Gentofte University Hospital Research Articles

No association between metal allergy and cardiac in-stent restenosis in patients with dermatitis-results from a linkage study

Percutaneous coronary intervention (PCI) with implantation of a metal stent is a common procedure performed in patients with symptomatic ischaemic heart disease. Intracoronary stents typically have a backbone of stainless steel, which contains nickel, chromium, and molybdenum, and it remains unclear whether individuals who are allergic to these metals have an increased risk of restenosis after PCI with stent implantation. To further evaluate whether dermatitis patients with nickel and/or chromium allergy had an increased risk of developing cardiac in-stent restenosis with stainless steel stents. An individual-level linkage study was performed to identify dermatitis patients who had been patch tested with the European baseline series between 1979 and 2007 at Gentofte University Hospital (N = 18794) and who had also undergone PCI at some point in a Danish hospital. One hundred and forty-nine (0.8%) dermatitis patients who had undergone PCI with a metal stent were included. One hundred and forty-seven were patch-tested before undergoing PCI. Of the patients, 14.1% (21/149) had cardiac in-stent restenosis. Among patients with metal allergy, 2 (11.8%) had restenosis. Nickel and/or chromium allergy in dermatitis patients does not appear to increase the overall risk of in-stent restenosis after PCI.

Quantitative assessment of diethylthiourea exposure in two cases of occupational allergic contact dermatitis

Ulrik Fischer Friis1, Jeanne Duus Johansen1, Teddy Krongaard2 and Torkil Menne3 1National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark, 2Department of Atmospheric Environment, National Environmental Research Institute, Aarhus University, 4000 Roskilde, Denmark, and 3Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark

Prevalence and cause of methylisothiazolinone contact allergy

Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) has been one of the most frequent sensitizers since the 1980s. In 2005, the use of MI alone was approved for the preservation of cosmetic and household products in the EU. Before that, MI was used in industrial products, and the first cases of isolated MI contact allergy were published. To present the prevalence and causes of MI contact allergy. Patch test results from 2536 dermatitis patients tested with MI at Gentofte University Hospital between May 2006 and February 2010 were analysed. A retrospective investigation of medical records from MI-allergic patients was performed to reveal the causes of their MI contact allergy. Of patch-tested patients, 1.5% had MI contact allergy. It was associated with occupational dermatitis, hand eczema and age above 40 years. Exposure to MI in cosmetic products was found in 12 (32%) cases, and exposure to MI in occupational products was found in 11 (30%) cases; 5 of the 11 were painters. The prevalence of MI contact allergy is already at the same level as that of other sensitizing preservatives, which have been on the market for several years, but no rising trend was identified. MI contact allergy was associated with both occupational and consumer products.

CONSERVATIVE OR SURGICAL TREATMENT OF A VESTIBULAR SCHWANNOMA

To the Editor: In the recent publication of Malhotra et al. "Clinical, radiographic, and audiometric predictors in conservative management of vestibular schwannoma" (1), we have noticed 2 flaws. In their article, which we read with interest, the conservative management of 202 patients with a vestibular schwannoma is discussed, and univariate and multivariate analyses were performed. We subscribe the need and use of a wait-and-scan policy in vestibular schwannomas because their tendency for growth and complications is on average low. Our main remark is regarding their discussion. Regarding radiotherapy and surgical treatment of vestibular schwannomas, they are stating that "these treatments carry nonnegligible consequences in terms of morbidity, mortality and quality of life." For mortality and facial nerve preservation, the risk is quoted and referred to recent articles. However, cerebrospinal fluid (CSF) leakage is quoted as approximately 15% with no reference. This is a wrong presumption and, without reference, not a sustainable figure. We have studied our result for many years with one of the largest series of surgical removal of vestibular schwannomas with a CSF leak rate of 0 and 1.4% (2,3). Even when not quoting the least amount of CSF rate reported in literature (2,3), a recent review has calculated an overall rate of 9.5% (4). We think that CSF leak in vestibular schwannoma surgery can be reduced to an absolute minimum with the use of the right surgical procedure (5). Malhotra et al. is furthermore stating in their introduction that "the present article describes the largest single-institution series of VS patients followed by conservative management," whereas for many years, the ENT Department of the Gentofte University Hospital in Copenhagen, Denmark, has the largest series. They even quote and refer (ref. [29]) to this series of 552 patients in their own article (6). Paul Merkus, M.D., Ph.D. Mario Sanna, M.D. Department of Otology and Skull Base Surgery Grupo Otologico Piacenza, Italy

