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Danish Medical Journal

Mads Ammitzbøll Danielsen
Rheumatod arthritis is a chronic systemic autoimmune disease, characterized by inflammation in joints and tendon sheaths, which frequently leads to permanent and serious disability due to joint destruction, but also tendon and ligament ruptures. Clinical management of rheumatoid arthritis has traditionally been supported by biochemical and radiographic findings. However, imaging modalities like ultrasound and magnetic resonance imaging (MRI) have improved the possibility for better management of rheumatoid arthritis patients, due to higher sensitivity and specificity for detecting ongoing inflammation, this thesis is focusing on tenosynovitis as recent studies have shown that inflammation in tendon sheaths, i...
March 2018: Danish Medical Journal
Katrine Bredahl Buggeskov

During conventional cardiopulmonary bypass (CPB) there is no active perfusion of the pulmonary circulation and the mechanical ventilation is ceased leaving the lungs exposed to warm ischemia.
Pulmonary dysfunction is seen in varying degrees after major surgery, but more severe in cardiac surgery patients probably due to the effects of CPB. The evidence for effect and safety are limited, but active pulmonary artery perfusion during CPB could be beneficial for the patients' postoperative oxygenation...
March 2018: Danish Medical Journal
Rikke Vibeke Nielsen
Increasing evidence indicate that pain is insufficiently treated following surgical procedures. It is essential that pain treatment is effective with a minimum of side effects in order to promote postoperative rehabilitation. Multimodal analgesia is most likely an important strategy in reducing postoperative pain. Combinations of different analgesics with different mechanisms of action may have an additive analgesic effect with fewer side effects compared to using a single drug. However, there is still a pronounced lack of documentation for the effect and side effects of these multimodal analgesic regimes...
March 2018: Danish Medical Journal
Kristoffer Andresen
Inguinal hernias are a protrusion of the peritoneum through a weakening in the groin in which abdominal content (intestines or fat) can herniate and cause a bulge. Inguinal hernias can be painful and require surgery. Worldwide, approximately 20 million patients are operated each year, with 10,000 in Denmark. The repair of inguinal hernias causes pain and 16% of patients experience chronic pain six months after the standard, open, mesh-based Lichtenstein technique. Therefore, surgeons are trying to improve the techniques by finding new ways of operating...
March 2018: Danish Medical Journal
Marie Louise Mølgaard Binderup
von Hippel-Lindau disease (vHL) is a hereditary tumor predisposition caused by mutations in the VHL tumor suppressor gene. VHL mutation-carriers are at life-long risk of multi-organ tumor development. The mainstay of vHL management is close surveillance and surgical tumor removal. The disease has been reported to be fully penetrant at 60 years of age, and has a highly variable phenotype, which complicates vHL management and causes distress and uncertainty for affected families. vHL survival has historically been poorer than the survival of the general population, with a median life expectancy for vHL patients of only 49 years...
March 2018: Danish Medical Journal
Maria Faurholt-Jepsen
Major reasons for the insufficient effects of current treatment options in bipolar disorder include delayed intervention for prodromal depressive and manic symptoms and decreased adherence to psychopharmacological treatment. The reliance on subjective information and clinical evaluations when diagnosing and assessing the severity of depressive and manic symptoms calls for less biased and more objective markers. By using electronic devices, fine-grained data on complex psychopathological aspects of bipolar disorder can be evaluated unobtrusively over the long term...
March 2018: Danish Medical Journal
Ulrik Nikolaj Ascanius Felding
Isolated fractures of the orbital floor or medial wall are often referred to as blowout fractures (BOFs). Debilitating double vision and aesthetic deformity may affect the patients' quality of life and daily living skills, for instance, working or driving a car. The management of blowout fractures is, however, challenging, since not all fractures demand surgery. Some patients may have symptoms which subside, or may never develop symptoms. Due to a lack of evidence, there are still considerable differences in opinion on the criteria for surgery...
