Danish medical journal最新文献

Introduction: Anaesthetic choices in cancer surgery, including the use of epidural analgesia, may affect immune function during the perioperative period and might play an important role in subsequent cancer spread and recurrence.

Methods: This was a prospective, randomised, controlled, double-blinded, single-centre study allocating patients scheduled for video-assisted thoracoscopic surgery (VATS) lobectomy to post-operative pain management using either thoracic epidural analgesia or oral morphine. We compared pre-, per-, and post-operative plasma levels of interleukin (IL)-6, IL-10, IL-12, and interferon (IFN)-γ using regression analysis, and conducted a two-year survival follow-up.

Results: A total of 66 patients were randomised. Fifty-six received the allocated treatment and were analysed. None of the investigated cytokines exhibited significant between-group differences in plasma concentrations when adjusted for the chosen covariates (p ≥ 0.204). A two-year follow-up showed no difference in survival between the two groups (p = 0.5).

Conclusion: Our study found no differences in the impact on the innate, non-specific immune system related to epidural analgesia for pain management in VATS.

Funding: The Danish Cancer Society (R150-A10139). Oberstinde Kirsten Jensa la Cours Mindelegat (JSP-25076). University of Southern Denmark, Region of Southern Denmark and Department of Anaesthesia and Intensive Care, Odense University Hospital.

Trial registration: NCT02359175 (ClinicalTrials.gov).

Introduction: Evidence in child abuse cases can be scarce and is often centred around the child's testimony. However, child testimony varies with the child's development. Here, an overview of suspects, case decisions and court verdicts from a cohort of children is presented, stratified across children aged 0-3, 4-7, 8-11, and 12-15 years.

Methods: Children seen at the Department of Forensic Medicine, Aarhus University, Denmark, in 2001-2013 were analysed, including all case files from the police, courts and healthcare services.

Results: A total of 647 cases were presented. The most frequent suspect was the child's parents. The police referred to the prosecutor in 69% of all cases, and 37% were tried in court. The lowest proportion of cases of tried cases was found among children aged 0-3 years (20%) and the highest among children aged 8-11 years (57%). Across ages, no corroborating evidence, the accused's refusal of guilt and no case to pursue (insufficient strong evidence) were the most frequent reasons for case closure. Cases relating to children aged 0-3 years were frequently dismissed because the fault could not be placed, whereas cases relating to children aged 12-15 were frequently rejected because of lacking evidence of compulsion (non-consent).

Conclusion: Results show variations across ages regarding children tried in court and case dismissal. A dedicated child court may be considered to ensure equal access to justice. Questioning during the forensic examination and the use of psychologists may strengthen the available evidence.

Funding: These materials have received financial support from the Danish Victims Fund. The execution, content and results of the materials are the sole responsibility of the authors. The analysis and viewpoints made evident from the materials belong to the authors and do not necessarily reflect the views of the Council of The Danish Victims Fund.

Trial registration: Not relevant.

This is a letter to the editor on the article "An algorithm for pharmacological treatment of mania during hospitalisation" Dan Med J 2024;71(5):A08230525.

This is a letter to the editor on the "Correspondence on "An algorithm for pharmacological treatment of mania during hospitalisation" Dan Med J 2024;71(5):A08230525.

Introduction: This study aimed to assess the short-term complication rate after US-guided core needle biopsies with an 18-gauge needle of retroperitoneal or intraabdominal masses (non-kidney group) compared with complications after biopsy from a renal mass (kidney group).

Methods: This was a retrospective analysis of 330 consecutive patients in the non-kidney group and 330 control patients in the kidney group. We recorded baseline characteristics, diagnostic yield, complications graded as Clavien-Dindo (CD) and readmissions within one and seven days.

