Danish medical bulletin最新文献

Introduction: Previous studies confirm the effect of collaborative assessment and management of suicidality (CAMS) in an experimental setup, but there is a need to test CAMS with regard to its effectiveness and feasibility in a real-life clinical context. The purpose of this study was to investigate CAMS in a Danish population in such a context.

Material and methods: In the present descriptive study, CAMS treatment was administered to a total of 42 patients referred during 1 August 2008 to 30 September 2009 to The Centre of Excellence in Suicide Prevention due to suicidal thoughts or a suicide attempt. Qualitative and quantitative data were obtained before and after CAMS treatment. Five major suicidal markers were regularly assessed. The patients' experiences of the importance of the treatment were studied as endpoints.

Results: A total of 81% of the patients completed treatment and 68% hereof completed the final evaluation. 74% from this group judged the sessions to be the main factor in the elimination of their suicidality. A significant decrease was observed in the five suicidal markers recorded for the 42 patients included. One patient attempted suicide and another patient committed suicide.

Conclusion: CAMS was assessed to be effective and useful in a real-life clinical context. Further studies in larger patient populations are needed as are studies to determine whether the CAMS method may be applied with equal effect to all patient groups.

Funding: not relevant.

Trial registration: Danish Data Protection Agency.

Introduction: The aim of this pilot study was to evaluate glycaemic control in diabetic patients admitted to hospital.

Material and methods: Patients were prospectively identified at 11 consecutive Wednesdays in one medical and one surgery department and information from the previous three days of admission was collected, including: bedside p-glucose readings, scheduled and supplemental insulin treatment.

Results: In total, 111 observation days were included from 37 diabetic patients (27 medical and ten surgical). P-glucose was measured on average four and 2.5 times daily at the medical and the surgery department, respectively. The median p-glucose level was 8.6 mmol/l (range 4.0-22), with no obvious difference between the two departments and no trend towards improvement observed. Approximately one third of the patients had median p-glucose values > 10 mmol/l. 7% of the patients at the medical and none at the surgery department had a p-glucose < 3 mmol/l. Supplemental insulin was prescribed to the majority of patients at the medical department and to 30% at the surgery department with a median p-glucose threshold of 12 and 14 mmol/l at the two departments, respectively. Supplemental insulin was not given despite being indicated in 37% of the elevated glucose episodes. Increments in scheduled insulin dose were rarely observed despite being indicated.

Conclusion: Despite acceptable median p-glucose levels, hyperglycaemia was frequent. The number of glucose readings was low and clinical inertia was observed, both with regard to intensification the scheduled insulin and with regard to administration of supplemental insulin.

Funding: not relevant.

Trial registration: not relevant.

Introduction: Prenatal screening for karyotype anomalies takes place in most European countries. In Denmark, the screening method was changed in 2005. The aim of this study was to study the trends in prevalence and prenatal detection rates of chromosome anomalies and Down syndrome (DS) over a 22-year period.

Material and methods: The study was based on data collected from the EUROCAT registry of congenital anomalies for Funen County. The registry includes information about live births, foetal deaths with a gestational age > 20 weeks and terminations of pregnancy after prenatal diagnosis of foetal anomaly (TOPFA). The study includes all foetuses/infants diagnosed with a chromosome anomaly born between 1986 and 2007 of a mother residing in Funen County.

Results: A total of 431 foetuses/infants had a chromosome anomaly corresponding to an overall prevalence of 35.6 chromosome anomalies per 10,000 births. This figure remained constant during the study period. Two hundred and three cases were live births (47% of total), 26 foetal deaths (6%) and 202 TOPFAs (47%). The prenatal detection rate for chromosome anomalies increased from 27% in the 1980s to 71% in the new millennium (p < 0.001). There were 235 cases with DS (55% of total cases), which yields an overall prevalence of 19 DS cases per 10,000 births.

Conclusion: The prevalence of all chromosomal anomalies and DS did not change over time. The prenatal DS detection rate more than doubled from 1986-1989 to 2000-2007. The number of TOPFAs increased, which is consistent with a decrease in the number of live births with DS as well as in all chromosomal anomalies.

Funding: not relevant.

Trial registration: not relevant.

Introduction: A minority of children treated with ventilation tubes develop chronic otorrhoea. To test the hypothesis that this condition might be caused by an underlying primary immunodeficiency, the immunological status was examined in a group of children with longstanding otorrhoea.

Material and methods: Eighteen children who had suffered from otorrhoea for a minimum of six months and who did not respond to relevant therapy were included. Thorough cleansing and suction was performed including removal of ventilation tubes. Swabs were obtained for microbiology and blood was collected for immunological analyses.

Results: One child out of 18 had a normal immune status. Five demonstrated isolated humoral deficiencies, four had isolated cellular deficiencies, whereas combined defects were identified among eight children. The humoral deficiencies consisted of selective or partial immunoglobulin A deficiencies, immunoglobulin G subclass and mannanbinding lectin deficiencies. The cellular deficiencies most often involved the cytotoxic T cells and the natural killer cells.

Conclusion: Primary immunodeficiencies were very prevalent in a highly selected group of children suffering from longstanding post tympanic otorrhoea. The condition should therefore be considered in case of chronic, refractory otorrhoea. The serostatus should be followed carefully to obtain information of the prognosis.

Funding: Not relevant.

Trial registration: Not relevant.

