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Nojgaard C.,Amager Hospital | Olesen S.S.,University of Aalborg | Frokjaer J.B.,University of Aalborg | Drewes A.M.,University of Aalborg
Clinical Physiology and Functional Imaging | Year: 2013

Diagnostics of pancreatic insufficiency rely mainly on tests of pancreatic exocrine function based on either measurement of pancreatic secretion or the secondary effects resulting from lack of digestive enzymes or imaging modalities. These methods have been developing rapidly over the last decades, and the aims of this review were to describe exocrine functional testing and imaging of the pancreas in chronic pancreatitis. © 2012 The Authors Clinical Physiology and Functional Imaging © 2012 Scandinavian Society of Clinical Physiology and Nuclear Medicine.


Elkjaer M.,Copenhagen University | Shuhaibar M.,Trinity College Dublin | Burisch J.,Copenhagen University | Bailey Y.,Trinity College Dublin | And 7 more authors.
Gut | Year: 2010

Background: The natural history of ulcerative colitis requires continuous monitoring of medical treatment via frequent outpatient visits. The European health authorities' focus on e-health is increasing. Lack of easy access to inflammatory bowel disease (IBD) clinics, patients' education and understanding of the importance of early treatment at relapse is leading to poor compliance. To overcome these limitations a randomised control trial 'Constant-care' was undertaken in Denmark and Ireland. Methods: 333 patients with mild/moderate ulcerative colitis and 5-aminosalicylate acid treatment were randomised to either a web-group receiving disease specific education and self-treatment via http://www.constant-care.dk or a control group continuing the usual care for 12 months. A historical control group was included to test the comparability with the control group. We investigated: feasibility of the approach, its influence on patients' compliance, knowledge, quality of life (QoL), disease outcomes, safety and health care costs. Results: 88% of the web patients preferred using the new approach. Adherence to 4 weeks of acute treatment was increased by 31% in Denmark and 44% in Ireland compared to the control groups. In Denmark IBD knowledge and QoL were significantly improved in web patients. Median relapse duration was 18 days (95% CI 10 to 21) in the web versus 77 days (95% CI 46 to 108) in the control group. The number of acute and routine visits to the outpatient clinic was lower in the web than in the control group, resulting in a saving of 189 euro/patient/year. No difference in the relapse frequency, hospitalisation, surgery or adverse events was observed. The historical control group was comparable with the control group. Conclusion: The new web-guided approach on http://www.constant-care.dk is feasible, safe and cost effective. It empowers patients with ulcerative colitis without increasing their morbidity and depression. It has yet to be shown whether this strategy can change the natural disease course of ulcerative colitis in the long term.


Bak K.,Amager Hospital | Bak K.,Gentofte Hospital | Sorensen A.K.B.,Gentofte Hospital | Jorgensen U.,Gentofte Hospital | And 5 more authors.
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2010

Purpose: Early repair of rotator cuff tears leads to superior results. To detect symptomatic full-thickness tears of the supraspinatus tendon at an early stage, we conducted a prospective study to evaluate the value of clinical examination with and without subacromial lidocaine within the first weeks after an acute injury to the shoulder. Methods: Of 104 patients included in a prospective investigation, 52 patients were selected to evaluate the diagnostic accuracy of clinical tests in acute full-thickness tears of the supraspinatus tendon. Clinical tests and ultrasound examination were performed at a median of 13 days (range, 3 to 49 days) after the initial injury. The study group consisted of 29 patients (median age, 56 years [range, 39 to 75 years]) who all had an acute complete tear of the supraspinatus tendon verified by ultrasound and arthroscopy. The control group consisted of 23 patients who all had an intact tendon confirmed by ultrasound (median age, 38 years [range, 19 to 73 years]). Results: The Hawkins sign (0.83) and the painful arc test (0.97) had high sensitivity but low specificity (0.23 and 0.05, respectively). The external rotation lag sign (ERLS) and the drop-arm test (DAT) had a sensitivity of 0.39 and 0.37, respectively, and specificity of 0.91 and 0.86, respectively, in diagnosing acute full-thickness tears of the rotator cuff. After a subacromial lidocaine injection, sensitivity of all lag sign tests was reduced, whereas specificity and likelihood ratios of the Jobe test, the ERLS, and the DAT improved. Active abduction was significantly reduced in the full-thickness tear group. Conclusions: A positive lag sign (ERLS or DAT) is indicative of a full-thickness supraspinatus tear, but a negative lag sign does not preclude a tear. After a subacromial injection of lidocaine, the specificity improves whereas the sensitivity is reduced. Overall, in patients with suspected acute rotator cuff tear, clinical tests cannot stand alone in the evaluation the first weeks after an acute injury. Level of Evidence: Level I, diagnostic study-testing of previously developed criteria in a series of consecutive patients (by use of arthroscopy and ultrasound as the gold standard). © 2010 Arthroscopy Association of North America.