Results: In all, 245 patients in the non-kidney and 281 patients in the kidney group had a biopsy performed. A total of 54 (22%) patients in the non-kidney group had a complication registered. However, 47 were minor complications (minor bleeding or localised pain, CD 1). In the kidney group, 47 (17%) patients had a complication, with 44 being graded as CD 1. No major complications (CD 3 or higher) were associated with the biopsies. Only 0.8% of patients in the non-kidney group and 0.7% in the kidney group had a treatment-requiring CD 2 complication (i.e. blood transfusion) directly caused by the US-guided biopsy. These complications were recognised less than 30 minutes or more than four hours after the procedure. We found no significant difference in the complication rate, diagnostic yield or risk of re-admission between the two groups.

Conclusion: The observation period for patients who undergo an uncomplicated US-guided biopsy from an intraabdominal or retroperitoneal mass can safely be reduced to 30 minutes.

Funding: None TRIAL REGISTRATION. Not relevant.

Introduction: Child abuse increases the risk of substance abuse and non-suicidal self-injury, but the topic of school absenteeism and number of offspring has not been studied prospectively. This study presents the first assessment of these four outcomes among children evaluated for exposure to child abuse.

Methods: In the 2001-2007 period, the Department of Forensic Medicine, Aarhus University, Denmark, evaluated 375 children for exposure to abuse. These children were age- and gender-matched to children from population registries at a 1:6 ratio. Excluding siblings, 2,573 children were analysed. We used the Danish Education Register, the National Patient Register and the Central Civil Register to estimate outcomes and covariates. Negative binomial or Poisson models were used. Follow-up included data until 2016.

Results: For children aged 10-16 years, the incidence rate ratio (IRR) of substance abuse was increased for suspected abuse. The IRR of severe non-suicidal self-injury was 5.03 (95% confidence intervals (CI): 2.59-9.77) for children ≥ 7 years old. School absenteeism had an IRR of 1.30 (95% CI: 1.01-1.68) among children aged 0-3 years. The number of offspring was increased among children aged 12-16 years with suspicion of sexual abuse, IRR = 1.67 (95% CI: 1.27-2.20), and for children aged 8-11 years with suspicion of any abuse, IRR = 3.93 (95% CI: 2.14-7.22).

Conclusions: Children evaluated for exposure to child abuse differed from their peers on all measured outcomes. The health and social services should devote attention to this group and the families they form.

Funding: This study received financial support from the Danish Victims Fund. The execution, content and results of the materials are the sole responsibility of the authors. The analysis and viewpoints presented in relation to the materials are the responsibility of the authors and do not necessarily reflect the views of the Council of The Danish Victims Fund.

Trial registration: Not relevant.

Introduction: The prevalence of age-related physiological impairments and conditions may influence clinical practice protocols on care delivery, risk assessment and current facilities. We aimed to characterise the acutely admitted geriatric patient using medical records and comprehensive assessments performed within 24 hours of admission.

Methods: Patients aged ≥ 65 years were included from the acute ward at Bispebjerg Hospital, Denmark, (n = 1,071). Body composition was investigated using bioelectrical impedance analyses. Physical function was assessed using handgrip strength and sit-to-stand ability. Cognitive impairment and malnutrition were assessed using questionnaires. Self-reported fall incidents within the year leading up to the admission were obtained. Clinical information was obtained from medical records.

Results: Severe comorbidity and polypharmacy were present in 58% and 73% of the cohort, respectively, with men showing a higher prevalence of severe comorbidity. Moderate-to-severe cognitive impairment and risk of severe malnourishment were present in 27% of the patients. Low muscle mass and muscle strength were present in 33% and 47% of the patients, respectively, and low muscle strength was more prevalent in men than women. More than 50% of the patients had fallen within the past year.

Conclusions: Along with highly prevalent multimorbidity and polypharmacy, we demonstrate that a substantial number of patients are cognitively and functionally impaired, are malnourished and have low muscle mass. Thus, they are at high risk of falls and deconditioning during hospitalisation.

Funding: This work was supported by funding from the Novo Nordisk Foundation; grant number NNF18OC0052826.

Trial registration: Not relevant.

Introduction: In orthopaedics, anterior cruciate ligament (ACL) reconstructions are among the most common surgical interventions. Two methods are preferably used: autografts from the hamstring tendon (HT) or patella tendon (PT). The purpose of this meta-analysis was to compare these two methods when returning to sports.

