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Kämppä N, Hulkkonen S, Grahn P, Laaksonen T, Repo J. The construct validity and internal consistency of QuickDASH in pediatric patients with upper extremity fractures. Acta Orthop 2024; 95:192-199. [PMID: 38686529 PMCID: PMC11058482 DOI: 10.2340/17453674.2024.40181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/14/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND PURPOSE Investigation of treatment options in the pediatric population necessitates the use of valid patient-reported outcome measures (PROMs). We aimed to assess the construct validity and internal consistency of the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) in the pediatric population with upper extremity fractures treated both operatively and conservatively. PATIENTS AND METHODS QuickDASH, along with several reference PROMs and objective outcome measures, was obtained from 148 5- to 18-year-old patients with a humeral medial epicondyle fracture or a fracture of the distal forearm in a cross-sectional setting with a single follow-up visit. Spearman's rank correlation and linear regression models were used to assess convergent validity, exploratory factor analysis (EFA) to assess structural validity, and Cronbach's alpha to investigate internal consistency. RESULTS The direction and magnitude of correlation showed by QuickDASH with reference outcome measures was consistent and demonstrated good convergent validity. EFA indicated a 3-factor model with poor fit indices and structural validity remained questionable. Construct validity was considered acceptable overall. QuickDASH demonstrated good internal consistency with an acceptable Cronbach's alpha (α = 0.75). CONCLUSION QuickDASH demonstrated acceptable construct validity and good internal consistency and is thus a valid instrument, with some limitations, to assess disability and quality of life in pediatric patients with upper extremity fractures.
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Affiliation(s)
- Niko Kämppä
- Department of Hand Surgery, Helsinki University Hospital and University of Helsink.
| | - Sina Hulkkonen
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki
| | - Petra Grahn
- Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, HUS Helsinki University Hospital, University of Helsinki
| | - Topi Laaksonen
- Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, HUS Helsinki University Hospital, University of Helsinki
| | - Jussi Repo
- Unit of Musculoskeletal Surgery, Department of Orthopedics and Traumatology, Tampere University Hospital and Tampere University, Finland
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Haapala H, Salonen A, Suominen E, Syvänen J, Repo J, Matsumoto H, Ahonen M, Helenius I, Saarinen A. Reliability and validity of the adapted Finnish version of the early onset scoliosis questionnaire (EOSQ-24). Spine Deform 2024:10.1007/s43390-024-00861-8. [PMID: 38578600 DOI: 10.1007/s43390-024-00861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/12/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND EOSQ-24 is a disease specific patient-reported outcome score used to assess the quality of life in patients with early-onset scoliosis. The aim of this study was to translate and cross-culturally adapt the English version of the EOSQ-24 to Finnish language and to assess the reliability and validity of the translation. METHODS Cross-cultural adaptation and cross-cultural validation were performed to the Finnish translation of the EOSQ-24. Patients and/or their caretakers were then recruited to assess the psychometric properties of the translation. We assessed the internal consistency, test-retest reliability, floor and ceiling effects, and discriminative abilities. One-hundred-and-three patients filled the questionnaire. RESULTS EOSQ-24 was successfully translated into Finnish. The translation showed excellent internal consistency (Cronbach alpha 0.94), satisfactory item-total correlations ranging from 0.6 to 0.9, and moderate to strong inter item correlations. Test-retest reliability ranged from 0.7 to 0.96 indicating good to excellent agreement. Patients with neuromuscular and syndromic scoliosis reported lower EOSQ-24 scores when compared to patients' idiopathic and congenital scoliosis. There was a significant negative correlation between major curve and EOSQ-24 scores in patients with idiopathic early onset scoliosis. CONCLUSION The internal consistency and test-retest reliability of the measure were found to be satisfactory. A marked ceiling effect was observed, indicating a potential source of error.
