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Forskningens

Forskningens dag

Forskningens dag Forskningens

dag

Forskningens dag

Forskningens dag den 11. maj 2011

Abstracts

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Program

12.00 - 12.10 Velkomsttale 12.10 - 13.00 Foredragssession I

13.00 - 13.20 Pause med mulighed for at se posters 13.20 - 14.10 Foredragssession II

14.10 - 14.25 Gæstetaler: Dekan, professor, overlæge, dr.med. Allan Flyvbjerg, Det Sundhedsvidenskabelige Fakul- tet, Aarhus Universitet: “Forskningssamarbejde mellem regionshospitalerne og Aarhus Universitet”

14.25 - 14.40 Præsentation af forskningspublikation for 2010 14.40 - 15.00 Præmieoverrækkelse og afslutning

Session I. 12.10 – 13.00

1. Marie Dahl Thomsen m.fl. Karkirurgisk forskningssektion, Regionshospitalet Viborg.

Initiale resultater af den forebyggende kredsløbsundersøgelse af 65-74-årige mænd i Region Midtjylland (VIVA).

2. Erland Erlandsen m.fl. Klinisk biokemisk afdeling, Regionshospitalet Viborg.

Erythropoietic protoporphyria in Denmark: Demographic, biochemical and genetic characteristics.

3. Henning Nielsen m.fl. Urologisk afsnit, Regionshospitalet Viborg.

Laparoskopisk assisteret kryo-ablation af maligne nyretumorer: Komplikationer og onkologiske resultater efter 6 år.

4. Vibeke Lorentzen m.fl. Center for Sygeplejeforskning - Viborg.

Mænds og kvinders oplevelser og reaktioner i forbindelse med diagnosen akut koronart syndrom.

5. Berit S. Hedegaard m.fl. Hjertemedicinsk forskningskontor, Regionshospitalet Viborg.

En svær pille at sluge …

Moderator: Professor, overlæge Lars Jelstrup Petersen

Session II. 13.20 – 14.10

1. Lars Lund m.fl. Urologisk afsnit, Regionshospitalet Viborg.

Survival of invasive bladder cancer patients, 1998-2009. A Danish population-based cohort study.

2. Nikolaj Grøndal m.fl. Karkirurgisk afdeling, Regionshospitalet Viborg.

The Scandinavian Propaten® trial – one year patency of PTFE vascular prostheses with heparin-bonded luminal surfaces compared to ordinary pure PTFE vascular prostheses – a randomised clinical controlled multi-centre trial.

3. Camilla Biering Lundquist. Fysioterapien, Regionshospitalet Viborg, Skive.

Effekten af Bobath behandling og sensorisk stimulering til arm og hånd hos apopleksipatienter.

4. Peter Agergaard m.fl. Børneafdelingen, Regionshospitalet Viborg.

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Foredrag på “Forskningens dag”

SeSSIon I:

Initiale resultater af den forebyggende kredsløbsundersøgelse af

65-74-årige mænd i Region Midtjylland (VIVA) ...6

Erythropoietic protoporphyria in Denmark: Demographic, biochemical and genetic characteristics ...7

Laparoskopisk assisteret kryo-ablation af maligne nyretumorer: Komplikationer og onkologiske resultater efter 6 år ...8

Mænds og kvinders oplevelser og reaktioner i forbindelse med diagnosen akut koronart syndrom ...9

En svær pille at sluge … ...10

SeSSIon II:

Survival of invasive bladder cancer patients, 1998-2009. A Danish population-based cohort study ...11

The Scandinavian Propaten® trial – one year patency of PTFE vascular prostheses with heparin-bonded luminal surfaces compared to ordinary pure PTFE vascular prostheses – a randomised clinical controlled multi-centre trial ...12

Effekten af Bobath behandling og sensorisk stimulering til arm og hånd hos apopleksipatienter ...13

Chromosome 22q11.2 deletions in children with congenital cardiac malformations. A population-based study ...14

Laparoskopisk assisteret kryo-ablation af pancreas tumorer i en dyremodel ...15

Øvrige indleverede abstracts til “Forskningens dag”

1. Association of ACE-inhibitor and statin treatment with small abdominal aortic aneurism progression ...16

2. Målsætnings- og motivationsarbejde inden for rehabilitering – specielt med fokus på apopleksi ...17

3. Epidemiological study of the Danish Acute Intermittent Porphyria population...18

4. Diet and risk of inflammatory bowel disease ...19

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9. Videocasebaseret undervisning: Vil det gavne patienterne? ...24

10. Hvor tit er “Obs Akut Koronart Syndrom” egentlig en hjertesygdom? ...25

11. Arthroscopy as an aid in treating tibial plateau fractures ...26

12. Oxidative Stress Is Involved in the Natural History of AAA: A Proteomic View ...27

13. Actinobaculum schaalii, an overlooked uropathogen in children ...28

14. Age- and sex-related differences in use of recommended combination of secondary medical prevention after vascular surgery: A nationwide follow-up study ...29

15. Does Tc99m-mebrofenin get metabolised in the intestines? ...30

16. Actinobaculum schaalii in urological patients, screened with real-time PCR ...31

17. Multidrug resistance protein 2 (MRP2) polymorphisms and risk of inflammatory bowel disease in relation to smoking ...32

18. Kan genetiske markører forudsige behandlingsresultatet hos patienter behandlet med TNF-hæmmere? ...33

19. Spontant sublingualt hæmatom som komplikation til peroral antikoagulationsbehandling ...34

20. Insulin-like growth factor I. A novel biomarker of abdominal aortic aneurysms ...35

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Foredrag på “Forskningens dag”

SeSSIon I

Initiale resultater af den forebyggende kredsløbsundersøgelse af 65-74-årige mænd i Region Midtjylland (VIVA)

Marie Dahl Thomsen (projektsygeplejerske), Nikolaj Grøndal, Anne Mette Saugmann, Winnie Lorentzen, Eskild W. Hen- neberg, Jes S. Lindholt

Karkirurgisk forskningssektion, Regionshospitalet Viborg

Baggrund: I 2008 startede en randomiseret forebyggende undersøgelse af alle 65-74-årige mænd i Region Midtjylland for abdominalt aortaaneurisme (AAA), perifer åreforkalkning (PAD) og ikke-erkendt hypertension.

Formål: At beskrive de initiale resultater af risikofaktorer, interesse, sygdomshyppighed og eksisterende forebyggelse i regionen, samlet og opdelt efter den nye, tredelte organisering af sygehusene i Region Midtjylland.

Metode: Ved randomisering stratificeret for kommune blev halvdelen af målgruppen inviteret til undersøgelse på de- res lokale hospital. Invitationen var vedhæftet et spørgeskema vedr. helbred og livskvalitet. Ud fra sygehusenes pri- mære optageområde defineredes tre områder: Område Øst, område Midt og område Vest.

Resultater: 50.313 blev randomiseret, hvoraf 25.098 blev inviteret, hvoraf 18.566 (74%) tog imod tilbuddet; 69% i Øst, 79% i Midt og 80% i Vest (P<0.001).

Hyppigheden af AAA var 3,2%; 3,4% i Øst, 3,2% i Midt og 2,9% i Vest* (P=0.164).

Hyppigheden af PAD var 10,5%; 10,1% i Øst, 13,2% i Midt og 9,1% i Vest* (P<0.001).

Hyppigheden af potentielt ikke-erkendt hypertension var 10,5%; 9,7% i Øst, 11,2% i Midt og 11,3% i Vest (P<0.001).

Vedr. rygning var 21% aktive rygere; 20,6% i Øst, 21,9% i Midt og 21,0% i Vest (P=0.026).

Hypertension var erkendt hos 42,5%; 43,3% i Øst, 41,9% i Midt og 41,2% i Vest (P=0.043).

Diabetes var erkendt hos 10,9%; 10,8% i Øst, 10,1% i Midt og 11,6% i Vest (P=0.0080).

Statin-behandling var opstartet hos 35,5%; 36,3% i Øst, 36,3% i Midt og 33,5% i Vest (P=0.002).

Endvidere fandtes stor forskel i de undersøgte parametre mellem Århus Kommune og øvrige kommuner i det østlige område.

