellom brettspill og ekteskap. Slik jeg ser det kan forestillingen om brettspillets tilknytning til ekteskapet spores helt tilbake til Gallehushornene fra folkevandringstid. Omkring år 1000 finner vi i Völuspá ved tussemøyenes ankomst en mulig henvisning til fruktbarhetsritualer og kanskje det hellige ekteskap mellom jotunkvinner og mannlige guddommer. 1200-tallets europeiske innflytelse gjorde temaet populært og 1300-tallets forfattere lar så detaljer inngå i sine fornaldersagaer som betegner forbindelsen mellom ekteskapet og brettspillet. Gjennom hele perioden som her er behandlet finner vi spor etter denne forestillingen til det kulminerer med folkevisen Teningspelet på midten av 1800-tallet. Tanken på en forsvunnet myte om Frøya og Od er nærliggende når fortellingen om dette paret har så store likheter med historien om Śiva og Pārvatī. I følge min oppfatning kan visen Terningspelet være en overlevering av en slik myte som har berget seg gjennom middelalderen i balladeform og så til sist ble nedskrevet på 1800-tallet. Det er ut fra mitt synspunkt tydelig at et strategispill fungerer mye bedre og oppnår interesse blant menneskene om det kan relateres til det samfunnet som spilleren kommer fra. Dette er trolig en av årsakene til at hnefatafl i middelalderen gikk ut av bruk. Etter at de Nordiske landene var samlet under hver sin konge og administrasjon, ble hnefatafls strategi uaktuell, mens sjakk på den andre siden hadde klare paralleller til middelaldersamfunnet. Økningen av gjenstander som kan knyttes til spill i Trondheim på 1200-tallet, har i følge moderne forskning, antagelig ført til økt risiko for å utvikle sykelig spillelidenskap. Det er overveiende sannsynlig at lovforbudene kom som et resultat av at brettspill ofte førte bråk og kiving med seg. Enten med bakgrunn i pengespørsmål, sjalusi eller mer generelt tapt ære. Det er også trolig at kvinner etter 1300 fant menns brettspill irriterende av de samme årsaker, men kvinnene handlet trolig ut fra nødvendigheten om å vokte ættens ære. Å være dyktig til å spille brettspill, å kunne svømme og å skyte med bue var egenskaper som gjennom vikingtid og middelalder fremstår som stabile. Brettspill ser ut til å ha vært særlig viktig blant de høyere lag av folket, det var også de mest velstående som i størst grad hadde tid til å spille for å bli dyktige. Det er klart at det i disse samfunnslagene var status knyttet til det å være dyktig til å spille brettspill. En av årsakene til at brettspill ble så høyt ansett var at man kunne lære seg strategisk tenkning gjennom spillet. Dette ville være nyttig for ledere både i hverdag og krig. Denne læremetoden kan kalles læring gjennom lek og vi kjenner begrepet igjen i nåtidens pedagogikk. De lavere samfunnslag vet vi lite om, de skriftlige kildene forteller lite og mennesker fra dårlige kår fikk få eller ingen gravgaver med seg. Dette er ikke beviser på at de ikke spilte brettspill, det er få ressurser som skal til for å spille hnefatafl. Et risset brett i sanden og noen steiner og nøtter er alt man trenger. På nåværende tidspunkt er det imidlertid ikke mulig å utale seg om dette var tilfelle blant de fattige og ufrie i samfunnet. Det er slik på sin plass å poengtere at i motsetning til i dagens samfunn, kan vi om brettspill i vikingtid og middelalder si at det langt fra var bare en lek

