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Friedewald JJ, Schantz K, Mehrotra S. Kidney organ allocation: reducing discards. Curr Opin Organ Transplant 2023; 28:145-148. [PMID: 36696090 DOI: 10.1097/mot.0000000000001049] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW The donation and kidney transplant system in the United States is challenged with reducing the number of kidneys that are procured for transplant but ultimately discarded. That number can reach 20% of donated kidneys each year. RECENT FINDINGS The reasons for these discards, in the face of overwhelming demand, are multiple. SUMMARY The authors review the data supporting a number of potential causes for high discard rates as well as provide potential solutions to the problem.
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Affiliation(s)
| | - Karolina Schantz
- Northwestern University Industrial Engineering and Management Sciences, Evanston, Illinois, USA
| | - Sanjay Mehrotra
- Northwestern University Industrial Engineering and Management Sciences, Evanston, Illinois, USA
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Mehrotra S, Gonzalez JM, Schantz K, Yang JC, Friedewald JJ, Knight R. Patient Preferences for Waiting Time and Kidney Quality. Clin J Am Soc Nephrol 2022; 17:1363-1371. [PMID: 35985699 PMCID: PMC9625104 DOI: 10.2215/cjn.01480222] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/16/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Approximately 20% of deceased donor kidneys are discarded each year in the United States. Some of these kidneys could benefit patients who are waitlisted. Understanding patient preferences regarding accepting marginal-quality kidneys could help more of the currently discarded kidneys be transplanted. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study uses a discrete choice experiment that presents a deceased donor kidney to patients who are waiting for, or have received, a kidney transplant. The choices involve trade-offs between accepting a kidney today or a future kidney. The options were designed experimentally to quantify the relative importance of kidney quality (expected graft survival and level of kidney function) and waiting time. Choices were analyzed using a random-parameters logit model and latent-class analysis. RESULTS In total, 605 participants completed the discrete choice experiment. Respondents made trade-offs between kidney quality and waiting time. The average respondent would accept a kidney today, with 6.5 years of expected graft survival (95% confidence interval, 5.9 to 7.0), to avoid waiting 2 additional years for a kidney, with 11 years of expected graft survival. Three patient-preference classes were identified. Class 1 was averse to additional waiting time, but still responsive to improvements in kidney quality. Class 2 was less willing to accept increases in waiting time for improvements in kidney quality. Class 3 was willing to accept increases in waiting time even for small improvements in kidney quality. Relative to class 1, respondents in class 3 were likely to be age ≤61 years and to be waitlisted before starting dialysis, and respondents in class 2 were more likely to be older, Black, not have a college degree, and have lower Karnofsky performance status. CONCLUSIONS Participants preferred accepting a lower-quality kidney in return for shorter waiting time, particularly those who were older and had lower functional status.
