Ulleval University Hospital Research Articles

Statistical Analysis of the TSAD Interactome in Multiple Sclerosis: Multiple Testing, High Dimensional Regression and Interactions

Multiple Sclerosis (MS) is a chronic inflammatory disease of the Central Nervous System (CNS). The presence of Oligoclonal Band (OCB) in Cerebrospinal Fluid (CSF) is an important diagnostic tool in MS. The main aim of this study was to determine SNPs and SNPs-SNPs interactions in the genomic TSAD (T-Cell Specific Adaptor Proteins) region which explain the difference between two MS conditions: OCB positive vs. OCB negative in sampled Norwegian patients. The data to this study was obtained from the MS Registry Ulleval University Hospital, Oslo, Norway. Of 899 patients, 802 were OCB positive and 97 OCB negative, each has 923 SNPs at specific position in their chromosome measure. The study incorporated two different statistical methods to our data analysis. First, we apply variable selection based on Lasso method, here we discuss Lasso for Logistic Regression Analysis and see interaction effect for the Lasso selected SNPs. In the second section, we analyze variable selection based on test of association. Here, we used Chi-Square and Fisher’s exact test of association to see association between the statuses of OCB to each SNP. We found out that the Chi-Square test of association selected 34 significant SNPs and the association test for Fisher’s exact test selected 38 significant SNPs at significance level of 0.05. Then we used Boferroni and False Discovery Rate to statistically significant SNPs for the multiple testing corrections. Finally, we looked for interaction effects to some selected SNPs from test of association and we have determined SNPs and SNP-SNP interactions which appear to have significant associated to the OCB subpopulation of MS patients, based on our study of the Norwegian cohort. These are selected SNPs which have been selected by any of the methods that we used (various hypothesis testing and regressions). This is the SNPs that we think should be studied further and validated on a new dataset. Of particular importance are the seven SNP-SNP interactions which we found. It is the first time a SNP-SNP study has been performed on these data, and the finding will be communicated to the Norwegian molecular biologists to be followed up. Keywords: Multiple Sclerosis, OCB, TSAD, Multiple Testing, High Dimensional Regressions, LASSO DOI : 10.7176/JMPB/61-01 Publication date: November 30 th 2019

Emergency Thoracotomy Saves Lives in a Scandinavian Hospital Setting

: Emergency thoracotomy (ET) is a life-saving procedure used to control hemorrhage and relieve cardiac tamponade. It has been in routine use at Ulleval University Hospital since 1987. Our objective was to see the outcome of patients subjected to ET in recent times. : One hundred and nine consecutive ET performed in our emergency department during a 6-year period were analyzed. Data were drawn from the hospital's trauma registry. Demographics, mechanism of injury, anatomic injuries, physiologic status, interventions, time lapse, and outcome 30 days after injury were registered prospectively. : Ten of 27 patients with penetrating (37%) and 10 of 82 patients with blunt injuries (12%) survived, giving a total survival of 18%. Median (quartiles) for the following parameters were Injury Severity Score 38 (26-50), Revised Trauma Score 1.3 (0-3.9), Glasgow Coma Scale score 3 (3-6), and probability of survival 0.06 (0.001-0.22). Survivors from penetrating injuries had significantly lower Injury Severity Score (25 vs. 34, p = 0.003), higher Revised Trauma Score (3.92 vs. 0.00, p < 0.001), higher Glasgow Coma Scale score (8 vs. 3, p < 0.001), and higher probability of survival (0.74 vs. 0.01, p < 0.001) than nonsurvivors. Conversely, no such differences were found for patients with blunt injury. Multiple logistic regression analysis failed to reveal any predictors of survival. : An overall survival of 18% suggests that ET is a life saving procedure. It is difficult to find good predictors of survival from logistic regression analysis. It should, for a trained trauma team, be a liberal attitude toward performing the procedure on the agonal patient.