Contact dermatitis from Welsh poppy [Meconopsis cambrica(L.) Vig.

Contact DermatitisVolume 62, Issue 3 p. 184-186 Contact dermatitis from Welsh poppy [Meconopsis cambrica (L.) Vig.] Evy Paulsen, Corresponding Author Evy Paulsen Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, 5000 Odense C, DenmarkEvy PaulsenDepartment of Dermatology and Allergy CentreOdense University HospitalSdr. Boulevard 295000 Odense CDenmarkTel: +45 6541 2705Fax: +45 6612 3819e-mail: evy.paulsen@ouh.regionsyddanmark.dkSearch for more papers by this authorGitte I. Strauss, Gitte I. Strauss Department of Dermatology, Gentofte University Hospital, University of Copenhagen Denmark, 2900 Hellerup, DenmarkSearch for more papers by this author Evy Paulsen, Corresponding Author Evy Paulsen Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, 5000 Odense C, DenmarkEvy PaulsenDepartment of Dermatology and Allergy CentreOdense University HospitalSdr. Boulevard 295000 Odense CDenmarkTel: +45 6541 2705Fax: +45 6612 3819e-mail: evy.paulsen@ouh.regionsyddanmark.dkSearch for more papers by this authorGitte I. Strauss, Gitte I. Strauss Department of Dermatology, Gentofte University Hospital, University of Copenhagen Denmark, 2900 Hellerup, DenmarkSearch for more papers by this author First published: 23 February 2010 https://doi.org/10.1111/j.1600-0536.2009.01689.xCitations: 7Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume62, Issue3March 2010Pages 184-186 RelatedInformation

Dynamic analysis of EUS used for the differentiation of benign and malignant lymph nodes

EUS elastography was reported to offer supplemental information that allows a better characterization of tissue, and that might enhance conventional EUS imaging. Our purpose was to apply real-time elastography during EUS examinations and to assess the accuracy of the differentiation of benign versus malignant lymph nodes. Prospective cross-sectional feasibility study. Department of Surgical Gastroenterology, Gentofte University Hospital, Hellerup, Denmark. Patients diagnosed by EUS with cervical, mediastinal, or abdominal lymph nodes were included, with a total number of 78 lymph nodes examined. The final diagnosis of the type of lymph node was obtained by EUS-FNA cytologic analysis or by surgical pathologic examination and by a minimum 6 months of follow-up. Hue histogram analysis of the average images computed from EUS elastography movies was used to assess the color information inside the region of interest and to consequently differentiate benign and malignant lymph nodes. Differentiate between malignant and benign lymph nodes. By using mean hue histogram values, the sensitivity, specificity, and accuracy for the differential diagnosis were 85.4%, 91.9%, and 88.5%, respectively, on the basis of a cutoff level of 166 (middle of green-blue rainbow scale). The proposed method might be useful to avoid color perception errors, moving artifacts, or possible selection bias induced by analysis of still images. Lack of the surgical standard in all cases. Computer-enhanced dynamic analysis based on hue histograms of the EUS elastography movies represents a promising method that allows the differential diagnosis of benign and malignant lymph nodes, offering complementary information added to conventional EUS imaging.