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Affiliation(s)
- Sanjay Mehrotra
- Department of Industrial Engineering and Management Sciences, McCormick School of Engineering, Northwestern University, Evanston, Illinois
| | - Juan Marcos Gonzalez
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina
| | - Karolina Schantz
- Department of Industrial Engineering and Management Sciences, McCormick School of Engineering, Northwestern University, Evanston, Illinois
| | - Jui-Chen Yang
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina
| | - John J. Friedewald
- Comprehensive Transplant Center, Department of Surgery, Northwestern Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois
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Friedewald JJ, Schantz K, Mehrotra S. Dealing With the Kidney Discard Problem in the United States-One Potential Solution for a Difficult Problem. Am J Kidney Dis 2022; 79:333-334. [PMID: 35033385 DOI: 10.1053/j.ajkd.2021.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/25/2021] [Indexed: 11/11/2022]
Affiliation(s)
- John J Friedewald
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Karolina Schantz
- Department of Engineering and Management Sciences, Northwestern University, Evanston, Illinois
| | - Sanjay Mehrotra
- Department of Engineering and Management Sciences, Northwestern University, Evanston, Illinois
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Mehrotra S, Schantz K, Friedewald JJ, Ladner DP, Becker Y, Formica R, Barah M, Gu J, Gordon EJ. Physician and patient acceptance of policies to reduce kidney discard. Clin Transplant 2020; 34:e14054. [PMID: 32738167 PMCID: PMC7929781 DOI: 10.1111/ctr.14054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 07/01/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 12/14/2022]
Abstract
Despite the shortage of kidneys for transplantation in the United States, approximately 18%‐20% of deceased donor kidneys are discarded each year. These discarded kidneys can offer a survival benefit to suitable patients. Revisions to the current kidney allocation policy may be needed to reduce deceased donor kidney discard. We surveyed transplant physicians and patients to assess their perceived acceptability of policy proposals to reduce the discard of deceased donor kidneys. Members of professional societies (AST, ASTS) and a patient organization (AAKP) were invited to complete the survey. Responses were obtained from 97 physicians and 107 patients. The majority of physicians (73.4%) and patients (73.8%) "somewhat" or "completely" accepted a policy for fast‐tracking kidneys at risk of discard. Physicians and patients also supported returning a proportion of waiting time to patients who accept KDPI >85 kidneys and experience graft failure within the first 12 months, with 36% of physicians and 50% of patients electing to return 100% of the waiting time. The majority of physicians (75%) "somewhat or completely" accepted a policy to skip less aggressive centers for KDPI 90 + offers. Physicians and patients provided insights into factors researchers, and policymakers should consider in the design and implementation of these policies.
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Affiliation(s)
- Sanjay Mehrotra
- Department of Engineering and Management Sciences, Northwestern University, Evanston, IL, USA
| | - Karolina Schantz
- Department of Engineering and Management Sciences, Northwestern University, Evanston, IL, USA
| | - John J Friedewald
- Department of Engineering and Management Sciences, Northwestern University, Evanston, IL, USA
| | - Daniela P Ladner
- Comprehensive Transplant Center Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Masoud Barah
- Department of Engineering and Management Sciences, Northwestern University, Evanston, IL, USA
| | - Jiayi Gu
- Department of Engineering and Management Sciences, Northwestern University, Evanston, IL, USA
| | - Elisa J Gordon
- Comprehensive Transplant Center Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Mehrotra S, Rahimian H, Barah M, Luo F, Schantz K. A model of supply-chain decisions for resource sharing with an application to ventilator allocation to combat COVID-19. Nav Res Logist 2020; 67:303-320. [PMID: 38607793 PMCID: PMC7267382 DOI: 10.1002/nav.21905] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 05/03/2023]
Abstract
We present a stochastic optimization model for allocating and sharing a critical resource in the case of a pandemic. The demand for different entities peaks at different times, and an initial inventory for a central agency are to be allocated. The entities (states) may share the critical resource with a different state under a risk-averse condition. The model is applied to study the allocation of ventilator inventory in the COVID-19 pandemic by FEMA to different U.S. states. Findings suggest that if less than 60% of the ventilator inventory is available for non-COVID-19 patients, FEMA's stockpile of 20 000 ventilators (as of March 23, 2020) would be nearly adequate to meet the projected needs in slightly above average demand scenarios. However, when more than 75% of the available ventilator inventory must be reserved for non-COVID-19 patients, various degrees of shortfall are expected. In a severe case, where the demand is concentrated in the top-most quartile of the forecast confidence interval and states are not willing to share their stockpile of ventilators, the total shortfall over the planning horizon (until May 31, 2020) is about 232 000 ventilator days, with a peak shortfall of 17 200 ventilators on April 19, 2020. Results are also reported for a worst-case where the demand is at the upper limit of the 95% confidence interval. An important finding of this study is that a central agency (FEMA) can act as a coordinator for sharing critical resources that are in short supply over time to add efficiency in the system. Moreover, through properly managing risk-aversion of different entities (states) additional efficiency can be gained. An additional implication is that ramping up production early in the planning cycle allows to reduce shortfall significantly. An optimal timing of this production ramp-up consideration can be based on a cost-benefit analysis.
