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Field trials of Abies lasiocarpa were undertaken with the aim of assessing the potential for Christmas tree production in Denmark. Twenty-six provenances originating from Alaska to New Mexico were tested. Damage by the insect Adelges piceae and the fungus Neonectria neomacrospora was recorded for the first time 8 and 12 years after the initial planting. Damage from N. neomacrospora increased rapidly in the period 12-15 years after planting. Trees from the northern provenances and humid climates exhibited less damage than those from southern ones. Previous attack by A. piceae had a minor effect on N. neomacrospora infection. Greenhouse tests showed that detached shoots from healthy Abies lasiocarpa can be used to rank provenances for resistance to N. neomacrospora, but results varied according to host subspecies. [ABSTRACT FROM AUTHOR]

Background: The modified version of the patients' Perceived Involvement in Care Scale (M-PICS) is a tool designed to assess cancer patients' perceptions of patient–health care provider pain communication process. The objective of this study was to examine the psychometric properties of the shortened Danish version of the M-PICS (SDM-PICS). Methods: The validated English version of the M-PICS was translated into Danish following the repeated back-translation procedure. Cancer patients were recruited for the study from specialized pain management facilities. Results: Thirty-three patients responded to the SDM-PICS, Danish Barriers Questionnaire II, Hospital Anxiety and Depression Scale, and Brief Pain Inventory Pain Severity Scale. A factor analysis of the SDM-PICS resulted in two factors: Factor one, patient information, consisted of four items assessing the extent to which the patient shared information with his/her health care provider, and Factor two, health care provider information, consisted of four items measuring the degree to which a health care provider was perceived as the one who shares information. Two separate items addressed the perceived level of information exchange between the patient and the health care provider. The SDM-PICS total had an internal consistency of 0.88. The SDM-PICS scores were positively related to pain relief and inversely related to the measures of cognitive pain management barriers, anxiety, and reported pain levels. Conclusion: The SDM-PICS seems to be a reliable and valid measure of perceived patient–health care provider communication in the context of cancer pain. [ABSTRACT FROM AUTHOR]

Background: Breakthrough pain (BTP) has not formerly been discussed as such in chronic non-malignant pain patients referred to pain centres and clinics. The purpose of the study was to investigate the prevalence, characteristics and mechanisms of BTP in opioid-treated chronic non-malignant pain patients referred to a pain centre and to assess the short-term effects of pain treatment. Methods: Patients were assessed at referral (T0) and after a treatment period of 3 months (T3) using the visual analogue scale (VAS) of the brief pain inventory (BPI) within somatic nociceptive, neuropathic and/or visceral pain conditions, the mini mental state examination (MMSE) and the hospital anxiety and depression scale (HADS). The main treatment intervention from T0 to T3 was to convert short-acting oral opioids to long-acting oral opioids and to discontinue on demand and parenteral use of opioids. Results: Thirty-three patients were assessed at T0 and 27 at T3. The prevalence of BTP declined significantly from T0 (90%) to T3 (70.4%). Worst, least, average and current pain intensities as well as duration of BTP were significantly reduced from T0 to T3. The majority of BTPs were exacerbation of background pain assumed to be of the same pain mechanisms. High average pain intensity (BPI) was significantly associated with high scores for both anxiety and depression (HADS). Conclusion: BTP in chronic non-malignant pain patients seems to be surprisingly frequent and severe. Stabilizing the opioid regimen seems to reduce pain intensity in general as well as the intensity and duration of BTP. Average pain intensity was associated with anxiety and depression. [ABSTRACT FROM AUTHOR]

The study describes the epidemiology and mortality of tetralogy of Fallot (TOF) in a population-based study in Western Denmark. Ninety-two infants with TOF were born during 1984-1992. Prevalence was 3.01 per 10,000 livebirths. Karyotype anomalies were present in 12 (13%) and extracardiac malformations in 16 (17%) of the infants. Down syndrome, cleft palate, cleft lip and palate and combined skeletal, gastrointestinal and renal lesions (VACTERL association) were prevalent. Twenty-four infants died (26% of total), 13 (54%) of the deaths occurring during the first year of life. Mortality was significantly increased in infants with extracardiac malformations (50% vs 19%, p < 0.05). Eighteen deaths (75% of total deaths) occurred before corrective surgery and 7 of these deaths were sudden. Extracardiac malformation(s) in infants with TOF is a significant risk factor for death. The study stresses the importance of population-based studies for the assessment of mortality from congenital heart malformations. Overall mortality may be very different from mortality related to cardiac surgery. [ABSTRACT FROM AUTHOR]

To identify possible weaknesses in cervical screening in Aarhus County, 10 years after the programme was introduced, screening histories were examined. A major problem for the screening programme was that 31% of women were never screened and 61% under-screened, the latter group being significantly dominated by older women and high-stage tumours. [ABSTRACT FROM AUTHOR]

Abstract: Bright and extensive noctilucent clouds (NLC) were observed in Århus (Denmark) on 3/4 July of 2008 with an automatic digital camera taking images every minute. This event was unique in the sense that bright NLC were seen at high elevation angles (more than 30°) that allowed observing the evolution of a Kelvin–Helmholtz (KH) wave, resulted in well-developed turbulence. In particular, coherent vortex structures of a horseshoe-shaped form were observed for the first time in noctilucent clouds. The turbulent diffusion coefficient and turbulent energy dissipation rate around the mesopause are estimated in the range 162–667m2/s and 300–1235mW/kg, respectively, representing a case of strong neutral air turbulence in noctilucent clouds. Turbulent structures were observed to be in the vicinity of breaking small-scale gravity waves that seems to be responsible for a high level of turbulence. At the same time, it has been demonstrated that it is of importance to take into account non-turbulent process such as the gravity wave motion that is always present in NLC layers. Unless non-turbulent process is taken into account, this certainly leads to overestimating of the value of the turbulent diffusion coefficient. More accurate characteristics of turbulence in NLC can be obtained by analyzing a sequence of high-resolution images with a high frame-rate high-resolution digital camera. [ABSTRACT FROM AUTHOR]

