Danish medical bulletin最新文献

Introduction: The objective of this study was to evaluate the effectiveness of explorative tympanotomy and sealing of the round window in patients diagnosed with sudden deafness.

Material and methods: A retrospective study of 22 patients presenting with sudden deafness who were treated with exploratory tympanotomy and sealing of the round window. The patients initially received conservative therapy for one month. If conservative treatment had no effect, exploratory tympanotomy and sealing of the round window was performed.

Results: The median pure tone average was 67 dB before surgery. Post-operatively, it was reduced to 55 dB. This is equivalent to a 12 dB (p = 0.008) improvement. Five patients improved beyond 30 dB and three patients out of 22 fulfilled the Belfast criteria for binaural hearing at the end of the observation period. Furthermore, three months after surgery, the incidence of vertigo and tinnitus had decreased from 58% to 8% and from 50% to 17%, respectively (p < 0.001 and p = 0.04). None of the patients experienced any severe or life-threatening complications.

Conclusion: The results suggest that explorative tympanotomy and sealing of the round window may improve hearing and reduce tinnitus and vertigo after spontaneous remission has come to an end. However, randomized controlled studies are needed.

Introduction: The aims of the present study were to evaluate physicians' satisfaction with medication services delivered by a clinical pharmacist (CP); to investigate and document to which extent a CP could improve the medication quality and reduce medication costs at an intensive care unit (ICU); and to explore which types of tasks the CP was asked to perform.

Material and methods: The project was conducted at an ICU from 1 February to 31 August 2008. The intervention consisted of certain tasks being performed by a CP. The intervention was evaluated on the basis of documentation of the intervention performed and on a questionnaire filled in by physicians at the end of the study.

Results: The majority of the physicians reported that the CP's intervention had raised their attention to medication costs (70%) and medication quality (76%). This physician-reported impression correlated with the CP's intervention which improved medication quality and catalysed an annual estimated cost saving of at least DKK 330,000, which was achieved by targeting particular medication areas. The CP was asked to perform various medication-related tasks during the project period. Indeed, the physicians reported that they found the CP qualified to perform several medication-related tasks--and many physicians reported that they had benefitted from input regarding those tasks.

Conclusion: The intervention occasioned positive physician feedback on clinical pharmacy services and the study shows that the CP was perceived by the physicians as a valuable professional collaborator.

Imaging of the dopamine transporter (DAT) with Single Photon Emission Computer Tomography (SPECT) has increasingly been used as a biomarker for the integrity of presynaptic dopaminergic nerve cells in patients with movement disorders. 123-I-labelled N-(3-iodoprop-2E-enyl)-2-β-carbomethoxy-3β-(4-methylphenyl) nortropane, named PE2I, is a relatively new radioligand that has about 10-fold higher in vitro selectivity for the DAT than for the serotonin transporter (SERT) compared to the slightly older but very used and licensed radioligand [123I]FP-CIT (DaTSCAN). Further [123I]PE2I has faster kinetics than [123I]FP-CIT. Because of its fast kinetic properties, quantification of [123I]PE2I binding to DAT is possible using kinetic or graphical analysis following bolus injection of tracer or as a combination of bolus and constant infusion. Based on preliminary bolus trials we have been able to calculate a B/I ratio of [123I]PE2I. This B/I ratio (2.7h) gave rise to steady state conditions and excellent reproducibility. Further, manual delineation of ROI directly on SPECT images performed equally well to a MRI-defined probability map based ROI delineation in terms of intrasubject variability of binding potential of DAT. Finally the in vivo SERT binding in DAT images obtained with [123I]FP-CIT was significant as compared to the [123I]PE2I image. [123I]PE2I is a super selective SPECT DAT radioligand with optimal kinetic properties for accurate quantification of the DAT availability in striatum. Apart from the more laborious B/I design it is currently to be considered the best radioligand for imaging the DAT in the human brain with SPECT.

Total hip replacement surgery is being performed on an increasingly large part of the population and at increasingly younger age. Because we live and stay physically active longer, and since hip replacement surgery has become quite successful, the treatment is being offered to progressively more patients. Unfortunately, about 17% of hip replacement surgeries currently involve revisions. Consequently, the longevity of both the primary and revision implant is an issue and warrants further investigation. Implants undergoing early instability or even subsidence correlate with an increased risk of aseptic loosening, subsequently requiring revision. Thus, the goal is early fixation by osseointegration of the implant. For revision implants, this is an even greater challenge since an allograft is often needed during surgery to obtain immediate stability of the implant. Bone grafts are rapidly resorbed. Thus, instability of the prosthesis may develop before new bone formation is well established and can mechanically secure the prosthesis. Strontium is a dual action drug; being both bone anabolic and anti-catabolic. In the form of strontiumranelate, it is used in the treatment of osteoporosis. Strontium may potentially improve the early osseointegration and fixation of implants. This dissertation consists of three studies investigating the effect of strontium at the bone-implant interface. The questions were firstly, what is the optimal delivery method for strontium to the interface, and secondly, can strontium exercise its dual action at the interface? The studies were performed in a cementless, experimental gap model in canine. The effects of strontium were evaluated by histomorphometrical analysis of the osseointegration and mechanical push-out test of implant fixation. Different stereological methods were used for the histomorphometrical analysis of each study. The methods used were reviewed critically and found valid. Study I compared a 5% strontium-substituted hydroxyapatite (HA) coating with an HA coating after 4 weeks and 12 weeks observation time. We examined whether fixation of the implant was improved by the strontium substitution. It was found that fixation of the implant was not improved by the strontium substituted HA coating at any of the two time points. Study II compared a 5% strontium-doped HA bone graft extender with an HA bone graft extender. The bone graft extender was mixed with allograft and impacted around a titanium implant. The objective of this study was to determine whether strontium doping of the bone graft extender could protect the allograft from fast resorption and increase gap healing, leading to the improved fixation of the implant. We found that the strontium doping increased gap healing and protected the allograft, however, results of the mechanical test were inconclusive. The reason might have been that the increased gap healing had not yet reached the implant during the 4 weeks observation time, so ongrowth onto

