Virtual Reality and Orthopedics

English abstrac

Etiketti vai pullon sisältö? : Euroopan turvallisuuskokoushanke ja Saksan liittotasavallan suhtautuminen Suomen Etyk-aloitteeseen

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.Suomen hallituksen aloite Euroopan turvallisuuskonferenssin järjestämiseksi toimitettiin 5. toukokuuta 1969 kaikkien Euroopan maiden sekä Yhdysvaltain ja Kanadan hallituksille. Ajatus konferenssin järjestämisestä ei sinänsä ollut uusi, sillä Neuvostoliitto oli ajanut Euroopan turvallisuuskokoushanketta jo 1950-luvulta lähtien. Suomen aloite oli kuitenkin ensimmäinen aloite, joka tuli Varsovan liiton ulkopuolelta. Konferenssin toteutuminen oli tässä vaiheessa kuitenkin erittäin epätodennäköistä. Suurimman uhan muodosti avoin Saksan-kysymys. Saksan liittotasavallan hallitus antoi 12. syyskuuta 1969 vastauksensa Suomen aloitteeseen. Tämän tutkielman tarkoituksena on selvittää, miten Saksan liittotasavalta reagoi Suomen Etyk-aloitteeseen ja miten ulko- ja sisäpoliittiset tekijät vaikuttivat tähän reaktioon. Lisäksi tutkimuksessa tarkastellaan Saksan liittotasavallan Etyk-kannan kehitystä vuonna 1969. Tutkimuksessa pyritään myös selvittämään, uskoiko Saksan liittotasavalta Suomen vakuutteluihin, että aloite oli täysin itsenäinen eikä Neuvostoliiton sanelema ja oliko sillä merkitystä, että aloite ainakin virallisesti tuli Varsovan liiton ulkopuolelta? Tutkimus etenee kronologisesti 1950-luvulta vuoteen 1969. Historiallisen viitekehyksen tutkimukselle luovat kyseisen ajanjakson maailmanpoliittisen ja Saksan liittotasavallan sisäpoliittisen tilanteen kehitys sekä turvallisuuskokoushankkeen taustat. Erityisen tarkasti tutkimuksessa paneudutaan vuosiin 1966–1969. Lähteinä tutkimuksessa on käytetty Saksan ulkopolitiikkaa käsittelevän, mahdollisimman tuoreen tutkimuskirjallisuuden lisäksi muistelmia. Alkuperäislähteinä on käytetty niin julkaistuja asiakirjakokoelmia kuin Saksan ja Suomen ulkoasiainministeriöiden arkistojen sekä Urho Kekkosen arkiston aineistoakin. Tutkielma osoittaa, että Suomen aloitteen luovuttamisajankohta oli Saksan liittotasavallan kannalta erittäin epäedullinen. Saksan liittotasavallan hallitus oli täysin toimintakyvytön hallituskumppaneiden välisten ristiriitojen ja edessä olevien liittopäivävaalien vuoksi. Saksan liittotasavalta ei myöskään missään nimessä halunnut, että konferenssi järjestettäisiin, ennen kuin Saksan-kysymys olisi ratkaistu. Toisaalta maailmanpoliittinen kehitys ja Saksan liittotasavallan liittolaiset painostivat sitä liennytykseen, eikä se voinut jättäytyä liennytyksen ulkopuolelle joutumatta eristyksiin. Ratkaisemattoman Saksan-kysymyksen vuoksi Saksan liittotasavallan Etyk-kanta säilyi vuoden 1969 ajan muuttumattomana. Saksan liittotasavallan vastaus Suomen aloitteeseen oli maailmapoliittisen tilanteen kehityksen vuoksi myönteinen, mutta Saksan sisäpoliittisen tilanteen ja ongelmallisen Saksan-kysymyksen vuoksi erittäin varovainen. Koska aloite virallisesti oli Suomen, vastauksen antamista oli helpompaa perustella myös Saksan liittotasavallan sisällä, kuin jos aloite olisi ollut Neuvostoliiton. Lähteistä kuitenkin käy ilmi, että todellisuudessa Saksan ulkoministeriössä epäiltiin Suomen aloitteen itsenäisyyttä

Jalan murskavamma - amputaatio vai rekonstruktio?

