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1.
Parkinsons Dis ; 2024: 5522824, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38623494

RESUMO

Background: Testing and titration of the right levodopa equivalent dose are usually performed during a hospital admission. However, optimal dose titration in people with Parkinson's disease (PwPs) may depend on home environment, emotional stress, and physical activity of everyday life. Objective: Firstly, to evaluate the feasibility and safety of a home-based LCIG titration program and patients'/caregivers' satisfaction. Secondly, to identify barriers and facilitators for home-based titration. Method: This study assesses the feasibility and safety of home-based titration of levodopa duodenal infusions with the use of self-reported evaluation questionnaires with open-ended questions included, registration of total time used, and number of contacts/visits. A telemedicine solution was used to remotely monitor the patients, adjust treatment, and provide support and guidance to patients and caregivers. Results: Ten of 12 PwPs (5 females and 7 males) completed the total titration program. Eight of the 12 PwPs were dependent on help. These 8 PwPs also had a high burden of nonmotor symptoms (NMS). Cognitive impairments varied in severity (range 16-30). Time spent with home visits was on average 93.4 minutes (ranging from 35 to 180 minutes), and the length of the total titration (LCIG initiation to termination of titration) was on average 3.4 days with 2-5 (mean 3.2) contacts/visits with PD team members. The average score on the satisfaction evaluation questionnaires was lower in the caregiver group (mean 31.8) than the PwP outcome (mean 36.2). Conclusions: Telehealth-assisted home-based titration programs are feasible due to the length of the titration period, number of contacts, and time spent in PwPs' private homes, are rated satisfactory and safe by PwPs and caregivers, and may be a substitute for in-hospital treatment. Clinical recommendations including facilitators and barriers from a patient/caregiver perspective are displayed. This trial is registered with NCT4196647.

2.
Ugeskr Laeger ; 185(5)2023 01 30.
Artigo em Dinamarquês | MEDLINE | ID: mdl-36760190

RESUMO

Sudden pain of the eye, nose or face can be a symptom of stroke located to the pons. This case report is about a 73-year-old women with acute debut of right-sided hemiparesis, ataxia, gait disturbance, dysarthria, hemisensory defects and contralateral burning eye pain. MRI showed acute ischaemia of the left pons. The case adds to the growing literature of this rare presentation of posterior circulation stroke.


Assuntos
Infartos do Tronco Encefálico , Acidente Vascular Cerebral , Humanos , Feminino , Idoso , Dor Ocular , Ponte , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/complicações , Imageamento por Ressonância Magnética
3.
Pract Neurol ; 2022 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-35863880

RESUMO

A 23-year-old man presented with right eye blurred vision; he was diagnosed with acute posterior multifocal placoid pigment epitheliopathy (APMPPE), and his symptoms resolved with prednisolone. Two months later, he developed a right arm weakness that resolved after 3 weeks. MR scan of brain identified changes suggesting multiple sclerosis, with four hyperintense FLAIR lesions; there was contrast enhancement of two lesions and no diffusion restriction. Cerebrospinal fluid showed mononuclear pleocytosis. We eventually diagnosed these as APMPPE-associated CNS lesions. APMPPE is a rare inflammatory chorioretinopathy that rarely can resemble multiple sclerosis clinically and radiologically.

4.
Acta Otolaryngol ; 140(2): 157-162, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31849248

RESUMO

Background: The main indication for transoral robotic surgery (TORS) has been the primary treatment of oropharyngeal squamous cell carcinoma (OPSCC). In the western world this is highly relevant due to the increasing incidence of human papillomavirus (HPV)-positive OPSCC. In Denmark, TORS was implemented in 2013 for use in the protocolled primary treatment of OPSCC.Aims/objectives: To perform a year-by-year comparative analysis of indications for TORS, hospitalization and complication rates to identify optimal future indications for TORS.Methods and materials: This is a retrospective single-centre case review from 2013-2017. Data were collected from patient files through electronic health care systems.Results: Since 2013, there has been a change of indications from performing benign and salvage surgery to mainly primary treatment of OPSCC and diagnostic use in patients with cancer of unknown primary (CUP). The overall complication rates have reduced considerably over time.Conclusions and significance: Lower complication rates may be explained by improved surgical experience, through better patient selection and changes in indications for TORS. Future applications of TORS will be in the management of CUP and as part of a Danish national randomized clinical trial aiming to compare long-term functional outcomes after treatment of early-stage OPSCC with TORS versus radiation treatment.


Assuntos
Neoplasias Primárias Desconhecidas/cirurgia , Neoplasias Orofaríngeas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Síndromes da Apneia do Sono/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Neoplasias Orofaríngeas/virologia , Infecções por Papillomavirus/complicações , Estudos Retrospectivos , Terapia de Salvação
5.
Ugeskr Laeger ; 181(48)2019 Nov 25.
Artigo em Dinamarquês | MEDLINE | ID: mdl-31791457

RESUMO

Acute vestibular syndrome (AVS) is an acute-onset of continuous vertigo with no other neurological deficits. AVS is most often of peripheral origin - vestibular organ or nerve. However, in some cases AVS is caused by a posterior circulation stroke (PCS). Head impulse, nystagmus and test of skew (HINTS) can be used to differentiate peripheral causes of AVS from central causes. Within the first 48 hours after onset of symptoms, HINTS has a higher sensitivity of detecting PCS (96-100%) than an MRI (72-87%). We recommend using HINTS for acute dizzy patients.


Assuntos
Nistagmo Patológico , Acidente Vascular Cerebral , Vertigem , Humanos , Náusea , Nistagmo Patológico/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Vertigem/etiologia , Vômito
6.
Ugeskr Laeger ; 180(47)2018 Nov 19.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30509345

RESUMO

Oropharyngeal squamous cell carcinoma (OPSCC) induced by human papillomavirus (HPV) is highly prevalent in the western part of the world. Patients with HPV-induced OPSCC are often younger and have a much better prognosis than patients with HPV-negative OPSCC. The newly introduced transoral robotic surgery offers the ability to perform en bloc tumour resection with good margin control. It may be an alternative to the traditional radiation therapy for early-stage OPSCC. A Danish randomised clinical trial is now aiming at comparing these two treatments with a focus on long-term functional outcomes.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Orofaríngeas , Procedimentos Cirúrgicos Robóticos , Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Neoplasias Orofaríngeas/cirurgia , Papillomaviridae , Infecções por Papillomavirus
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