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Affiliation(s)
- Sanjay Mehrotra
- Department of Industrial Engineering and Management SciencesNorthwestern UniversityEvanstonIllinoisUSA
| | - Hamed Rahimian
- Department of Industrial Engineering and Management SciencesNorthwestern UniversityEvanstonIllinoisUSA
| | - Masoud Barah
- Department of Industrial Engineering and Management SciencesNorthwestern UniversityEvanstonIllinoisUSA
| | - Fengqiao Luo
- Department of Industrial Engineering and Management SciencesNorthwestern UniversityEvanstonIllinoisUSA
| | - Karolina Schantz
- Department of Industrial Engineering and Management SciencesNorthwestern UniversityEvanstonIllinoisUSA
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Schantz K, Reighard C, Aikens JE, Aruquipa A, Pinto B, Valverde H, Piette JD. Screening for depression in Andean Latin America: Factor structure and reliability of the CES-D short form and the PHQ-8 among Bolivian public hospital patients. Int J Psychiatry Med 2017; 52:315-327. [PMID: 29108457 DOI: 10.1177/0091217417738934] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective We assessed the validity and reliability of the Center for Epidemiologic Studies-Depression scale (CES-D) short form and the Patient Health Questionnaire-8 (PHQ-8) (two measures of depressive symptoms) among urban, low-income patients from a heavily indigenous area of Andean Latin America. This is a patient population that is in many ways culturally distinct from the populations that have been included in previous Spanish language validation studies of these instruments. Methods We administered the CES-D Yale version short form and the PHQ-8 to 107 outpatients at public hospitals in La Paz and El Alto, Bolivia. We conducted exploratory factor analysis, checked internal reliability, and examined concordance between the two measures in identifying patients with clinically significant depressive symptoms. Results Internal reliability was high for both scales: PHQ-8 (Cronbach's α = 0.808) and CES-D (α = 0.825). A one-factor solution for the PHQ-8 was maintained after the removal of one poorly loading item. The CES-D showed a two-factor solution, with items for somatic symptoms and interpersonal problems loading on the same factor as negative affect. Using both the cutoff for depression recommended in prior studies and a sample specific cutoff of ≥1 standard deviation above the mean, the two scales demonstrated only moderate agreement (κ = 0.481-0.486). Conclusions The PHQ may be more appropriate for clinical use in the Andean region, given its greater specificity; however, lower than expected agreement between the scales suggests that they also measure different elements of depression. Irregularities with the factor structure of both scales suggest that further research with this population is needed to better understand depressive symptomology and improve screening in the region.
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Affiliation(s)
- Karolina Schantz
- 1 Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - James E Aikens
- 3 Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - John D Piette
- 6 University of Michigan School of Public Health and Medicine, Ann Arbor, MI, USA
- 7 VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
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Abstract
Multiple epiphyseal dysplasia tarda (MEDT) and spondylo-epiphyseal dysplasisa tarda (SEDT) are genetically transmitted conditions affecting the hips, which may resemble bilateral Legg-Perthes disease (LPD). Misdiagnoses are not uncommon, with serious implications for treatment, prognosis and genetic counseling. An epidemiologic study of MEDT and SEDT in a well-defined population of 453 921 persons in Denmark was performed. A population prevalence of 0.7 per 100000 inhabitants with SEDT and 4.0 per 100 000 inhabitants with MEDT was found. Distinguishing features between MEDT, SEDT and bilateral LPD based on radiologic findings in the hips, other joints, and spine were ascertained. Bilateral LPD is always asymmetric, exhibits patches of increased density in the epiphyses and often metaphyseal cyst-like changes. No spinal lesion or affection of other joints is present, and the acetabula are normal. In MEDT and SEDT the capital femoral epiphyses are symmetrically flattened, fragmented and uniformly slightly sclerotic. Generalised platyspondyly is a constant finding in SEDT.