Background: Knowledge about the effect of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) of non-cardiac origin is lacking. We aimed to investigate the association between bystander CPR and survival in OHCA of presumed non-cardiac origin., Methods: From the Danish Cardiac Arrest Registry and through linkage with national Danish healthcare registries we identified all patients with OHCA of presumed non-cardiac origin in Denmark (2001-2014). These were categorized further into OHCA of medical and non-medical cause. We analyzed temporal trends in bystander CPR and 30-day survival during the study period. Multiple logistic regression was used to examine the association between bystander CPR and 30-day survival and reported as standardized 30-day survival chances with versus without bystander CPR standardized to the prehospital OHCA-factors and patient characteristics of all patients in the study population., Results: We identified 10,761 OHCAs of presumed non-cardiac origin. Bystander CPR was associated with a significantly higher 30-day survival chance of 3.4% (95% confidence interval [CI]: 2.9-3.9) versus 1.8% (95% CI: 1.4-2.2) without bystander CPR. A similar association was found in subgroups of both medical and non-medical OHCA. During the study period, the overall bystander CPR rates increased from 13.6% (95% CI: 11.2-16.5) to 62.7% (95% CI: 60.2-65.2). 30-day survival increased overall from 1.3% (95% CI: 0.7-2.6) to 4.0% (95% CI: 3.1-5.2)., Conclusion: Bystander CPR was associated with a higher chance of 30-day survival among OHCA of presumed non-cardiac origin regardless of the underlying cause (medical/non-medical). Rates of bystander CPR and 30-day survival improved during the study period., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aims: Several drugs increase the risk of ventricular fibrillation and sudden cardiac death (SCD). We aimed to investigate in detail the toxicological findings of all young SCD throughout Denmark., Methods and Results: Deaths in persons aged 1-49 years were included over a 10-year period. Death certificates and autopsy reports were retrieved and read to identify cases of sudden death and establish cause of death. All medico-legal autopsied SCD were included and toxicological reports collected. Positive toxicology was defined as the presence of any substance (licit and/or illicit). All toxicological findings had previously been evaluated not to have caused the death (i.e. lethal concentrations were excluded). We identified 620 medico-legal autopsied cases of SCD, of which 77% (n = 477) were toxicologically investigated post-mortem, and 57% (n = 270) had a positive toxicology profile. Sudden cardiac death with positive toxicology had higher rates of sudden arrhythmic death syndrome (SADS), compared with SCD with negative toxicology (56% vs. 42%, P < 0.01). In total, 752 agents were detected, and polypharmacy (defined as the presence of more than one drug) was present in 61% (n = 164), all substances combined. Psychotropic drugs were the most frequent (62%, n = 467), and 82% (n = 385) were in pharmacological or subpharmacological levels., Conclusion: We found that more than half of all toxicologically investigated SCD victims have positive post-mortem toxicological findings, and polypharmacy is displayed in a considerable proportion. SCD with positive toxicology had higher rate of SADS, suggesting that the compounds may play a proarrhythmic role in these cases.

Background Stroke is the fifth leading cause of death in young individuals globally. Data on the burden of sudden death by stroke are sparse in the young. Aims The aim of this study was to report mortality rates, cause of death, stroke subtype, and symptoms in children and young adults who suffered sudden death by stroke. Methods We conducted a retrospective, nationwide study including all deaths within Danish borders between 2000-2009 and 2007-2009 in persons aged 1-35 years and 36-49 years, respectively. Two physicians identified all sudden death cases through review of all death certificates. All available autopsy reports and records from hospitals and general practitioners were retrieved and a neurologist identified all sudden death by stroke cases. Results Of the 14,567 deaths in the 10-year period, there were 1,698 sudden death cases, of which 52 (3%) were sudden death by stroke. There was a male predominance (56%) and the median age was 33 years. The incidence of sudden death by stroke in individuals aged 1-49 years was 0.19 deaths per 100,000 person-years. Stroke was hemorrhagic in 94% of cases, whereof subarachnoid hemorrhage was the cause of death in 63% of cases. Seventeen (33%) cases contacted the healthcare system because of neurological symptoms, whereof one was suspected of having a stroke (6%). Conclusions Sudden death by stroke in children and young adults occurs primarily due to hemorrhagic stroke. We report a high frequency of neurological symptoms prior to sudden death by stroke. Increased awareness among healthcare professionals towards stroke symptoms in children and young adults may lead to earlier detection of stroke, and thereby potentially lowering the incidence of sudden death by stroke.