March 2018: Danish Medical Journal
Andreas Hjelm Brandt
This PhD project is based on a longstanding collaboration between physicists and engineers from the Center of Fast Ultrasound Imaging (CFU) at the Technical University of Denmark and medical doctors from the department of Radiology at Rigshospitalet. The intent of this cooperation is to validate new ultrasonic methods for future clinical use. 
Study I compares two B-mode ultrasound methods: the new experimental technique Synthetic Aperture Sequential Beam-forming combined with Tissue Harmonic Imaging (SASB-THI), and a conventional technique combined with THI...
March 2018: Danish Medical Journal
Daniel Mønsted Shabanzadeh
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by pain, swelling and progressive destruction of the joints leading to loss of function and invalidity. The bone destruction in RA is characterised by two distinct features: structural joint damage and hand bone loss, and their prevention is an important treatment goal. Inhibitors of tumour necrosis factor alpha (TNF-inhibitors) have markedly improved the treatment options in RA patients who fail treatment with conventional synthetic Disease Modifying Anti Rheumatic Drugs (sDMARDS), but their effectiveness with regards to structural joint damage and hand bone loss, predictors thereof and the association with disease activity during treatment have mainly been investigated in randomized controlled trials (RCTs) with limited generalizability due to strict in- and exclusion criteria...
March 2018: Danish Medical Journal
Hellen McKinnon Edwards
This thesis is comprised of three studies focusing on severe postpartum haemorrhage (PPH). PPH is a major cause of maternal morbidity and mortality worldwide. Risk factors include retained placenta, prolonged duration of the third stage of labour, previous caesarean section, and operative vaginal delivery. Occurrence and development of PPH are, however, unpredictable and can sometimes give rise to massive haemorrhage or even hysterectomy and maternal death. Severe haemorrhage can lead to coagulopathy causing further haemorrhage and requiring substitution with blood transfusions...
March 2018: Danish Medical Journal
Morten Rune Blichfeldt-Eckhardt
The thesis comprises an overview and four papers, all published or submitted for publication in international peer-reviewed scientific journals.
Chronic pain after surgery is a common and debilitating complication after many types of surgery. The cause and pathology behind is still mainly uncovered, though several risk factors have been proposed. One of the strongest risk factors for persistent postsurgical pain is the intensity of the acute pain response though the mechanisms involved remain unsettled...
March 2018: Danish Medical Journal
Helle Molter Duriaud, Niels Kroman, Henrik Kehlet
INTRODUCTION: Improvement in perioperative care programmes has facilitated post-operative recovery and use of short-term or outpatient procedures. The aim of this study was to assess the feasibility and safety of an outpatient breast cancer programme in patients referred to a large breast cancer unit. METHODS: After an introduction period involving 554 consecutive patients, all patients operated from 1 November 2015 to 30 June 2016 (a total 483 patients) were treated with multimodal oral analgesia, preoperative high-dose glucocorticoids and no routine use of drains...
March 2018: Danish Medical Journal
Malene Roland Pedersen, Catherine Horsfield, Oliver Foot, Jan Lindebjerg, Palle Jørn Sloth Osther, Peter Vedsted, Ashish Chandra, Søren Rafael Rafaelsen, Henrik Møller
INTRODUCTION: Testicular cancer is the most common type of cancer in young Caucasian men. It has been suggested that testicular microlithiasis (TML) is a premalignant condition. This study's objective was to investigate TML histology prevalence in testicular cancer patients in two European populations. METHODS: We analysed archived histopathology orchiectomy specimens from 152 patients diagnosed with testicular cancer at Fredericia Hospital in Denmark from 2004 to 2014, and 106 patients diagnosed at St Thomas' Hospital in London from 2011 to 2015...