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Piette JD, Marinec N, Janda K, Morgan E, Schantz K, Yujra ACA, Pinto B, Soto JMH, Janevic M, Aikens JE. Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country. Telemed J E Health 2016; 22:261-8. [PMID: 26352854 PMCID: PMC4968278 DOI: 10.1089/tmj.2015.0099] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients' engagement in mobile health (m-health) interventions using interactive voice response (IVR) calls is less in low- and middle-income countries (LMICs) than in industrialized ones. We conducted a study to determine whether automated telephone feedback to informal caregivers ("CarePartners") increased engagement in m-health support among diabetes and hypertension patients in Bolivia. MATERIALS AND METHODS Patients with diabetes and/or hypertension were identified through ambulatory clinics affiliated with four hospitals. All patients enrolled with a CarePartner. Patients were randomized to weekly IVR calls including self-management questions and self-care education either alone ("standard m-health") or with automated feedback about health and self-care needs sent to their CarePartner after each IVR call ("m-health+CP"). RESULTS The 72 participants included 39 with diabetes and 53 with hypertension, of whom 19 had ≤6 years of education. After 1,225 patient-weeks of attempted IVR assessments, the call completion rate was higher among patients randomized to m-health+CP compared with standard m-health (62.0% versus 44.9%; p < 0.047). CarePartner feedback more than tripled call completion rates among indigenous patients and patients with low literacy (p < 0.001 for both). M-health+CP patients were more likely to report excellent health via IVR (adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI], 1.07, 6.32) and less likely to report days in bed due to illness (AOR = 0.42; 95% CI, 0.19, 0.91). CONCLUSIONS In this study we found that caregiver feedback increased engagement in m-health and may improve patients' health status relative to standard approaches. M-health+CP represents a scalable strategy for increasing the reach of self-management support in LMICs.
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Affiliation(s)
- John D. Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kathryn Janda
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Emily Morgan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Karolina Schantz
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Mary Janevic
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - James E. Aikens
- School of Medicine, University of Michigan, Ann Arbor, Michigan
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Harager K, Hviid K, Jensen CM, Schantz K. Successful immediate weight-bearing of internal fixated ankle fractures in a general population. J Orthop Sci 2001; 5:552-4. [PMID: 11180917 DOI: 10.1007/s007760070004] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [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: 02/04/2000] [Accepted: 06/28/2000] [Indexed: 02/09/2023]
Abstract
Several studies on operated ankle fractures have shown that immediate weight-bearing is recommendable. Consequently, we changed our postoperative standard regimen, from 3 weeks of non-weight-bearing followed by 3 weeks of weight-bearing, to full immediate weight-bearing in all 6 weeks. A below-knee walking cast was applied immediately after surgery. Between December 1995 and September 1996, we studied 62 patients (median age, 55 years; range 21-92 years; M/F, 24/38), with ankle fractures who attended our emergency department and were subsequently admitted for open reduction and internal fixation. We excluded patients with distal tibia fracture and patients under 18 years of age. Overall, our elderly population did not have complication rates higher than those reported in similar studies on younger patients. In 1 patient, we observed radiographic widening of the ankle joint, of about 3 mm, 6 weeks postoperatively. No patients required reoperation. Our study indicates that full immediate weight-bearing after open reduction and internal fixation is recommendable, even in an elderly population.
