Krenk L.,Copenhagen University |
Kehlet H.,Copenhagen University |
Kehlet H.,Lundbeck |
Hansen T.B.,Holstebro Hospital |
And 3 more authors.
Anesthesia and Analgesia | Year: 2014
BACKGROUND: Postoperative cognitive dysfunction (POCD) is reported to occur after major surgery in as many as 20% of patients, elderly patients may especially experience problems in the weeks and months after surgery. Recent studies vary greatly in methods of evaluation and diagnosis of POCD, and the pathogenic mechanisms are still unclear. We evaluated a large uniform cohort of elderly patients in a standardized approach, after major joint replacement surgery (total hip and knee replacement). Patients were in an optimized perioperative approach (fast track) with multimodal opioid-sparing analgesia, early mobilization, and short length of stay (LOS ≤3 days) and discharged to home. METHODS: In a prospective multicenter study, we included 225 patients aged ≥60 years undergoing well-defined fast-track total hip or total knee replacement. Patients had neuropsychological testing preoperatively and 1 to 2 weeks and 3 months postoperatively. LOS, pain, opioid use, inflammatory response, and sleep quality were recorded. The practice effect of repeated cognitive testing was gauged using data from a healthy community-dwelling control group (n = 161). RESULTS: Median LOS was 2 days (interquartile range 2-3). The incidence of POCD at 1 to 2 weeks was 9.1% (95% confidence interval [CI], 5.4%-13.1%) and 8.0% (95% CI, 4.5%-12.0%) at 3 months. There was no statistically significant difference between patients with and without early POCD, regarding pain, opioid use, sleep quality, or C-reactive protein response, although the CIs were wide. Patients with early POCD had a higher Mini Mental State Examination score preoperatively (difference in medians 0.5 [95% CI, -1.0% to 0.0%]; P = 0.034). If there was an association between early POCD and late POCD, the sample size was unfortunately too small to verify this (23.6% of patients with early POCD had late onset vs 6.7% in non-POCD group; risk difference 16.9 (95% CI, -2.1% to 41.1%; P = 0.089). CONCLUSIONS: The incidence of POCD early after total hip and knee replacement seems to be lower after a fast-track approach than rates previously reported for these procedures, but late POCD occurred with an incidence similar to that in previous studies of major noncardiac elective surgery. No association between early and late POCD could be verified. Copyright © 2014 International Anesthesia Research Society.
Furtula J.,Aarhus University Hospital |
Johnsen B.,Aarhus University Hospital |
Christensen P.B.,Aarhus University Hospital |
Pugdahl K.,Aarhus University Hospital |
And 5 more authors.
Clinical Neurophysiology | Year: 2013
Objective: This study compares the new Motor Unit Number Estimation (MUNE) technique, MUNIX, with the more common incremental stimulation MUNE (IS-MUNE) with respect to reproducibility in healthy subjects and as potential biomarker of disease progression in patients with ALS. Methods: Thirteen ALS patients and 48 control subjects were prospectively investigated - both groups were studied with MUNIX and IS-MUNE applied on the abductor digiti minimi (ADM) muscle. Additional retest was performed on 14 control subjects. Follow-up tests were carried out on 6 patients. The analysis included measures of reproducibility (Intraclass Correlation Coefficient (ICC)) and diagnostic performance (Receiver Operating Characteristic (ROC) analysis). Results: Test-retest reproducibility was low to moderate for MUNIX and IS-MUNE (ICC. = 0.38 and 0.56, respectively). Repeated MUNIX and IS-MUNE measurements on the same subject had a mean percentage difference (MPD) of 20% and 46%, respectively (p= 0.039). In the control group, the coefficient of variation was markedly lower for MUNIX than for IS-MUNE (26% and 44%, respectively, p<. 0.0005). In ALS patients MUNIX had a notably better responsiveness in follow-up than IS-MUNE (percent change per month, 9.4 versus 5.6, p= 0.046). ROC analysis suggested similar diagnostic accuracy of both tests. Conclusions: MUNIX is a useful MUNE indicator when assessing progression of lower motor neuron affection in ALS. Furthermore, MUNIX displayed lower intrasubject variability, but no evident better diagnostic yield compared with IS-MUNE. Significance: This study has established comparative assessment of MUNIX and IS-MUNE performance in test-retest setting and as diagnostic tests on a distal muscle in ALS patients. © 2012 International Federation of Clinical Neurophysiology.