1147 Prognostic importance of quantitative echocardiography in patients suspected of non-massive pulmonary embolism

s S203 Eur J Echocardiography Abstracts Supplement, December 2006 1147 Prognostic importance of quantitative echocardiography in patients suspected of non-massive pulmonary embolism J. Kjaergaard 1 ; B.K. Schaadt 2 ; J.O. Lund 1 ; C. Hassager 2 1Copenhagen University Hospital Rigshospitalet, Cardiology B2141 Dept., Copenhagen, Denmark; 2Copenhagen University Hospital Gentofte, Nuclear Medicine Dept., Copenhagen, Denmark Background: Echocardiography (TTE) is an essential adjunct to the diagnostic work-up of the patients admitted with acute dyspnea with acute onset suspected of possible Pulmonary Embolism (PE). TTE has been shown to be helpful in identifying RV dysfunction and thereby choosing the appropriate treatment strategy, as well as identifying differential diagnoses. The present study evaluated the prognostic information from quantitative echocardio-graphic parameters in patients with dyspnea suspected of nonmassive PE. Methods: Of 296 patients included, 13 had V/Q scans of insufficient quality for interpretation, 2 patients were lost to follow-up, leaving 281(94%) patients for analysis, of whom 58 (20%) had high probability of PE. Echocardiographic covariates previously evaluated for their diagnostic value were entered in a multiple, backward-elimination Cox proportional hazard model: pulmonary acceleration time (a previously established measure of RV pressure), peak strain and systolic velocity of the right ventricular free wall, as well as age and sex, and left ventricular function as potential confounding factors. Results: Patients were followed for a median of 2.3 years (max. 3.0 years); 74 patients (26%) died during this period. Survival rate in patients diagnosed with PE and patients without were no different (log-rank test p=0.86). The results of the multivariate model showed that age, left ventricular ejection fraction and pulmonary acceleration time were independent prognostic factors, see Table. Conclusion: The present study identifies pulmonary acceleration time among quantitative echocardio-graphic markers of RV pressure and function as significant, independent prognostic marker in patients admitted for acute dyspnea, suspected of non-massive PE. These findings support the use of TTE in the initial assessment of patients with acute onset dyspnea suspected of

The Low-Molecular-Weight-Heparin, Tinzaparin, Is Effective and Safe in the Treatment and Prophylaxis of Venous Thromboembolic Disease during Pregnancy.

During pregnancy the incidence of venous thromboembolism (VTE) is approximately 6 times higher than in age-matched, non-pregnant women and venous thromboembolism remains the most common cause of maternal morbidity and mortality. Low-molecular-weight-heparins are recommended for treatment of VTE during pregnancy and for prophylaxis of VTE in pregnant women with major thromboembolic risk factors. We used tinzaparin for prophylaxis and treatment of VTE in 305 consecutive pregnant women referred to the Thrombosis Centre, Gentofte University Hospital, from 1997 to 2004. In 268 pregnancies the mothers had thrombophilia, 52 women were admitted with acute VTE and 184 had previous VTE. Other clinical risk factors included previous bad obstetric outcome, recurrent miscarriages, cardiac disorders or previous thromboembolic stroke. An individual risk assessment of each pregnant woman was performed. Very high risk females were treated with tinzaparin 90 – 100 IU/kg bid, high risk females were treated with tinzaparin 100 – 125 IU/kg daily and women with moderate risk were treated with 50 – 75 IU/kg daily.302 of 305 pregnancies (99 %) in 263 females resulted in 310 healthy babies. 306 of 310 babies had appropriate birth weight for gestational week and all babies had normal Apgar score. Two females had miscarriages (week 10 and 20) and 1 female had an elective abortion. No females had pulmonary embolism. Deep venous thrombosis occurred in 4 of 305 pregnancies = 1,3 % (week 6, 11, 27 and one day postpartum). Wound hematoma was observed after cesarean section in two women and postpartum bleeding episodes (700 – 1500 ml) were observed in 7 women (4 had severe vaginal or cervical tearings, 2 had retained placenta and 1 had placental abruption). We found no incidence of thrombocytopenia or symptomatic osteoporosis.We find that individually dosed tinzaparin is safe and seems effective in the prevention of thromboembolic complications during pregnancy. Individual risk stratification is recommended.