Hansen P.,Copenhagen University | Kovanen V.,University of Jyväskylä | Holmich P.,Amager Hospital | Krogsgaard M.,Copenhagen University | And 6 more authors.
American Journal of Sports Medicine | Year: 2013

Background: The Achilles tendon is one of the strongest tendons in the human body, and yet it frequently ruptures, which is a substantial clinical problem. However, the cause of ruptures remains elusive. Hypothesis: Ruptured human Achilles tendon displays inferior biomechanical properties and altered collagen composition compared with noninjured tendon. Study Design: Controlled laboratory study. Methods: Biopsy specimens were obtained at the rupture site and the noninjured part of the tendon (internal controls) in 17 patients with acute Achilles tendon rupture. Age- and weight-matched human cadaveric Achilles tendons (external controls) were also obtained. Tendon samples were tested micromechanically and biochemically. Results: The mean Young modulus was lower (P<.01) in ruptured (256.7 ± 100.8 MPa) and internal control tendon (262.4 ± 111.5 MPa) compared with external control tendon (512.9 ± 209. ± MPa; P<.01), whereas failure strength did not display similar differences (P = .06-.16). Collagen content, lysyl pyridinoline (LP), hydroxylysyl pyridinoline (HP), and pentosidine (PENT) did not display regional differences between ruptured and noninjured tendon. However, collagen content was less in ruptured (0.457 ± 0.093 mg/mg) and noninjured tendon (0.476 ± 0.072 mg/mg) compared with external control tendon (0.585 ± 0.044 mg/mg, P<.001). Pentosidine was similar in all tendon samples and was positively related to age in all samples (r2 = 0.44-0.72, P< .05). Collagen content was positively related to failure stress but only in ruptured samples (r2= 0.36; P<.05). HP, LP, and PENT content were unrelated to failure stress and Young modulus in ruptured, noninjured, and cadaveric tendon. Conclusion: These data imply that there may be a mechanical weakening of the tendon and that a reduced collagen content may be related to the pathophysiological characteristics of Achilles tendon rupture. Clinical Relevance: Earlier studies have demonstrated that specific training regimens to treat tendon injury can improve tendon composition and mechanical properties. This study supports the notion that treatment measures should aim to increase tendon collagen content and improve micromechanical quality of the tendon matrix. © 2012 The Author(s).


Tsuji T.,University of Maryland Baltimore County | Kline E.,University of Maryland Baltimore County | Sorensen H.J.,Copenhagen University | Sorensen H.J.,Amager Hospital | And 5 more authors.
Schizophrenia Research | Year: 2013

Social functioning deficits are a core component of schizophrenia spectrum disorders, and may emerge years prior to the onset of diagnosable illness. The current study prospectively examines the relation between teacher-rated childhood social dysfunction and later mental illness among participants who were at genetic high-risk for schizophrenia and controls (n= 244). The teacher-rated social functioning scale significantly predicted psychiatric outcomes (schizophrenia-spectrum vs. other psychiatric disorder vs. no mental illness). Poor premorbid social functioning appears to constitute a marker of illness vulnerability and may also function as a chronic stressor potentially exacerbating risk for illness. © 2013 Elsevier B.V.


Jakobsdottir G.,Lund University | Bjerregaard J.H.,Glostrup Hospital | Skovbjerg H.,Amager Hospital | Nyman M.,Lund University
Scandinavian Journal of Gastroenterology | Year: 2013