Background: Lung cancer is an increasing problem in the older patient population due to the improvement in life expectation of the Western population. In this study we examine trends in lung cancer incidence and mortality in Denmark from 1980 to 2012 with special focus on the elderly., Material and Methods: Lung cancer was defined as ICD-10 codes C33-34. Data derived from the NORDCAN database with comparable data on cancer incidence, mortality, prevalence, and relative survival in the Nordic countries, where the Danish data were delivered from the Danish Cancer Registry and the Danish Cause of Death Registry with follow-up for death or emigration until the end of 2013., Results: In 2012, about 50% of lung cancers were diagnosed among persons aged 70 years or more. For men and women older than 75 years the incidence rates have been increasing and for those aged 80-84 years, the rates have doubled since 1980. Due to the poor survival, similar trends were seen in mortality rates. Over the period, the one-year relative survival rates almost doubled in patients aged 70 years or more, but still only 25% of the patients aged 80-89 years survived their lung cancer for one year., Conclusion: The incidence of lung cancer is closely linked to the pattern of tobacco smoking with the differences between gender and age groups reflecting smoking behavior in birth cohorts. Elderly patients with lung cancer are a heterogeneous group in whom treatment should be offered according to comorbidity and a geriatric assessment.

Background: Preparticipation screening programs have been suggested to reduce the numbers of sports-related sudden cardiac deaths (SrSCD)., Objective: The purpose of this study was to identify and characterize all SrSCD aged 12-49 years and to address the difference in incidence rates between competitive and noncompetitive athletes., Methods: All deaths among persons aged 12-49 years from 2007-2009 were included. Death certificates were reviewed. History of previous admissions to hospital was assessed, and discharge summaries and autopsy reports were read. Sudden cardiac deaths (SCDs) and SrSCD cases were identified., Results: In the 3-year period, there were 881 SCDs, of which we identified 44 SrSCD. In noncompetitive athletes aged 12-35 years, the incidence rate of SrSCD was 0.43 (95% confidence interval [CI] 0.16-0.94) per 100,000 athlete person-years vs 2.95 (95% CI 1.95-4.30) in noncompetitive athletes aged 36-49 years. In competitive athletes, the incidence rate of SrSCD was 0.47 (95% CI 0.10-1.14) and 6.64 (95% CI 2.86-13.1) per 100,000 athlete person-years in those aged 12-35 years and 36-49 years, respectively. The incidence rate of SCD in the general population was 10.7 (95% CI 10.0-11.5) per 100.000 person-years., Conclusion: The incidence rates of SrSCD in noncompetitive and competitive athletes are not different. The study showed an increase in the incidence rate of SrSCD in persons aged 36-49 years in both noncompetitive and competitive athletes compared to those aged 12-35 years. Importantly, SCD in the general population is much more prevalent than is SrSCD in all age groups., (Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Introduction: Knowledge of trauma patients is often based on US studies. However, these may not be representative of the Scandinavian population. Knowing which trauma patients are at risk of dying might help us target and optimise their treatment. The purpose of this study was to examine the epidemiological characteristics and the mortality among patients who did not survive after being admitted to a Danish trauma centre., Material and Methods: This was a historical cohort study. The study population comprised trauma patients admitted to Aarhus University Hospital from January 2000 to July 2011. Those admitted alive and who subsequently died while still at the hospital were analysed as dead. All injuries were scored according to the abbreviated injury scale, and the mechanisms of trauma were categorised by the NOMESCO classification system. The annual odds ratios (OR) for death were calculated adjusting for potential confounders using logistic regression analysis., Results: During the study period, a total of 6,299 trauma patients were admitted of whom 280 (4.4%) died. The OR for death was significantly lower in 2004 than in the remaining years, but there was no difference in mortality during the rest of the study period. Most patients died within the first 24 hours (67%), and 87% died within the first week. The primary cause of death was damage to the central nervous system (56%) and exsanguination (13%)., Conclusion: Survival has not been improved in the period from January 2000 to July 2011. Initiatives that could potentially improve survival include the introduction of an increased focus on older patients, treatment within the first 24 hours and treatment of cerebral and vascular injuries., Funding: not relevant., Trial Registration: not relevant.

Background: Knowledge of the burden and causes of sudden cardiac death (SCD) is sparse in persons aged<50 years; better understanding is needed to lower the risk of SCD. The aim of this study was to report SCD incidence rates and autopsy findings in persons aged 1 to 49 years., Methods and Results: All deaths in persons aged 1 to 49 years were included in 2007 to 2009. Death certificates were reviewed by 2 physicians. History of previous admissions to hospital was assessed, and discharge summaries were read. Sudden unexpected death cases were identified and autopsy reports were collected. In the 3-year study period, there were 7849 deaths of which we identified 893 (11%) SCD cases. The annual incidence rate per 100 000 persons increased from 2.3 (95% confidence interval, 2.0-2.7) to 21.7 (95% confidence interval, 20.2-23.4) in persons aged 1 to 35 and 36 to 49 years, respectively. Coronary artery disease was the most common cause of death and was found in 158 (36%) autopsied cases, followed by 135 (31%) cases of sudden unexplained death., Conclusions: In a nationwide cohort of persons aged<50 years, the annual incidence rate of SCD was ≈10× higher in persons aged 36 to 49 years than in persons aged 1 to 35 years. Notably, coronary artery disease was the most common cause of SCD, followed by unexplained deaths. These findings may help in developing strategies to prevent SCD in the future.