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Affiliation(s)
- Hermanni Haapala
- Department of Paediatric Surgery, Orthopaedics and Traumatology, New Children's Hospital, Helsinki, Finland
| | - Anne Salonen
- Department of Paediatric Surgery, Tampere University Hospital, Tampere, Finland
| | - Eetu Suominen
- Department of Paediatric Surgery, Orthopaedics and Traumatology, University of Turku and Turku University Hospital, Turku, Finland
| | - Johanna Syvänen
- Department of Paediatric Surgery, Orthopaedics and Traumatology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Repo
- Department of Orthopaedics and Traumatology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Matti Ahonen
- Department of Paediatric Surgery, Orthopaedics and Traumatology, New Children's Hospital, Helsinki, Finland
| | - Ilkka Helenius
- Department of Paediatric Surgery, Orthopaedics and Traumatology, New Children's Hospital, Helsinki, Finland
- Department of Paediatric Surgery, Orthopaedics and Traumatology, University of Turku and Turku University Hospital, Turku, Finland
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Saarinen
- Department of Paediatric Surgery, Orthopaedics and Traumatology, University of Turku and Turku University Hospital, Turku, Finland.
- Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland.
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Salminen S, Jäämaa S, Nevala R, Sormaala MJ, Koivikko M, Tukiainen E, Repo J, Blomqvist C, Sampo M. Ultra-low-dose computed tomography and chest X-ray in follow-up of high-grade soft tissue sarcoma-a prospective comparative study. Sci Rep 2024; 14:7181. [PMID: 38531939 DOI: 10.1038/s41598-024-57770-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 03/21/2024] [Indexed: 03/28/2024] Open
Abstract
Ultra-low-dose computed tomography (ULD-CT) may combine the high sensitivity of conventional computed tomography (CT) in detecting sarcoma pulmonary metastasis, with a radiation dose in the same magnitude as chest X-ray (CXR). Fifty patients with non-metastatic high-grade soft tissue sarcoma treated with curative intention were recruited. Their follow-up involved both CXR and ULD-CT to evaluate their different sensitivity. Suspected findings were confirmed by conventional CT if necessary. Patients with isolated pulmonary metastases were treated with surgery or stereotactic body radiation therapy (SBRT) with curative intent if possible. The median effective dose from a single ULD-CT study was 0.27 mSv (range 0.12 to 0.89 mSv). Nine patients were diagnosed with asymptomatic lung metastases during the follow-up. Only three of them were visible in CXR and all nine in ULD-CT. CXR had therefore only a 33% sensitivity compared to ULD-CT. Four patients were operated, and one had SBRT to all pulmonary lesions. Eight of them, however, died of the disease. Two patients developed symptomatic metastatic recurrence involving extrapulmonary sites+/-the lungs between two imaging rounds. ULD-CT has higher sensitivity for the detection of sarcoma pulmonary metastasis than CXR, with a radiation dose considerably lower than conventional CT.Clinical trial registration: NCT05813808. 04-14-2023.
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Affiliation(s)
- Samuli Salminen
- Comprehensive Cancer Center, Helsinki University Hospital (HUH), Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Sari Jäämaa
- Comprehensive Cancer Center, Helsinki University Hospital (HUH), Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Riikka Nevala
- Comprehensive Cancer Center, Helsinki University Hospital (HUH), Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Markus J Sormaala
- Department of Radiology, Helsinki University Hospital, Meilahti Campus Topeliuksenkatu 32, N0029, Helsinki, Finland
| | - Mika Koivikko
- Department of Radiology, Helsinki University Hospital, Meilahti Campus Topeliuksenkatu 32, N0029, Helsinki, Finland
| | - Erkki Tukiainen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jussi Repo
- Department of Orthopedics and Traumatology, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Carl Blomqvist
- Comprehensive Cancer Center, Helsinki University Hospital (HUH), Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Mika Sampo
- HUSLAB Pathology and University of Helsinki, Helsinki, Finland.