Diskussion og konklusion: Der er størst interesse for et tilbud om forebyggende kredsløbsundersøgelse i den midt- og vestlige del af regionen, hvilket dog kan skyldes, at forsøget udgår fra Viborg. Modsat har Midt-Vest en højere hyppig- hed af rygere og lavere forekomst af erkendt hypertension, hvilket må formodes at være pga. manglende diagnose. I overensstemmelse hermed er andelen af positive fund højere i midten af regionen*.

*: Resultaterne vil blive valideret, da der er kendskab til ikke-registrerede positive tilfælde i Vest.

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erythropoietic protoporphyria in Denmark: Demographic, biochemical and genetic characteristics

Erlandsen EJ1, Østergaard M1, Brusgaard K2, Mortensen PR1, Skovmose MS1, Brock A1

1Department of Clinical Biochemistry, Viborg Regional Hospital, Viborg, Denmark

2Department of Clinical Genetics, Odense University Hospital, Odense, Denmark

Introduction: The porphyrias is a group of diseases caused by a defective heme biosynthesis. In erythropoietic pro- toporphyria (EPP), which is an inherited cutaneous porphyria the combination of the IVS3-48T>C polymorphism (low activity allele) and a mutation in the opposite allele of the ferrochelatase gene (FECH) leads to a partial deficiency in enzyme activity. The resulting accumulation of protoporphyrin IX (PPIX) in erythrocytes, skin and liver leads to acute photosensitivity. The aim of the study was to investigate the demographic, biochemical and genetic features of Danish EPP patients.

Materials and methods: Biochemical test results for erythrocyte PPIX and Zn-protoporphyrin IX (Zn-PPIX) from the period 2000-2010 was reviewed together with FECH mutation status when available. Erythrocyte PPIX and Zn-PPIX were analysed by HPLC. Molecular genetic analysis of FECH was performed by sequencing analysis.

Results: Fifty-six patients were diagnosed with EPP based on increased PPIX (PPIX > 4 µmol/L, reference interval 0.0- 0.5 µmol/L). At the end of 2010 53 patients (26 men and 27 women aged 7.0-80.1 and 9.4-73.5 years, respectively) were still alive (2 women aged 86 and 90 years, and one man aged 86 years had died). The total number of samples was 608, ranging from 1-33 (mean 10.9) in individual patients. The PPIX and Zn-PPIX concentrations varied between 4.7-408.6, and 0.8-21.5 µmol/L (reference interval 0.0-1.5), respectively. DNA analysis was performed in 26 patients. All carried the FECH low activity allele. In 15 patients a FECH mutation was observed. In three patients the genetic variant (IVS1- 23C>T) was identified. In eight patients no mutation was identified.

Conclusion: The prevalence of EPP at the end of year 2010 was 1:103,774 in the Danish population (5.5 mill. inha- bitants). The prevalence differed between the five regions, ranging from 1:623,866 in Central Denmark Region to 1:

57,320 in the Capital Region of Denmark.

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Laparoskopisk assisteret kryo-ablation af maligne nyretumorer: Komplikationer og onkologiske resul- tater efter 6 år

Nielsen H, Pedersen SL, Barsi T, Jønler M og Lund L Urologisk afdeling, Regionshospitalet Viborg

Formål: At beskrive komplikationer og recidiv efter alle kryo-ablative procedurer for maligne nyretumorer.

Materialer og metoder: I alt 59 patienter (43 mænd, 16 kvinder) blev laparoskopisk assisteret kryo-behandlet i en seks- årig periode. Positionering af kryo-nåle og frysning af tumorer blev overvåget peroperativt ved laparoskopisk ultralyd.

Ablation blev betragtet som en succes, når tumorer ved efterfølgende kontrol ikke viste opladning i tumor vurderet ved CT- eller MR-scanning. Alle patienter fik præ- og postoperativt foretaget renografi og GFR-måling.

Resultater: Alle tumorer blev præoperativt biopsi-verificeret værende maligne. Gennemsnitlig tumor størrelse var 3,4 cm (2,0-6,5 cm). Gennemsnitsalder var 67 år (spændvidde 29-87 år). Kryo-terapi var mulig hos alle patienter. Ingen patienter havde behov for blodtransfusion. Der var ingen peroperative komplikationer. Én patient fik postoperativt et myokardieinfarkt. En patient udviklede hydronefrosis, muligvis på grund af fryseskade på den uretero-pelvine over- gang. Perioperative mortalitet (30 dage) var 0 %. Den gennemsnitlige follow-up tid var 39 måneder (spændvidde 2-60 måneder). Fem patienter (8,5 %) fik biopsi-verificeret recidiv, hvoraf fire blev re-ableret og en nefrectomeret. Tre pa- tienter har udviklet dissemineret sygdom og er blevet behandlet på onkologisk afdeling. Den ene af disse patienter blev efterfølgende hemi-nefrectomeret.

Konklusion: Denne seksårs-opfølgning viste, at kryo-ablation er nefron-besparende og en effektiv onkologisk behand- ling af nyrekræft i udvalgte tilfælde med få komplikationer. Langtids follow-up data er nødvendige. En national eller europæisk database anbefales.

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Mænds og kvinders oplevelser og reaktioner i forbindelse med diagnosen akut koronart syndrom

Lorentzen, V. og Larsen, B.H.

Center for Sygeplejeforskning – Viborg

Undersøgelsen: I denne præsentation sammenholdes mænds og kvinders oplevelser og reaktioner i forbindelse med diagnosen akut koronart syndrom (AKS) som et delelement af undersøgelsen Men and women with acute coronary syndrome. The experienced cause of hospitalisation, udført af CSF-V ved Regionshospitalet Viborg, Skive i perioden 12.11.07 til 14.11.09. Baggrunden for dette projekt var, at kvinder debuterer 10 år senere med hjerteproblemer end mænd, og at megen forskning om hjertesygdomme som følge heraf ikke tidligere havde inkluderet kvinder. Da store forskelle på mænds og kvinders symptomer og indlæggelsesforløb i forbindelse med AKS blev kendt, resulterede det i fokusering på kvinder, og studier, der inkluderede både mænd og kvinder med specifik fokus på køn, blev således næ- sten fraværende.

Formål: At belyse oplevelser og reaktioner, mænd og kvinder udviser efter symptomdebut på AKS indtil 48 – 72 timer efter hospitalsindlæggelse i den hensigt at identificere og sammenligne forskelle og ligheder i de deltagende kvinders og mænds opfattelser, oplevelser og reaktioner. Forskelle og ligheder, som kan have betydning i forhold til plejeperso- nalets møde, pleje og rehabilitering af disse patienter.

Metode: 15 mænd og 15 kvinder indlagt med AKS blev inviteret til at deltage. Inklusionskriterier: Deltagerne skulle være mellem 40-75 år, ikke tidligere have været indlagt med AKS, skulle kunne forstå og tale dansk og være fysisk og mentalt i stand til at indgå i et struktureret interview udført af sygeplejerske med specialekendskab. Deltagerne blev rekrutteret fortløbende.

Resultater: Bliver præsenteret ud fra tre omdrejningspunkter.

Før indlæggelse:

- Negligering af symptom

- Forekomsten af en mediatorfunktion, dvs. en mægler eller mellemmand, der afgør, at situationen er så alvorlig, at der skal skrides til handling.

Efter indlæggelse:

- Kvinder tænker nutid og mænd tænker fremtid.

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en svær pille at sluge …

Projektsygeplejerske Berit S. Hedegaard

Hjertemedicinsk forskning, Regionshospitalet Viborg

Investigator: Overlæge, dr.med. Ib Chr. Klausen. Medicinsk afd., Regionshospitalet Viborg

Formål: At synliggøre metoden til fastholdelse af patienter i den lipidmodificerende behandling: Nikotinsyre.

Nikotinsyre kan være en vanskelig pille at sluge, da den både er stor og har bivirkninger i form af forbigående hedestig- ninger samt rødme i huden ved påbegyndelse af behandlingen.

Hjertemedicinsk forskningsenhed deltager i en verdensomspændende undersøgelse HPS2-THRIVE, der netop har ni- kotinsyre som behandlingstiltag. Nikotinsyre øger det gode kolesterol HDL og sænker triglycerid i blodet.

HPS2-THRIVE undersøgelsen er initieret af Oxford Universitet.

