Bruger:Jørgen Degn

Lumbar disk prolapse surgery. Can intervention at an incorrect level be prevented?

Degn JD, Gjerris F. Ugeskr Laeger. 2004 May 3;166(19):1757-9. Danish.

Introduktion: Antallet af anmeldelser af patientskader i sygehusvæsenet er steget jævnt gennem de seneste ti år. Formålet med vores undersøgelse var at vurdere resultatet af operation på forkert niveau ved lumbal diskusprolaps og dermed at sætte fokus på kvalitetssikring og skadeforebyggelse inden for rygkirurgi (ortopædkirurgi og neurokirurgi).

Materiale og metoder: I Patientforsikringens register var det muligt at finde 36 patienter, som i 1996-2000 var blevet opereret for lumbal diskusprolaps på et forkert niveau. Ved sammenligning med Sundhedsstyrelsens Landspatientregister kunne frekvensen af og risici for operation på forkert niveau ved lumbal diskusprolaps vurderes.

Resultater: Den lumbale diskusprolaps var hos næsten alle patienterne lokaliseret ud for 4. eller 5. diskus. Nitten patienter fik ikke foretaget peroperativ røntgengennemlysning, og højden blev hos disse patienter vurderet ud fra anatomiske forhold. Sytten patienter blev – trods peroperativ røntgengennemlysning – opereret på et forkert niveau, i de fleste tilfælde på et niveau kranialt for den ønskede højde. I perioden 1998-2002 blev der udført 12.707 lumbale operationer i Danmark, og de 19 operationer, som er foretaget i årene 1998-2000 og færdigbehandlet i Patientforsikringen, giver en komplikationsrate på 1,5‰, dog med betydelige regionale forskelle.

Diskussion: Ud fra de foreliggende data kan man ikke bekræfte, at peroperativ røntgengennemlysning ville kunne have sikret et korrekt niveau, men almindelig sund fornuft peger på, at undersøgelse med moderne gennemlysningsapparatur kombineret med kirurgens operative erfaring og kendskab til patienten vil kunne øge sikkerheden betydeligt. Den reelle risiko for operation på et utilsigtet niveau er således ikke høj, men dog formentligt større end den påviste 1,5‰.

Chlamydia pneumoniae infection in adults with chronic cough compared with healthy blood donors

Birkebaek NH, Jensen JS, Seefeldt T, Degn J, Huniche B, Andersen PL, Ostergaard L. Eur Respir J. 2000 Jul;16(1):108-11.

In a small uncontrolled study, persistent cough has recently been found to be associated with serological evidence of acute Chlamydia pneumoniae infection. In order to assess whether C. pneumoniae plays a role in chronic cough, the prevalence of C. pneumoniae infection in 201 adult patients with chronic cough was compared with the prevalence in 106 healthy blood donors without respiratory tract symptoms in the preceding 3 months. A microimmunofluorescence antibody test was used to determine C. pneumoniae antibodies in the immunoglobulin (Ig)M, IgG and IgA fractions. Further, nasopharyngeal aspirates from the 201 patients were examined for C. pneumoniae deoxyribonucleic acid by polymerase chain reaction (PCR). As judged by serology, nine patients (4%) and one control (1%) had acute C. pneumoniae infection, and 92 patients (46%) and 42 controls (40%) had previous or chronic C. pneumoniae infection. Of the nine patients with acute infection, three were C. pneumoniae PCR positive, and they all had an IgM antibody titre response. The remaining six patients had either an IgG antibody titre of > or =512 (five patients) or an IgA antibody titre of > or =512 (one patient). None of these six patients had detectable IgM antibodies. The mean cough period for the five IgG positive patients (10.8 weeks) was significantly longer than the mean cough period for the remaining patient population (6.4 weeks; p=0.004). It is concluded that Chlamydia pneumoniae infection was not statistically significantly more prevalent in patients with chronic cough than in healthy blood donors, and that Chlamydia pneumoniae appears to have a minor role in patients with chronic cough. Direct detection of Chlamydia pneumoniae by polymerase chain reaction on nasopharyngeal aspirates is highly correlated with detectable immunoglobulin M antibodies, but in the late stages of prolonged cough serological testing of immunoglobulin G and immunoglobulin A may be more beneficial for obtaining a microbiological diagnosis.

Bordetella pertussis and chronic cough in adults

Birkebaek NH, Kristiansen M, Seefeldt T, Degn J, Moller A, Heron I, Andersen PL, Moller JK, Ostergård L. Clin Infect Dis. 1999 Nov;29(5):1239-42.

To evaluate Bordetella pertussis as a cause of persistent cough in adults, we examined 201 patients who had a cough for 2-12 weeks and no pulmonary disease. We obtained the following at presentation: medical history, chest radiograph, respiratory function measurement, nasopharyngeal aspirate for polymerase chain reaction (PCR), nasopharyngeal swab specimen for culture, and a blood sample (acute serum). Four weeks later a second blood sample (convalescent serum) was obtained. Control sera were obtained from 164 age-matched healthy blood donors with no history of cough during the previous 12 weeks. Four patients were B. pertussis culture-positive; 11 (including the culture-positive patients) were B. pertussis PCR-positive; and 33, including 10 of the 11 PCR-positive patients, had serological evidence of recent B. pertussis infection. Pertussis-positive and -negative patients could not be discriminated by a history of cough. We conclude that B. pertussis infection is a common cause of persistent cough in adults. This is of concern, because these patients may be B. pertussis reservoirs from which transmission may occur to infants, in whom the disease can be devastating.

Effect of nerve crush on perikaryal number and volume of neurons in adult rat dorsal root ganglion

Degn J, Tandrup T, Jakobsen J. J Comp Neurol. 1999 Sep 13;412(1):186-92.

Assumption-free stereological methods were applied to assess the effect of nerve crush on perikaryal number and mean volume of neuronal subpopulations in adult rat dorsal root ganglion (DRG). The L5 spinal nerve of 20 Wistar rats was crushed approximately 7 mm distal to the DRG, and the contralateral spinal nerve and DRG were left intact and used as controls. After four, 15, 45, and 120 days, the rats were killed, and the tissue was fixed and processed for subsequent preparation of 30-microm-thick sections. Estimates of neuron number were obtained with the optical fractionator technique and estimates of the mean perikaryal volume with the vertical planar rotator principle. Perikaryal loss was progressive during the early study period but stabilized 45 days after nerve injury. The mean number (n) of all neurons in intact L5 DRG was 16,400 (S.D. = 2,000). The loss of perikarya was 16% (P < 0.05) after four days, 15% (P < 0.05) after 15 days, 30% (P = 0.059) after 45 days, and 34% (P < 0. 05) after 120 days. B cells were lost at an earlier time than were A cells, and the B cell loss was more pronounced (39% vs. 22%, respectively, after 120 days). For A cells, the mean perikaryal volume was initially reduced but was normalized at the end of the study. Distributions of perikaryal volume showed that the curves of both A and B cells were uniformly displaced toward smaller values 15 and 45 days after injury. Neuronal loss caused by crush seems similar to that seen in rats exposed to permanent axotomy (Vestergaard et al. [1997] J Comp Neurol 388:307-312) at the same location, indicating that survival of perikarya is not dependent on possibility for fiber growth.