Obesity is a world wide epidemic; it is becoming more usual to be overweight or obese than to be normal weight. Obesity increases the risk of an extensive range of diseases such as cardiovascular disease, diabetes mellitus type 2, hypertension, depression and some types of cancer. Adipose tissue is more than a storage organ for surplus energy - it is also a setting for complex metabolic processes and adipose tissue releases substances that interact with other parts of the body to influence several systems including food intake and energy metabolism. The endocannabinoid system (ECS) is one of the signalling systems that control feeding behaviour. The ECS is implicated in many functions, such as pain, memory, addiction, inflammation, and feeding, and could be considered a stress recovery system. It also seems to integrate nutrient intake, metabolism and storage maintaining homeostatic balance. The ECS is a recently discovered system, and research indicates hyperactivity in obesity. The aim of this thesis is to elaborate on the relationships of this widespread system and its elements in adipose tissue in obesity. Study I is a 4 weeks rat intervention study to investigate whether weight independent effect of Rimonabant treatment exists. We found that food intake-tolerance development could be circumvented by cyclic administration of Rimonabant and implications of weight independent effects of treatment. Study II is a cross-sectional study to establish the expression of cannabinoid receptor 1 from various adipose tissue depots of lean and obese persons. In this study we conclude, that the subcutaneous adipose tissue express more CBR1 than the visceral depot in lean, but comparable levels in obese. Study III is a 10 weeks human intervention study to asses the effects on the ECS of 10% weight loss. We found reduction in the ECS in obesity that normalised with weight loss. Our results clearly show the presence of all the components of the ECS in human adipose tissue, and suggest that the ECS is reduced in adipose tissue in obesity. Our results do not support the hypothesis of hyperactivity of the ECS in human obesity. Possible future treatment of obesity with CBR1 antagonist could involve cyclic treatment of specific peripheral compounds.

Introduction: 30-40% of the adult population in Denmark are overweight and 10-13% are obese. The number of bariatric operations reached 3,000 in 2009, and it is expected that a third or more of the patients need corrective plastic surgery.

Material and methods: Medical charts of all patients who had abdominoplasty performed during a 2.5-year period. We included 72 patients of whom 21 had lost weight after bariatric surgery and 51 patients had lost weight through diet and exercise or had not been overweight.

Results: The overall complication rate was 21% (43% of the post-bariatric patients and 12% of the non-post-bariatric patients, p < 0.01). When adjusted for the maximum body mass index (BMI) and BMI at the time of abdominoplasty, post-bariatric patients still had a higher complication rate than non post-bariatric patients (OR = 4.8; 95% CI: 0.92-25.04). Post-bariatric patients had a significantly higher maximum weight, weight at the time of abdominoplasty and had lost more BMI units.

Conclusion: Our data show that post-bariatric patients who have an abdominoplasty performed suffer a high complication rate which appears to be higher than that of patients who do not have bariatric surgery. We have also shown a tendency towards increased costs of abdominoplasty in post-bariatric patients due to a slightly longer operating time and more postoperative office visits.

Introduction: Phantom breast sensation (PBS) following mastectomy has been recognized for many years. PBS is a feeling that the removed breast is still there. The reported prevalence and risk factors have not been established in large well-defined patient series. The purpose of this study was to examine the prevalence of PBS following mastectomy and associated risk factors.

Material and methods: This study was part of a nationwide cross-sectional questionnaire study of women aged 18-70 years treated for primary unilateral breast cancer in Denmark between 1 January 2005 and 31 December 2006. A detailed questionnaire was mailed to respondents between January and April 2008. Only questionnaires from mastectomised women were analyzed. The main outcome measures were prevalence of PBS in mastectomized Danish women and adjusted odds ratio (OR) of PBS with respect to age, pain in the breast area, surgical technique, chemotherapy and radiotherapy.