Formål med HPS2-THRIVE: At forebygge nye kardiovaskulære hændelser ved at øge HDL kolesterol med nikotinsyre og intensivere den LDL-sænkende behandling.

Antal deltagere: 25.000 patienter med kardiovaskulære hændelser heraf 1863 patienter i Danmark og 105 i Viborg.

Retention er en af de største udfordringer.

Viborg ligger på en delt tredjeplads i forhold til fastholdelse af patienterne i behandlingen.

Metode:

Sygeplejerskens rolle:

- Viden om dyslipidæmi

- Viden om præperatet og muligheder for at tilpasse behandlingen til den enkelte - Indsigt i psykologi og adfærdsteorier inden for lærings- og forandringsprocesser - Anvende pædagogiske redskaber som pjecer og tegninger

- Udvise interesse for hele personen - Udvise ro og tid til den enkelte

- Lade patienten komme ind til aftalt tid. Undgå ventetider

- Lytte til patienten og anerkende de symptomer, patienten måtte opleve

- Give konkrete råd, der passer til den enkeltes arbejdstider, sovevaner, spisetider etc.

- Videregive ny viden omkring behandlingen

- Følge med i pressen i forhold til debat om den kolesterolsænkende bahandling Motivation hos patienten:

- At erkende sygdom

- At anerkende viden om forebyggende tiltag - At se blodprøvetallene flytte sig

- At være tilknyttet én sygeplejerske, der kan kontaktes telefonisk på alle hverdage - At have tilknytning til samme overlæge i hele forløbet

- Planlagt sygeplejekontakt til patienten efter fire og otte uger ved opstart – derefter hver sjette måned ved blodprø- vetagning

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Survival of invasive bladder cancer patients, 1998-2009. A Danish population-based cohort study

Lund L1,2, Erichsen R1, Nørgaard M1, Larsen EH3, Borre M4, Jacobsen J1

1Department of Clinical Epidemiology, Aarhus University Hospital, 2Department of Urology, Viborg Regional Hospital,

3Department of Urology, Aarhus University Hospital, Aalborg, and 4Department of Urology, Aarhus University Hospital, Skejby, Denmark

objective: Invasive bladder cancer (IBC) is a common urological malignancy accounting for 4-5 % of all cancers in Den- mark. Our aim was to examine possible changes in short- and long-term survival of patients with IBC during 1998 to 2009.

Study design and setting: Data on all patients (N= 4,032) with an incident diagnosis of IBC within a population of 1.8 million were retrieved from the Danish National Registry of Patients from 1998 to 2009. We computed survival after 1, 3 and 5 years stratified by age and gender, and estimated mortality rate ratios (MRR) using Cox proportional hazard regression to compare mortality over time controlling for age and gender.

Results: During the study period the annual numbers of incident IBC patients remained stable. The median age was 74 years in each of the four 3-years periods in the study. The survival was relatively stable during the first three peri- ods whilst data from the last period showed modest improvement. The overall 1-year survival increased from 68% in 1998-2000 to 70% in 2007-2009, corresponding to an age and gender adjusted MRR of 0.89 (95% confidence interval (CI):0.76-1.03). The 3- and 5-year survival is predicted to increase from 44% to 49% and 35% to 40% respectively. This corresponded to a 3-year age and gender adjusted MRR of 0.87 (95% CI: 0.77-0.98) and a 5-year MRR of 0.88 (95% CI:

0.79-0.99). The 1-, 3- and 5-year overall survival increased for each gender in all age groups (< 70 years, 70-79 years, ≥ 80 years) except in women less than 70 years of age.

Conclusion: Survival in patients with IBC in central and northern Denmark showed a modest improvement in the most recent years.

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The Scandinavian Propaten® trial – one year patency of PTFe vascular prostheses with heparin-bonded luminal surfaces compared to ordinary pure PTFe vascular prostheses – a randomised clinical controlled multi-centre trial

Grøndal N(1), Gottschalksen B(2), Johannesen N(3), Dueholm D(4), Ravn H(5), Christensen ED(6), Viddal B(7), Flørenes T(8), Pedersen G(9), Christensen M(10), Carstensen M(11), Fasting H(1), Lindholt JS(1)

Institutions

1Vascular Research Unit, Viborg Regional Hospital, Denmark

2Department of Vascular Surgery, Slagelse Hospital, Denmark

3Department of Vascular Surgery, Aalborg Hospital, University Hospital of Aarhus, Denmark

4Department of Vascular Surgery, Kolding Hospital, Denmark

5Department of Vascular Surgery, Eksjö District Hospital, Sweden

6Department of Vascular Surgery, Aabenraa Hospital, Denmark

7Department of Vascular Surgery, Stavanger University Hospital , Norway

8Department of Vascular Surgery, Oslo University Hospital, Aker, Norway

9Department of Vascular Surgery, Haukeland University Hospital, Norway

10Department of Vascular Surgery, Gentofte Hospital, Denmark

11Department of Vascular Surgery, Rigshospitalet, Denmark

Baggrund: Neointimal hyperplasi forårsager en relativt høj hyppighed af graftokklusion inden for det første år. Dyre- forsøg har vist, at heparin reducerer neointimal hyperplasidannelse ved karskade.

Formål: At sammenholde et års patency for luminalt heparin-beklædte Propaten® bypassgrafter med standard polyte- traflourethylene (PTFE) grafter i et randomiseret multicenter studie.

Materiale og metoder: Elleve skandinaviske karkirurgiske centre inkluderede 569 patienter med kronisk underekstre- mitets-iskæmi i perioden 2006-2009 med henblik på at undergå femoro-femoral bypass eller femoro-popliteal bypass.

Patienterne blev randomiseret 1:1, stratificeret på centre. Patency blev vurderet ved duplex ultralydsskanning, og 546 (96%) gennemgik relevant follow-up.

Resultater: Et års primær patency var 86.4% for Propaten® grafter og 79.9% for PTFE grafter (HR=0.638, 95% CI:

0.420;0.968). Et års sekundær patency var 88% for Propaten® grafter og 81% for PTFE grafter (HR=0.600 (0.385;0.934)).

Subgruppe-analyser afslørede en non-signifikant forskel i patency for femoro-femoral bypassgrafter: (HR=0.872 (0.436;1.746)), en signifikant 40% risikoreduktion, når Propaten® blev brugt til femoro-popliteal bypassgrafter (HR=0.607 (0.363;1.034)) og en signifikant 50% risikoreduktion for Propaten® når brugt ved kritisk iskæmi (HR=0.484 (0.266;0.879)).

Gennemsnitlig perioperativ blødning var for Propaten® grafter 399 ml og for PTFE grafter 370 ml (p=0.32).

Konklusion: Propaten® grafter fungerer tilsyneladende efter hensigten og reducerer forekomsten af graftokklusion, men ordinær PTFE fungerer også overraskende godt sammenholdt med tidligere studier. Ikke desto mindre reducerer Propaten® grafter signifikant den samlede risiko for primær graft-svigt med 36%. Ved kritisk iskæmi er reduktionen 50% .

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effekten af Bobath behandling og sensorisk stimulering til arm og hånd hos apopleksipatienter

Fysioterapeut Camilla Biering Lundquist

Fysio- og ergoterapien, Regionshospitalet Viborg, Skive

Baggrund: Bobath behandling og sensorisk stimulering benyttes af fysio- og ergoterapeuter i behandlingen af neuro- logiske patienter.

Formål:

1. Vurdere effekten af sensorisk stimulering og Bobath behandling på sensibilitet og motorik i overekstremiteten 2. Vurdere, om bestemte undergrupper af apopleksipatienter har bedre effekt af sensorisk stimulering og Bobath

behandling end andre

3. Kunne opstille reliable, valide, sensitive effektmål til måling af sensibilitet og motorik i arm, hånd og fingre 4. Kunne opstille overordnede retningslinjer for fremtidige RCT-studier omhandlende Bobath behandling

Metode: Systematisk litteraturgennemgang. Søgning i fem databaser, udelukkende RCT-studier inkluderedes. Med udgangspunkt i Cochrane Handbook for Systematic Reviews of Interventions blev studierne karakteriseret og gen- nemgået for risiko for bias.

Resultater: 18 studier blev inkluderet.