Cesarean Section is Associated With More Frequent Pneumothorax and Respiratory Problems in the Neonate

We have investigated whether the incidence of neonatal pneumothorax (NP), use of mechanical ventilation (MV) or Continuous Positive Airways Pressure (CPAP) is increased in neonates delivered at term and preterm by cesarean section (CS). All deliveries at Ulleval University Hospital, Oslo, during the period 2001-2005 (n=29,358) were included, among whom 5,957 were delivered by CS (20.3%). Data were collected on mode of delivery, elective or emergency CS, gestational age, maternal age, gender and parity. Among the 26,664 neonates born at term (> or =37th gestational week), 4,546 were delivered by CS (17.0%), of whom 0.5% by elective and 0.6% by emergency CS with NP. The incidence of diagnosed NP was significantly higher after CS than after vaginal delivery (0.6% vs. 0.10%, p<0.001). In addition, the need for MV was significantly increased (0.41% vs. 0.19%; p=0.01) but use of CPAP was not (0.28%vs. 0.15%; p=0.08). Among 2,694 neonates born preterm (<37th gestational week), 1,266 were delivered by CS (47.0%). The incidence of diagnosed NP was 2.05% when delivered by CS but only 0.63% when delivered vaginally (p<0.01). Among the preterm infants delivered by CS, 17.7% needed CPAP compared to 6.9% when delivered vaginally (p<0.001) and MV was required for 8.1 and 3.7% (p<0.001), respectively. Among neonates delivered at term or moderately preterm (30-36 weeks) by CS the incidence of NP and other respiratory problems was significantly increased.

Precision of field triage in patients brought to a trauma centre after introducing trauma team activation guidelines.

BackgroundField triage is important for regional trauma systems providing high sensitivity to avoid that severely injured are deprived access to trauma team resuscitation (undertriage), yet high specificity to avoid resource over-utilization (overtriage). Previous informal trauma team activation (TTA) at Ulleval University Hospital (UUH) caused imprecise triage. We have analyzed triage precision after introduction of TTA guidelines.MethodsRetrospective analysis of 7 years (2001–07) of prospectively collected trauma registry data for all patients with TTA or severe injury, defined as at least one of the following: Injury Severity Score (ISS) > 15, proximal penetrating injury, admitted ICU > 2 days, transferred intubated to another hospital within 2 days, dead from trauma within 30 days. Interhospital transfers to UUH and patients admitted by non-healthcare personnel were excluded. Overtriage is the fraction of TTA where patients are not severely injured (1-positive predictive value); undertriage is the fraction of severely injured admitted without TTA (1-sensitivity).ResultsOf the 4 659 patients included in the study, 2 221 (48%) were severely injured. TTA occurred 4 440 times, only 2 002 of which for severely injured (overtriage 55%). Overall undertriage was 10%. Mechanism of injury was TTA criterion in 1 508 cases (34%), of which only 392 were severely injured (overtriage 74%). Paramedic-manned prehospital services provided 66% overtriage and 17% undertriage, anaesthetist-manned services 35% overtriage and 2% undertriage. Falls, high age and admittance by paramedics were significantly associated with undertriage. A Triage-Revised Trauma Score (RTS) < 12 in the emergency department reduced the risk for undertriage compared to RTS = 12 (normal value). Field RTS was documented by anaesthetists in 64% of the patients compared to 33% among paramedics.Patients subject to undertriage had an ISS-adjusted Odds Ratio for 30-day mortality of 2.34 (95% CI 1.6–3.4, p < 0.001) compared to those correctly triaged to TTA.ConclusionTriage precision had not improved after TTA guideline introduction. Anaesthetists perform precise trauma triage, whereas paramedics have potential for improvement. Skewed mission profiles makes comparison of differences in triage precision difficult, but criteria or the use of them may contribute. Massive undertriage among paramedics is of grave concern as patients exposed to undertriage had increased risk of dying.

The First Metallo-β-Lactamase Identified in Norway Is Associated with a TniC-Like Transposon in a Pseudomonas aeruginosa Isolate of Sequence Type 233 Imported from Ghana