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Saarinen M, Ojala K, Suominen S, Repo J. Validation of the BODY-Q Chest module in Finnish trans men undergoing chest wall masculinization. Scand J Surg 2023; 112:180-186. [PMID: 37264645 DOI: 10.1177/14574969231176111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of gender affirmation surgery is to ease gender dysphoria. In transgender men, chest wall masculinization is the most common gender affirmation surgery. The BODY-Q Chest module is currently the only instrument developed to measure health-related quality of life (HRQL) in men undergoing chest wall surgery. Linguistic validation and cultural adaption to Finnish were performed previously. The study aims to validate the BODY-Q Chest module in transgender men who have undergone surgical chest wall masculinization. METHODS All transgender patients who underwent chest wall masculinization at Helsinki University Hospital between 2005 and 2018 were invited to the study. The BODY-Q Chest module comprises two scales-chest and nipple. Data were obtained using the BODY-Q Chest module, the 15D questionnaire, and specifically targeted items designed by the authors. The statistical analyses were conducted to exclude selection bias, evaluate validity of the instrument, and compare it to other instruments. RESULTS Of the 220 patients invited, 123 participated in the survey (response rate 56%). Ceiling effects were observed with 18.9% and 20.5% scoring maximum points. Cronbach's alpha was 0.92 and 0.88 for the chest and nipple scales, respectively. In exploratory factor analysis, both scales loaded to one factor confirming unidimensionality. Correlation with the generic 15D questionnaire was low. CONCLUSIONS The BODY-Q Chest module provides valid scores with sufficient consistency and reliability when measuring HRQL in transgender men undergoing chest wall masculinization. Moreover, it offers specificity that existing or generic instruments cannot provide. Ceiling effect was expected due to the postoperative status of participants.
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Affiliation(s)
- Mirjam Saarinen
- Department of Plastic SurgeryHelsinki University Hospital and the University of Helsinki P.O. Box 281Stenbackinkatu 1100029 Helsinki Finland
| | - Kaisu Ojala
- Department of Plastic Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Sinikka Suominen
- Department of Plastic Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Jussi Repo
- Department of Orthopedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital and the University of Tampere, Tampere, Finland
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Linnanmäki L, Hevonkorpi T, Repo J, Karjalainen T. Anterior locking plate versus non-operative treatment in different age groups with distal radial fractures: a systematic review and meta-analysis. J Hand Surg Eur Vol 2023; 48:532-543. [PMID: 36624925 DOI: 10.1177/17531934221143636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This meta-analysis compared anterior locking plate and non-operative treatment for distal radial fractures and assessed if the age of the patients is associated with the treatment effect. We searched the MEDLINE, Embase and CENTRAL databases and included 12 studies with 1366 patients. Compared with non-operative care, anterior locking plate treatment does not seem to provide clinically important benefits in mean DASH score, mean pain or their mean quality of life at 12 to 24 months if the patients' ages are not considered (moderate to low certainty evidence). However, the younger the patients, the larger the benefit for surgery. Meta-regression with the DASH score suggested that while people over 70 likely experience no clinically relevant benefit from surgery, the mean effects cannot be generalized to people under 60. The evidence regarding the risk of adverse events is too uncertain to make firm conclusions.
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Affiliation(s)
| | | | - Jussi Repo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
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Laurila RE, Böhling TO, Blomqvist CP, Karlsson C, Tukiainen EJ, Repo J, Sampo MM. Visual Counting and Automated Image-analytic Assessment of Ki-67 and their Prognostic Value in Synovial Sarcoma. Cancer Diagn Progn 2022; 2:7-14. [PMID: 35400010 PMCID: PMC8962852 DOI: 10.21873/cdp.10070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/15/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Ki-67 is a widely used proliferation marker reflecting prognosis in various tumors. However, visual assessment and scoring of Ki-67 suffers from marked inter-observer and intra-observer variability. We aimed to assess the concordance of manual counting and automated image-analytic scoring methods for Ki-67 in synovial sarcoma. PATIENTS AND METHODS Tissue microarrays from 34 patients with synovial sarcoma were immunostained for Ki-67 and scored both visually and with 3DHistech QuantCenter. RESULTS The automated assessment of Ki-67 expression was in good agreement with the visually counted Ki-67 (r Pearson =0.96, p<0.001). In a Cox regression model automated [hazard ratio (HR)=1.047, p=0.024], but not visual (HR=1.063, p=0.053) assessment method associated high Ki-67 scores with worse overall survival. CONCLUSION The automated Ki-67 assessment method appears to be comparable to the visual method in synovial sarcoma and had a significant association to overall survival.