Konklusion: Flere forskellige former for sensoriske interventioner blev fundet og kun 1-2 studier omhandlede den en- kelte intervention. Der var god effekt af:

• en termisk intervention for at bedre sensibiliteten

• uriaspose til at bedre sensibilitet og motorik

• mirrorbox til at bedre sensibilitet og motorik

• øget træningsdosis af somatosensorisk intervention resulterede i bedret outcome Det er ikke muligt at komme med en entydig konklusion på effekten af Bobath behandling.

Der blev ikke fundet bestemte undergrupper af apopleksipatienter, som havde særlig gavn af sensorisk stimulering og Bobath behandling. Det vurderes dog, at det giver god mening i behandlingen af patienter med en meget paretisk arm.

Hvis effekten af Bobath konceptet fremover skal undersøges, er det vigtigt at have en homogen patientgruppe; at kon- ceptet er klart defineret, og at terapeuterne har Bobath kurser af nyere dato. Der skal være nok inkluderede patienter, så type 2-fejl undgås. Outcome-målene kan eksempelvis være to-punkts diskrimination, Motor Assessment Scale og FIM.

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Chromosome 22q11.2 deletions in children with congenital cardiac malformations. A population-based study

Agergaard P1, Olesen C2, Østergaard JR2, Christiansen M3, Sørensen KM3

1Department of Pediatrics, Viborg Regional Hospital, Viborg, Denmark

2Department of Pediatrics, Aarhus University Hospital, Skejby, Denmark

3Department of Clinical Biochemistry and Immunology, Statens Serum Institut, Copenhagen, Denmark

Background: Deletion on chromosome 22q11.2 is considered one of the most frequent genetic causes of congeni- tal cardiac malformations. It is predominantly associated with conotruncal malformations, but it may also be present among patients with a wide spectrum of non-conotruncal malformations.

Aim: The aim of the present study was to establish the prevalence of 22q11.2 deletions in children with congenital cardiac malformations.

Methods: The study population was defined as individuals born in 2000-2008, who were registered in the Danish Na- tional Patient Registry with a diagnosis of congenital cardiac malformation from one of the two national departments of pediatric cardiology. Sensitive multiplex ligation-dependent probe amplification (sMLPA) was performed on dried blood spot samples from each individual’s neonatal screening test. Results were cross-linked with Danish Cytogenetic Central Registry (DCCR).

Results: The study population consisted of 2,952 children with congenital cardiac malformations, of whom 2,478 were eligible for genetic testing. Altogether, 46 individuals (1.9% [1.4-2.5%]) carried the deletion, and the highest prevalence was found in conotruncal malformations such as interrupted aortic arch (22% [11-40%]), common arterial trunk (12%

[4-26%]), and tetralogy of Fallot (8% [5-13%]). The most frequent diagnoses among individuals carrying the deletion were tetralogy of Fallot and ventricular septal defect (n=15).

Comparison of sMLPA results and DCCR unveiled 12 individuals who were not diagnosed prior to the present sMLPA testing.

Conclusions: The prevalence of 22q11.2 deletions in an unbiased population of Danish children with cardiac malforma- tions is 1.9% [1.4-2.5%]. Among individuals registered with conotruncal malformations, the prevalence is 8% [6-11%].

Among individuals with non-conotruncal malformations, the deletion is very rare and not as common as previously assumed. The study shows that 12/46 cases (26%) were not diagnosed if systematic genetic testing had not been performed.

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Laparoskopisk assisteret kryo-ablation af pancreas tumorer i en dyremodel

Nielsen, C.1 , Mortensen, F V.2, Svendsen, RT.2, Vyberg, M.3, Lund, L.4

Kirurgisk afdeling1, Regionshospitalet Viborg; Kirurgisk afdeling2 , Aarhus Universitets hospital; Patologisk afdeling3, Aalborg Universitetetshospital; Urologisk afdeling4, Regionshospitalet Viborg

Baggrund: Lokale tumorer i pancreas kan fjernes ved en Whipple´s operation, som er meget omfattende og stiller store krav til patientens almene tilstand. Der er stor mortalitet og morbiditet forbundet med operationen og især fistule- ringer er frygtet. Små neuroendokrine tumorer i corpus eller cauda af pancreas, som ses hos ældre patienter, kunne med fordel fjernes ved mindre omfattende kirurgi. Kryoablation (frysebehandling) er en etableret behandling af renale tumorer mindre end 4 cm. Kryobehandling er før afprøvet på grise og ser ud til at være en brugbar metode. Der er dog ikke beskrevet eksperimentelle overlevelsesforsøg.

Metode: Der er opereret otte grise med laparoskopisk teknik. Efter etablering af pneumoperitoneum indførtes tre por- te. Pancreas frilægges og ultralydskannes laparoskopisk. Herefter placeredes en fryse- og temperaturnål. Et område af cauda pancreatis blev udvalgt til behandling og frosset til en temperatur mindre end minus 40 grader. Der fryses i ti minutter ad to omgange. Efter endt behandling blev porthullerne lukket og grisen vækket. Postoperativt blev grisene monitoreret med temperatur, blodprøver (leverparametre, infektionstal, glucose) samt velfærd. Efter 14 dage, blev grisene aflivet og obduceret. Pancreasvævet blev histologisk undersøgt.

Resultater: Pancreas blev kryobehandlet på alle otte grise. Syv grise blev planmæssigt obduceret efter 14 dage, mens en udviklede pancreatit og måtte aflives efter syv dage. Der var ingen fistuleringer eller tegn på ekstrapancreatisk skade. Alle blodprøver blev normaliseret efter 14 dage.

Konklusion: Kryobehandling er en skånsom og tilgængelig modalitet til lokalbehandling af cauda pancreatis i en grise- model. Behandlingen tolereres godt og har ikke givet anledning til fisteldannelse.

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Øvrige indleverede abstracts til “Forskningens dag”

1. Association of ACe-inhibitor and statin treatment with small abdominal aortic aneurysm progression

Wemmelund, H. 1, Høgh, A. 1, 2, Horsdal, H.T. 2, Johnsen, S.P. 2, Lindholt, J. 1

1Vascular Research Unit, Viborg Regional Hospital

2Department of Clinical Epidemiology, Aarhus University Hospital

Background: The prevalence of diagnosed small infrarenal abdominal aortic aneurysms (AAA) is expected to increase in the future due to i.e. the extended use of diagnostic imaging in daily clinical practice. Currently there is no well- established medical treatment to slow the growth of AAA in respect to avoid surgical interventions and their poten- tially lethal complications. Recent studies indicate that drugs usually used in prevention of cardiovascular disease, angiotensin converting enzyme (ACE) inhibitors and statins, might alter the expansion rate of AAA independently of their cardioprotective effect.

objectives: To evaluate whether either ACE inhibitors or statins affect expansion rates and size of AAA.

Design: Historical population-based follow-up study using data from the Danish national health databases registries and medical records.

Subjects: Cases diagnosed with AAA in Jutland, Denmark from 1996-2008 (estimated 1000-1500 with available data on expansion (2 or more measurements) and about 4000-6000 with only one measurement).

Methods: Expansion data defined as 2 or more measurements from diagnostic images (ultrasonographies, computer topographies (CT) or magnetic resonance imaging (MRI)) will be sampled from medical records to compute rate of expansion and define the max. AAA diameter. Data on diagnose, medical history (co-morbidity), medication, smoking status, age, gender and socio-economic status will be sampled to adjust for confounding factors.

Main outcome measures: Analysis of average AAA expansion rate and max. AAA diameter in users of ACE inhibitors and statins respectively versus non-users.

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2. Målsætnings- og motivationsarbejde inden for rehabilitering – specielt med fokus på apopleksi

Olesen, Jens. Klinisk underviser, fysioterapeutisk specialist i rehabilitering Fysio- og ergoterapien, Regionshospitalet Viborg, Skive

Abstract: Denne fagartikels formål er at belyse og analysere målsætnings- og motivationsbegreberne for at omsætte eksisterende videns betydninger for rehabilitering set i et kommunikationsperspektiv med specielt fokus på apopleksi og hjerneskade. Etiske og faglige paradokser i forbindelse med rehabilitering gennemgås. Motivation er en relationel følelsesproces, som kan påvirkes indefra såvel som udefra. ICFs personlige faktorers indflydelse på målsætnings- og motivationsprocessen fremhæves. Klientcentreret kommunikation, som indirekte kan motivere og katalysere patien- tens ressourcer, præsenteres kort. Målgruppen er fysioterapeuter og andre behandlere inden for såvel rehabilitering som neurorehabilitering.

nøgleord: Målsætning, følelser, motivation, apopleksi, rehabilitering, kommunikation, klientcentrering.