Unlabelled: Non-small cell lung cancer (NSCLC) is associated with poor survival even though patients are treated with curatively intended radiotherapy. Survival is affected negatively by lack of loco-regional tumour control, but survival is also influenced by comorbidity caused by age and smoking, and occurrence of distant metastasis. It is challenging to evaluate loco-regional control after definitive radiotherapy for NSCLC since it is difficult to distinguish between radiation-induced damage to the lung tissue and tumour progression/recurrence. In addition it may be useful to distinguish between intrapulmonary failure and mediastinal failure to be able to optimize radiotherapy in order to improve loco-regional control even though it is not easy to discriminate between the two sites of failure., Material and Methods: This study is a retrospective analysis of 331 NSCLC patients treated with definitive radiotherapy from 2002 to 2011. The patients were treated consecutively at the Department of Oncology, Odense University Hospital, Denmark with at least 60 Gy. All patients were followed in a planned follow-up schedule and no patients were lost for follow-up., Results: At the time of the analysis 93 patients had loco-regional failure only. Of these patients, 68 had intrapulmonary failure only, one patient had failure in mediastinum only, and 24 patients had intrapulmonary failure as well as mediastinal failure. Of the patients which had lung failure only, 78% had mediastinal involvement at treatment start. The only covariate with significant impact on developing intrapulmonary failure only was gross tumour volume. Median survival for the total group of 331 patients was 19 months. The median survival for patients with intrapulmonary failure only was 19 months, and it was 20 months for the patients with mediastinal relapse., Conclusion: We conclude that focus should be on increasing doses to intrapulmonary tumour volume, when dose escalation is applied to improve local tumour control in NSCLC patients treated with definitive radiotherapy, since most recurrences are located here.

Objectives: To compare clinical characteristics of children with chronic non-infectious osteomyelitis (CNO) with either mono- or multifocal bone lesions, and to report potential advantages of using whole-body MRI., Methods: A retrospective evaluation of 31 children (19 girls, 12 boys) diagnosed with CNO between 2001 and 2011. CNO was diagnosed as mono-, or multifocal inflammatory bone lesions (osteomyelitis, osteitis, osteosclerosis), duration of complaints more than 6 weeks and exclusion of infection and malignancy. Clinical and radiological data were registered. The definition of mono- or multifocality was based on the description of imaging results., Results: Mean age at disease onset was 10.3 ± 2.6 years. Mean duration of active disease was 44.4 ± 25.6 months. Twenty-two (71.0%) had two or more bone lesions and 9 (29.0%) had one lesion. Of those with multifocal lesions six were initially detected as monofocal. The most frequent location of the bone lesions was in the metaphysis of the lower extremities. MRI/CT discovered most lesions compared to x-ray and scintigraphy. MRI was performed in 93.5% of which 25.8 % had a whole-body-MRI. Whole-body MRI revealed disclosure of several silent lesions. Extra-osseous involvement occurred in 64.5%. In the multifocal group 22.7 % had psoriasis and 13.6 % had pustulosis palmoplantaris but neither was seen in the monofocal group. All were treated with NSAIDs; 54.8% corticosteroids, 29.1 % methotrexate, 9.7 % pamidronate and 3.2 % infliximab., Conclusions: Monofocal CNO had comparable clinical and radiological characteristics to multifocal disease. We conclude that whole-body MRI is a relevant screening instrument for the diagnosis of CNO.

A look at the wider applications of poly(vinyl chloride) and how the industry is committed to achieving a more sustainable future.

The purpose of our study was to provide descriptive data on victim and assault characteristics in sexual violence and to ascertain risk factors in the sequence of the assault events. Retrospective data were collected on all sexual assault victims presented to the sexual referral centre, the police and the Institute of Forensic Medicine in Aarhus, Denmark, during a five-year period. Four hundred and twenty-three victims were included. The annual incidence rate was 14.5 per 100,000 inhabitants aged 12-87 years and the "dark figure" was estimated to be 1.34. Median age was 21 years; 69% of the victims knew the assailant, and penile intercourse was reported in 59% of the cases. Young age and drinking alcohol were risk factors for the assault to take place in a public place. Information to high-risk groups identified by this study should be integrated in approaches of modifying sexual behaviour. Furthermore, the results from this study are useful in supporting staff and police investigators in the guidance of their efforts regarding treatment and inquiries.

A survey was done of 307 alleged victims of sexual violence reported to the police departments in Greater Aarhus, Denmark, in 1999-2004. The legal disposition was ascertained and related to victim and assault characteristics together with the forensic medical and laboratory findings. The police pressed charges in more than half of the cases and 11% turned out to be false allegations. Nineteen percent of all cases ended with sentencing of the defendant. Sperm was detected in 35% of the examined and analysed cases, and in 46% consumption of alcohol prior to the assault was reported. Information in the forensic report regarding injury documentation, intoxication, and detection of sperm and DNA match between victim and alleged assailant did not aid in the prosecution of the case. Severe coercion used by the assailant increased the likelihood of conviction. Intoxication estimation and sperm detection suffered from low sensitivity compared with laboratory analyses. Results suggest the need for new research and optimising the sexual assault examination protocol to strengthen the legal impact of forensic evidence.

Splenic injury is a rare and serious complication of colonoscopy. The most likely mechanism is tension on the splenocolic ligament and adhesions. Eight cases were identified among claims for compensation submitted to the Danish Patient Insurance Association during the period 1992-2006, seven of which were reported after 2000. The total number of colonoscopies in Denmark in 2004 was 39 067. Seven of the eight patients were aged 65 years or over. Loops causing difficulties during the colonoscopy had been reported in four patients. All the patients had a symptom-free interval after the colonoscopy, ranging from 4 hours to 7 days, before presenting with signs of splenic injury. In all cases the spleen was torn, and the amount of blood in the peritoneal cavity ranged from 1500 mL to 5000 mL. Two patients died postoperatively. The number of cases reported after 2000 indicates that this potentially lethal complication might be more common than was previously assumed, and it is possibly under-reported. Preventive measures include good colonoscopic technique to avoid loop formation and the use of excessive force; and it is possible that emerging endoscopic technologies will lead to a reduced risk of splenic injury. The information given to patients both before and after the procedure should include information on the signs of this complication, and patients should be also informed that these signs can develop after a symptom-free interval.

