Danish medical journal最新文献

Introduction: Optimal care for patients with simultaneous chronic rhinosinusitis (CRS) and asthma is often complicated due to interaction between these conditions. This study depicts the lack of attention to asthma within the otorhinolaryngological field, and the relationship between CRS and asthma, including the risk of revision surgery in such patients.

Methods: A retrospective cohort study was conducted on patients undergoing functional endoscopic sinus surgery (FESS) because of CRS with nasal polyps (CRSwNP) and without nasal polyps in a five-year period. Patients were examined for adherence to guidelines, asthma, revision FESS, allergies and septo-/turbinoplasty. Results were compared to international reports.

Results: A total of 589 patients had FESS because of CRS of whom 203 (34.5%) had co-existing asthma. A higher risk of asthma (relative risk (RR) = 1.82 (95% confidence interval (CI): 1.29-2.56), p less-than 0.001) and revision FESS (RR = 2.20 (95% CI: 1.33-3.65), p less-than 0.001) was found in patients with CRSwNP. Attention to asthma was poor in patients with no asthma diagnosis before referral.

Conclusions: Asthma was lower in the study population than in the literature. Danish national guidelines on CRS management are insufficient regarding attention to asthma. Results call attention to the need for more multidisciplinary team management.

Funding: None.

Trial registration: Not relevant.

INTRODUCTION. Timely diagnosis of malignant melanoma (MM) is crucial for optimal patient outcomes. Thus, the Danish Health Authority implemented a fast-track referral system (FTRS) comprising a clinical diagnostic filter function (CDFF) and a cancer package. This study aimed to characterise the flow of patients with a tentative MM diagnosis referred through the CDFF to a department of dermatology.METHODS. Retrospective data from the Danish patient and pathology file system were analysed for patients referred to the Department of Dermato-Venereology at Bispebjerg Hospital, Denmark, via the CDFF, with suspected MM in a one-year period.RESULTS. Among 860 patients with 895 skin lesions, 283 (31.6%) were discharged with a clinical benign diagnosis after their initial consultation, whereas treatment of another 77 (8.6%) patients concluded following a three-month observation period. One-year follow-up of these 360 (283 + 77) clinically benign skin lesions showed no malignancy. Among 100 MM-suspicious lesions promptly referred for excision to a department of plastic surgery, 48% were MM.CONCLUSIONS. In a Danish population with tentative MM diagnosis referred through the CDFF to a dermatological hospital department, one-third of patients were discharged with a clinically benign diagnosis. Half of the skin lesions referred for excision to the department of plastic surgery were MM. This indicates a decreased burden of overdiagnosis and a potential reduction of unnecessary surgical scars when dermatologists serve as gate keepers of the FTRS for MM.FUNDING. NoneTRIAL REGISTRATION. Data obtained with permission from BBH j. no. 20078406.

Neuropeptides represent the most diverse family of neurotransmitters counting numerous members and even more G protein-coupled receptors, all of which are potential targets for drug development. Here, we focus on galanin and its three receptors by describing their possible involvement in pain and regeneration. Although animal experiments indicate that galanin, together with other molecules, may act as an endogenous system protecting against pain and improving nerve growth, these results have so far not been translated into patient treatments.

Introduction: Chronic pain is a common complication after surgery and trauma. The incidence of chronic pain may potentially be reduced by effective management of severe acute pain, in hospital and during the subacute post-operative phase at home.

Methods: This was a cohort study from an outpatient follow-up service for patients with pain at discharge after orthopaedic surgery and trauma in a level 1 university hospital setting. The patients' charts were reviewed. Demographics, diagnosis and treatment were registered. The objective of this study was to describe the first five years of experience with this service.

Results: A total of 261 patients were included. The median age was 39 (interquartile range (IQR): 26-76) years, and 53% were men. The median pain duration was ten (IQR: 5-22) months. Neuropathic pain was diagnosed in 83% of patients. Complex regional pain syndrome was diagnosed in 10% and suspected in 8%. Before the consultation, 48% were using paracetamol and/or non-steroid anti-inflammatory drugs (NSAIDs), 25% opioids, and 36% used gabapentioids or antidepressants. After their consultation, only 13% used paracetamol and/or NSAIDs and 8% opioids, whereas 86% were treated with gabapentinoids or antidepressants. A plan for opioid weaning was provided for all patients if opioids were continued (8%).