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3. epidemiological study of the Danish Acute Intermittent Porphyria population

Skovmose MS1, Brusgaard K2, Erlandsen EJ1, Mortensen PR1, Østergaard, M1, Brock, A1

1Department of Clinical Biochemistry, Viborg Regional Hospital, Viborg, Denmark

2Department of Clinical Genetics, Odense University Hospital, Odense, Denmark

Aim: We wished to describe the occurrence of Acute Intermittent Porphyria (AIP) in Denmark demographically, gene- tically and biochemically.

Materials & methods: The study was based on a database of all Danish patients known with porphobilinogen deami- nase (PBGD) mutations at the end of year 2010. 132 individuals were registered (84 (64%) women, 48 (36%) men). 14 of these had died during the period, and three had emigrated (excluded from further analysis). The geographical distri- bution of PBGD mutation carriers was based on their addresses at the end of the study period. Furthermore, we looked at PBGD mutations in patients living in Greenland and the Faroe Islands. PBGD mutations were detected by standard exon and splice site sequencing procedures.The biochemical diagnosis of an acute porphyria attack was based on a urine porphobilinogen/creatinine ratio of ≥ 5.0 mmol/mol (reference interval 0.0–0.8 mmol/mol).

Demographic distribution and prevalence:

Region of Population Number of Number of Approximate

Denmark figure different carriers prevalence

mutations identified

Capital 1.662.285 7 17 1:98.000

Zealand 821.252 7 16 1:51.000

South 1.194.659 12 37 1:32.000

Central 1.247.732 5 27 1:46.000

North 580.515 6 18 1:32.000

Total 5.506.443 21 115 1:48.000

Greenland 56.061 2 2 1:28.000

Faroe Islands 48.644 1 15 1:3.000

Results: 25(22%) of the 115 PBGD mutation carriers who entered the study had experienced an acute porphyria attack (6 (13%) men, 19 (28%) women).The 14 individuals who died during the registration period showed a higher prevalence of acute porphyria attack (43%). Interestingly, they were all women showing a shorter mean lifespan (68 years, range 44-93) than the general female population (80.78 years).

In total, 22 different PBGD mutations were discovered. The mutations were widely distributed across regions, with the striking exception of the Faroe Islands, where all 15 individuals carried the same mutation (c.498+1G>A, p.splicedefect).

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4. Diet and risk of inflammatory bowel disease

Andersen V1, Olsen A3, Carbonnel F2, Tjønneland A3, Vogel U4

1Medical Department, Viborg Regional Hospital, DK-8800 Viborg, Denmark, 2Service d’Hépatogastroentérologie, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Le Kremlin Bicêtre, France, 3Danish Cancer Society, Institute of Cancer Epidemiology, DK-2100 Copenhagen, Denmark, 4National Research Centre for the Working Environment, DK-2100 Copenhagen, Denmark; National Food Institute, Technical University of Denmark, DK-2860 So- borg, Denmark

Background & aims: A better understanding of the environmental factors leading to inflammatory bowel disease (IBD) should help to prevent occurrence of the disease and its relapses. Aim of the study was to review current knowledge on dietary risk factors for development of IBD.

Methods: The PubMed and Cochrane Library were searched for studies in the scope of diet and risk of IBD (October 2010).

Results: Epidemiological studies suggest that genetically susceptible individuals may develop IBD when exposed to certain life-style and environmental factors associated with “westernized” living. Established non-diet risk factors in- clude family disposure, smoking, appendectomy, intestinal infections and antibiotics. Numerous retrospective case- control studies on diet and risk of IBD are available; however, these studies are encumbered with methodological pro- blems, including the patients’ unconscious changing of the diet prior to diagnosis and recall bias. Prospective studies suggest that a diet high in protein, particular protein from meat and fish, may be associated with risk of IBD. Further- more, intake of linoleic acid, which constitutes 85-90% of the dietary n-6 PUFA, mainly from red meat may confer risk of developing UC, whereas a non-significant protective effect of n-3 PUFAs (mainly from fish) was found. No effect was found by high intake of dietary fibers, sugar, macronutrients, total energy, vitamin C, D, E, Carotene, or Retinol (vitamin K) on risk of UC. No prospective data on risk of fruits and vegetables or food microparticles was found.

Conclusions: Data on diet and subsequent risk of developing IBD based on prospective studies is limited. No food item reaches causality criterias. Some studies did find an association between one food item and subsequent IBD but these findings were not reproduced. More data may be expected during the coming years due to the ongoing observation of existing populations-based cohorts.

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5. Survival of patients with kidney cancer in northern Denmark, 1998-2009

Pelant T1,2, Larsen EH1,2, Lund L3, Borre M4, Erichsen R1, Nørgaard M1, Jacobsen J1

Department of Clinical Epidemiology1, Aarhus University Hospital, Department of Urology2, Aarhus University Hospi- tal, Aalborg, Department of Urology3, Viborg Regional Hospital, Department of Urology4, Aarhus University Hospital, Skejby, Denmark

objective: For decades kidney cancer patients in Denmark have had lower survival than patients in the other Scandina- vian countries. Our aim was to study possible changes in survival of patients with kidney cancer after implementation of two national Danish cancer plans.

Study design and setting: From 1998 through 2009 we included all patients (N= 2659) with an incident diagnosis of kidney cancer in two Danish regions (population 1.8 millions). Data were retrieved from the Danish National Registry of Patients. We computed survival after 1, 3 and 5 years stratified by age, and estimated mortality rate ratios (MRR) using Cox regression to assess changes over time controlling for age and gender. Among patients who had a nephrectomy we also computed 30-day mortality and 30-day MRR.

Results: The number of patients diagnosed with kidney cancer increased from 583 in the period 1998-2000 to 853 in the period 2007-2009. The median age at diagnosis was 69 years throughout the study period. The overall 1-year survi- val improved from 56% (1998-2000) to 63% (2007-2009) corresponding to an adjusted MRR of 0.78 (95% confidence interval (CI):0.66-0.93). We predicted the 3-year survival to increase from 40% to 51% and the 5-year survival rate to increase from 33% to 42% corresponding to predicted MRRs of 0.76 (95% CI 0.66-0.87) and 0.77 (95% CI 0.68-0.89), respectively. Survival increased in all age groups (15-59 years, 60-74 years, 75+ years) in both gender except for men below 60 years, for whom the 1-year survival declined from 76% to 69%. The 30-day mortality after nephrectomy decli- ned from 4% to 2% during the study period.

Conclusion: We observed an improvement in the survival and relative mortality in kidney cancer patients, although not in men younger than 60 years.

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6. Survival of prostate cancer patients in northern Denmark, 1998-2009

Borre M1,2, Erichsen R1, Lund L3, Larsen EH4, Nørgaard M1, Jacobsen J1

Department of Clinical Epidemiology1, Aarhus University Hospital, Department of Urology2, Aarhus University Hospital, Skejby, Department of Urology3, Viborg Regional Hospital, Department of Urology4, Aarhus University Hospital, Aal- borg, Denmark

objective: Prostate cancer is the most common non-cutaneous cancer among Danish men. During the last decade use of PSA testing has increased and in clinical localized prostate cancer curative intended treatment has gained a footing.

Our aim was to examine possible changes in the short and long term survival of patients with prostate cancer during 1998 - 2009.

Study design and setting: From two Danish regions (population, 1.8 million) we included all patients (N=10,547) with an incident diagnosis of prostate cancer retrieved from the Danish National Registry of Patients. We determined survi- val after 1, 3 and 5 years stratified by age, and estimated mortality rate ratios (MRR) using Cox proportional hazard regression to assess changes over time controlling for age.