English summar

Avoimen silmävamman tunnistaminen ja hoito

Vertaisarvioitu.Avoin eli lävistävä silmävamma vaatii pikaista leikkaus- ja sairaalahoitoa. Vamma on usein selvästi tunnistettavissa, mutta siihen viittaavat löydökset voivat olla myös hienovaraisia tai jäädä huomaamatta muiden vammojen vuoksi. Näköennuste riippuu vammaan liittyvistä tekijöistä, hoitoonpääsyn nopeudesta ja asianmukaisesta alkuhoidosta. Avoimen silmävamman epäileminen löydösten ja vammamekanismin perusteella ja viiveetön kirurginen hoito on tärkeää parhaan mahdollisen lopputuloksen saavuttamiseksi

ISSLS prize in clinical science 2022 : accelerated disc degeneration after pubertal growth spurt differentiates adults with low back pain from their asymptomatic peers

Purpose In this prospective observational cohort study, the development of lumbar intervertebral discs (LIVD) on magnetic resonance imaging (MRI) was investigated from childhood to adulthood with emphasis on the possible association of disc degeneration (DD) to low back pain (LBP). Methods In 2021, 89 subjects who were enrolled in 1994 in a longitudinal study with lumbar spine MRI at ages 8, 11 and 18 were invited to participate in a long-term follow-up comprising a clinical examination, selected patient-reported outcome measures and a lumbar spine MRI. We assessed all MRIs (three lowest LIVDs) with the Pfirrmann summary score, and the ratio of signal intensity of nucleus pulposus to signal intensity of cerebrospinal fluid (SINDL). We further analyzed whether disc changes at any age were associated with self-reported LBP at age 34. Results Of the 48 subjects in the follow-up, 35 reported LBP at age 34. The Pfirrmann summary score significantly increased with age (p < 0.001). Subjects reporting LBP at age 34 demonstrated statistically significantly higher summary scores at age 18 and 34 compared to asymptomatic subjects (p = 0.004 at age 18, and p = 0.039 at age 34). SINDL significantly decreased with age (p < 0.001 for all levels separately), but no significant differences between subjects with or without LBP at age 34 were noticed. Conclusion Subjects with LBP at age 34 had more widespread or severe DD already at age 18 compared to those without LBP.Peer reviewe

Anterior cruciate ligament reconstruction-related patient injuries : a nationwide registry study in Finland

Background and purpose ? Treatment outcomes of anterior cruciate ligament (ACL) injuries are generally good, but complications after ACL reconstruction (ACLR) can result in long-lasting problems. Patient injury claims usually fall on the more severe end of the complication spectrum. They are important to investigate because they may reveal the root causes of adverse events, which are often similar regardless of the complication?s severity. Therefore, we analyzed ACL-related patient injuries in Finland, the reasons for these claims, causes of complications, and grounds for compensation. Patients and methods ? We analyzed all claims filed at the Patient Insurance Centre (PIC) between 2005 and 2013 in which the suspected patient injury occurred between 2005 and 2010. This study also reviewed all original patient records and available imaging studies. General background data were obtained from the National Care Register for Social Welfare and Health Care (HILMO). Results ? There were 248 patient injury claims, and 100 of these were compensated. Compensated claims were divided into 4 main categories: skill-based errors (n = 46), infections (n = 34), knowledge-based errors (n = 6), and others (n = 14). Of the compensated skill-based errors, 34 involved graft malposition, 26 of them involved the femoral-side tunnel. All compensated infections were deep surgical site infections (DSSI). Interpretation ? This is the first nationwide study of patient injuries concerning ACLRs in Finland. The most common reasons for compensation were DSSI and malposition of the drill tunnel. Therefore, it would be possible to decrease the number of serious complications by concentrating on infection prevention and optimal surgical technique.Peer reviewe

Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Arthroscopy is often used to treat patients with chronic patellofemoral pain syndrome (PFPS). As there is a lack of evidence, we conducted a randomized controlled trial to study the efficacy of arthroscopy in patients with chronic PFPS.</p> <p>Methods</p> <p>A total of 56 patients with chronic PFPS were randomized into two treatment groups: an <it>arthroscopy group </it>(<it>N </it>= 28), treated with knee arthroscopy and an 8-week home exercise program, and a <it>control group </it>(<it>N </it>= 28), treated with the 8-week home exercise program only. The arthroscopy included finding-specific surgical procedures according to current recommendations. The primary outcome was the Kujala score on patellofemoral pain and function at 9 months following randomization. Secondary outcomes were visual analog scales (VASs) to assess activity-related symptoms. We also estimated the direct healthcare costs.</p> <p>Results</p> <p>Both groups showed marked improvement during the follow-up. The mean improvement in the Kujala score was 12.9 (95% confidence interval (CI) 8.2–17.6) in the arthroscopy group and 11.4 (95% CI 6.9–15.8) in the control group. However, there was no difference between the groups in mean improvement in the Kujala score (group difference 1.1 (95% CI -7.4 - 5.2)) or in any of the VAS scores. Total direct healthcare costs in the arthroscopy group were estimated to exceed on average those of the control group by €901 per patient (<it>p </it>< 0.001).</p> <p>Conclusion</p> <p>In this controlled trial involving patients with chronic PFPS, the outcome when arthroscopy was used in addition to a home exercise program was no better than when the home exercise program was used alone.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN 41800323</p