18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG-PET/CT) is a non-invasive method for visualization of focally increased metabolism in the presence of discrete morphological changes. Based on a systematic review of current literature, PET/CT cannot be recommended as a primary diagnostic procedure in breast cancer; but it has the potential to be useful for the detection of distant metastases and for monitoring response to chemotherapy in breast cancer patients. PET/CT should still be regarded as a supplement to conventional diagnostic procedures such as CT and MRI.

Introduction: The epidemiology of appendicitis seems to be changing; the proportion of complicated appendicitis cases is growing. The outcome of childhood appendectomy in Denmark has not previously been evaluated nationwide in Denmark.

Material and methods: Data on all Danish children treated for appendicitis were obtained from the National Patient Registry. Reoperation, readmittance or length of hospital stay (LOS) exceeding five days were considered nonsatisfactory outcomes.

Results: A total of 2,617 children, 55% boys and 45% girls, were operated at 32 hospitals. Their mean age was 11.1 years. Mortality was 0%. A laparoscopic procedure was used in 34% of the cases. The medians of the postoperative LOS were one day for both the open and laparoscopic appendectomy groups, the corresponding means were 2.5 and 2.0 days (p<0.05). 4.5% had one or more reoperations. 18% had a LOS>5 days or readmittance. The typical reasons were wound infection, need for prolonged antibiotics treatment and simple, prolonged recovery.

Conclusion: The Danish practice for appendicitis has acceptable rates of reoperation, medians and means of LOS, and a rate of readmission which is comparable to that reported in other studies. However, a nonsatisfactory outcome after appendectomy in about 20% calls for improvement and further studies.

Funding: Not relevant.

Trial registration: Not relevant.

Introduction: Clinical symptoms in brain tumours in children are variable at onset and diagnosis is often delayed. Symptoms were investigated with regard to brain tumour localisation, prediagnostic symptomatic intervals and malignancy.

Material and methods: Clinical data from children aged 0-17 years from Southern Denmark were analysed retrospectively and the results were correlated with data on prehospital symptoms obtained from interviews with parents and general practitioners.

Results: A total of 55 children diagnosed during a period of five years were indentified and 31 interviews were obtained. A total of 19 (41%) of the tumours were supratentorial hemispheric and midline and 27 (59%) were infratentorial. At supratentorial localisations, 42% experienced vomiting as their first symptom followed by seizures in 37% and headache in 31%. At infratentorial localisations, headache occurred in 62%, vomiting in 55% and ataxia in 48% of the cases. The prediagnostic symptomatic interval had a median duration of 30 days with vomiting (range 3-330 days), a median of 75 days with headache (5-730 days) and a median of 75 days with ataxia (1-730 days).

Conclusion: Diagnosis is often late in relation to the presenting symptoms. An earlier diagnosis may be achieved if a brain tumour is considered as soon as any child presents with the relevant symptoms.

Funding: Not relevant.

Trial registration: ISRCTN88306789.

Introduction: Recent studies implicate the presence of Fusobacterium necrophorum (FN) in recurrent tonsillitis (RT), acute tonsillitis and peritonsillar abscess. The objective of the present study was to determine whether FN plays a role in RT by comparing bacteriologic results from patients suffering from RT, tonsillar hypertrophy and halitosis or persistent sore throat syndrome (PSTS). We analyzed both tonsils to determine the degree of concordance.

Material and methods: A prospective study was conducted in 80 patients aged 8-30 years who were undergoing elective tonsillectomy. The patients were divided into four groups according to indication for surgery. Aerobic and anaerobic cultures from the tonsillar surface and core were analyzed.

Results: FN was detected less frequently in the tonsillar cores of RT patients (22%) than in those of patients without RT (30%) (p=0.44). FN detection frequencies ranged between 20% and 35% across the four groups. Betahaemolytic streptococci groups A/C/G (BHS) were detected significantly (p=0.007) more often in the RT group than in the halitosis/PSTS group.

Conclusion: A possible role of FN in RT was not substantiated. Our results indicate that FN is likely to be part of the normal flora. The tonsillar surface and core flora carry considerable interpersonal diversity, but is very similar bilaterally in each individual. Other factors seem to play a major role in the development of the represented tonsillar diseases.

Funding: Not relevant.

Trial registration: The study was approved by The Research Ethics Committee of Aarhus County (no. 20050034).

Introduction: The number of elderly intensive care unit (ICU) patients is increasing. We therefore assessed the long-term outcome in the elderly following intensive care.

Material and methods: The outcome status for 91 elderly (=75 years) and 659 nonelderly (18-74 years) ICU patients treated in the course of a one year period was obtained. A total of 36 of 37 eligible elderly survivors were interviewed about their health related quality of life (HRQOL), social services and their wish for intensive care.

Results: The mortality (54% at follow-up and 64% after one year) was higher in the elderly ICU patients than in non-elderly ICU patients (33% and 37%, respectively, p<0.001) and than in the Danish background population≥75 years (9%, p<0.001). Elderly ICU survivors had significantly lower HRQOL scores in two of four physical domains and a lower physical component summary score than age matched controls (38 (31-46) versus 43 (36-52), p=0.01). However, ICU survivors scored like controls in three of four mental domains and higher than controls in "mental health" (p=0.04). At follow-up, 89% had returned to live in their own home.

Conclusion: Elderly ICU patients had high long-term mortality rates and survivors had impaired physical function. Nevertheless, their mental function was in line with that of the background population and the majority had returned to their home and wished intensive care again.

Funding: The study was supported only by Rigshospitalet's Research Council.

Trial registration: Not relevant.