Graffe C.C.,Holstebro Hospital |
Graffe C.C.,University of Aarhus |
Bech J.N.,Holstebro Hospital |
Lauridsen T.G.,Holstebro Hospital |
And 2 more authors.
American Journal of Physiology - Renal Physiology | Year: 2012
Renal handling of sodium and water is abnormal in chronic kidney diseases. To study the function and regulation of the aquaporin-2 water channel (AQP2) and the epithelial sodium channel (ENaC) in autosomal dominant polycystic kidney disease (ADPKD), we measured urinary excretion of AQP2 (u-AQP2), the β-subunit of ENaC (u-ENaC β), cAMP (u-cAMP), and prostaglandin E 2 (u-PGE 2); free water clearance (C H2O); fractional sodium excretion (FE Na); and plasma vasopressin (p-AVP), renin (p-Renin), angiotensin II (p-ANG II), aldosterone (p-Aldo), and atrial and brain natriuretic peptide (p-ANP, p-BNP) in patients with ADPKD and healthy controls during 24-h urine collection and after hypertonic saline infusion during high sodium intake (HS; 300 mmol sodium/day) and low sodium intake (LS; 30 mmol sodium/day). No difference in u-AQP2, u-ENaC β, u-cAMP, u-PGE 2, C H2O, and vasoactive hormones was found between patients and controls at baseline, but during HS the patients had higher FE Na. The saline caused higher increases in FE Na in patients than controls during LS, but the changes in u-ENaC β, p-Aldo, p-ANP, p-BNP, p-Renin, and p-ANG II were similar. Higher increases in u-AQP2 and p-AVP were seen in patients during both diets. In conclusion, u-AQP2 and u-ENaC β were comparable in patients with ADPKD and controls at baseline. In ADPKD, the larger increase in u-AQP2 and p-AVP in response to saline could reflect an abnormal water absorption in the distal nephron. During LS, the larger increase in FE Na in response to saline could reflect a defective renal sodium retaining capacity in ADPKD, unrelated to changes in u-ENaC β. © 2012 the American Physiological Society.
Madsen L.B.,Holstebro Hospital |
Christiansen T.,University of Southern Denmark |
Kirkegaard P.,Section of General Practitioners |
Pedersen E.B.,Holstebro Hospital
Blood Pressure | Year: 2011
Aims. The purpose of the present study was to compare the costs of home blood pressure (BP) telemonitoring (HBPM) with the costs of conventional office BP monitoring. In a randomized controlled trial, 105 hypertensive patients performed HBPM and 118 patients received usual care with conventional office BP monitoring during 6 months. Costs were quantified from the healthcare perspective. Non-parametric simulations were performed to quantify the uncertainty around the mean estimates and cost-effectiveness acceptability curves were made. Major findings. Systolic and diastolic daytime and night-time ambulatory BP (ABP) were reduced in both groups. The uncertainty around the incremental cost effectiveness ratio point estimates was considerable for both systolic and diastolic ABP. For systolic ABP, the difference in cost effectiveness ratio between the two groups was 256 Danish kroner (DKK)/mmHg [95% uncertainty interval, UI -860 to 4544]. For diastolic ABP, the difference in cost effectiveness ratio between the two groups was 655 DKK/mmHg [95% UI -674 to 69315]. Medication and consultation costs were lowest in the intervention group, but were offset by the cost of the telemonitoring equipment. Conclusions. Cost-effectiveness analysis showed that telemonitoring of home BP was more costly compared with usual monitoring of office BP. The cost-effectiveness result is surrounded with considerable uncertainty. © 2011 Scandinavian Foundation for Cardiovascular Research.
Rokkjaer M.S.,Holstebro Hospital |
Klug T.E.,Aarhus University Hospital
European Archives of Oto-Rhino-Laryngology | Year: 2014
The aim of this systematic literature review was to investigate the prevalence of unsuspected tonsillar malignancy in routine tonsillectomy specimens and to discuss whether histological examination is indicated in tonsillectomy specimens from patients without well-defined risk factors. PRISMA 2009 guidelines were considered and applied whenever possible. Articles on prevalence of unsuspected tonsillar malignancy in routine tonsillectomy specimens were selected. Unsuspected tonsillar malignancy was defined as a malignant histological diagnosis after routine tonsillectomy without the presence of the following risk factors: tonsillar asymmetry, visible lesion, tonsillar firmness, cervical adenopathy, unexpected weight loss and constitutional symptoms, history of malignancy, previous radiotherapy, or immunodeficiency. We identified 37 articles comprising 72,322 patients. A total of 11 patients (0.015 %) had unsuspected malignancy. Considering the adult population only, 12 studies including 6,434 patients were identified. Three patients (0.05 %) had unsuspected malignancy. Regarding paediatric data, 21 studies including 21,223 children were identified. Three children (0.01 %) had unsuspected malignancy. The rarity of unsuspected malignancy in clinically benign tonsils fails to provide adequate justification for routine histological examination. National guidelines or statements by ENT societies are warranted. © 2014 Springer-Verlag Berlin Heidelberg.