Metallo-β-lactamases (MBLs) are an emerging problem among various clinically important gram-negative bacilli, such as Pseudomonas aeruginosa, Acinetobacter spp., and Enterobacteriaceae (8). Scandinavian countries are renowned for their low level of antibiotic resistance (1), and previous reports on the emergence of new resistance mechanisms have been associated with strain import, such as with the first Swedish MBL, derived from Greece (3). As part of an ongoing national study of MBLs in clinical isolates of P. aeruginosa, the National Reference Centre received a carbapenem-resistant isolate (K34-7) from the Ulleval University Hospital in the autumn of 2006. The isolate was recovered from tracheal secretions upon admission of a patient who transferred to the hospital after prolonged hospitalization in Ghana. The isolate is therefore likely to have been imported to Norway from Ghana. Susceptibility testing of the isolate using Etests (AB Biodisk, Solna, Sweden) showed that the isolate was susceptible only to colistin, intermediate to aztreonam, and resistant to other β-lactams (imipenem-meropenem MIC, >32 μg/ml), aminoglycosides, and fluoroquinolones according to EUCAST clinical breakpoints. The isolate had a positive MBL Etest ratio, and MBL production was confirmed by spectrophotometric analysis of imipenem hydrolysis by crude cell extracts and subsequent inhibition by EDTA (11). The sequence of the blaVIM-2 gene was confirmed by PCR using consensus primers for blaVIM, and sequence analysis of the genetic context using oligonucleotides for the 5′ conserved sequence (5′CS), the 3′CS, blaVIM, and tniC showed that the blaVIM-2 gene was located in an unusual class 1 integron flanked by the tni module similar to Tn402 (7) and not the normal 3′CS end (fused qacEΔ1-sul1). PCR linking blaVIM-2 to tniA, orf6, and tniB and sequencing confirmed that the whole tni module was present. The gene cassette array of aacA7-blaVIM-2-dhfrB5-aacC-A5 is identical to other TniC-like transposons found in isolates from the United States (6), Russia (GenBank accession no. {type:entrez-nucleotide,attrs:{text:DQ522233,term_id:102231610,term_text:DQ522233}}DQ522233), and Taiwan (12) and almost identical to a TniC-like transposon found in an Indian isolate (10). Multilocus sequence typing showed that K34-7 belonged to ST233, which is not part of any clonal complexes; however, Russian isolates with the same transposon belong to ST235, which is part of a clonal complex harboring MBL isolates from several countries in Europe (2, 4, 9). Further, pulsed-field gel electrophoresis (PFGE) analysis (SpeI digestion) and serotyping of K34-7 and isolates possessing TniC-like transposons from Russia (GenBank accession no. {type:entrez-nucleotide,attrs:{text:DQ522233,term_id:102231610,term_text:DQ522233}}DQ522233) and Taiwan (12) showed that the isolates had different PFGE profiles and were of different serotypes (Russian isolate, O11; Taiwan isolate, O2; and K34-7, O6). Thus, the appearance of this TniC-like transposon in unrelated P. aeruginosa isolates suggests that the transposon is itself transferable and also responsible for the dissemination of blaVIM-2. The chromosomal location of the TniC-like transposon was confirmed by hybridization of a radiolabeled blaVIM-2 probe to a chromosomal band larger than 1 megabase after I-Ceu-1 digestion of K34-7 genomic DNA and PFGE (5; data not shown). In conclusion, this study highlights the importance of TniC-like transposons in the global dissemination of blaVIM-2 and also the contribution of human population dynamics in spreading MBL genes. (Part of this study was presented at the 17th European Congress of Clinical Microbiology and Infectious Diseases, Munich, Germany.)

Severe Malaria and Artesunate Treatment, Norway

Severe Malaria and Artesunate Treatment, Norway

Retaining the patient perspective in the International Classification of Functioning, Disability and Health Core Set for low back pain

To examine the relationship between health problems as rated by the health professionals in the Norwegian form of the Core Set for low back pain and the patients' self-reported health problems in Oswestry Disability Index (ODI) and World Health Organization Disability Assessment Schedule II (WHODAS II). This was part of an international multicenter study where a convenience sample of 118 Norwegian patients with low back pain (LBP) participated. The ICF Core Set for LBP was filled in by the health professionals. The patients reported their health problems in the WHODAS II and ODI. The items in WHODAS II and ODI were linked to the ICF. The problems reported in WHODAS II and ODI were compared to the problems scored by the health professionals in the linked ICF categories in the Comprehensive ICF Core Set for LBP. All items in ODI could be linked the ICF. Four items in WHODAS II could not be linked to the ICF and additionally two items could not be linked to specific ICF categories. All ICF categories linked to the ODI were included in the Comprehensive Core Set for LBP, whereas six items in WHODAS II could not be linked, and additionally 11 of the items were not represented in the Core Set. With the exception of sexual function, above three quarter of the patients' reported problems within body functions was captured by the health professionals. Within several of the activities and participation categories the health professionals scores in the ICF reflected the patients' reported problems well. Surprisingly some of the problems in activities of daily living were poorly reflected. The Comprehensive ICF Core Set for LBP covers most of the items in ODI and WHODAS II in areas where patients report significant problems, with some exceptions. The subjective dimension related to the impact of the health condition as well as the feeling of being a burden to their family appeared to be important to these patients and not covered in the ICF. Problems with sexual functions and relationship were poorly reflected in the health professionals' scores in the Comprehensive ICF Core Set for LBP. In clinical practice it is a challenge to assess the individual patients' broad spectrum of problems precisely.