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Affiliation(s)
- K Harager
- Department of Orthopaedics, University Hospital, Gentofte, 65 Niels Andersensvej, Hellerup 2900, Denmark
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Hviid K, Harager K, Schantz K. [Aftercare of malleolar fractures in Denmark. A questionnaire study]. Ugeskr Laeger 2000; 162:2747-50. [PMID: 10827543] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
A questionnaire was sent out to 59 orthopaedic departments. Seventy-eight percent returned the questionnaire. Four thousand two hundred ankle fractures are treated annually. Fifty percent are operated on (range 12.5-83%). Large departments are on average more surgically active than smaller ones. The noticeable difference, however, in surgical frequency is not connected to size, function or location of orthopaedic department. All fractures are usually immobilized with a circular plaster bandage. Thirty percent use dynamic bandages for some stable ankle fractures. Eighty-five percent bandage for six weeks, 15% for up to eight weeks. Very few allow early mobilization of surgically treated fractures (6%). The rest do not allow mobilization until at least three weeks after surgery. Stable fractures are more frequently permitted immediate mobilization. Several randomized studies recommend that all ankle fractures should be mobilized immediately, surgically treated in a circular plaster bandage, stable fractures in dynamic bandages.
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Affiliation(s)
- K Hviid
- Ortopaedkirurgisk afdeling, Amtssygehuset i Gentofte
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Jensen I, Wester JU, Rasmussen F, Lindequist S, Schantz K. Prognosis of fracture of the talus in children. 21 (7-34)-year follow-up of 14 cases. Acta Orthop Scand 1994; 65:398-400. [PMID: 7976283 DOI: 10.3109/17453679408995478] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
14 children suffering from a fracture of the talar neck or body were examined after 21 (7-34) years. The talar neck was fractured in 10 children and the talar body in 4.3 fractures were displaced and primarily treated with reduction and immobilization. Nondisplaced fractures were treated conservatively. All fractures healed. All patients with displaced fractures had exercise-induced pain at follow-up. Of 11 patients with nondisplaced fractures only 1 had minor complaints. CT and conventional radiographs showed arthrosis in the talocrural joint and normal subtalar joints in those with displaced fractures. The radiographic findings were normal after nondisplaced fractures.
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Affiliation(s)
- I Jensen
- Department of Diagnostic Radiology, Odense University Hospital, Denmark
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Wester JU, Jensen IE, Rasmussen F, Lindequist S, Schantz K. Osteochondral lesions of the talar dome in children. A 24 (7-36) year follow-up of 13 cases. Acta Orthop Scand 1994; 65:110-2. [PMID: 8154273 DOI: 10.3109/17453679408993733] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
13 patients who in childhood had had osteochondral lesions (OCL) of the talar dome participated in a long-term follow-up including physical examination, computed tomography (CT) and conventional radiographs. Most of the cases were caused by trauma. Conventional radiographs showed abnormal findings in 4 cases and CT in a further one. In 3 cases the primary lesion could still be seen as an osteochondral defect, and 2 had a loose body in the joint. 3 of these 5 patients had mild symptoms. We conclude that arthrosis following OCL in childhood is infrequent and recommend conservative treatment initially. In those with persisting symptoms, additional imaging evaluation with CT and MRI is recommended.
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Affiliation(s)
- J U Wester
- Department of Orthopedics, Odense University Hospital, Denmark
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Strange-Vognsen HH, Neergaard K, Schantz K, Lebech A. [Computer tomography compared to tomography in suspected femoral neck fractures]. Ugeskr Laeger 1993; 155:704-5. [PMID: 8456512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
A follow-up examination of 21 cases of anterior interosseous nerve syndrome in 20 patients is presented. In 15 patients the anterior interosseous nerve was explored, with objective signs of compression in nine. 11 of these patients showed satisfactory function and three had a tendon transfer. Five cases were not operated on. Two recovered and three had continuous paralysis after more than four years. One patient had a primary tendon transfer. We conclude that exploration of the anterior interosseous nerve is the treatment of choice, and that expectant treatment can be reserved for patients with slight disability or poor general health. As recovery may take over a year, tendon transfer should be postponed until after this period in patients who do not show satisfactory recovery.