Kancir A.S.P.,Aarhus University Hospital |
Johansen J.K.,Holstebro Hospital |
Ekeloef N.P.,Holstebro Hospital |
Pedersen E.B.,Aarhus University Hospital
Anesthesia and Analgesia | Year: 2015
BACKGROUND: Although hydroxyethyl starch (HES) is commonly used as an intravascular volume expander in surgical patients, recent studies suggest that it may increase the risk of renal failure in critically ill patients. We hypothesized that patients undergoing radical prostatectomy and receiving HES would be more likely to develop markers of renal failure, such as increasing urinary neutrophil gelatinase-associated lipocalin (u-NGAL), creatinine clearance (Ccrea), and decreasing urine output (UO). METHODS: In a randomized, double-blinded, placebo-controlled study, 40 patients referred for radical prostatectomy received either 6% HES 130/0.4 or saline 0.9%; 7.5 mL/kg during the first hour of surgery and 5 mL/kg in the following hours; u-NGAL, urine albumin, Ccrea, UO, arterial blood pressure, and plasma concentrations of creatinine, renin, angiotensin II, aldosterone, and vasopressin were measured before, during, and after surgery. RESULTS: Thirty-six patients completed the study. u-NGAL, Ccrea, UO, plasma neutrophil gelatinase-associated lipocalin, p-creatinine, urine albumin, and arterial blood pressure were the same in both groups. Blood loss was higher in the HES group (HES 1250 vs saline 750 mL), while p-albumin was reduced to a significantly lower level. P-renin and p-angiotensin-II increased in both groups, whereas p-aldosterone and p-vasopressin increased significantly in the saline group. CONCLUSIONS: We found no evidence of nephrotoxicity after infusion of 6% HES 130/0.4 in patients undergoing prostatectomy with normal preoperative renal function. Hemodynamic stability and infused fluid volume were the same in both groups. We observed an increased blood loss in the group given 6% HES 130/0.4. © 2015 International Anesthesia Research Society.
Rokkjaer M.S.,Holstebro Hospital |
Klug T.E.,Aarhus University Hospital
European Archives of Oto-Rhino-Laryngology | Year: 2015
Unsuspected tonsillar malignancy in routine tonsillectomy specimens is rare. A potentially increased risk of unsuspected tonsillar malignancy in adult patients presenting with peritonsillar abscess (PTA) was noted in a recent review. Furthermore, a literature search revealed several case reports concerning tonsillar malignancy presenting as PTA. Thus, the aim of the current study was to explore the prevalence of tonsillar malignancy in adult patients with PTA. A retrospective review of all adult patients undergoing tonsillectomy due to PTA from January 2001 to December 2012 at the Ear-Nose-Throat Department was performed. In 275 consecutive adult patients with PTA (median age 40 years, range 30–89 years), we identified one patient with unsuspected tonsillar malignancy (prevalence 0.3 %); a 40-year-old, previously healthy, male was diagnosed with acute myeloid leukaemia. Reviewing the literature, we identified 13 cases of tonsillar malignancy presenting as PTA (median age 49 years, range 2–66 years). Our data represents the only series of histological examined tonsillectomy specimens from PTA patients reported in the literature. We identified one case of unsuspected tonsillar malignancy in this relatively small series. We find it important to stress, that we had no knowledge of this patient before designing the study. Hence, the prevalence of 0.3 % is unbiased in this respect. More, and preferably, larger studies are needed to determine the prevalence with greater certainty. At present, no definitive conclusions can be made, but clinicians should be aware that PTA infrequently masquerade tonsillar malignancy. © 2014, Springer-Verlag Berlin Heidelberg.