344 SPONTANEOUS WEIGHT CHANGE AND THE RISK FOR TOTAL HIP REPLACEMENT

H. Apold1, H. Meyer2, L. Nordsletten1, B. Espehaug3, L. Havelin3, G. Flugsrud4. 1Orthopedic Department, Ulleval University Hospital, Oslo, NORWAY, 2Department for preventive medicine and epidemiology, University of Oslo, Oslo, NORWAY, 3The Norwegian Arthroplasty Register, Orthopedic department, Haukeland University Hospital, Bergen, NORWAY, 4Orthopedic department, Ulleval University Hospital, Oslo, NORWAY

Night blindness after duodenal switch

Night blindness after duodenal switch Erlend T. Aasheim, M.D.*, Torgeir T. Sovik, M.D., Espen F. Bakke, M.D. Hormone Laboratory, Department of Endocrinology, Aker University Hospital and Faculty Division Aker University Hospital, University of Oslo, Oslo, Norway Department of Gastrointestinal Surgery, Aker University Hospital, Oslo, Norway Department of Ophthalmology, Ulleval University Hospital, Oslo, Norway Received April 24, 2008; revised May 2, 2008; accepted May 2, 2008 Surgery for Obesity and Related Diseases 4 (2008) 685–686

Different definitions of patient outcome: Consequences for performance analysis in trauma

Death during acute care hospitalisation is commonly used as a principal outcome indicator in injury research. This endpoint excludes post-hospital trauma-related deaths, which are substantial according to recent US studies. Two additional ways of defining outcome in trauma victims are also used; by end of somatic care, and at 30 days after injury. Our primary aim was to analyse how the different definitions of trauma outcome influence performance analyses. Secondly, we wanted to evaluate whether 30 days mortality after injury, which is widely used in other parts of biomedicine and recommended by the United Nations for use in transport statistics, is a suitable endpoint in trauma research. We conducted a retrospective analysis of prospectively collected data from the hospital based trauma registry at Ulleval University Hospital (UUH) in Oslo, Norway. Outcome measure was mortality at discharge from UUH, i.e., by "end of acute care", at end of somatic care defined as discharge from final acute care hospital, and at 30 days after injury. Analyses were performed according to conventional TRISS methodology. 3332 of 3446 patients from the years 2000-2004 were included. Of these, 323 (9.7%) died within 30 days of injury or during somatic care more than 30 days after injury. Mortality varied with outcome definition, with 264 deaths (81.7% of total deaths) before discharge from UUH, 318 (98.4%) before end of somatic care, and 308 (95.4%) within 30 days after injury. TRISS-based trauma system performance evaluation for blunt trauma showed significantly better outcome than predicted with discharge from UUH as outcome definition, whereas for category 30 days after injury, performance was clearly less favourable. Performance for penetrating trauma was not affected, since all deaths occurred before 30 days, and nearly all before discharge from UUH. A substantial number of in-hospital deaths following blunt trauma occurs after discharge from the primary institution, i.e., unnoticed when "end of acute care" is used as outcome definition. Consequently, outcome definition influenced performance when comparing our institution to an acknowledged standard. We recommend mortality occurring within 30 days of injury as endpoint in trauma research.

954 PREVALENCE OF CANCER PAIN IN OUTPATIENTS AT A NORWEGIAN COMPREHENSIVE CANCER CENTRE

European Journal of PainVolume 10, Issue S1 p. S247a-S247 954 PREVALENCE OF CANCER PAIN IN OUTPATIENTS AT A NORWEGIAN COMPREHENSIVE CANCER CENTRE U.E. Kongsgaard, U.E. Kongsgaard Dep of Anesthesiology and Intensive Care, The Norwegian Radium Hospital, OsloSearch for more papers by this authorA. Holtan, A. Holtan Dep of Anesthesiology, Ulleval University Hospital, OsloSearch for more papers by this authorN. Aass, N. Aass Palliative Care Research Unit, The Norwegian Radium Hospital, Oslo, NorwaySearch for more papers by this author U.E. Kongsgaard, U.E. Kongsgaard Dep of Anesthesiology and Intensive Care, The Norwegian Radium Hospital, OsloSearch for more papers by this authorA. Holtan, A. Holtan Dep of Anesthesiology, Ulleval University Hospital, OsloSearch for more papers by this authorN. Aass, N. Aass Palliative Care Research Unit, The Norwegian Radium Hospital, Oslo, NorwaySearch for more papers by this author First published: 13 January 2012 https://doi.org/10.1016/S1090-3801(06)60957-9Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume10, IssueS1September 2006Pages S247a-S247 RelatedInformation

Scoring of anatomic injury after trauma: AIS 98 versus AIS 90—do the changes affect overall severity assessment?