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Affiliation(s)
- Riikka E Laurila
- Department of Pathology, HUSLAB and University of Helsinki, Helsinki, Finland
| | | | - Carl P Blomqvist
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Örebro University, School of Health sciences, Örebro, Sweden
| | | | - Erkki J Tukiainen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jussi Repo
- Department of Orthopedics and Traumatology, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Mika M Sampo
- Department of Pathology, HUSLAB and University of Helsinki, Helsinki, Finland
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7
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Suominen EN, Sandelin H, Puhakka J, Repo J, Ovaska M. Traumatic Rupture and Herniation of the Peroneus Tertius Muscle Leading to Compartment Syndrome and Entrapment of the Superficial Peroneal Nerve: A Case Report. Surg J (N Y) 2021; 7:e154-e157. [PMID: 34295974 PMCID: PMC8289680 DOI: 10.1055/s-0041-1731423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/25/2021] [Indexed: 10/29/2022] Open
Abstract
We present a patient with compartment syndrome and entrapment of the superficial peroneal nerve due to a direct hit to the lateral part of the right lower extremity. The diagnosis of evolving compartment syndrome was made without delay and the patient was quickly taken to the operating theater. Intraoperatively, the entrapment of the superficial peroneal nerve caused by rupture and herniation of the peroneus tertius muscle was surprisingly observed at the site, where the nerve pierces the anterior compartment. The nerve was successfully released in conjunction with fasciotomies of the anterior and lateral compartments. Meticulous diagnosis of compartment syndrome is critical to prevent ischemic injury to muscles and nerves. Recognition of anatomy and anatomical variations is important to prevent iatrogenic injury in unusual circumstances.
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Affiliation(s)
- Eetu N Suominen
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Henrik Sandelin
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Orthopaedics, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Jani Puhakka
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jussi Repo
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Mikko Ovaska
- Sports Clinic and Hospital, Pihlajalinna Dextra, Helsinki, Finland
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8
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Kask G, Barner-Rasmussen I, Repo J, Blomqvist C, Tukiainen E. Functional Outcome After Lower Extremity Soft Tissue Sarcoma Treatment: A Pilot Study Based on Translated and Culturally Adapted Measures. Scand J Surg 2018; 108:164-171. [PMID: 30187826 DOI: 10.1177/1457496918798210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The present standard of care in treating lower extremity soft tissue sarcomas is function-sparing, limb-preserving resection and reconstruction with or without oncological therapy. The aim of this pilot study was to test the suitability and adequacy of the Finnish translations of two functional outcome questionnaires (Toronto Extremity Salvage Score and Musculoskeletal Tumor Society score) and to perform a preliminary investigation of functional outcomes of Finnish lower-limb soft tissue sarcoma patients after operative treatment. MATERIALS AND METHODS Between June 2015 and December 2015, consecutive surgically treated outpatients were asked to participate in the study. Demographic, clinical, surgical, and oncological outcome data were collected. Two functional outcome questionnaires were used (Toronto Extremity Salvage Score and Musculoskeletal Tumor Society scores). A comparative analysis is presented. RESULTS A total of 19 lower-limb soft tissue sarcoma patients with a mean follow-up time of 2 years and 10 months were included. All (n = 19) invited patients participated in the study. Mean age was 62.3 years. In total, 13 had high-grade sarcomas. Eight wounds were closed directly, four used skin grafts, and five required flap reconstructions. One patient required a tumor prosthesis, and one required a rotationplasty. A total of 14 patients received oncological therapy. No problems or difficulties were reported in using and completing the Finnish versions of the Toronto Extremity Salvage Score or Musculoskeletal Tumor Society questionnaires. The overall Toronto Extremity Salvage Score and Musculoskeletal Tumor Society scores were 88 and 76, respectively. CONCLUSION This pilot study suggests that the Finnish versions of the Toronto Extremity Salvage Score and Musculoskeletal Tumor Society questionnaires are suitable for measuring functional outcome after lower extremity soft tissue sarcomas treatment. Functional outcomes vary from moderate to excellent.