Introduction: No previous reports on 3-D conformal radiotherapy of Danish patients with inoperable local advanced non-small-cell lung cancer have been published., Materials and Methods: From 1995 to 2003, 158 patients with inoperable non-small-cell stage III lung cancer received radical radiotherapy in doses of 60-66 Gy in 30-33 fractions. Neoadjuvant chemotherapy was administered to 77 patients., Results: The median survival time was 15.8 months. The one, two-, three-, four-, and five-year survival rates were 61%, 35%, 23%, 19% and 17%, respectively. Gender and age had no influence on survival, while patients in performance status 2 tended to have poorer survival rate than patients in performance status 0-1. The lung function as evaluated byh FEV1 and FVC declined by 8-9% during the first year and was reduced by 9-13% after three years. The cause of death in 90% of the cases was lung cancer. In 50% of all cases, a loco-regional relapse was found, and in 41% distant metastases existed., Discussion: These results show that a significant number of stage III patients treated with modern radiotherapy with curative intent will be long-term survivors.

Objective: In 1998, the Danish Society for Head and Neck Oncology decided to conduct a nationwide survey at the five head and neck oncology centers with the aim of evaluating the surgical outcome of salvage laryngectomy after radiotherapy with special emphasis on identifying factors that could contribute to the development of pharyngocutaneous fistulae., Patients: A total of 472 consecutive patients undergoing postirradiation salvage laryngectomy in the period July 1, 1987-June 30, 1997 were recorded at the five head and neck oncology centers in Denmark. Age ranged from 36 to 84 years, median 63 years, 405 men and 67 women. Primary tumor site was glottic larynx (n = 242), supraglottic larynx (n = 149), other larynx (n = 45), pharynx (n = 27), and other (n = 9). All patients had received prior radiotherapy., Results: Median time between radiotherapy and laryngectomy was 10 months (range, 1-348 months). A total of 89 fistulae lasting at least 2 weeks were observed, corresponding to an overall average fistulae risk of 19%. The number of performed laryngectomies per year decreased linearly (from 58 to 37), whereas the annual number of fistulae increased slightly (from 7 to 11), which meant that the corresponding estimated fistulae risk increased significantly from 12% in 1987 to 30% in 1997. Other significant risk factors for fistulae in univariate analysis included younger patient age, primary advanced T and N stage, nonglottic primary site, resection of hyoid bone, high total radiation dose, and large radiation fields. Multiple logistic regression analysis of these parameters suggested that nonglottic tumor site, late laryngectomy period (1987-1992 vs 1993-1997), and advanced initial T stage were independent prognostic factors for fistulae risk. Surgical parameters like resection of thyroid/tongue base/trachea or radiotherapy parameters like overall treatment time or fractions per week did not influence fistulae risk., Conclusions: The risk of fistulae is especially high in patients initially treated with radiotherapy for nonglottic advanced stage tumors. A significant decrease in the number of performed salvage laryngectomies over the 10 years was seen. Over the same time period, the annual number of fistulae remained almost constant. The resulting more than doubling of fistulae rate could thus in part be explained by less surgical routine., (Copyright 2003 Wiley Periodicals, Inc. Head Neck 25: 711-716, 2003)

Objectives: The purpose of this study is to present the treatment results and to identify possible prognostic indicators in patients with hypopharyngeal squamous cell carcinoma (HPC)., Study Design: A consecutively admitted series of 110 patients was analyzed retrospectively. The female male ratio was 29: 81. The sites of the tumors were: pyriform fossa (72%), postcricoid area (18%), and posterior pharyngeal wall (10%). T-status was T1: 15%, T2: 26%, T3: 28%, and T4: 37%. N-status was N0: 27%, N1: 33%, N2: 26%, and N3: 14%., Methods: One hundred three patients (94%) were treated with curative intent. Two of these received primary surgery; the remaining 101 patients had primary radiotherapy. Seven patients (6%) received no or only palliative treatment., Results: The 5- and 10-year estimates for crude survival (CS) were 16% and 7% and disease-specific survival (DSS) 28% and 23%, respectively. In the group of patients treated with curatively intended radiotherapy, 71 recurrences were observed at the time of analysis. The 5- and 10-year RFS estimates were both 17%. The values for CS were 18% and 8% and the values for DSS were 31% and 26%, respectively. Univariate survival analyses of age, sex, T-status, N-status, and TNM staging did not show any significant influence on survival., Conclusions: We conclude that the survival of patients with HPC treated with primary radiotherapy and salvage surgery is poor and that other treatment modalities have to be considered.

