Danish medical journal最新文献

Introduction: Loss of taste and smell is a debilitating yet overlooked complication of certain medical procedures. This study aimed to characterise patients with permanent iatrogenic olfactory or gustatory dysfunction referred to a flavour clinic.

Methods: This retrospective cohort study included patients assessed at the Flavour Clinic, Regional Hospital West Jutland, between May 2017 and November 2024. Patients were included if they experienced olfactory or gustatory dysfunction lasting more than one year, with a clear temporal relationship to a medical intervention. Standardised sensory testing, otorhinolaryngological examination, and relevant imaging and laboratory assessments were performed.

Results: Out of more than 3,000 patients assessed, 55 met the inclusion criteria. Sinonasal surgery using local anaesthesia was the predominant cause of olfactory dysfunction (n = 11), despite procedures being remote from the olfactory cleft. Gustatory dysfunction was primarily associated with tonsillectomy (n = 18), frequently involving glossopharyngeal or facial nerve damage. A smaller number of cases were linked to general anaesthesia or systemic therapy. Recommendations to reduce the risks are presented.

Conclusions: Permanent iatrogenic olfactory or gustatory dysfunction is rare but clinically significant. Tonsillectomy, sinonasal surgery and anaesthesia - both local and general - are key contributors. Greater awareness, meticulous surgical technique and comprehensive informed consent are essential to minimise incidence and medicolegal consequences.

Funding: None.

Trial registration: Not relevant.

Introduction: Glucocorticoids are the cornerstone of treatment of idiopathic inflammatory myositis (IIM) but are associated with significant side effects, especially during long-term use. Intravenous immunoglobulin (IVIG) has emerged as a promising steroid-sparing alternative, particularly for refractory cases.

Methods: This retrospective cohort study included patients aged ≥ 18 years treated with IIM who received IVIG treatment between August 2018 and August 2023. Outcomes included changes in myositis-related symptoms, functional exercise tests, creatinine kinase (CK) levels and prednisolone dosage at three and six months.

Results: A total of 22 patients were included, with the most common IIM subtypes being polymyositis (36%), immune-mediated necrotizing myopathy (23%) and dermatomyositis (18%). Dysphagia improved in 87.5% of patients, and cardiac symptoms resolved in all affected individuals by six months. Significant improvements were observed in functional performance and CK levels at both time points. Prednisolone dosage decreased from 44.7 mg/day (standard deviation (SD): ± 29.7) at baseline to 9.9 mg/day (SD: ± 12.8) at six months, representing a 77% reduction.

Conclusions: IVIG is an effective treatment and steroid-sparing therapy in IIM, yielding substantial reductions in glucocorticoid use, symptom improvement and functional recovery. These findings suggest that IVIG may be considered earlier in the disease course, especially in patients with contraindications to glucocorticoids.

Funding: None.

Trial registration: This study was not registered as it was a quality improvement project and did not meet criteria for trial registration.

Low-intensity extracorporeal shock wave therapy (Li-ESWT), stem cell therapy and platelet-rich plasma (PRP) injections have emerged as possible treatments for erectile dysfunction (ED) and Peyronie's disease (PD). Li-ESWT appears to work by prompting angiogenesis, yet clinical trials in ED and PD have yielded contradictory results, often compromised by methodological limitations. Similarly, while preliminary studies on stem cell therapy and PRP suggest potential benefits, their clinical efficacy remains uncertain. Standardised research is needed to establish the possible effect of these approaches.

Depressive episodes are more challenging for patients and clinicians than other bipolar disorder episodes. The reasons for this include: 1. the prevalence of depressive episodes is higher than for other episodes; 2. functioning; 3. cognition is more impaired; 4. suicide is more prevalent; 5. and treatment is more complex. This paper aims to highlight the controversy between the poor evidence from science on the effects of antidepressants for bipolar depression versus the high use of antidepressants in clinical practice, and to specify the clinical role of antidepressants in bipolar disorder in relation to other drugs.