Methyldibromo glutaronitrile: clinical experience and exposure-based risk assessment.

In the year 2000, the level of methyldibromo glutaronitrile (MDGN) allergy in dermatology clinics in Europe exceeded the level of allergies to all other preservatives, with a prevalence of 3.5%. In the present study, cases of primary sensitization and elicitation to MDGN due to cosmetic products were collected over an 8-month period at the Department of Dermatology, Gentofte University Hospital. The aim was to identify the products related to hand eczema, assess exposure to MDGN in these products and relate the findings to results from a newly developed updated risk assessment model for contact allergy. Out of 24 patients with a positive patch test to MDGN, 17 patients with hand eczema were identified. In 11 of these patients, cosmetic products used in relation to the onset of the disease were shown to contain MDGN (65%). In 8 of these 11 cases, primary sensitization was probable, 5 due to hand/body lotions and 3 due to lotions and/or liquid hand soap. Chemical analysis of 12 products showed that lotions contained 149-390 ppm of MDGN, liquid hand soap 144-399 ppm, a rinsing cream 293 ppm and shampoos 78-79 ppm. The shampoo exposure was not of certain relevance to the eczema. Applying the newly developed updated risk assessment model showed that the concentrations of MDGN in lotions of 149-390 ppm exceeded the calculated maximum acceptable exposure level for MDGN, which would be expected to lead to sensitization in consumers using such products, as seen in the current study. The present cases and updated exposure-based risk assessment process add to the evidence and need for re-defining safe-use concentrations of MDGN in cosmetic products.

Results after Re-Operation in the Groin for Recurrent Varices of the Long Saphenous Vein

Objective: To evaluate the outcome of re-operation in the groin for recurrent varicose veins. Design: Retropective follow-up study Setting: Department of Vascular Surgery, Gentofte University Hospital, Copenhagen, Denmark. Methods and materials: Thirty-two patients with 43 operated legs. Operations were performed between January 1996 and the end of April 1997 and solely as a groin dissection; no stripping was done. Follow-up consisted of a clinical examination and duplex scanning with an ATL HDI 5000 scanner. Results: Sixteen cured legs, 17 with reflux beginning at mid-thigh, mainly a Hunter's perforating vein, and 10 with remaining reflux at the sapheno-femoral junction. Conclusion: Recurrence rate in the groin is acceptable. Stripping of the long saphenous vein is mandatory to bring down the recurrence rate from mid-thigh perforating veins. This is now standard procedure in our department.

Danish Anaesthesia Allergy Centre - preliminary results.

Anaphylactoid reactions in anaesthesia are rare and should ideally be investigated in specialist centres. At Gentofte University Hospital, we established such a centre in 1998 as a joint venture between the Departments of Anaesthesiology and Dermatology. We present the methodology, diagnostic algorithm and preliminary results from our centre. We are open for referral of patients from all of Denmark. Reactions are classified using a three-grade severity scale and all reactions ranging from mild to severe are investigated. Investigations follow a standard step-by-step protocol of in vitro testing and skin testing. Blood samples for tryptase analysis are taken at the time of reaction and a control sample is taken together with samples for specific IgE analysis 2-4 weeks after the reaction. Subsequent skin testing comprises both prick tests and intradermal tests in most cases. Patients are tested with all substances they were exposed to, including antibiotics, colloids, latex and chlorhexidine. A total of 68 patients have been referred to date (July 2001) and 36 have completed investigations. Positive test results were mainly seen in patients with more severe reactions, and there were more men than women in the group with the most severe reactions. Six patients had positive specific IgE, three for penicillin, two for latex and one for thiopental. In all, 21 patients had positive skin tests to various substances, of whom four men with anaphylactic shock tested positive for chlorhexidine. Only one patient has tested positive to a neuromuscular blocking drug (NMBD) so far. Our preliminary results appear to differ in two ways from results usually found in this field. Firstly, only one patient has tested positive for a NMBD and secondly, we have had four patients with anaphylactic shock who have tested positive for chlorhexidine. Possible reasons for these differences are discussed.