March 2018: Danish Medical Journal
Louise Vølund Larsen, Alice Viktoria Egset, Camilla Holm, Stine Rosenkilde Larsen, Susanne Holm Nielsen, Jacob Bach, Jens Peter Helweg-Larsen, Jens Højberg Wanscher, Christian Godballe
INTRODUCTION: Fine-needle aspiration (FNA) is a cornerstone in diagnosing thyroid nodules. For decades, Danish FNA has been categorised into the groups: "FNA not performed", "Inadequate", "Cystic", "Inconclusive", "Benign", "Suspicious", "Malignant" and "Information missing". Internationally, The Bethesda Classification System (TBCS) is increasingly accepted, especially owing to a detailed specification of FNA suspicious for malignancy...
March 2018: Danish Medical Journal
Kristoffer Weisskirchner Barfod, Anja Falk Riecke, Anders Boesen, Philip Hansen, Jens Friedrich Maier, Simon Doessing, Anders Troelsen
INTRODUCTION: Valid length measurements of the different segments of the Achilles tendon are needed in order to investigate if differential elongation of the Achilles tendon takes place after rupture. The purpose of this paper was to present data concerning the accuracy and reliability of an ultrasound measurement of the free part of the Achilles tendon. METHODS: Both legs of 19 non-injured subjects were examined by magnetic resonance imagining (MRI) and ultrasound...
March 2018: Danish Medical Journal
Emil Osman Thybo Karanfil, Ann Merete Møller
INTRODUCTION: Post-operative pulmonary complications are a common cause of morbidity and mortality in patients undergoing heart surgery. The aim of this systematic review was to determine if preoperative inspiratory muscle training could prevent the development of pneumonia and atelectasis in patients undergoing coronary artery bypass grafting (CABG) or heart valve surgery. METHODS: Systematic searches were performed in MEDLINE, Embase and the Cochrane Library. The included studies compared the development of pneumonia and atelectasis in CABG patients or heart valve surgery patients who were prescribed either preoperative inspiratory muscle training or usual care...
March 2018: Danish Medical Journal
Mike Mikkelsen Lorenzen, Lotte Poulsen, Signe Poulsen, Jens Ahm Sørensen, Kirsten K Roessler
INTRODUCTION: Body contouring surgery is associated with changes in body image and identity. The primary aim of the study was to investigate a multidisciplinary assessment of potential psychological challenges before and after body contouring surgery. METHODS: Eight pre- and post-operative patients undergoing plastic surgery, two surgeons and two nurses were investigated using semi-structured and focus group interviews to capture the perspectives of both the healthcare professionals and the patients...
March 2018: Danish Medical Journal
John Asger Petersen
Clinical deterioration of patients hospitalized on general wards is often preceded by worsening vital signs. If identified early and acted upon quickly, it is conjectured that further deterioration can be prevented. To this means the early warning score (EWS) was implemented in all hospitals in the Capital Region of Denmark in 2013. EWS consists of an aggregated weighted track-and-trigger system (TTS), to identify at-risk patients early, and a treatment protocol to escalate care appropriately and determine the level of competency of the provider...
February 2018: Danish Medical Journal
Daniel Mønsted Shabanzadeh
Gallstone disease is highly prevalent in Denmark and other countries of northern Europe, and cholecystectomy for the treatment of clinical gallstone disease is one the most frequently performed surgical procedures. Research efforts for the identification of mechanisms involved in gallstone formation have a long history and the most established include bile cholesterol saturation, gallbladder motor function, and the enterohepatic circulation of secondary bile salts produced by fecal microbiota. A small number of determinants that are believed to affect these mechanisms have been identified until now...
February 2018: Danish Medical Journal
Martin Grønnebæk Tolsgaard
Ultrasound is a core skill in obstetrics-gynecology, but is highly operator-dependent. The evidence supporting the use of different methods for assessment and training of ultrasound skills was examined from different perspectives through a series of explorative and experimental studies.
We found that ultrasound performance of trainees in obstetrics-gynecology depended on a combination of motor skills, visual skills, and cognitive skills. We then established international multispecialty consensus on an assessment instrument designed to evaluate ultrasound skills...
February 2018: Danish Medical Journal
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