Laparoscopic-Assisted ERCP in Gastric Bypass Patients-No Stones Left Unturned: A Single Center Retrospective Cohort Study.

PURPOSE: The long-term need for biliary duct intervention following Roux-en-Y gastric bypass surgery (RYGB) is uncertain. We investigated the rate of laparoscopic assisted retrograde cholangiopancreatography (LAERCP) following RYGB. Also, the pre-LAERCP diagnostic workup together with the true rate of choledocholithiasis in patients with or without prior cholecystectomy was investigated. MATERIALS AND METHODS: Retrospective cohort study of RYGB and LAERCP performed at the Hospital South West Jutland, University Hospital of Southern Denmark, from 1 January 2013 to 31 May 2022. RESULTS: One percent of patients (n = 13) with a history of RYGB (n = 1363) underwent LAERCP at our facility during a median follow-up of 60.6 months. The stone extraction rate was 66.7% in patients with in situ gallbladder and 12.5% in patients with prior cholecystectomy. Cannulation of the common bile duct was achieved in 96.7% of cases. Postoperative complications were observed in 22.6% of the cases. CONCLUSION: Approximately 1% of RYGB patients needed LAERCP during a median follow-up of 5 years. In patients with a history of cholecystectomy, the LAERCP rate of stone extraction was very low (12.5%).

Impact of Time to Treatment Initiation in Patients with Human Papillomavirus-positive and -negative Oropharyngeal Squamous Cell Carcinoma.

AIMS: The distinct difference in disease phenotype of human papillomavirus-positive (HPV+) and -negative (HPV-) oropharyngeal squamous cell cancer (OPSCC) patients might also be apparent when assessing the effect of time to treatment initiation (TTI). We assessed the overall survival and progression-free survival (PFS) effect from increasing TTI for HPV+ and HPV- OPSCC patients. MATERIALS AND METHODS: We examined patients who received curative-intended therapy for OPSCC in eastern Denmark between 2000 and 2014. TTI was the number of days from diagnosis to the initiation of curative treatment. Overall survival and PFS were measured from the start of treatment and estimated with the Kaplan-Meier estimator. Hazard ratios and 95% confidence intervals were estimated with Cox proportional hazard regression. RESULTS: At a median follow-up of 3.6 years (interquartile range 1.86-6.07 years), 1177 patients were included (59% HPV+). In the adjusted analysis for the HPV+ and HPV- patient population, TTI influenced overall survival and PFS, most evident in the HPV- group, where TTI >60 days statistically significantly influenced overall survival but not PFS (overall survival: hazard ratio 1.60; 95% confidence interval 1.04-2.45; PFS: hazard ratio 1.46; 95% confidence interval 0.96-2.22). For patients with a TTI >60 days in the HPV+ group, TTI affected overall survival and PFS similarly, with slightly lower hazard ratio estimates of 1.44 (95% confidence interval 0.83-2.51) and 1.15 (95% confidence interval 0.70-1.88), respectively. CONCLUSION: For patients treated for a HPV+ or HPV- OPSCC, TTI affects outcome, with the strongest effect for overall survival among HPV- patients. Reducing TTI is an important tool to improve the prognosis.

[Reactions to torture and persecution. Traumatized refugees in the Danish health service]. / Reaktioner på tortur og forfølgelse. Traumatiserede flygtninge i det danske sundhedsvaesen.

The Danish health services encounter a growing number of refugees who suffer from the effects of persecution and torture. To be a traumatised refugee in a foreign culture often causes psychological reactions and biological changes, and, at the same time, adaptation to a new culture is a demanding existential challenge. The condition is rather poorly described by the diagnoses "post-traumatic stress disorder" and "enduring personality change after catastrophic experience". These conditions can cause difficulties both diagnostically and treatment-wise, as the trauma story can awaken violent reactions in the doctor, and because the symptoms can be so culturally framed they are difficult to interpret. The prognosis depends on a number of issues pertaining to the patient, the trauma, and the patient's overall state after the trauma. At best, the prognosis is relatively good, but in a number of cases the patient's state becomes chronic and disabling. At present, the recommended treatment is a combination of psychotherapy, psychopharmacological treatment, physiotherapy, and social initiatives. There is still uncertainty as to the optimal treatment, and the organisational situation regarding treatment in Denmark is unclear.