Gender and ethnicity referral bias for ADHD: the school's view

In school, all children at some time have been disruptive; however, there are a select few who are continually disruptive and identified by school personnel as those who may have a disruptive behavior disorder such as ADHD. Many times these children are boys and of a minority group (Root & Resnick, 2003). Information collected from school teachers and parents most often provides the basis for diagnosing ADHD, whether reliable or objective. The purpose of the study was to investigate any differences in the way in which teachers respond to behavioral difficulties associated with ADHD for African American girls and boys as compared to White girls and boys, with control for SES and perceived school climate as potential confounds. These results are promising in that teachersâ responses suggest similarity in perceptions of childrenâÂÂs behavior regardless of childrenâÂÂs socioeconomic status, gender and ethnicity. The results indicated that a significant difference exists in that teachers would talk to the counselor about the childâÂÂs behavior based on the childâÂÂs ethnicity, gender, and SES. When controlling for school climate, there was a significant difference in teacher responses to unusualness of inattention, which indicated that the better the school climate, the more unusual the inattention was perceived. Also, results indicated that the teacherâÂÂs ethnicity and/or ethnicity and gender affected how they perceived the childâÂÂs behavior

Lamotrigine therapeutic thresholds

SummaryPurposeTo evaluate therapeutic drug monitoring (TDM) of lamotrigine (LTG) with establishment of individual therapeutic thresholds (TT) in outpatients of a tertiary epilepsy centre on monotherapy.MethodsIn the outpatient clinic of the Danish Epilepsy Centre, Dianalund, all patients treated in 2004 with LTG monotherapy were identified. Patients who had not reported seizures or adverse reactions in the last 6 months were considered seizure free and well-medicated on LTG monotherapy, and were further evaluated. Plasma levels from routine LTG TDM obtained by reversed-phase high-pressure liquid chromatography (HPLC) during up-titration were used to calculate the TT for each patient as the mean of the highest subtherapeutic and the lowest therapeutic level.ResultsEighty-two patients undergoing LTG monotherapy were reported seizure free as defined above. In 34 the TT could not be calculated because they became seizure free on the first chosen dose. TTs of the remaining 48 patients ranged from 4.0 to 42.0μmol/l. There were no differences between children and adults, and between generalized and localization-related epilepsies. The therapeutic levels of patients with undefined TT tended to be lower. The level–dose ratio in both groups varied only moderately indicating absence of major exogenous influences.ConclusionEven in patients of a tertiary referral centre only a minority had high TTs and needed therapeutic levels in a range where toxicity is increasingly observed. TDM appears useful in LTG treatment both for the establishment of individual reference ranges and for the identification of the individual level-to-dose ratio

The Swedish Knee Arthroplasty Register: a review.

We are entering a new era with governmental bodies taking an increasingly guiding role, gaining control of registries, demanding direct access with release of open public information for quality comparisons between hospitals. This review is written by physicians and scientists who have worked with the Swedish Knee Arthroplasty Register (SKAR) periodically since it began. It reviews the history of the register and describes the methods used and lessons learned. Cite this article: Bone Joint Res 2014;3:217-22

Bacterial colonization and resistance patterns in 133 patients undergoing a primary hip- or knee replacement in Southern Sweden.

Background and purpose Prosthetic joint infections can be caused by bacteria derived from the patient's skin. The aim of the study was: (1) to determine which bacteria colonize the nose and groin in patients planned for primary hip or knee arthroplasty, (2) to determine the antimicrobial resistance patterns, and (3) to monitor changes in bacterial colonization and resistance patterns connected to surgery. Patients and methods 2 weeks before scheduled primary hip or knee arthroplasty, culture samples were taken from the anterior nares and from the groin of 133 consecutive patients. At surgery, cloxacillin was given prophylactically and cement with gentamicin was used. 2 weeks after surgery, another set of samples were taken from 120 of these patients. Bacterial findings and resistance patterns were analyzed. Results Preoperatively, 95% of the patients had coagulase-negative staphylococci (CNS) in the groin and 77% in the nose. The proportion of patients with a methicillin-resistant CNS in the groin increased from 20% preoperatively to 50% postoperatively (p < 0.001), and the proportion of patients with a gentamicin-resistant CNS in the groin increased from 5% to 45% (p < 0.001). 28% of the patients had Staphylococcus aureus in the nose preoperatively, and 7% in the groin. Methicillin-resistant Staphylococcus aureus (MRSA) was found in the nose of 1 patient. Interpretation In southern Sweden, beta-lactams were effective against 99% of the Staphylococcus aureus strains and 80% of the CNS strains colonizing the patients undergoing primary hip or knee arthroplasty. Gentamicin protects against most CNS strains in cemented primary joint replacements