Ugeskrift for laeger最新文献

Hereditary multiple exostoses is a rare congenital condition with autosomal dominant inheritance. It consists of formation of osteocartilaginous exostoses, most commonly from the metaphysis of long bones. Surgery is the main treatment as there is no available medical treatment. Clinical follow-ups with orthopaedic specialists are important, both in childhood and adulthood. In childhood, focus is on managing symptoms and removing symptomatic exostoses, while in adulthood, MRI is performed to rule out malignant transformation, as argued in this review.

Dislocation after primary total hip arthroplasty is a frequent complication. This review investigates its circumstances, and incidences from 0% to 10% are reported due to different study designs and outcome availability, combined with the multifactorial causality influenced by patient-, implant-, and surgery-related factors. Accurate monitoring of this complication has not been possible in a register setting. However, a recent Danish study revealed the »true« 2-year incidence of dislocation and created an algorithm capable of identifying dislocations with high sensitivity, to reduce future dislocation rates.

Cancer-associated thrombosis (CAT) remains a challenging aspect of managing patients with cancer. This review discusses evidence regarding anticoagulants in the treatment of CAT, with particular emphasis on direct oral anticoagulants (DOAC). Apixaban, rivaroxaban and edoxaban have proven attractive alternatives to low-molecular weight heparins, and interactions with medical cancer treatment does not pose a major challenge. The majority of guidelines have endorsed the use of DOAC, and we highlight points to consider when choosing the optimal anticoagulant for the individual patient.

Managing anticoagulant therapy in patients with comorbidities such as kidney disease, liver disease, obesity, thrombophilia and increased bleeding risk with thrombocytopenia presents unique challenges. Renal impairment affects drug clearance. Liver disease alters coagulation and drug metabolism. Obesity affects drug distribution and dosing. Increased bleeding risk with thrombocytopenia often requires different dosing. This review finds that tailored therapeutic strategies are essential to balance the risks and benefits in these complex patient populations.

During the last decades, the prognosis for patients with congenital heart disease (CHD) has gone through a tremendous development due to improvement in diagnostic tools, treatment, and follow-up. This has resulted in a demographic change of the population with CHD so that the number of adults exceeds that of paediatric patients. The improved survival has led to new challenges including re-interventions addressing residual lesions as well as long-term complications such as arrhythmia and heart failure. This has resulted in the development of novel catheter-based interventions e.g. percutaneous valve implantation, pulsed-field ablation, and lymphatic procedures as summarised in this review. Despite this, further developments are needed since morbidity and mortality are still significantly increased in patients with CHD compared to the background population.

Up to 70% of all sudden cardiac deaths (SCD) in persons under 50 years are due to inherited cardiovascular diseases. First-degree relatives to younger SCD patients should be evaluated for inherited cardiovascular disease, as argued in this review. An improved understanding of SCD subtypes and genetics is expected to improve risk stratification and SCD prevention. Preventing ischaemic heart disease (IHD) is a cornerstone as IHD is the most common cause of SCD.

Direct current (DC) cardioversion is an everyday clinical procedure used to restore sinus rhythm from atrial fibrillation. This review summarises the current state of art in Denmark. Sufficient anticoagulation must be ensured before DC cardioversion to reduce the risk of thromboembolism. Biphasic maximum energy shocks delivered via anterolateral electrodes are recommended. Overall success is high, and the complication rate is low. Relapse of atrial fibrillation is common, and a long-term treatment strategy which may include antiarrhythmics, ablation and lifestyle change should be established in collaboration with the patient.