[Spread and control of methicillin resistant Staphylococcus aureus in a department of dermatology]. / Spredning og kontrol af methicillinresistente Staphylococcus aureus i en hudafdeling.

Patients with skin diseases caused a spread of methicillin-resistant Staphylococcus aureus (MRSA) to 17 patients in our Department of Dermatology, because of their heavily scaly skin. Patients with severe dermatosis are regularly treated with dicloxacillin. The resistance of bacteria strain concerned suggests a selection because of the use of dicloxacillin in the Department. The strain is sensitive to gentamicin, which differentiates it from strains imported from abroad. Increased hygienic precautions, isolation of infected patients, staff and management efforts and a close contact with the microbiologists prevented MRSA from spreading to other hospital wards.

Retirement from work. The recent lowering of retirement age--causes and consequences.

The recent change in early retirement is described and related to the development in social policy, labour market and individual attitudes towards work and retirement. Particular attention is given to the orientation toward life after work in relation to retirement. The development in retirement pattern is seen as an institutionalisation of early retirement.

[Evaluation of treatment at the Copenhagen County Hospital Stolpegård. 2. A follow-up study of psychotherapeutic effects after one year]. / Behandlingsevaluering på Københavns Amts Sygehus Stolpegård. 2. En efterunderundersøgelse af psykoterapeutisk effekt et år senere.

This one-year follow investigation is a sequel of a previous controlled review of the therapeutic results at conclusion of treatment in 348 patients. Only 286 completed the treatment and, of these, 191 (67%) attended the follow-up investigation. Three had committed suicide and the remainder defaulted or did not wish to participate. The population followed-up had slightly better therapeutic results and were slightly less socially and mentally stressed than the treated patients as a whole. One year after the conclusion of treatment, 78% had still improved and 64% of those who improved primarily had improved further in the course of the follow-up year and this held also true for 63% of those who did not improve originally. The durability of the primary improvement was found to be 82%. Age was connected with the therapeutic result, subsequent improvement and also the durability so that the result was poorer with increasing age. Numerous other parameters also suggested that treatment gives the best result in patients less firmly established in social and mental circumstances of life. The therapeutic result was independent of sex, type of treatment and duration of treatment. The considerable subjective and clinical improvement as regards general wellbeing and cessation or reduction of symptoms/problems were not associated with greater connection with employment or reduction of assistance from the local authority.

[Violence by patients towards personnel/furniture in a psychiatric department. Patients' characteristics and reactions of the staff]. / Patientvold mod personer/inventar på en psykiatrisk afdeling. Patientkarakteristika og behandlerreaktioner.

Violent behaviour by patients in the Psychiatric Department in Frederiksberg Hospital was registered during a period of seven months. A total of 135 violent episodes by a total of 35 patients were registered. Female patients were responsible for 84% of the episodes. 53% occurred during day hours and were often precipitated by attempts to limit the behaviour of the patients. In 111 cases, violence was directed to the staff. Staff members experienced sequelae in 87 cases. None of the episodes were notified to the local insurance organisations.

Mortality and fertility in Arctic Communities Greenland - A case study.

Summary The purpose of this paper is to estimate the present level of mortality and fertility as well as its history amongst the indigenous population of Greenland during the period 1834-1953 on the basis of a series of censuses taken during that time. Mortality and fertility parameters have been estimated by techniques particularly suited for the analysis of incomplete demographic data - e.g. stable population analysis. During the period studied Greenland was a Danish colony. It did not become constitutionally part of Denmark until 1953. The paper shows that even though the importance of Danish - and other European - influence should not be underestimated, the socio-economic structure of Greenland was relatively stable until 1953. The results show an extremely high mortality and a correspondingly high fertility. There is also evidence that mortality fluctuated considerably during the period. This might also be true of fertility, but it is impossible to establish this by means of the techniques used. These results are supported by an analysis of registrations of births and deaths for part of the period. The paper concludes with an evaluation of the validity of the techniques of estimation, having regard to the nature of the Greenland censuses. It is pointed out that the empirical material from which model stable populations must have been constructed varies somewhat from that applicable to an Arctic population.