Restoration and maintenance of sinus rhythm in patients with left ventricular dysfunction and atrial fibrillation/ flutter is associated with improved survival. A DIAMOND substudy Ole D. Pedersen. department of Cardiology P, Gentofte University Hospital, Hellerup, Denmark

Restoration and maintenance of sinus rhythm in patients with left ventricular dysfunction and atrial fibrillation/ flutter is associated with improved survival. A DIAMOND substudy Ole D. Pedersen. department of Cardiology P, Gentofte University Hospital, Hellerup, Denmark

Primary Speech Restoration at Laryngectomy by Insertion of Voice Prosthesis - 10 Years' Experience

A total of 88 patients underwent laryngectomy at the ENT Department, Gentofte University Hospital, Hellerup, Denmark, from May 1989 to May 1999. Of these, 85 patients underwent salvage operations for squamous cell laryngeal carcinoma after previous full course radiotherapy. A total of 76 patients had primary tracheo-oesophageal puncture performed at the time of laryngectomy, 11 had a secondary procedure performed, 7 of these had been laryngectomized elsewhere. Eight patients were not eligible for tracheo-oesophageal puncture due to age, social reasons or extensive surgery. In all, 79 patients were able to use the prosthesis for communicative purposes weeks after the operation and developed fluent speech. During the observation time, 14 patients had their voice prosthesis removed or disconnected for various reasons. The average life duration for Provox voice prosthesis generation I vs Provox generation II was 3.1 and 2.3 months, respectively.

A visit to Professor Mirko Tos, Gentofte University Hospital, Copenhagen

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Reversal of Intense Mivacurium Block with Human Plasma Cholinesterase in Patients with Atypical Plasma Cholinesterase

Departments of Anesthesiology, Gentofte University Hospital, Hellerup, Denmark, and National University Hospital, Rigshospitalet, Denmark

Cystic Acoustic Neuromas: Results of Translabyrinthine Surgery

This study was designed to investigate the surgical outcome of translabyrinthine surgery of cystic acoustic neuromas. Prospective registration of audiovestibular, otoneurologic, and neuroradiologic data of all patients operated on for cystic neuromas in the period 1976 to 1992. The diagnosis was proposed by neuroradiologic investigation, confirmed at surgery, and verified histologically. Clinical follow-up was performed 1 year after surgery. The study included all patients with cystic acoustic neuromas from the entire country, referred to the centralized otoneurosurgical team in the Department of Otorhinolaryngology-Head and Neck Surgery, Gentofte University Hospital, and Department of Neurosurgery, Rigshospitalet, University of Copenhagen, Denmark. The study included 23 patients (11 female and 12 male). Ages ranged between 23 and 77 years with a median of 51.2 years. Our hypothesis suggested that surgical outcome of cystic acoustic neuromas was poorer compared with noncystic acoustic neuromas of matching size. The results of this study seem to confirm the hypothesis. The results are rather poor compared with results achieved in surgery of noncystic tumors of matching size, particularly the poor postoperative facial nerve function. Even though the operation for a cystic acoustic neuroma may appear to be easier and faster than the operation for a solid tumor, there is a high risk for accidental lesion of the facial nerve, in spite of using facial nerve monitoring. Rapid symptomatic worsening may occur due to sudden expansion of cystic elements and, therefore, a wait-and-see policy should not be applied to patients with cystic tumors.

The implications of introducing the symphyseal‐fundal height‐measurement. A prospective randomized controlled trial

A total of 1639 women attending the antenatal clinic of Gentofte University Hospital, Copenhagen, during 1986-1987 was randomized into a symphyseal fundal (SF)-group and a control group. The women in the SF-group had their fundal height measured from the 29th week until delivery. The measurements were used along with the other usual screening procedures. The SF-measurements were not found helpful in the prediction of small-for-gestational-age infants and no significant differences were found between the two groups regarding the number of interventions, additional diagnostic procedures, or the condition of the newborns.