Objectives: To assess the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in detecting common bile duct stones in the preoperative investigation of patients electively referred for gallstone disease, to find out the incidence of asymptomatic common duct stones, and to correlate clinical symptoms and history and liver function tests (LFT) with the actual occurrence of common duct stones., Design: Prospective study., Setting: General hospital, Denmark., Patients: 180 consecutive non-jaundiced patients referred with symptomatic gallstones for elective cholecystectomy., Interventions: LFT, abdominal ultrasonography, MRCP, endoscopic retrograde cholangiopancreatography (ERCP), questionnaire., Main Outcome Measures: Positive and negative predictive values and accuracy of MRCP, number of patients with asymptomatic stones, and correlation of symptoms with the presence of stones., Results: 26/180 patients had common duct stones (14%). Only one (<1%) had an asymptomatic stone. For detection of such stones, MRCP's positive predictive value was 0.95 (95% confidence interval (CI): 0.86 to 1.00), negative predictive value 0.96 (0.93 to 0.99), and accuracy 0.85 (0.93 to 0.99). MRCP missed 5 stones 1-4 mm in size in 5 patients; 17/64 patients with raised LFTs had stones (27%). The probability of stones was highest when the patients had both raised LFTs and a dilated common (>7 mm) bile duct (82%). There were no readmissions with ductal stones in the 6-month postoperative period., Conclusions: The predicive values of MRCP were fairly good, but MRCP misses some small stones <5 mm in size. Asymptomatic stones in the common duct are not common in this population and should not be screened for. The probability of stones increases with the number of predictive factors. Patients should be questioned carefully about signs of biliary obstruction, and only be offered preoperative MRCP should they have a suspicious history, raised LFTs, or a dilated common duct.

Surgery for congenital heart defects has since its beginnings fifty years ago evolved from being palliative to corrective in many cases. Surgery for the more simple defects is now performed with low surgical mortality and excellent prognoses, but the mortality for some of the more complex defects is still high, and the treatment regarded as palliative. The principles for and the results of the surgical treatment of some more complex defects are reviewed. The importance of follow-up is emphasized. Future possibilities are discussed.

Aim: To observe the natural course of gastro-oesophageal reflux disease (GERD) in patients without oesophagitis following effective symptom relief, and to determine the place of acid pump inhibitor therapy in the long-term management of these patients., Methods: We investigated the efficacy of on-demand therapy with omeprazole 20 mg or 10 mg, or placebo in a double-blind, randomized multicentre trial. It involved 424 patients with troublesome heartburn without endoscopic evidence of oesophagitis in whom heartburn had been resolved with short-term treatment. Patients were told to take study medication on demand once daily on recurrence of symptoms until symptoms resolved over a 6-month period. They also had access to antacids. The primary efficacy variable was time to discontinuation of treatment, due to unwillingness to continue., Results: According to life-table analysis, after 6 months the remission rates were 83% (95% CI: 77-89%) with omeprazole 20 mg, 69% (61-77%) with omeprazole 10 mg, and 56% (46-64%) with placebo (P < 0.01 for all intergroup differences). The mean (s.d.) number of study medications used per day in these groups was 0.43 (0.27), 0.41 (0.27) and 0.47 (0.27), respectively. The use of antacids was highest in the placebo group and lowest in the omeprazole 20 mg group. Treatment failure was associated with more than a doubling of antacid use, and a deterioration in patient quality of life., Conclusions: Approximately 50% of patients with heartburn who do not have oesophagitis need acid inhibitory therapy in addition to antacid medication to maintain a normal quality of life. On-demand therapy with omeprazole 20 mg, is an effective treatment strategy in these patients.

Two cases of occupational accidents and post-traumatic stress disorder (PTSD) of various types are described. These accidents occurred in different occupations and encompass dramatic, life-threatening situations. The cases were compatible with a diagnosis of chronic PTSD. In both cases compensation for occupational injury was awarded on the basis of a PTSD diagnosis.

This study focuses on post-traumatic stress disorder in a follow up one to two years after the occupational accident. The aim was to estimate the prevalence of PTSD, changes in general health status and issues of compensation. The material was all serious accidents registered in the Danish National Register of Work Accidents during 1991. Seriousness was defined by type of injury, including all cases of amputations, bone fractures and extensive body lesions. Of 4745 possible, 3663 persons (77%) participated in a questionnaire study. The prevalence fulfilling the complete set of criteria of posttraumatic stress disorder as a chronic state was 2.8% (102 persons), of whom half had been given compensation. Among the most severe accidents the prevalence was 7.6%. In conclusion, in a large cohort of persons with moderate and severe occupational injuries this study demonstrated that post-traumatic stress disorder and lasting psychological distress should be a matter for concern in addition to the physical injury.

In a prospective study, 99 consecutive patients with an operative indication due to severe aortic stenosis (AS) were put on a surgical waiting list. The waiting time to aortic valve replacement (AVR) averaged 6.3 months (0.5-19 months). There were 58 men and 41 women with a mean age of 61 years (21-82 years). The patients were divided into three groups: group 1 (N = 81) with an uneventful stay on the waiting list; group 2 (N = 11) with significant worsening of a prognostic index; and group 3 (N = 7) with patients who died during the waiting time. The waiting list death rate was 13.5%/patient-year compared with a post-AVR death rate of 4.9% patient-year (p < 0.05) with a mean post-AVR follow-up of 5.7 years. According to a prognostic index (Cox regression model) at inclusion, group 2 patients had a predicted 7-year post-AVR survival probability of 72%, but only of 61% according to their prognostic index immediately preoperatively; their observed 7-year post-AVR survival was 60%. Logistic regression analysis identified high age, short duration of symptoms, signs of severe hypertrophy and strain in the ECG, female gender, and deranged left ventricular diastolic function (related to severely increased left ventricular muscle mass) as independent predictors of prognostic worsening and death while on the waiting list. The predictive models did not allow sufficiently accurate identification of the patients at risk during the waiting period. The consequences of a surgical waiting period averaging 6 months are serious for AS patients. The death rate is high and a subgroup worsens its prognostic profile with a significantly reduced post-AVR long-term survival as the result.