Results: During the study period the annual number of incident prostate cancer patients more than doubled and the median age at diagnosis decreased from 74 to 70 years. The survival improved over the study period, particularly in the last half of the period (2004-2009). Thus 1-year survival increased from 80% (1998-2000) to 90% (2007-2009) cor- responding to an age adjusted MRR of 0.54 (95% confidence interval (CI):0.46-0.63). The expected increase in 3- and 5-year survival was even more pronounced: 47 to 73% and 34 to 60%, respectively..This corresponded to a 3-year age adjusted MRR of 0.46 (95% CI: 0.42-0.51) and a 5-year MRR of 0.50 (95% CI: 0.46-0.54). The 1-, 3- and 5-year overall survival increased in all age groups (< 70 years, 70-79 years, ≥ 80 years).

Conclusion: Survival after prostate cancer has improved in Denmark within the last decade. However, the annual num- ber of new cases increased substantially and it is likely that lead and length time bias can explain a large part of this prognosis improvement.

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7. Meta-analysis of postoperative mortality after elective repair of abdominal aortic aneurysms de- tected by screening

Lindholt JS, Norman PE

Vascular Research Unit, Viborg Regional Hospital, Viborg, Denmark

School of Surgery, University of Western Australia, Perth, Western Australia

Background: The aim of this study was to compare the mortality rate within 30 days of elective surgery for abdominal aortic aneurysm (AAA) in men randomized to an invitation for ultrasound screening with that of men in the control group, whose aneurysms were detected incidentally.

Methods: Relevant reports from randomized trials of screening were identified through a systematic search of MED- LINE. Four relevant trials were identified, and supplemented with data from the Viborg Vascular screening trial. Data were updated in two studies.

Meta-analysis was undertaken with effects calculated as a fixed odds ratio (OR) with 95 per cent confidence interval.

Heterogeneity between the studies was assessed by the χ(2) test.

Results: There were 25 deaths (2•9 per cent) following elective surgery in 858 men invited for screening compared with 21 (5•5 per cent) of 383 in the control group (OR 0•49, 0•27 to 0•88). There were 18 deaths (2•4 per cent) following elective surgery for 747 screen-detected AAAs compared with 28 (6•1 per cent) following elective repair of 459 inciden- tally detected aneurysms (OR 0•37, 0•20 to 0•68).

Conclusion: The offer of screening identifies men whose early survival following elective AAA repair is better than that of men with an AAA detected incidentally.

Br J Surg. 2011 Mar 4. doi: 10.1002/bjs.7464. [Epub ahead of print]

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8. Preliminary experience with nd-YAG laser waves to treat pilonidal cysts

Christine S. Lindholt (1), Jan S. Lindholt(1), Jes S. Lindholt(2)

1Kirurgisk Klinik, Århus

2Karkirurgisk Forskningssektion, Regionshospitalet Viborg

Background: A pilonidal cyst usually contains hair and an increased amount of blood vessels caused by inflammation, which theoretically gives Nd-YAG laser waves potential to destroy the deep fistula-systems of the cysts without af- fecting the overlying skin.

Aim: To describe the preliminary experience with Nd-YAG laser waves to treat pilonidal cysts.

Method and material: 41 consequtive patients with pilonidal cysts finalized the intended Nd-YAG laser-treatment.

Structural telephone interviews were achieved in 37 (90%).

Results: The median duration of treatment and observation time was 5.1 months and 15.2 months, respectively. Three (7%) received additional surgery; two had granulomas removed by a minor excision, and one wanted more traditional surgery.

At follow-up, 28 out of 37 (75.7%) reported freedom from symptoms without supplemental treatment, and 30 out of 37 (81%) to be symptom-free after supplemental laser- and minimal surgery, if needed (81%).

Discussion: A potential for an extremely gentle treatment compared with conventional surgery has been exposed.

The cohort is sought to be substantially increased and followed through register-based techniques with a comparable control group.

Conclusion: Nd-YAG laser treatment of pilonidal cysts may prove to be an attractive treatment alternative for pilonidal- cysts.

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9. Videocasebaseret undervisning: Vil det gavne patienterne?

Jonas Hansen og Thomas Balslev

Børneafdelingen, Regionshospitalet Viborg

Formål: Interaktiv brug af patient video cases kan forbedre indlæring og diagnostisk præcision hos læger. I dette studie ønskede vi at belyse, om deltagelse i et interaktivt møde med klinisk case-diskussion kan medføre efterfølgende foran- dringer i lægens adfærd.

Metode: Under et patient-videocase-baseret møde med emnet “Epilepsi og tilstande, der ligner epilepsi”, blev en trin- vis, team-baseret læringsstrategi anvendt:

1) Kort, tekstbaseret patientpræsentation 2) Fremvisning af patient-videocase 3) Diskussion i små grupper

4) Diskussion i plenum med feedback fra en ekspert

Ni patient-videocases blev diskuteret. Efter mødet udfyldte alle 17 deltagere (10 specialister og 7 uddannelsessøgende læger) et spørgeskema. Spørgsmålene var designet til at undersøge niveau 2 og 3 i Kirkpatrick-modellen, som inddeler udbytte af undervisning i 4 niveauer. Niveau 1 er deltagerholdning, niveau 2 er øget viden, niveau 3 er ændret adfærd, mens niveau 4 er forbedring for brugere (patienterne).

Resultater: Alle deltagere angav at de havde forøget deres viden under mødet (Kirkpatrick niveau 2, læring)

94 % rapporterede forøget viden om undersøgelser ved epilepsi og 71 % angav forøget viden om behandling af epilepsi.

Fem ud af 10 deltagende specialister planlagde nu yderligere undersøgelser for specifikke patienter (Kirkpatrick niveau 3, adfærd).

Konklusion: Dette lille studie indikerer, at et møde, som involverer interaktiv brug af patient-videocases ikke bare fører til opfattelse af øget viden hos deltagerne, men også kan føre til ændret adfærd hos de deltagende specialister.

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10. Hvor tit er “obs Akut Koronart Syndrom” egentlig en hjertesygdom?

Basislæge Andreas Glahn Wernlund

Afdelingslæge, ph.d. Hanne Maare Søndergaard Medicinsk afdeling, Regionshospitalet Viborg

Diagnosen “Obs Akut Koronart Syndrom” (AKS) er en hyppig indlæggelsesdiagnose.

Formålet med undersøgelsen var at belyse, hvor mange af patienterne der blev udskrevet med diagnosen AKS, samt hvilket udredningsprogram de gennemgik, såfremt diagnosen AKS blev afkræftet vha. EKG og koronare biomarkører.

Alle patienter, der blev visiteret direkte til hjertemedicinsk afdeling, Regionssygehuset Viborg, under diagnosen “Obs AKS”, som ikke præhospitalt havde ST-Elevationsmyokardieinfarkt, indgik i undersøgelsen. Efterfølgende blev der foretaget journalreview, hvor udskrivningsdiagnose og evt. opfølgning blev registreret. Undersøgelsen søgte at inklu- dere alle patienter indlagt i juni 2010 på hjertemedicinsk afdeling.

I alt 62 patienter blev inkluderet, heraf forblev 21 patienter diagnostisk uafklarede. Af de 62 havde 11 patienter anden kardiel eller vaskulær genese end AKS (atrieflimmer, aortastenose, lungeemboli, aortadissektion m.fl.), og 19 patienter havde anden ikke-kardiel eller -vaskulær genese (øvre abdominalia, pneumoni, bevægapparat sygdom m.fl.). Kun 10 patienter havde AKS.

Af de 21 uafklarede blev 10 udskrevet uden yderligere diagnostisk afklaring ud over EKG og basal biokemi inklusiv koro- narmarkører. De resterende 11 af de uafklarede blev yderligere kardiologisk udredt med enten ekkokardiografi og/eller koronarangiografi, CT-angio eller myocardiescintigrafi. De 10 patienter med AKS blev udredt og behandlet i henhold til nationale guidelines.

Indlæggelsesdiagnosen AKS dækker således over en bred vifte af sygdomme, der alle har et symptombillede, der ligner hinanden. Undersøgelse viser, at en ud af seks patienter har AKS, mens størstedelen viser sig at fejle noget andet.

Der blev gjort et stort arbejde for at udrede patienterne hurtigt, idet den gennemsnitlige liggetid var 2,5 dage. Hos en tredjedel af alle patienterne fandt man ikke frem til nogen diagnose. Af disse blev halvdelen udskrevet uden yderligere udredning, mens den anden halvdel blev forsøgt udredt enten under indlæggelsen eller ambulant.