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Affiliation(s)
- K Schantz
- Department of Orthopaedics, Rigshospitalet, University of Copenhagen, Denmark
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15
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Abstract
In a prospective study the diagnostic value of CT scanning and tomography were compared in the cases of eight consecutive patients in whom initial radiographs showed a suspected hip fracture. CT scan did not contribute more to diagnosis than tomography.
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Affiliation(s)
- H H Strange-Vognsen
- Department of Orthopaedic Surgery, Gentofte Hospital, University of Copenhagen, Denmark
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16
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Abstract
The usefulness of ultrasound in the detection of foreign bodies was examined in a blind study in human cadavers using glass, plastic and wood as foreign bodies. Of 65 foreign bodies placed in 102 cicatrices, 58 were found using a 5 MHz transducer. The sensitivity was 89% and the specificity 93% making ultrasound a useful clinical tool for this purpose.
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Affiliation(s)
- P J Blyme
- Department of Orthopaedics T, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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17
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Schantz K, Andersen PE, Justesen P. Spondyloepiphyseal dysplasia tarda. Report of a family with autosomal dominant transmission. Acta Orthop Scand 1988; 59:716-9. [PMID: 3213464 DOI: 10.3109/17453678809149433] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We present a clinical and radiographic study of a family with the autosomal dominant form of spondyloepiphyseal dysplasia tarda, in some patients associated with hearing deficiency. Although no causal treatment is possible, correct diagnosis is important to avoid unnecessary treatment and for information about prognosis, genetic counseling, and recommendation of future occupation.
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Affiliation(s)
- K Schantz
- Department of Orthopedics, Odense University Hospital, Denmark
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18
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Andersen PE, Schantz K, Bollerslev J, Justesen P. Bilateral femoral head dysplasia and osteochondritis. Acta Radiol 1988. [DOI: 10.3109/02841858809171969] [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: 11/13/2022]
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19
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Andersen PE, Schantz K, Bollerslev J, Justesen P. Bilateral femoral head dysplasia and osteochondritis. Multiple epiphyseal dysplasia tarda, spondylo-epiphyseal dysplasia tarda, and bilateral Legg-Perthes disease. Acta Radiol 1988; 29:705-9. [PMID: 3190947] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Multiple epiphyseal dysplasia tarda (MEDT) and spondylo-epiphyseal dysplasia tarda (SEDT) are genetically transmitted conditions affecting the hips, which may resemble bilateral Legg-Perthes disease (LPD). Misdiagnoses are not uncommon, with serious implications for treatment, prognosis and genetic counseling. An epidemiologic study of MEDT and SEDT in a well-defined population of 453,921 persons in Denmark was performed. A population prevalence of 0.7 per 100,000 inhabitants with SEDT and 4.0 per 100,000 inhabitants with MEDT was found. Distinguishing features between MEDT, SEDT and bilateral LPD based on radiologic findings in the hips, other joints, and spine were ascertained. Bilateral LPD is always asymmetric, exhibits patches of increased density in the epiphyses and often metaphyseal cyst-like changes. No spinal lesion or affection of other joints is present, and the acetabula are normal. In MEDT and SEDT the capital femoral epiphyses are symmetrically flattened, fragmented and uniformly slightly sclerotic. Generalised platyspondyly is a constant finding in SEDT.
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Affiliation(s)
- P E Andersen
- Department of Diagnostic Radiology, Odense University Hospital, Denmark
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20
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Abstract
Fifteen children who sustained a displaced intraarticular calcaneal fracture, treated closed, were reexamined after 12 (1-29) years. All were satisfactory, although slight inconvenience was encountered as a result of the fracture. Immobilization and nonweight bearing from 4 to 6 weeks seem sufficient to treat a calcaneal fracture in children.