Poly(vinyl chloride) (PVC) continually arouses debate, but it remains the most widely used polymer in the industry. Important decisions about the use of materials should be based on scientific fact. This article provides the latest data on the use of PVC and describes how Denmark, the most environmentally radical country in Europe, is handling the issues.

Background: The risk of bile duct injury in laparoscopic cholecystectomy has been a concern since the procedure became part of the surgical armamentarium. Our study assesses the incidence, types, and treatment for laparoscopic bile duct injury., Study Design: Prospective case registration in a national database with participation by all departments of surgery performing laparoscopic cholecystectomy in Denmark since the first operation in January 1991. The case notes for bile duct injury have been reviewed., Results: From 1991 through 1994, 57 of 7,654 patients sustained bile duct injury (0.74 percent; 95 percent confidence interval, 0.55 percent to 0.94 percent), including nine injuries occurring after conversion. The annual incidence did not decrease. Thirty-nine percent of the laparoscopic bile duct injuries were incisions, 39 percent were transections, and 12 percent were clip injuries or strictures. One patient, who sustained transection during open reoperation for bleeding after a converted procedure, died. Bile leaks for reasons other than bile duct injury occurred in 2.1 percent; 71 percent of these were cystic duct leaks. Acute cholecystitis was the indication for laparoscopic cholecystectomy in 968 patients, with 1.3 percent sustaining laparoscopic bile duct injury (95 percent confidence interval, 0.62 percent to 2.08 percent), while the incidence in patients with other indications for laparoscopic cholecystectomy was 0.62 percent (95 percent confidence interval, 0.44 percent to 0.82 percent) (p > 0.05). Preoperative knowledge of bile duct anatomy was available by means of preoperative endoscopic retrograde cholangiopancreatography or intravenous cholangiography in 26 percent of patients undergoing laparoscopic cholecystectomy but this did not reduce the risk of bile duct injury. The frequency of bile duct injury in patients who had intraoperative cholangiography was not significantly different from those who did not. Intraoperative cholangiography was done in 14 cases of injury (diagnostic for injury in 8, misinterpreted in 2, and normal in 4 patients). The case notes described operative difficulties in 11 of 48 cases of laparoscopic bile duct injury, most often because of fibrosis or difficulty delineating the anatomy., Conclusions: The incidence of bile duct injury in laparoscopic cholecystectomy is higher than previously generally anticipated and did not decrease from 1991 through 1994. Risk factors and possible preventive measures should be evaluated in prospective studies.

In order to analyse changes in the pattern of primary treatment of breast cancer after introduction of mammography screening in the Copenhagen municipal area every second year, retrospective analyses of data from the Danish Breast Cancer Cooperative Group were performed. Newly diagnosed patients with breast cancer of the age of 50-69 years from the Copenhagen municipal area (1040 patients) were compared to a similar group of patients from the rest of Denmark (7353 patients). Parameters such as tumour size, lymph node status, grade of anaplasia, frequency of breast preserving surgery and adjuvant treatment were analysed. Introduction of mammography screening resulted in almost a doubling of newly diagnosed patients with invasive breast cancer during the prevalence phase, and a significant increase in the number of patients with tumour size < or = 1 cm without metastases to the axillary nodes. The frequency of breast preserving surgery increased from 5 to 45% in the municipality of Copenhagen compared to 6 to 19% in the rest of the country. Ratio between low-risk versus high-risk patients increased from 1.0 before screening to 2.7 in the following prevalence phase and 2.5 in the first year of the subsequent incidence phase, while the ratio in the rest of Denmark was the same throughout the whole study period. It can be concluded that the introduction of mammography screening resulted in significant changes in the treatment pattern of patients with primary breast cancer.

Laparoscopic cholecystectomy (LC) was introduced in Denmark in 1991, and a prospective case register was established. All departments performing LC agreed to participate. In 1991-1992, 2,415 patients underwent LC in 44 departments. The median number of procedures was 32 (interquartile range 18-58, range 1-370), performed by a median of four surgeons per department (3-5, 1-23). Two hundred and forty-two patients (10%) had acute cholecystitis. Eighteen point five percent had had an ERCP performed prior to LC. The rate of conversion to open operation was 10.5%, occurring significantly more often in acute cholecystitis (25.6%) than in patients with other indications (8.8%) (p < 0.001). Intraoperative cholangiography was used in 22.4%. The median duration of LC was 90 minutes (70-120, 25-415). The postoperative course was without complications in 90.4%. Laparotomy for complications was necessary in 43 patients (2.0%), mainly because of bile leaks. Twelve patients (0.6%) were treated endoscopically for complications. Bile duct injury occurred in 16 patients (0.66%, 95% CI 0.34-0.99%), including three transsections, one stricture, and 12 minor injuries. Six patients (0.25%, 95% CI 0-0.45%), three of whom had procedure-related complications, died postoperatively. All were > or = 72 years of age. Median time to discharge was two days, while median time to resumed work/normal activity was eight days. A comparison with the number of LC registered in the National Patient Register indicates that reporting is complete.