Rokkjaer M.S.,Holstebro Hospital |
Klug T.E.,Holstebro Hospital
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery | Year: 2014
The aim of this systematic literature review was to investigate the prevalence of unsuspected tonsillar malignancy in routine tonsillectomy specimens and to discuss whether histological examination is indicated in tonsillectomy specimens from patients without well-defined risk factors. PRISMA 2009 guidelines were considered and applied whenever possible. Articles on prevalence of unsuspected tonsillar malignancy in routine tonsillectomy specimens were selected. Unsuspected tonsillar malignancy was defined as a malignant histological diagnosis after routine tonsillectomy without the presence of the following risk factors: tonsillar asymmetry, visible lesion, tonsillar firmness, cervical adenopathy, unexpected weight loss and constitutional symptoms, history of malignancy, previous radiotherapy, or immunodeficiency. We identified 37 articles comprising 72,322 patients. A total of 11 patients (0.015 %) had unsuspected malignancy. Considering the adult population only, 12 studies including 6,434 patients were identified. Three patients (0.05 %) had unsuspected malignancy. Regarding paediatric data, 21 studies including 21,223 children were identified. Three children (0.01 %) had unsuspected malignancy. The rarity of unsuspected malignancy in clinically benign tonsils fails to provide adequate justification for routine histological examination. National guidelines or statements by ENT societies are warranted.
Larsen T.,Holstebro Hospital |
Mose F.H.,Holstebro Hospital |
Bech J.N.,Holstebro Hospital |
Hansen A.B.,Holstebro Hospital |
Pedersen E.B.,Holstebro Hospital
American Journal of Hypertension | Year: 2012
BackgroundLow 25-hydroxy-vitamin D (25(OH)D) levels are inversely related to blood pressure (BP) and have been associated with incident hypertension. In people living at northern latitudes diminished cholecalciferol synthesis in the winter increases the risk of vitamin D deficiency. We wanted to test the hypothesis that daily cholecalciferol supplementation in the winter lowers BP in patients with hypertension.MethodsWe investigated the effect of 75g (3,000 IU) cholecalciferol per day in a randomized, placebo-controlled, double-blind study in 130 hypertensive patients residing in Denmark (56 N). Ambulatory BP (24-h BP) and arterial stiffness were measured before and after 20 weeks of treatment, that took place between October and March.ResultsA total of 112 patients (mean age 61 ± 10) with a baseline p-25(OH)D of 23 ± 10 ng/ml completed the study. Compared with placebo, a nonsignificant 3/1 mm Hg (P = 0.26/0.18) reduction was found in 24-h BP. In patients with vitamin D insufficiency (32 ng/ml) at baseline (n = 92), 24-h BP decreased by 4/3 mm Hg (P = 0.05/0.01). Central BP (CBP) estimated by applanation tonometry and calibrated with a standardized office BP was reduced by 7/2 mm Hg (P = 0.007/0.15) vs. placebo. No differences in carotid-femoral pulse wave velocity (PWV) or central augmentation index (AIx) were found between treatment arms. ConclusionsCholecalciferol supplementation, by a dose that effectively increased vitamin D levels, did not reduce 24-h BP, although central systolic BP decreased significantly. In a post-hoc subgroup analysis of 92 subjects with baseline p-25(OH)D levels 32 ng/ml, significant decreases in 24-h systolic and diastolic BP occurred during cholecalciferol supplementation. © 2012 American Journal of Hypertension, Ltd.
Moesgaard L.,Holstebro Hospital
Danish medical journal | Year: 2012
Tonsillectomy may be performed by several methods. It is continuously being discussed which method is preferable with regard to postoperative haemorrhage, pain, activity and nutrition. The present study is a prospective non-randomized study of tonsillectomy. It included 198 patients aged 14-40 years who either underwent coblation tonsillectomy or traditional "cold" tonsillectomy after random allocation to different surgeons. A total of 51 patients underwent coblation tonsillectomy and 147 patients underwent traditional tonsillectomy. We tested the hypothesis that there is no difference in postoperative pain experience between the two surgical techniques. The patients were followed for nine days postoperatively. They filled in a questionnaire on postoperative pain score, activity level and food intake. We found no statistically significant difference in pain perception between the two groups and there was no difference in their levels of activity. The intraoperative haemorrhage was significantly reduced in the coblation tonsillectomy group, but there was no difference in postoperative haemorrhage between the two groups. The overall results of this study suggest that neither coblation tonsillectomy nor traditional tonsillectomy enjoys an advantage over the other in patients aged 14-40 years. not relevant. not relevant.