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Affiliation(s)
- G Kask
- 1 Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - I Barner-Rasmussen
- 1 Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - J Repo
- 1 Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.,2 Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - C Blomqvist
- 2 Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - E Tukiainen
- 1 Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
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Kyrölä K, Repo J, Mecklin JP, Ylinen J, Kautiainen H, Häkkinen A. Spinopelvic Changes Based on the Simplified SRS-Schwab Adult Spinal Deformity Classification: Relationships With Disability and Health-Related Quality of Life in Adult Patients With Prolonged Degenerative Spinal Disorders. Spine (Phila Pa 1976) 2018; 43:497-502. [PMID: 28767623 DOI: 10.1097/brs.0000000000002370] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional, observational study. OBJECTIVE To study the occurrence of sagittal malalignment, the adaptability of a simplified sagittal modifiers grading of the Scoliosis Research Society (SRS)-Schwab adult spinal deformity (ASD) classification, and the deformity-specific SRS questionnaire version 30 (SRS-30) in an unselected adult cohort with symptomatic degenerative spinal disorders. SUMMARY OF BACKGROUND DATA The sagittal modifiers of the SRS-Schwab ASD classification correlate with health-related quality of life (HRQoL) measures in patients with ASD. The deformities and disabilities caused by sagittal malalignment in patients with common degenerative spinal disorders of multiple etiologies are rarely studied. A simplified and categorizing version of the SRS-Schwab ASD classification in relation to the Oswestry Disability Index (ODI) and the SRS-30 outcomes has not yet been developed. METHODS We recruited 874 consecutive patients with degenerative spinal disorders between March 2013 and February 2014. Full spine radiographs were taken and the patients divided into sagittal deformity severity groups: mild or none, moderate, and marked deformity. Participants completed the ODI, SRS-30, and a general health questionnaire. RESULTS We included 637 patients in the analysis. The severity of sagittal deformity was mild or none in 407 (63.9%) patients, moderate in 159 (25.0%), and marked in 71 (11.1%). Linearity across the modifier grades and deformity classes was found for ODI total score (P = 0.033), and the function/activity (P = 0.004) and self-image/appearance (P = 0.030) domains of the SRS-30. Age, body mass index, duration of symptoms, and the use of painkillers increased while physical activity, working, and educational status decreased significantly with deformity severity. CONCLUSION Sagittal spinopelvic malalignment is significantly related to deterioration of the ODI and the SRS-30 in symptomatic adults with degenerative spinal disorders. The SRS-Schwab classification sagittal modifiers categorized into three groups is a practical tool to detect various clinically significant grades of deformity in a cohort with no recognized ASD. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Kati Kyrölä
- Department of Orthopaedics and Traumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Jussi Repo
- Department of Orthopaedics and Traumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Jukka-Pekka Mecklin
- Department of Education and Science, Central Finland Health Care District, Jyväskylä, Finland.,Department of Surgery, University of Eastern Finland, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Rehabilitation, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Arja Häkkinen
- Department of Physical Rehabilitation, Central Hospital of Central Finland, Jyväskylä, Finland.,Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Yan Adrian S, Repo J, Huovinen M, Karttunen V, Ma Stephanie WY, Greiner R, Vähäkangas K, El-Nezami H. Potential Toxicity of Silver Nanoparticles (AgNP) to Human Placenta. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.07.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sommarhem A, Roine R, Sintonen H, Halonen T, Tukiainen E, Repo J. Free Vascularized Fibular Graft is Reliable in Upper Extremity Long-Bone Reconstruction with Good Long-Term Outcomes. J Reconstr Microsurg 2016; 32:513-9. [DOI: 10.1055/s-0036-1581075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Antti Sommarhem
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Risto Roine
- Group Administration, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland, Helsinki, Finland
| | - Timo Halonen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Erkki Tukiainen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jussi Repo
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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12
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Barner-Rasmussen I, Roine R, Sintonen H, Tukiainen E, Repo J. Role of Free Iliac Crest Flap in Foot and Ankle Reconstruction. J Reconstr Microsurg 2016; 32:386-94. [DOI: 10.1055/s-0036-1571441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ian Barner-Rasmussen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, HUS, Finland