Conclusions: Establishing an outpatient pain service for persistent pain after surgery and trauma may encourage the use of analgesia regimens that are in accordance with international guidelines and ensure that opioids are not continued inappropriately.

Funding: None.

Trial registration: Not relevant.

This is a letter to the editor on the article "A comparison of cover letters written by ChatGPT-4 or humans" Dan Med J 2023;70(12):A06230412.

Elderly people and patients with chronic lifestyle diseases are at risk of being hit harder by environmental influences. Environmental impacts increase the risk of various lifestyle diseases. Biomimetics gives us a unique opportunity to find new treatments for lifestyle diseases and counteract health effects of environmental threats. A biomimetic alliance for better health achieved through cross-disciplinal collaboration may not only contribute to better health but also to a better and more sustainable environment: What is good for the planet is good for our health.

Introduction: Portal pressure predicts the occurrence of decompensations in cirrhosis. Portal pressure is primarily measured via hepatic vein catheterisation (HVC), to which a transjugular liver biopsy (TJLB) may be added. Indications for HVC are mainly therapy control and prognosis. TJLB is performed when a percutaneous liver biopsy is contraindicated or for other diagnostic reasons. Both procedures have reported low complication rates. The aim of this study was to identify indications and 30-day postprocedural complications.

Methods: Based on procedure codes, a list was generated in the report database compromising procedures from 1 January 2018 to 31 January 2022. Procedures were identified in electronic charts (Cosmic Arkiv). A total of 209 patients undergoing 277 procedures were included. Information regarding indications, complications, age, sex, diagnosis, comorbidity and blood tests was also analysed.

Results: The more frequently reported indications for HVC were control of betablockers and diagnosis. Indications for TJLB were diagnostic and research purposes. Complications after HVC included pain and transient supraventricular arrythmias. Four major complications after TJLB were found, which led to admission due to various causes of bleeding.

Conclusion: HVC and TJLB are safe procedures. The complication rate for HVC and TJLB was 3.3% and 6.8%, respectively. Complications were minor; only four major complications after TJLB were found - none of which were mortal.

Funding: None.

Trial registration: Not relevant.

This is a reply to the: "Correspondence on "cover letters written by ChatGPT-4 or humans"" Dan Med J 2024;71(1):A205177.

Introduction: Tibial shaft fractures are among the most common lower extremity fractures. Treatment of tibial shaft fractures with intramedullary nailing has become the treatment of choice in adults. However, commonly reported outcomes include knee pain, limitations in activities of daily living and reduction in quality of life (QOL). The literature lacks high-quality studies to document superiority of intramedullary nailing versus other surgical treatment methods. The present study aims to compare the 12-month Knee Injury and Osteoarthritis Outcome Score (KOOS) - sport and recreation activities (sport/rec) after standard intramedullary nailing with external ring fixation for adult patients with isolated tibial shaft fractures.

Methods: This study is a multicentre randomised, prospective clinical trial. A total of 67 patients will be included in the study, and the primary outcome will be the KOOS-sport/rec at 12 months after surgery.

Conclusions: With KOOS-sport/rec as the primary outcome, the findings of the present study are expected to advance our understanding of knee pain, function and QOL, regardless of the treatment option and the outcome of the study.

Funding: The project is partially funded by the Independent Research Found Denmark.

Trial registration:

Clinicaltrials: gov ID: NCT-03945669, version 1.1, 21 September 2022.

Introduction: Outpatient (OPT) thyroid surgery is increasing, with patient selection being pivotal for safety. While numerous studies exist, most are retrospective and encompass both benign and malignant cases.

Methods: We conducted a randomised clinical trial on patients undergoing hemithyroidectomy for benign thyroid disease. Participants were assigned to OPT or inpatient groups. We collected data on complications, failure to discharge on surgery day, post-operative pain, nausea, sleep quality and patient satisfaction.

Results: Among 97 patients, 27.5% (14/51) in the OPT group could not be discharged on the day of surgery due to minor complications, primarily nausea (36%) and neck swelling (29%). No reoperations were needed. Though OPT patients exhibited a higher rate of minor complications (29%), they reported less post-operative nausea, better sleep and a faster return to normal activity.

Conclusions: Discharge on the day of surgery is not always possible with OPT thyroid surgery. However, our findings suggest that OPT hemithyroidectomy for benign cases can be both safe and feasible for a selected group of patients.

Funding: None TRIAL REGISTRATION.

Clinicaltrials: gov Identifier: NCT02891252.