a randomized, open, multicenter phase III trial of lenalidomide/dexamethasone versus lenalidomide/dexamethasone plus subsequent autologous stem cell transplantation and lenalidomide maintenance in patients with relapsed multiple myeloma

Background Despite novel therapeutic agents, most multiple myeloma (MM) patients eventually relapse. Two large phase III trials have shown significantly improved response rates (RR) of lenalidomide/dexamethasone compared with placebo/dexamethasone in relapsed MM (RMM) patients. These results have led to the approval of lenalidomide for RMM patients and lenalidomide/dexamethasone has since become a widely accepted second-line treatment. Furthermore, in RMM patients consolidation with high-dose chemotherapy plus autologous stem cell transplantation has been shown to significantly increase progression free survival (PFS) as compared to cyclophosphamide in a phase III trial. The randomized prospective ReLApsE trial is designed to evaluate PFS after lenalidomide/dexamethasone induction, high-dose chemotherapy consolidation plus autologous stem cell transplantation and lenalidomide maintenance compared with the well-established lenalidomide/dexamethasone regimen in RMM patients. Methods/Design ReLApsE is a randomized, open, multicenter phase III trial in a planned study population of 282 RMM patients. All patients receive three lenalidomide/dexamethasone cycles and - in absence of available stem cells from earlier harvesting - undergo peripheral blood stem cell mobilization and harvesting. Subsequently, patients in arm A continue on consecutive lenalidomide/dexamethasone cycles, patients in arm B undergo high dose chemotherapy plus autologous stem cell transplantation followed by lenalidomide maintenance until discontinuation criteria are met. Therapeutic response is evaluated after the 3rd (arm A + B) and the 5th lenalidomide/dexamethasone cycle (arm A) or 2 months after autologous stem cell transplantation (arm B) and every 3 months thereafter (arm A + B). After finishing the study treatment, patients are followed up for survival and subsequent myeloma therapies. The expected trial duration is 6.25 years from first patient in to last patient out. The primary endpoint is PFS, secondary endpoints include overall survival (OS), RR, time to best response and the influence of early versus late salvage high dose chemotherapy plus autologous stem cell transplantation on OS. Discussion This phase III trial is designed to evaluate whether high dose chemotherapy plus autologous stem cell transplantation and lenalidomide maintenance after lenalidomide/dexamethasone induction improves PFS compared with the well-established continued lenalidomide/dexamethasone regimen in RMM patients. Trial registration: ISRCTN16345835 (date of registration 2010-08-24)

Effectiveness of Chêneau brace treatment for idiopathic scoliosis: prospective study in 79 patients followed to skeletal maturity

<p>Abstract</p> <p>Background</p> <p>Progressive idiopathic scoliosis can negatively influence the development and functioning of 2-3% of adolescents, with health consequences and economic costs, placing the disease in the centre of interest of the developmental medicine. The aim of this study was to evaluate the effectiveness of Chêneau brace in the management of idiopathic scoliosis.</p> <p>Methods</p> <p>A prospective observational study according to SOSORT and SRS recommendations comprised 79 patients (58 girls and 21 boys) with progressive idiopathic scoliosis, treated with Chêneau brace and physiotherapy, with initial Cobb angle between 20 and 45 degrees, no previous brace treatment, Risser 4 or more at the final evaluation and minimum one year follow-up after weaning the brace. Achieving 50° of Cobb angle was considered surgical recommendation.</p> <p>Results</p> <p>At follow-up 20 patients (25.3%) improved, 18 patients (22.8%) were stable, 31 patients (39.2%) progressed below 50 degrees and 10 patients (12.7%) progressed beyond 50 degrees (2 of these 10 patients progressed beyond 60 degrees). Progression concerned the younger and less skeletally mature patients.</p> <p>Conclusion</p> <p>Conservative treatment with Chêneau orthosis and physiotherapy was effective in halting scoliosis progression in 48.1% of patients. The results of this study suggest that bracing is effective in reducing the incidence of surgery in comparison with natural history.</p