The aim of the study was to investigate the time spent on different procedures in an orthopaedic operating theatre, and to evaluate the ability of doctors to predict their own time consumption. Time schedules were registered for 146 operations, of these 104 were either knee or hip replacements. Sixty percent of the total time was spent on surgery. The median misjudgment was 15 minutes for surgeons and five minutes for anaesthetists. An improvement in the doctors' ability to predict their own time consumption in the course of the study period could not be demonstrated. Comparing the study period with the similar period the year before it was not possible to demonstrate a change in the number of cancelled operations or the number of days with overtime. Epidural anaesthesia with bupivacaine was the most time consuming anaesthesia, the differences between the other forms of anaesthesia used were insignificant.

We present the social and medical history of a Danish war sailor in the merchant navy during the 2nd World War. He was exposed to severe sustained mental stress without a simultaneous physical stress. After about 60 hospital admissions to the hospital he was diagnosed as having a full-blown war sailor syndrome, equivalent to the DSM-III diagnosis of post-traumatic stress disorder.

A cohort of children who attended first grade in 1983 was identified in a Danish community with low-level lead pollution. Two groups with high and low postnatal lead exposure were generated on the basis of the dentin-lead concentration in shed deciduous incisors. At age 8 years, examination of 162 children matched according to gender and socioeconomic status had shown lead-related deficits in verbal intelligence and visuomotor coordination. Re-examination was now carried out in 141 children at age 15 years using the Wechsler Intelligence Scale for Children (WISC), Bender Visual Motor Gestalt, Trail Making, and Visual Gestalts. In general, no lead-related effects could be detected in the group. However, in children with a history of neonatal jaundice, increased lead exposure was associated with mild neurobehavioral deficits, as indicated by lower verbal IQ scores and decreased visuomotor coordination. This finding suggested that moderate neonatal hyperbilirubinemia may have precipitated an increased sensitivity to subsequent exposure to lead.

In a retrospective survey, the epidemiological characteristics of nursing sickness in Standard Black and Pastel mink (Mustela vison) were examined in a Danish fur research farm. Based on the clinical diagnosis of the disease, the overall morbidity in a total of 1774 lactating females amounted to 14.4% and the case fatality rate to 7.8%. Apparently healthy females weaned an average of 5.0 kits per litter, while dams suffering from nursing sickness raised and weaned an average of 5.4 kits per litter (p less than 0.01). Based on logistic regression analysis, the increasing age of the lactating dam, followed by littersize and female weight loss, appeared to be major determinants for the development of nursing sickness. The impact of additional covariates such as litter weight gain and female color type were remarkably low. At weaning (day 43) the mean individual live weight of the kits of either sex did not differ between healthy and sick dams. In Standard Black, the total biomass of the offspring raised by sick dams was significantly larger than that of the healthy controls (p less than 0.01). During the final two weeks of lactation, apparently healthy dams lost on average 14% of their body mass, whereas those affected by nursing sickness had a mean weight loss of about 31% (p less than 0.001). Postmortem examination of 25 dams with severe nursing sickness verified the clinical findings of progressive dehydration and emaciation. The gastrointestinal tract was empty and gastric ulcers and melaena were frequently present. Other common findings included small livers,enlarged adrenals and pitted kidneys.(ABSTRACT TRUNCATED AT 250 WORDS)

Serious problems emerge when evaluating evidence on lead neurotoxicity in children. The extent of these problems and ways to control them were explored in a study of 1291 children from the first class in the schools of Aarhus municipality, Denmark. The lead retention in circumpulpal dentin in shed deciduous teeth was used as an indicator of cumulated lead exposure; it correlated most strongly with traffic density at the residence of each family and at the day-care institutions. In a nested case-control group selected on the basis of dentin lead concentrations, 29 of 200 children had encountered obstetrical complications and other medical risks for neurobehavioral dysfunction; these children primarily belonged to the low-lead group. As lead-related neurobehavioral effects are nonspecific, inclusion of these children in the data analysis would therefore have distorted the results toward the null hypothesis. Children from the high-lead group who had experienced neonatal jaundice showed impaired performance when compared to other high-lead children; this finding may suggest a synergistic effect. The Bender gestalt test scored by the Göttingen system was the test that was most sensitive to lead exposure. The conclusion that neurobehavioral effects can be caused by the relatively low lead exposures in Denmark may not be surprising, as current exposures to this toxic metal greatly exceed the prepollution levels to which the human body originally adapted.

A regimen of aclarubicin (ACR) of 75 mg/m2 daily for 3 days plus a continuous intravenous infusion of cytosine arabinoside (ara-C) of 100 mg/m2 per day for 7 days was compared with daunorubicin (DNR) 45 mg/m2/day for 3 days plus ara-C for 7 days as first-line chemotherapy of de novo acute myeloid leukemia (AML) in a randomized, nationwide Danish study. A total of 180 patients aged between 17 and 65 years were entered onto the protocol. Patients who achieved complete remission (CR) were given five courses of intensive consolidation therapy consisting of two courses of high dose ara-C, two courses of amsacrine plus etoposide, and one course of DNR plus ara-C. Of 174 evaluable patients, 99 achieved CR. The rate of CR was significantly higher on ACR plus ara-C than on DNR plus ara-C [66% versus 50% (p = 0.043)] and decreased significantly with increasing age. The hematological toxicity was identical for the two regimens. A total of 83 patients entered consolidation therapy. At 4 years, 37% of patients with CR following ACR were still in remission compared with 33% following DNR (p = 0.48), and the total survival at 4 years was 29% versus 20% (p = 0.26). The duration of remission and total survival both decreased with increasing age. ACR plus ara-C seem at least as good or better than DNR plus ara-C as first-line chemotherapy of AML.