Introduction: Post-tonsillectomy haemorrhage (PTH) is typically self-limiting but may require medical intervention or surgery. PTH is classified as either primary (within 24 hours) or secondary (after 24 hours). Secondary haemorrhage is often linked to eschar sloughing, though the exact cause remains unclear. Secondary PTH is often an out-of-office-hour event. We aimed to investigate the diurnal variations of PTH in a Danish cohort.

Methods: This retrospective cohort study recruited patients from ear-nose-throat (ENT) departments in the Region of Southern Denmark from January 2017 to December 2021. Patients with the International Classification of Diseases, tenth version (ICD-10) codes related to tonsillectomy (emb 10, -15, -20, and -99) combined with the post-operative haemorrhage ICD-10 (DT810) were included in the study. The exclusion criteria were haemorrhage other than PTH and misclassification. The exact time and date for hospital arrival were assigned in three-hour slots. The primary outcome was diurnal variation. Secondary outcomes included the severity of PTH, among other demographic variations. The data were evaluated by a χ2 test.

Results: A total of 459 contacts were analysed, corresponding to a PTH contact rate of 8%. Hereof, 382 events had active PTH (6.7%). When only secondary PTH (n = 375) were considered, the diurnal PTH contacts fluctuated significantly; nocturnal events (9 PM-9 AM) accounted for 233 hospital contacts (62%).

Conclusions: We found that PTH contacts were more frequent at nighttime, highlighting the need for vigilance to optimise healthcare resources and patient safety. Further research on PTH aetiology is needed.

Funding: None.

Trial registration: Not relevant.

Introduction: After total pancreatectomy (TP), patients are at high risk of hypoglycaemia regardless of insulin treatment modality. Information on treatment targets and modalities of insulin treatment following TP is sparse. This descriptive study presented experiences with a standardised insulin protocol and examined how the addition of intermittently scanned continuous glucose monitoring (isCGM) influenced the treatment of diabetes following TP.

Methods: Results from two retrospective cohorts of patients who had undergone total pancreatectomy were collected, 30 patients not using isCGM served as references (operated in 2018-2019, mean age 65.4 years) for 40 patients using isCGM (operated in 2020-2021, mean age 63.3 years). An identical insulin treatment protocol was used for both cohorts. HbA1c, insulin doses, weight and episodes with severe hypoglycaemia were recorded at three, six, nine and 12 months after TP. Percentage of time below range (TBR), time in range (TIR) and time above range (TAR) were collected for isCGM users.

Results: HbA1c and insulin doses were similar in the two groups during the first year following TP. In isCGM users, TBR was 0%, TIR 43-48% and TAR 52-57%. Episodes of severe hypoglycaemia were numerically but not significantly lower in isCGM users (zero versus four, p = 0.21). The same applied to days of readmittance 4.0 ± 7.7 days versus 15.5 ± 40 (p = 0.13) per patient/year.

Conclusions: In the first year following TP, the use of isCGM was not associated with better glycaemic control. A non-significant trend towards less severe cases of hypoglycaemia and a nonsignificant numerical reduction in days of hospitalisation were observed in isCGM users.

Funding: None.

Trial registration: Not relevant.

Introduction: First-line treatment for obstructive sleep apnoea (OSA) is continuous positive airway pressure (CPAP). However, adherence to CPAP is poor. Non-adherent patients may benefit from other treatment modalities. Drug-induced sedation endoscopy (DISE) is a validated tool to suggest individualised treatment options. This study aimed to investigate the outcome of DISE in patients with OSA or severe snoring.

Methods: Patients with OSA and/or snoring who had poor compliance with CPAP were included in a database from May 2020 to October 2022. The inclusion criteria were BMI less-than 35 kg/m2, age 18-65 years and no contraindications to propofol infusion. DISE was performed, and anatomic collapse during DISE was evaluated using the velum-oropharynx-tongue-base-epiglottis classification. Treatment suggestions were registered.