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Affiliation(s)
- K Schantz
- Department of Radiology, Odense University Hospital, Denmark
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Pedersen P, Adamsen S, Schantz K, Gerner-Smidt P. [Necrobacillosis. Fusobacterium necrophorum septicemia]. Ugeskr Laeger 1987; 149:3333-4. [PMID: 3445381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
We reviewed 80 fractures of the calcaneus in 78 children through a 30-year period. The fractures were more equally distributed between the sexes than in adults. In contrast to adults, intraarticular fractures of the calcaneus in children constitute less than half, probably because a lower proportion of children sustain the fracture as a result of a fall. Associated injuries were mainly encountered by children who were traffic accident victims. It is disputable that the calcaneus in children is more resistant to fracture than in adults. The rarity of the fracture in children is more likely the result of less exposure to trauma leading to calcaneal fractures and also that the fracture is often overlooked.
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Affiliation(s)
- K Schantz
- Department of Orthopedics, Odense University Hospital, Denmark
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24
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Rasmussen F, Schantz K. Radiologic aspects of lunatomalacia. Eur J Radiol 1987; 7:199-202. [PMID: 3653111] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A radiological classification of lunatomalacia, based upon the chronological radiologic manifestations in 93 patients is presented. Compression fractures were not seen as the initial event. Fifty-seven per cent of the patients had a short ulna (ulna minus variant). The presence of ulna minus variant was especially observed in the younger patients. In 16 patients suffering from a lunate fracture and in 20 patients with lunate or perilunate luxations, lunatomalacia did not develop. Immobilization as treatment of the disorder resulted in a progressive course in all patients, but one, an 8-year-old girl. The lesion of the lunate was arrested and tended to heal following radial osteotomy in all patients.
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Affiliation(s)
- F Rasmussen
- Department of Diagnostic Radiology, Odense University Hospital, Denmark
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25
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Andersen PE, Green A, Bollerslev J, Justesen P, Høst A, Schantz K. [Generalized congenital skeletal dysplasias in the county of Funen. A clinical, radiological and epidemiological study]. Ugeskr Laeger 1987; 149:586-9. [PMID: 3824662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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26
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Abstract
A case of advanced lunatomalacia in an 8-year-old girl treated by immobilization is described. After 2 years of treatment, the girl had a normal wrist, and radiographically the condition had improved, albeit with some collapse of the radial part of the lunate. Our case suggests that the natural course of lunatomalacia is favorable in children as compared with adults.
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27
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Abstract
One hundred and forty-three calcaneal fractures in 140 patients under the age of 19 years were reviewed. Of the total number, 75 per cent were in males. Eighty fractures were seen in females under 13 years of age and in males under 16 years of age. Fifteen (19%) of these fractures were initially not recognized. Four projections were available in the majority of the cases, and were reviewed: lateral, axial, straight dorsoplantar and oblique dorsoplantar views. The various types of fractures had different courses and localizations. The optimum demonstration of a fracture in a certain projection will therefore be dependent on the type of fracture present. It is clinically difficult to foresee a specific type of calcaneal fracture, and consequently it is recommended that all four views should be obtained routinely following trauma to the calcaneal region in patients of the pertinent age groups.
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28
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Georgsen J, Schantz K. [Cerebral apoplexy. I. Patients with newly developed cerebral apoplexy admitted to a general medical department in the course of a year]. Ugeskr Laeger 1985; 147:2664-7. [PMID: 4071703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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29
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Schantz K, Georgsen J. [Cerebral apoplexy. II. The social consequences of cerebral apoplexy]. Ugeskr Laeger 1985; 147:2695-8. [PMID: 4071708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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30
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Schantz K, Kjaersgaard-Andersen P. [Non-traumatic necrosis of the femoral head associated with alcohol abuse]. Ugeskr Laeger 1985; 147:858-60. [PMID: 3984058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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31
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Paul T, Schantz K. �ber die Bestimmung des Siedepunktes als Merkmal der Reinheit. Anal Bioanal Chem 1921. [DOI: 10.1007/bf01419108] [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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