Results: A total of 1,131 women (84%) answered the questionnaire. A total of 26% experienced PBS, viz. the proportion ranged from 18% to 35% within the six well defined treatment groups, but only young age was a risk factor for PBS (OR 1.030 per year; 95% CI 1.010-1.050; p = 0.0026).

Conclusion: The prevalence of PBS during the first 1-3 years after mastectomy is about 25% and it is related to young age.

Urinary tract infections (UTIs) are among the most common bacterial infectious diseases encountered in clinical practice and account for significant morbidity and high medical costs. Escherichia coli is the most predominant pathogen causing 80-90% of community-acquired UTIs and 30-50% of nosocomially-acquired UTIs. Recurrent UTIs (RUTIs) are reported in 25% of women within 6 months of an acute UTI episode and pose a major problem. The aim of the present thesis was to look for bacterial characteristics of importance for recurrence of UTI caused by E. coli. The thesis is based on three papers. The study is based on E. coli from 236 Swedish women with community-acquired symptomatic lower UTI from a large study of 1162 patients treated with one of three different dosing regimens of pivmecillinam or placebo. The women were evaluated clinically and bacteriologically at the initial visit and at two scheduled follow-up visits. According to pulsed-field gel electrophoresis (PFGE) and culture results all primary infecting E. coli (initial isolates, pretherapy) were assigned into whether the initial infection was followed by cure, persistence, reinfection or relapse during follow-up. The prevalence of virulence factor genes (VFGs), phylogenetic groups, biofilm formation, plasmids and resistance to antimicrobials among primary infecting E. coli causing persistence or relapse at the follow-up visits were compared with the prevalence of these among E. coli followed by cure or reinfection. Previous studies of RUTI using phenotypically based typing methods or less specific DNA based typing methods have concluded, that RUTIs are mainly attributable to reinfection with new strains. However, applying PFGE showed that 77% of RUTIs were caused by a relapse with the primary infecting E. coli (Paper I). This may support the recent observation that E. coli can invade and replicate within the murine bladder forming biofilm-like intracellular bacterial communities (IBCs) and establish quiescent intracellular reservoirs that may represent stable reservoirs for RUTIs. The IBC pathogenic cycle has not been studied in humans; however, recently exfoliated IBCs were detected in urine from women with acute uncomplicated cystitis supporting the presence of the IBC pathway and occurrence of an intracellular bacterial niche in some women with UTI. Based on a triplex PCR E. coli can be divided into four main phylogenetic groups (A, B1, B2 and D). Phylogenetic group B2 was the most predominant group among the primary infecting E. coli followed by group D, A and B1. The majority of the tested 29 VFGs were associated with phylogenetic group B2, whereas only a few VFGs were more broadly distributed among the phylogenetic groups (Paper III). Primary infecting E. coli causing persistence or relapse of the infection were associated with phylogenetic group B2, whereas primary infecting E. coli followed by cure or reinfection were associated with group D (Paper II). Phylogenetic group

Diabetic nephropathy is the most common cause of end-stage renal disease in the western world. Despite major improvements in both prevention and treatment of diabetic nephropathy, there is a continuous need to improve identification and treatment of "non-responders". In recent years, several experimental studies have shown that aldosterone plays a role in the development and progression of diabetic nephropathy, independent of angiotensin II and blood pressure levels. Blocking the renin-angiotensin-aldosterone system with an ACE-inhibitor (ACEI) and/or ambulatory blood pressure should theoretically inhibit the secretion of aldosterone. However, an increase in aldosterone during long-term treatment with ACEIs, so-called aldosterone escape or aldosterone breakthrough, has been described. In the present thesis, our studies evaluating the incidence and clinical impact (i.e. a faster rate of decline in kidney function) of aldosterone escape in type 1 diabetic patients with diabetic nephropathy, possible mechanisms of aldosterone escape, and finally the beneficial effect of blocking aldosterone on albuminuria, blood pressure and renal autoregulation is being reviewed, together with some aspects of the existing treatment recommendations.

National Danish guidelines for the diagnosis and treatment of Helicobacter pylori (Hp) infection have been approved by the Danish Society for Gastroenterology. All patients with peptic ulcer disease, gastric cancer, and MALT lymphoma should be tested for Hp. We also recommend testing in first degree relatives to patients with gastric cancer, in NSAID-naive patients, who need long-term NSAID therapy, and in patients presenting with dyspepsia and no alarm symptoms. Non-endoscoped patients can be tested with a urea-breath test or a faecal antigen test. Endoscoped patients can be tested with a rapid urease test. Proton pump inhibitor therapy should be stopped at least 1 week prior to Hp testing. All infected patients should be offered Hp eradication therapy. First-line treatment is 7-day triple therapy with a proton pump inhibitor and clarithromycine in combination with metronidazole or amoxicilline. Quadruple therapy for 2 weeks with bismuthsubsalicylate, tetracycline, metronidazole and a proton pump inhibitor is recommended in case of treatment failure. Hp testing should be offered to all patients after eradication therapy but is mandatory in patients with ulcer disease, noninvasive gastric cancer or MALT lymphoma. Testing after eradication should not be done before 4 weeks after treatment has ended.