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11. Arthroscopy as an aid in treating tibial plateau fractures

Jensen, S.S., Hansen, F., Stroem, J.

Department of Orthopaedic Surgery, Viborg Regional Hospital, Denmark

Purpose: Fractures of the tibial plateau are complex injuries which continue to challenge orthopaedic surgeons in achieving alignment and anatomic or near anatomic reduction. The purpose of this retrospective study was to investi- gate the effect and complications of using arthroscopy assisted procedure as an aid in treating tibial plateau fractures.

This procedure has often been discarded due to risk of infection and compartment syndrome.

Methods and material: Patients who had undergone an arthroscopic procedure as an aid in operative treatment of tibial plateau fractures within the last seven years were included in the study. 39 patients (12 men and 27 woman) with a mean age of 61 (range 16-83) comprised the study population. The fracture types were as follows: Schatzker type I – IV; 20 patients and V– VI; 19 patients.

Results: All arthroscopic procedures were done by experienced arthroscopists. There were no peroperative complica- tions and no patients were seen postoperatively with infection or acute compartment syndrome.

In 11 cases the procedure resulted in further reduction of the fracture and in 16 cases the procedure resulted in a therapeutic arthroscopic procedure. In 4 of the cases, the procedure resulted in both further reduction of the fracture and a therapeutic arthroscopic procedure.

Patients with fracture types V-VI had a better profit of the arthroscopic procedure, whereas 80 % of the patients in this group had further reduction of the fracture or had a therapeutic arthroscopic procedure done, compared to 40% of the patients with fracture types I-IV.

Conclusion: Arthroscopy as an aid in treating tibial plateau fractures is a safe procedure and in our series of 39 pa- tients without complications. Arthroscopy seems necessary, especially in the more severe fractures, Schatzkers, V-VI.

Arthroscopy is considered an effective mean in achieving alignment and anatomic or near anatomic reduction, without exposing patients for complications.

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12. oxidative Stress Is Involved in the natural History of AAA: A Proteomic View

Sigitas Urbonavicius¹ , Jes S. Lindholt¹, Grazina Urbonaviciene¹, Eskild W. Henneberg¹, Bent Honore²

¹ Department of Vascular surgery, Regionshospital Viborg, Viborg 8800, Denmark

² Department of Medical Biochemistry, University of Aarhus, Aarhus 8200, Denmark

Background: Proteomic is evolving as an important research technique in cardiovascular disease. Identification of cir- culating biomarkers for the progression and rupture of abdominal aortic aneurysms (AAA) holds the key to non-surgi- cal intervention and improved selection of patients to AAA repair.

Aim: To investigate the basic serum proteins composition and to associate with different AAA expansion rate by pro- teomic.

Material and methods: A proteomic approach was used consisting of two-dimensional gel electrophoresis (2D-PAGE) and mass spectrometry (MS) to identify differentially expressed proteins in sera from 15 AAA operated patients. The percentage volumes of protein-spots with AAA were determined by computerized imaging, and associated with AAA expansion rate. Relevant protein-spots were in-gel digested and identified by liquid chromatography - tandem mass spectrometry (LC-MS/MS).

Results: Four hundred and thirty-two spots were demonstrated on the gels. Fourteen protein spots correlated strong- ly with AAA expansion rate (rho>+/-0.6). Nine protein spots showed positive and negative correlation represented fragments of albumin, highly abundant in serum.. The five negatively correlated spots were apolipoprotein A-IV (rho=- 0.67, p=0.038); fibrinogen-β-chain (rho=-0.66, p=0.036); haptoglobin in two spots (rho=-0.66, p=0.038 and rho=-0.65, p=0.042); Ig-α-1 or 2 chain C (rho=-0.76, p=0.011) and peroxiredoxin-2 (rho=-0.62, p=0.05). Importantly, in our previous study peroxiredoxin-2 was up-regulated 8.1-fold in the ruptured AAA wall group compared with non-ruptured AAA wall as determined by 2D-PAGE. Western blot analysis confirmed the significant up-regulation of peroxiredoxin-2 in ruptu- red aortic tissue.

Conclusion: A proteomic approach to identify potential biomarkers for prediction of natural history of AAA seems va- luable, and identified several candidates. Collectively, these studies provide support for the hypothesis that oxidative stress is an important component in formation and enlargement of AAA through activation of MMPs and induction of apoptosis within the aortic wall. Further studies are required to confirm the potential and clinical role of peroxire- doxin-2 in AAA formation.

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13. Actinobaculum schaalii, an overlooked uropathogen in children

Lise Bols Andersen1, Steffen Bank2, Birgitte Hertz1 and Jørgen Prag2

1Department of Paediatrics, 2Department of Clinical Microbiology, Viborg Regional Hospital

Background: Actinobaculum schaalii is known to cause urinary tract infection (UTI) in elderly patients. However A.

Schaalii infection is not well published in children. Here we describe the pathology in seven children harbouring A.

schaalii in urine samples.

Methods: Routine urine samples from 29 children in the age of 0-15 year were consecutively examined by wet smear microscopy, incubated in an atmosphere of 5 % CO2 for 1-2 days and examined by species specific real-time polymerase chain reaction (PCR). Furthermore two children with established A. schaalii infection were included.

Results: Five patients harbouring low quantities of A. schaalii were identified by real-time PCR. However no growth on agar plates was found. One of two children where A. schaalii was identified by culture had been treated with trimet- hoprim but the symptoms did not disappear. A. schaalii was resistant to trimethoprim and after a change to penicillin the symptoms disappeared.

Conclusion: If wet smear microscopy and/or stix reveal leukocytes, gram positive coccobacilli and no growth in ambi- ent atmosphere A. schaalii infection should be considered and the urine should be incubated in 5 % CO2. Furthermore it is important to consider an A. schaalii infection if microscopy reveals leukocytes and coccobacilli but treatment with trimethoprim and ciprofloxacin is inefficient.

Key words: Children, Actinobaculum schaalii, urinary tract infection, quantitative real-time PCR, colonization

Corresponding author: Lise Bols Andersen, Department of Paediatrics, Viborg Regional Hospital, Heibergs Allé 4, DK- 8800 Viborg, Denmark; email: Lise.Andersen@Viborg.RM.dk

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14. Age- and sex-related differences in use of recommended combination of secondary medical preven- tion after vascular surgery: A nationwide follow-up study

Annette Høgh1,2, Søren P. Johnsen2, Jes S. Lindholt1

1Department of Vascular Surgery, Viborg Regional Hospital, Denmark

2Department of Clinical Epidemiology, Aarhus University, Denmark

objective: To analyse the use of recommended combination of secondary medical prevention (lipid-lowering drugs and anti-platelet therapy supplemented with antihypertensive treatment) among Danish patients hospitalized to primary vascular reconstruction in between 1996 to 2007. We put special attention to age- and sex-related differences and dif- ferences in prescription practice early (1996-2000) and late (2001-2007) in the study-period.

Methods: The nation-wide Danish Vascular Registry was the main sours of data, facilitated to other nation-wide data- bases via the civil registration number. Prescriptions rates for recommended combination of secondary medical pre- vention 6 months, 3, 5, and 10 years primary vascular reconstruction were identified. Poisson analysis with robust error estimates was used to perform crud and adjusted comparisons (RR) across age- and sex-groups 6 months after surgery (males 40-<60 years as reference).

Results: 20761 patients were included, 54.5% were males (median age 68.8 years). Overall prescription rates of re- commended secondary medical prevention were low (30-60% six months after surgery). Furthermore a general de- cline was seen in between a half to three years after surgery.

The older the lesser the chance became for prescription of recommended combination therapy, existing in all the pre- defined periods in time as well as in comparison between early (1996-2000) and late (2001-2007) period. In general we found females to have higher prescriptions rates than males in equal age-groups. When comparing early (1996-2000) and late (2001-2007) period supreme progress were seen in patients >80years (ex.: male early RR 0.19[0.09;0.38] to late RR 0.86[0.75;0.98]).