Methods: Eleven studies were included based on a literature search conducted in PubMed. The primary outcome was return to preinjury sport level in athletes. Post-operative results such as the Lysholm score, the International Knee Documentation Committee (IKDC) subjective score, the Tegner Activity Score and KT-1000 arthrometry and autograft re-rupture rates were analysed as secondary outcomes.

Results: The analysis showed no significant difference in return to preinjury sports level at a two-year follow-up between patients operated with hamstring or patella autograft. Considering the secondary outcomes, no significant differences were recorded in Lysholm score, IKDC score or re-rupture rate. The Tegner Activity Scale demonstrated a significantly higher activity level in the PT group than in the HT group (OR 0.79, p = 0.003). At the two-year follow-up, the KT-1000 arthrometer analysis also showed a significant difference in laxity, which was higher for the HT autografts (OR -0.31, p = 0.02).

Conclusion: This study showed no significant differences between hamstring and patella autografts. Even so, the choice of method when operated for ACL rupture remains crucial for the individual and should be a weighted decision made jointly by the patient and the physician.

Introduction: Intravenous loop diuretics have been a key component in treating pulmonary oedema since the 1960s and have a Class 1 recommendation in the 2021 guidelines for acute heart failure (AHF). While the diuretic effect of loop diuretics is well established, it remains unclear how furosemide influences pulmonary congestion and cardiac filling pressures in the hyperacute phase before significant diuresis occurs.

Methods: This was a prospective study of adult patients with AHF and objective signs of pulmonary congestion admitted to the cardiac ward. Remote dielectric sensing (ReDS) will directly measure lung fluid content, and cardiac filling pressures will be assessed by echocardiography with Doppler and strain analysis.

Conclusions: This study will examine if furosemide leads to a hyperacute reduction in pulmonary congestion assessed by ReDS independent of diuretic effects in patients with AHF. We hypothesise that the haemodynamic effect of furosemide shown on pulmonary congestion may explain the subjective instant relief in patients with AHF receiving furosemide.

Funding: Dr. Grand's salary during this project is supported by a research grant from the Danish Cardiovascular Academy funded by Novo Nordisk Foundation grant number NNF20SA0067242 and by the Danish Heart Foundation.

Trial registration: This protocol was approved by the Scientific Ethical Committee, H-23029822, and the Danish Data Protection Agency P-2013-14703. The protocol was registered with ClinicalTrial.org on 29 August 2023 (Identifier: NCT06024889).

Introduction: Greenlandic patients may be referred to Denmark for specialised diagnostics and treatment. The main collaborator for these activities is the National University Hospital, Rigshospitalet, Copenhagen. We aimed to investigate the referral pattern of Greenlandic paediatric patients to Rigshospitalet.

Methods: This was an observational quality assurance project comprising all Greenlandic patients below 18 years who received healthcare services at Rigshospitalet in the 2017-2021 period. This period was chosen to obtain the most updated, available and coherent data possible. Unique patients and disease courses were stratified by paediatric subspecialities and procedures.

Results: During the five-year period, a total of 310 unique patients were referred to Rigshospitalet, resulting in a total of 676 disease courses and yielding an average 62 annual referrals of paediatric Greenlandic patients. This represents around 0.5% of all Greenlandic children. Age groups were distributed as 28% aged 0-1 years, 23% 2-4 years, 13% 5-9 years, 21% 10-14 years and 16% 15-17 years. During the study period, the number of disease courses increased by 89% with most patients being managed as outpatients. The subspecialities with most referrals were ophthalmology (17%), oto-rhino-laryngology (16%) and cardiovascular diseases (10%).

Conclusions: Approximately 0.5% of Greenlandic children were referred annually to Rigshospitalet with a marked increase being observed during the five-year study period. We observed a shift towards an increasing proportion of outpatient treatments at Rigshospitalet.

Funding: None.

Trial registration: Not relevant.