Although several changes were implemented in the 1998 update of the abbreviated injury scale (AIS 98) versus the previous AIS 90, both are still used worldwide for coding of anatomic injury in trauma. This could possibly invalidate comparisons between systems using different AIS versions. Our aim was to evaluate whether the use of different coding dictionaries affected estimation of Injury Severity Score (ISS), New Injury Severity Score (NISS) and probability of survival (Ps) according to TRISS in a hospital-based trauma registry. In a prospective study including 1654 patients from Ulleval University Hospital, a Norwegian trauma referral centre, patients were coded according to both AIS 98 and AIS 90. Agreement between the classifications of ISS, NISS and Ps according to TRISS methodology was estimated using intraclass correlation coefficients (ICC) with 95% CI. ISS changed for 378 of 1654 patients analysed (22.9%). One hundred and forty seven (8.9%) were coded differently due to different injury descriptions and 369 patients (22.3%) had a change in ISS value in one or more regions due to the different scoring algorithm for skin injuries introduced in AIS 98. This gave a minimal change in mean ISS (14.74 versus 14.54). An ICC value of 0.997 (95% CI 0.9968-0.9974) for ISS indicates excellent agreement between the scoring systems. There were no significant changes in NISS and Ps. There was excellent agreement for the overall population between ISS, NISS and Ps values obtained using AIS 90 and AIS 98 for injury coding. Injury descriptions for hypothermia were re-introduced in the recently published AIS 2005. We support this change as coding differences due to hypothermia were encountered in 4.3% of patients in the present study.

Consultation liaison psychiatry in Norway

The history of Norwegian CL psychiatry dates back to 1951 when a psychiatrist was appointed to perform psychiatric consultations at the National Hospital. Over the next 20 years, two more psychiatrists were appointed at the same hospital. A separate department was established in 1972 and is now known as the Department of Psychosomatic Medicine, which is under the leadership of Professor Ulrik F. Malt. The department has been steadily growing, mainly after the head of the department also became professor at the University of Oslo in 1985. In the beginning, the department had only psychiatrists, now, there are 9 medical doctors and 6 psychologists, as well as nurses, physiotherapists, and secretaries, for a total of 24 staff members. The department is the leading CL unit in Norway, with regard to magnitude and broadness of clinical and scientific activities. In addition to meeting hospital requirements, it employs several general practitioners and specialists. It is the only Norwegian CL unit with an outpatient clinic. In addition to general CL services to patients with various medical disorders, special services are given within the field of complex psychosomatic or affective disorders, clinical psychopharmacology, neuropsychiatry, and gender identity disorder. At Ulleval University Hospital, which is the Norwegian hospital with the most number of beds, a part-time psychiatrist was affiliated to one of the medical departments in the late 1950s, mainly working with patients with lung disease and, later, with those with cardiac problems. In the late 1970s, a full-time CL psychiatrist was appointed. The psychiatric department had no formal CL unit, and the psychiatrists on duty, often young residents, provided the service. The author has been working as a consultant psychiatrist at the Department of Acute Medicine since

Assessing Quality of Care in a Trauma Referral Center: Benchmarking Performance by TRISS-Based Statistics or by Analysis of Stratified ISS Data?

Using prospectively collected data from Ulleval University Hospital in Norway, standard TRISS-based methods with case mix correction were compared with analysis based on ISS stratified data. Reference data were The Major Trauma Outcome Study (MTOS) controlled sites, used for calculation of AIS 90 based TRISS coefficients. Present TRISS convention requires RTS scoring on hospital admission, excluding many severely injured patients intubated before arrival. Therefore, all Ulleval patients were RTS scored using prehospital data if needed. There was 6.6% of MTOS controlled sites patients (mortality rate 26.7%) that had been excluded before estimation of TRISS coefficients because of lack of data for Ps calculation. Analyses based on ISS stratified data included these patients and indicated significant better performance at Ulleval for blunt, but not for penetrating trauma. No TRISS-based analysis detected this difference. The RTS convention should be changed to reduce patient exclusion. Presently, stratified ISS based data should also be analyzed.