Background. Short-chain fatty acids (SCFAs), particularly propionic and butyric acids, have been shown to have many positive health effects. The amount and type of SCFAs formed from dietary fibre by the colonic microbiota depends on the substrate available and is reflected in blood. The total intake and type of dietary fibre in people with gastrointestinal diseases differs considerably from healthy subjects. Objective. To compare fasting SCFA concentrations in subjects with microscopic colitis (MC), celiac disease and controls without these diseases. SCFAs were also analysed over 6.5 h in young healthy subjects, who had eaten a fibre-rich breakfast, to identify a possible peak concentration of SCFAs after a meal. Methods. SCFAs in serum were pre-concentrated using hollow fibre-supported liquid membrane extraction and gas chromatography. Results. The MC group had a higher concentration of valeric acid than the control group (p < 0.01). No significant differences in other SCFA concentrations were seen between groups, but the control group tended to have higher concentration of acetic acid (p = 0.1). Furthermore, males had higher concentrations of SCFAs (with the exception of valeric acid) than females (p < 0.05), which were independent of groups. The peaks for acetic, propionic and butyric acids came approximately 5 h, 6.5 h and 2-3 h, respectively, after breakfast. Conclusion. The fasting concentrations of SCFAs were quite similar, although the fibre intake had probably been quite different for a long time. The results might have been different if SCFAs had been recorded over a longer period. © 2013 Informa Healthcare.


Thomsen F.B.,Copenhagen University | Bandak M.,Copenhagen University | Thomsen M.F.,Amager Hospital | Lauritsen J.,Copenhagen University | And 2 more authors.
Cancer | Year: 2014

BACKGROUND Germ-cell cancer (GCC) patients aged ≥40 years have a two-fold higher GCC-specific mortality. It has been hypothesized that reduced treatment intensity combined with increased treatment related toxicity could be the explanation. The objective was to analyze chemotherapy intensity, treatment related toxicity and survival in patients aged ≥40 years treated with standard chemotherapy for GCC compared with a younger control group that received similar treatment during the same period. METHODS From 1984 to 2011, 135 patients aged ≥40 years with disseminated GCC treated with bleomycin, etoposide and cisplatin (BEP). A control-group of 135 patients aged 18-35 years was randomly selected matched on year of BEP treatment. Cumulated doses of BEP as well as bone marrow toxicity, renal- and lung functions were recorded before, during and after termination of treatment. All patients were followed until death or October 1, 2011. RESULTS The cumulated doses of BEP were comparable between the two groups, however, more patients aged ≥40 years were reduced in bleomycin doses based on a decrease in carbon monoxide diffusion capacity corrected for haemoglobin (P = 0.03). No differences between the two groups were found regarding bone marrow toxicity or mean percentage changes in lung- or renal function. Patients aged ≥40 year had increased cancer specific mortality, HR = 4.8 (P = 0.005). In particular patients with disease progression after first line chemotherapy had increased mortality (P = 0.015). Moreover, the 5-year overall survival for patients aged ≥40 years was 82.5% compared to the expected 5-year survival of the background population of 96.3% (P <0.001). CONCLUSIONS Treatment related toxicity could not explain the increased cancer specific mortality in patients aged ≥40 years compared to a younger control-group, and while there were no differences in the administrated doses of cisplatin/etoposide, a decreased number of bleomycin doses were administered in the older patients. Apart from this, the inferior prognosis could be related to tumour biology, increased co-morbidity, or more severe toxicity in relation to second line treatment. Cancer 2014;120:43-51. © 2013 American Cancer Society. Compared with a younger control group, patients aged ≥40 years who have disseminated germ cell cancer and receive standard chemotherapy with bleomycin, etoposide, and cisplatin have increased cancer-specific mortality compared with a younger control group and decreased overall survival compared with the expected survival for the general population. This increased mortality is not caused by treatment toxicity or reduced doses of cisplatin/etoposide. © 2013 American Cancer Society.


Elkjaer M.,Copenhagen University | Burisch J.,Copenhagen University | Avnstrom S.,Amager Hospital | Lynge E.,Institute of Public Health | Munkholm P.,Copenhagen University
European Journal of Gastroenterology and Hepatology | Year: 2010