Results: The database included 190 referred patients, and 109 patients underwent DISE. Among these, 34 had mild OSA or snoring (Apnea-Hypopnea Index (AHI) less-than 15 events/hour)) and 75 had moderate-severe OSA (AHI ≥ 15 events/hour). A total of 51% of patients were recommended sleep surgery, the most frequent being tonsillectomy. Surgery was recommended more among patients with AHI ≥ 15 events/hour.

Conclusions: DISE suggests a personalised treatment for eligible patients with OSA or severe snoring. When the DISE findings were considered, half of the patients were recommended for sleep surgery. The value of DISE in planning such surgery in this cohort needs to be determined.

Funding: None.

Trial registration: The study was approved by the Institutional Review Board and the Scientific Ethical Committee of the Central Denmark Region (no: 1-10-72-228-17).

Introduction: We determined the semiology, causes, risk factors and outcomes of patients with acute nutritional neuropathies requiring hospitalisation in high-income countries.

Methods: We searched PubMed, Cochrane Library and Embase for non-alcoholic malnutrition neuropathy cases published since 1990.

Results: Thirty-six studies were identified, including 83 patients (mean age 39.8 years; 70% women) with deficient levels of thiamine (54%), pyridoxine (16%), copper (11%) or folate (7%). Common clinical signs were lower extremity weakness (100%), hypesthesia (63%), hypo-/areflexia (54%) and cranial nerve deficits (27%). Thirty-two (39%) patients also had Wernicke's encephalopathy. The mean time from symptom onset to hospitalisation was 4.2 weeks (range: 1-12). Ten (12.1%) patients required intensive care. Risk factors were weight loss (60%), vomiting (51%) and diarrhoea (11%). Aetiologies included bariatric surgery (n = 60, 72%), psychiatric disorders (n = 15, 18%) and hyperemesis gravidarum (n = 4, 5%). Electrophysiology showed axonal polyneuropathy in 60 (72.3%) patients, typically with sensorimotor involvement (n = 42). Besides nutritional supplements, 19 (23%) patients also received IVIG, plasmapheresis or steroids. Forty-nine patients had a one-year follow-up, with a good outcome (modified Rankin Scale Score ≤ 2) in 25 (51%).

Conclusions: Nutritional neuropathies may mimic axonal Guillain-Barré syndrome. Early recognition is crucial to avoid lasting deficits and unnecessary therapy like IVIG or plasmapheresis.

Systematic PSA-based screening for prostate cancer remains controversial due to the trade-off between reduced mortality and risk of overdiagnosis and overtreatment. Adding new tools like magnetic-resonance-imaging-targeted biopsies and genetic markers may limit the harms, but we lack definitive mortality data. While opportunistic PSA testing is widely used in Denmark, unsystematic use may potentially be harmful. Introduction of a systematic screening programme in Denmark requires careful consideration of the clinical, psychological, societal and economic impacts, and Danish politicians should thus engage in the debate to clarify these issues.

Introduction: The rapid adoption of digital health solutions highlights the potential benefits of mobile-based follow-up care. This study examines the feasibility of implementing a digital pain management app for post-operative follow-up in a Danish surgical department.

Methods: A feasibility study was conducted based on the framework by Bowen et al., assessing feasibility domains such as "Population," "Acceptance," "Integration" and "Adherence." Patients aged 15+ years undergoing same-day ear-nose-throat surgery at a tertiary university hospital were included, provided they owned a smartphone with the MinSP app. Patients received both standard care and optional digital follow-up, with outcomes being analysed using simple mathematical processing.

Results: Among 491 eligible patients, 201 (41.9%) accessed the digital solution. Due to an unanticipated technical error in the automated app allocation, several patients did not receive the app, reducing the success in practical implementation. Among participants, 68.1% completed at least one questionnaire within seven days, with 26.9% requesting staff calls. Although usage was selective, patient interest and acceptance were high, suggesting feasibility following technical improvements.

Conclusions: Digital post-operative pain management follow-up may be feasible within current hospital resources, but requires consistent app allocation. Future implementations should address technical allocation gaps to ensure broader adoption.

Funding: None.

Trial registration: Not relevant.