Conclusion: Prescriptions rates of recommended combinations of secondary medical prevention were low in our study compared to international guidelines. Despite these findings supreme progress were seen for all age- and sex-groups when comparing prescription rates in 1996-2000 to 2001-2007, most clearly for patients >80years. Ongoing efforts to implement recommendations concerning cardiovascular prophylactic are crucial, especially to elderly patients with symptomatic peripheral arterial disease.

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15. Does Tc99m-mebrofenin get metabolised in the intestines?

H.D. Zacho, J. Abrahamsen

Department of clinical physiology, Viborg Regional Hospital

Background: Measurement of the hepatic blood flow(HBF) is useful when investigating drug-metabolism in the liver and investigating for chronic intestinal ischaemia. The HBF can be measured using the Fick principle with infusion of a tracer e.g. Tc99m-mebrofenin (Tc-MBF). When the infusion rate of the tracer, the concentration of tracer in the portal and the hepatic vein is known the flow can be calculated. In patients it is not possible to obtain blood samples from the portal vein instead arterial blood samples are used. This part of the study aims at determines the difference in Tc-MBF between an arterial and portal vein plasma in a porcine model.

Materials and Methods: In 15 pigs catheters were placed in the portal vein, abdominal aorta for collecting blood samp- les, and a peripheral vein for infusion of tracer. Blood samples were taken from the aorta and the portal vein every 10 min. 5 times during fasting and 7 times after ingestion of a meal in order to see if the alterations in the hepatic haemo- dynamics would have any impact on the metabolism of Tc-MBF in the intestines.

Results: The mean difference between the arterial and portal concentration of Tc-MBF expressed in percentage of the arterial concentration is 0.21% (95% c.i.: -0.12 to 0.54%) and no significant inference with time (p = 0.48).

Discussion: No net metabolism of Tc-MBF in the intestines was found. The content in arterial and portal vein plasma did not differ and most importantly the ingestion of a standard meal did not change this. An arterial sample can be used to calculate the HBF. This is assumed to be correct for humans too, although this requires further studies of the kinetics of Tc-MBF in man.

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16. Actinobaculum schaalii in urological patients, screened with real-time PCR

Steffen Bank1, Thomas Michael Hansen1, Karen Marie Søby1, Lars Lund2 and Jørgen Prag1

1Department of Clinical Microbiology and 2Urology, Viborg Regional Hospital

Background: Actinobaculum schaalii can cause urinary tract infections (UTI) and can occasionally cause septic com- plication. It is a CO2-requiring gram positive rod which is overlooked if urines are cultured in ambient air or if there is growth of conventional species.

objective: To find the frequency of A. schaalii in consecutive cohorts of patients with kidney stones, children with suspected UTI and patients with indwelling catheter.

Method: A quantitative real-time polymerase chain reaction (PCR) assay was used to consecutively screen urine samp- les from 142 patients consisting of 76 patients with kidney stones, 29 children and 37 with indwelling catheter.

Results: In patients with kidney stones A. schaalii was found in 7 (29%) of the 24 leukocyte esterase stix positive urines which was twice as often as in the stix negative urines (p = 0.22). A. schaalii was found in 5 (36%) of 14 children less than three years old but not in 15 children 3 to 15 years old (p = 0.02). The 8 (22%) of the 37 catheterized patients with A.

schaalii were elderly and half had comorbidities. In the patients where A. schaalii was found other uropathogens were found from 5 (33%) of the 15 patients with kidney stones, 1 (20%) of the 5 children and 7 (87%) of the 8 with indwelling catheter.

Conclusion: A. schaalii is common among elderly with suspected UTI and might be clinical significant, when found alone or together with other bacteria, among children and patients treated for kidney stones.

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17. Multidrug resistance protein 2 (MRP2) polymorphisms and risk of inflammatory bowel disease in re- lation to smoking

Bank S1, Østergaard M2, Ernst A3, Krarup HB3, Jacobsen BA4, Vogel U5 and Andersen V1

1Department of Medicin and 2Clinical Biochemistry, Viborg Regional Hospital, 8800 Viborg, Denmark, 3Department of Clinical Biochemistry, Aarhus University Hospital, 9000 Aalborg, Denmark, 4Department of Medicin, Aalborg Hospital, 9000 Aalborg, Denmark, 5National Research Center for the Working Environment, 2100 Copenhagen, Denmark

Background: Inflammatory bowel diseases (IBD) are chronic inflammations with a complex aetiology comprising of genetic and environmental factors. Smoking modulates the risk of IBD with different effect on Crohn´s Disease (CD) and ulcerative colitis (UC). Multidrug resistance protein 2 (MRP2, ABCC2) is primarily located in the small intestine and mediates the efflux of organic anions including tobacco metabolites. In this study functional polymorphisms in ABCC2 which may affect transport of tobacco metabolites were examined. A difference in the examined functional polymorphisms could explain why smoking has a different effect on CD and UC.

Method: Three functional polymorphisms in ABCC2 which down-regulate (rs717620), up-regulate (rs8187710) and change substrate specificity (rs2273697) of MRP2/ABCC2, respectively, were determined in a Danish cohort of 362 CD and 523 UC patients.

Results: No differences were found between CD and UC in relation to current and former smokers in the three exami- ned polymorphisms in ABCC2.

Conclusion: No associations were found between the studied ABCC2 functional polymorphisms and the different en- vironment effect smoking has on CD and UC. Our results suggest that the MRP2 substrates tobacco metabolites NNK and NNAL-O-glucuronide are not main risk factors for IBD in general and can not explain the differential effect smoking has on the risk of developing CD and UC.

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18. Kan genetiske markører forudsige behandlingsresultatet hos patienter behandlet med TnF-hæm- mere?

Steffen Bank1, Paal Skytt Andersen2, Vibeke Østergaard Thomsen2, Ulla B. Vogel3 og Vibeke Andersen1

1Medicinsk Afdeling, Regionshospitalet Viborg, 2Mikrobiologisk Overvågning og Forskning, Statens Serum Institut, 3Det Nationale Forskningscenter for Arbejdsmiljø, København

Baggrund: Antistoffer (TNF-hæmmere) mod pro-inflammatory cytokine tumor necrosis factor-alfa (TNF-alfa) anven- des ofte til behandling af alvorligt syge patienter med kronisk tarmbetændelse (Inflammatory Bowel Disease (IBD)).

Inden start af behandling med TNF-hæmmere undersøges vanligvis for tuberkulose (TB) antistoffer i blodet via en blodprøve. Testen udføres på Statens Serum Institut (SSI).

Men ca. en tredjedel af patienterne responderer dårligt eller slet ikke på behandling med TNF-hæmmere. En test, som kan forudsige respons, vil være et meget værdifuldt værktøj og give basis for en mere individualiseret behandling.

I første omgang er vi ved at etablere en web-baseret database indeholdende kliniske data på patienterne for at kunne evaluere effekten af behandlingen.

Formål: Undersøgelsens forventede fordele består i, at behandlende læger via en blodprøve kan forudsige det for- ventede behandlingsresultat af TNF-hæmmer-behandlingen hos det enkelte individ ud fra patientens genetiske profil (individualiseret behandling). Målet på kort sigt er dermed at forbedre behandlingen af det enkelte individ. På længere sigt er målet at fremme udviklingen af nye behandlingsstrategier gennem en større forståelse af den biologiske meka- nisme bag sygdoms- og behandlingsprocessen og dermed få større viden om potentielle nye mål (targets) for effektiv medicinsk behandling.

Metode: Blodprøver fra patienter, der har fået sendt en blodprøve til SSI til undersøgelse for TB antistoffer, er blevet indsamlet. Vi har indsamlet blodprøver fra 2135 patienter med IBD, og DNA vil blive oprenset fra blodprøverne. Ved hjælp af enkeltnukleotid-polymorfi (SNP)-analyser vil vi undersøge, om gener, der er involveret i den inflammatoriske kaskade, er associeret med behandlingsrespons. Herefter vil genotypefordelingen blandt patienter, der responderer på behandlingen, og patiente,r der er non-responders, blive sammenlignet, og risikoestimatet udregnes. Herved kan genetiske markører, der kan forudsige effekten af behandlingen, identificeres.

Patienter med IBD er blevet identificeret ved hjælp af Landspatientregistret og ud fra den henvisende afdeling. Kliniske data indhentes via Dansk Colitis-Crohn Database, sundhed.dk og hospitalsjournaler.

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