Endovascular Stent in the Acute Treatment of Blunt Renal Arterial Injury

From the Orthopaedic Centre and the Department of Cardiovascular Radiology, Ulleval University Hospital, Oslo, Norway. Submitted for publication April 24, 2003. Accepted for publication July 21, 2003. This case has been presented at the International Trauma Anaesthesia and Critical Care Society Congress TraumaCare, Stavanger, Norway, 2002, and at the annual meeting of the Norwegian Association of Surgeons, Oslo, Norway, 2002. Address for reprints: Gunnar B. Flugsrud, MD, Orthopaedic Center, Ulleval University Hospital, N-0407 Oslo, Norway; email: [email protected]

Impact of socio‐demographic factors, knowledge and attitude on the use of herbal drugs in pregnancy

Herbal drugs are often promoted as 'natural' and 'safe'. These claims may especially attract pregnant women who are often concerned about their unborn child's well-being. Few studies have assessed the use of herbal drugs in pregnancy and the factors related to this use. To investigate the impact of socio-demographic factors, knowledge and attitude on the use of herbal drugs in pregnancy. A total of 400 postpartum women at Ulleval University Hospital in Oslo, Norway were interviewed within 3 days after giving birth by using a structured questionnaire in the period from February to June 2001. In all, 36% of the women reported herbal use during their pregnancy. Both women who had used herbal drugs in pregnancy and those not, had a positive attitude toward the use of herbal drugs in pregnancy. Echinacea was the most well known herb among both groups of women. The factors associated with the use of herbal drugs in pregnancy were: prior use of herbs, high knowledge about herbal drugs and age between 26 and 35 years. There was a non-significant higher frequency of herbal drugs use in pregnancy among women with a higher education level. The widespread use and positive attitude toward herbal drugs in pregnancy indicates an increased need for documentation about both the efficacy and safety of herbal drugs in pregnancy. Women between 26 and 35 years with a prior history of herbal drug use and high knowledge about herbs, are more prone to using herbal drugs in pregnancy.

Essential hypertension in women

INGRID OS, SUZANNE OPARIL, EVA GERDTS AND AUD HOIEGGEN From the Department of Pharmacotherapeutics, University of Oslo, Oslo, Norway, Department of Nephrology, Ulleval University Hospital, Oslo, Norway, Division of Cardiovascular Disease, Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, USA, Department of Cardiology, Haukeland University Hospital, Bergen, Norway

Testing for toxoplasmosis in pregnancy: a study of the routines in primary antenatal care.

The question of benefit of screening for antibodies against Toxoplasma gondii in pregnancy to prevent impairment in the infant has not been settled. Despite this, it is believed that such testing is common. The aim of this study was to describe the test routines and to identify factors associated with testing in primary antenatal care. Ulleval University Hospital, Oslo, Norway. All women who gave birth at Ulleval University Hospital, Oslo, Norway, in May 2000 were included. The number of antibody tests during pregnancy was obtained from the patient registry at the department of microbiology at the same hospital. 81% (361/446) had been tested for antibodies against Toxoplasma gondii during pregnancy. Women attending primary antenatal care at a specialist in obstetrics and gynaecology were most likely to be tested. Among women with no signs of prior toxoplasmosis, 35% (110/317) were tested only once. The majority of pregnant women are being tested for toxoplasmosis even though such testing has no documented preventive effect and has not been recommended.

International Trauma Anesthesia and Critical Care Society (ITACCS).

International Trauma Anesthesia and Critical Care Society (ITACCS).

Cost of Surgical Treatment of Closed Ankle Fractures

Background: Assessment of costs following open reduction and internal fixation of closed ankle fractures has not been reported previously. Patients and Methods: All 224 patients admitted to Ulleval University Hospital with an ankle fracture during two 12-month periods in 1995 and 1998 were evaluated for inclusion, 191 patients (118 women, 73 men) treated by open reduction and internal fixation were followed up for a minimum of 3 months. Patients with multiple injuries (n = 10), open fractures (n = 10) and a clinical observation time < 3 months (n = 13) were excluded. The costs of surgery, hospitalization, follow-up appointments, and sickness benefits during the 1st postoperative year were assessed. Results: The overall cost of treatment in the 1st postoperative year was calculated at Euro 12,498.- (SD 8,728.-). The expenses did not significantly differ when comparing age, sex and fracture types. The difference in the total cost for the patients with no, minor and major soft tissue problems was highly significant (p < 0.001). Conclusions: The results of this study indicate that open reduction and internal fixation of ankle fractures are costly. Efforts should be made to avoid major complications as these increase the costs considerably.