Background: Ulcerative colitis (UC) is a lifelong disease with increasing incidence. UC requires frequent outpatient clinic visits and continuous medical treatment. Web-based self-management in other chronic diseases influences disease course, and increases self-adherence, compliance and quality of life (QoL). Lack of easy access to inflammatory bowel disease clinics and patient education, their understanding of the importance of early treatment at relapse, poor compliance and self-adherence can be partly solved by a newly developed Web-based concept. AimS: To describe the development and validation of the Web-based 'Constant-Care' concept. Methods: A Web-based treatment program (www.constant-care.dk) and a Patient Educational Centre for UC Patients were developed. The feasibility and acceptance of the concept was validated before (group A) and 6 months after (group B) the start of a randomized controlled trial. Patients' level of disease-specific knowledge, QoL, anxiety and depression were evaluated. Results: Ten (group A) and 11 (group B) Patients fulfilling the diagnostic criteria of mild-to-moderate UC participated in the study. All Patients reported an ability to initiate self-treatment after the educational training (ET). A significant increase in knowledge from 36 to 69% (group A) and 28 to 75% (group B) was obtained. A majority of the Patients were satisfied with the ET. Patients' QoL, anxiety, depression and general well-being showed no difference after the ET. Conclusion: Patient education and training through a Web-based program (www.constant-care.dk) seems to be a feasible concept for increasing Patients' ability to self-initiate treatment and increase the level of disease-specific knowledge. Relevant adjustment of the concept was implemented. The final outcome of the 'Constant-Care' concept is pending. © 2010 Wolters Kluwer Health | Lippincott.


Roug S.,Amager Hospital | Madsen L.G.,Amager Hospital | Madsen L.G.,Koge Hospital
Danish Medical Journal | Year: 2012

INTRODUCTION: To optimize the care for Helicobacter pylori- associated diseases, we wanted to evaluate the completeness of follow-up after H. pylori eradication therapy in a single Danish endoscopy unit. Furthermore, the eradication rates and possible clinical characteristics associated with failure of eradication therapy were considered. MATERIAL AND METHODS: Patients who tested positive for H. pylori infection using a rapid urease test (RUT) during a three-year period were evaluated retrospectively according to demographics, eradication rate, type of eradication therapy, endoscopic findings and number of former attempts of eradication therapy. RUT-positive patients without a posttreatment evaluation were invited for a urea breath test. RESULTS: The overall H. pylori infection rate was 15% (117/796). Only 48/105 (46%) patients had a post-treatment examination to test the effect of H. pylori eradication therapy. The eradication rate by first-line therapy was 75% (58/77). The second-line eradication rate was 87%. 94% (72/77) had the recommended standard triple therapy for first-line eradication therapy. The number of former eradication attempts was the only clinical characteristic that significantly predicted failure of eradication therapy. Among patients with H. pylori-positive peptic ulcer, 21/28 (75%) achieved successful eradication after first-line treatment. CONCLUSION: Organised follow-up regimes are recommended, especially in patients with absolute treatment indications with a view to optimizing the care for patients infected with H. pylori.


Jacobsen M.E.,Copenhagen University | Andersen M.J.,Copenhagen University | Hansen C.O.,Amager Hospital | Konge L.,Copenhagen University
The Journal of bone and joint surgery. American volume | Year: 2015

BACKGROUND: Diagnostic knee arthroscopy is a common procedure that orthopaedic residents are expected to learn early in their training. Arthroscopy requires a different skill set from traditional open surgery, and many orthopaedic residents feel less prepared for arthroscopic procedures. Virtual reality simulation training and testing provide an opportunity to ensure basic competency before proceeding to supervised procedures in patients.METHODS: Twenty-six physicians (thirteen novices and thirteen experienced arthroscopic surgeons) were voluntarily recruited to perform a test consisting of five arthroscopic procedures on a knee arthroscopy simulator. Performance was evaluated by obtaining predefined metrics from the simulator for each procedure, and z-scores, describing suboptimal performance, were calculated from the metrics. The intercase reliability of the simulator metrics was explored by calculating an intraclass correlation coefficient. Finally, a pass-or-fail standard was set with use of the contrasting groups method, and the consequences of the pass-or-fail standard were explored.RESULTS: One procedure was excluded from the final test because of a lack of validity. The total Z-scores for the four procedures included in the final test showed an intercase reliability of 0.87 (95% confidence interval, 0.78 to 0.93). The total mean z-score (and standard deviation) was 38.6 ± 27.3 points for the novices and 0.0 ± 9.1 points for the experienced surgeons (p < 0.0005). The pass-or-fail standard was set at a total z-score of 15.5 points, resulting in two of the novices passing the test and a single experienced surgeon failing the test.CONCLUSIONS: By combining four procedures on a virtual reality arthroscopy simulator, it was possible to create a valid, reliable, and feasible test of basic arthroscopic competency and to establish a credible pass-or-fail standard.CLINICAL RELEVANCE: The simulation-based test and pass-or-fail standard could aid in assessing and ensuring basic competency of future orthopaedic residents before proceeding to supervised procedures in patients. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

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