| | - Risto Roine
- Group Administration, Helsinki University Hospital and University of Helsinki, Helsinki, HUS, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, HUS, Finland
| | - Erkki Tukiainen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, HUS, Finland
| | - Jussi Repo
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, HUS, Finland
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Skrifvars MB, Kuisma M, Boyd J, Määttä T, Repo J, Rosenberg PH, Castren M. The use of undiluted amiodarone in the management of out-of-hospital cardiac arrest. Acta Anaesthesiol Scand 2004; 48:582-7. [PMID: 15101852 DOI: 10.1111/j.0001-5172.2004.00386.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Resuscitation 2000 Guidelines recommends amiodarone as the antiarrhythmic drug of choice in treatment of resistant ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). Amiodarone has been associated with side-effects and difficulty of administration, due to recommended dilution, rendering it suboptimal for out-of-hospital cardiac arrest (CA) management. In the present study we report experiences and side-effects of the use of undiluted amiodarone in CA management in Helsinki Emergency Medical Service (EMS) during a 2-year period. METHODS On October 1, the Resuscitation 2000 Guidelines were put into practice in Helsinki EMS. Thus, in the cardiac arrest treatment protocol, after three ineffective shocks and 1 mg of adrenaline (epinephrine), a bolus of 300 mg of undiluted amiodarone (Cordarone 50 mg ml(-1), Sanofi-Synthelabo, Helsinki, Finland) was administered into a vein located as centrally as possible. The Helsinki EMS performs systematic data collection according to the Utstein Guidelines. The blood pressure levels, heart rates and the need for vasopressors, of the patients with sustained return of spontaneous circulation (ROSC), were collected from the ambulance charts. RESULTS During October 1, 2000 and September 30, 2002, 712 patients were considered for resuscitation and 566 were resuscitated. The initial rhythms were as follows: 32% had VF/VT, 36% had asystole and 32% had pulseless electrical activity (PEA). Of the 180 patients with VF/VT, 75 (42%) received undiluted amiodarone in addition to other resuscitative measures. Of the patients with asystole or PEA, 12 (6%) and 18 (10%), respectively, received amiodarone. The blood pressure levels and the need vasopressors after ROSC and during transportation to the hospital were similar among the patients who received and those who did not receive amiodarone. CONCLUSIONS The present study suggests that amiodarone can be administered undiluted without unmanageable haemodynamical side-effects in the treatment of out-of-hospital cardiac arrest. This is likely to save time and simplifies the treatment protocol in the prehospital setting.
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Affiliation(s)
- M B Skrifvars
- Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland
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Abstract
Early defibrillation by emergency medical services has been a success story in the treatment of ventricular fibrillation. This success has been followed by recommendations to allow public access to defibrillation equipment. We tracked the changes in incidence of ventricular fibrillation from prospectively collected data from the Helsinki Cardiac Arrest Register. We found that the incidence of out-of-hospital ventricular fibrillation of cardiac origin fell by 48% from 1994 to 1999 (p=0.0036). The primary and secondary prevention of coronary artery disease may not be the only reasons for this change and so new public-access defibrillation programmes should be delayed until our findings are confirmed.
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15
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Abstract
The purpose of the study was to determine the epidemiology and the etiology of cardiac arrests witnessed by emergency medical services (EMS) personnel and the survival from resuscitation according to the Utstein style. Consecutive prehospital cardiac arrests witnessed by EMS personnel in the Helsinki City EMS system between January 1, 1994 and December 31, 1995 were included in this prospective cohort study. A total of 809 cardiac arrests were registered during the study period, 108 (13.3%) of which were EMS-witnessed. The incidence of EMS-witnessed cardiac arrests was 1.8 per 1,000 urgent calls per year. Resuscitation was attempted in 94 patients, 45 of whom (47.9%) were hospitalized alive and 15 of whom (16.0%) were discharged. Fourteen of the survivors were discharged with overall performance category I or II. Cardiac etiology was verified in 60 (55.6%) cases. In multivariate analysis, initial rhythm of ventricular fibrillation and cardiac etiology remained independent factors of survival. These results indicate that overall survival rates in EMS-witnessed cardiac arrests have remained low but those who survive are discharged without major neurological sequelae. Noncardiac etiology accounts for 45% of cases and seems to be a major determinant of low overall survival rates.
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