Forskningens

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Forskningens

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Hospitalsenhed Midt

Forskningens dag den 2. maj 2013

Abstracts

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Program “Forskningens dag” 201312.00 - 12.05 Velkomst12.05 - 13.05 Foredragssession I 13.05 - 13.20 Pause med mulighed for at se posters 13.20 - 14.20 Foredragssession II14.20 - 14.40 Gæstetaler: Ove Andersen MD. PhD. Forskningschef, Klinisk Forskningscenter, Hvidovre Hospital “Op-

bygning af en forskningsenhed fra 2 - 75 medarbejdere på 10 år”14.40 - 15.00 Præmieoverrækkelse og afslutning

Session I. 12.05 - 13.05

1. Lars Frost m.fl., Diagnostisk Center Body fat, body fat distribution, lean body mass and atrial fibrillation. A Danish cohort study.2. Annette Høgh m.fl., Kardiovaskulært Forskningscenter, Karkirurgisk Afdeling Beta blocker use and clinical outcomes after primary vascular surgery: A nationwide propensity-score matched

study.3. Marie Dahl Thomsen m.fl., Kardiovaskulært Forskningscenter, Karkirurgisk Afdeling Undersøgelse af risikofaktorer for hjertekarsygdomme og diabetes blandt 60-75 årige danske kvinder. Præliminære

resultater.4. Holger Wemmelund m.fl., Kardiovaskulært Forskningscenter, Karkirurgisk Afdeling Preadmission statin use and risk of rupture of abdominal aortic aneurism: A nationwide, population-based study.5. Niklas Blach Rossen m.fl., Diagnostisk Center Targeting nocturnal hypertension in type 2 diabetes.6. Steffen Bank m.fl., Medicinsk Afdeling Genetic determinants of increased expression of toll-like receptors and tumor necrosis factor alpha (TNF-α) are

associated with response to TNF-α inhibitor treatment in a Danish cohort of inflammatory bowel disease.

Moderator: Ledende overlæge, dr.med. Jan Abrahamsen, Klinisk Fysiologisk Afdeling

Session II. 13.20 - 14.20

1. Lone Ramer Mikkelsen m.fl., Center for Planlagt Kirurgi The influence of assistive devices and movement restrictions after fast-track total hip replacement.2. Ina Qvist m.fl., Kardiovaskulært Forskningscenter, Diagnostisk Center Implementation of nurse-led atrial fibrillation clinics in Denmark.3. Nikolaj Grøndal m.fl., Kardiovaskulært Forskningscenter, Karkirurgisk Afdeling Detections and costs of combined population screening for abdominal aortic aneurism and peripheral arterial di-

sease: The Viborg vascular (VIVA) screening trial.4. Mette Østergaard m.fl., Klinisk Biokemisk Afdeling Lever HbA1c analysen op til sin nye rolle som diagnostisk markør for diabetes?5. Carsten Behr-Rasmussen m.fl., Kardiovaskulært Forskningscenter, Karkirurgisk Afdeling The role of the mural thrombus in the progression of abdominal aortic aneurisms. A large population-based pro-

spective cohort study.6. Rikke Hansen m.fl., Vestdansk Center for Rygmavsskade Discharge from hospital and readmission - an active element in rehabilitation?

Moderator: Overlæge, lektor, dr.med. Lars Frost, Diagnostisk Center

Hvert oplæg har en varighed af otte minutter, herefter er der afsat to minutter til diskussion.

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Foredrag på “Forskningens dag”

SeSSIon I:1. Body fat, body fat distribution, lean body mass and atrial fibrillation. A Danish cohort study ...................................... 6

2. Beta blocker use and clinical outcomes after primary vascular surgery: A nationwide propensity-score matched study .......................................................................................................................... 7

3. Undersøgelse af risikofaktorer for hjertekarsygdomme og diabetes blandt 60-75 årige danske kvinder. Præliminære resultater .................................................................................................................................................................... 8

4. Preadmission statin use and risk of rupture of abdominal aortic aneurism: A nationwide, population-based study ......................................................................................................................................... 9

5. Targeting nocturnal hypertension in type 2 diabetes ............................................................................................................. 10

6. Genetic determinants of increased expression of toll-like receptors and tumor necrosis factor alpha (TNF-α) are associated with response to TNF-α inhibitor treatment in a Danish cohort of inflammatory bowel disease .. 11

SeSSIon II:1. The influence of assistive devices and movement restrictions after fast-track total hip replacement .................... 12

2. Implementation of nurse-led atrial fibrillation clinics in Denmark ...................................................................................... 13

3. Detections and costs of combined population screening for abdominal aortic aneurism and peripheral arterial disease: The Viborg vascular (VIVA) screening trial ..................................................................... 14

4. Lever HbA1c analysen op til sin nye rolle som diagnostisk markør for diabetes? ........................................................... 15

5. The role of the mural thrombus in the progression of abdominal aortic aneurisms. A large population-based prospective cohort study ............................................................................................................... 16

6. Discharge from hospital and readmission - an active element in rehabilitation? ........................................................... 17

Øvrige indleverede abstracts til “Forskningens dag”1. Does dynamic contrast-enhanced magnetic resonance (DCE-MRI) aid the diagnosis of early rheumatoid arthritis in the wrist? ................................................................................................................................. 18

2. Fast-track diagnostics: An anthropological study exploring how fast-track diagnostic cancer pathways frame clinical encounters and the configuring of patients and health professionals .................................................... 19

3. Har højre-venstreskelnen betydning for effekten af spejlbehandling til apopleksipatienter? Et kohortestudie .. 20

4. A Minimal invasive case study: Arthroscopic-assisted stabilization fractures of the patella ...................................... 21 5. A novel technique: Preliminary clinical results of cement augmentation of intertrochanteric fractures stabilized with an intermedullary nail ..................................................................................... 22

6. Responsiveness of the Danish version of the disabilities of arm, shoulder and hand (DASH) .................................... 23

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7. A novel technique of minimally invasive procedure in treating fractures in an osteoporotic patient ....................... 24

8. Selvstyret læring hos medicinstuderende I klinisk ophold .................................................................................................... 25

9. Does size matter? Report on a popliteal catastrophe ............................................................................................................ 26

10. Epidemiology of microscopic colitis. A 10-year nationwide Danish cohort study ........................................................... 27

11. Isolation, identification, cultivation and differentiation of porcine cardiac stem cells - in pursuit of cardiac regeneration therapies ........................................................................................................................... 28

12. ”At komme hjem”, - en interview undersøgelse af rygmarvsskadede patienters erfaringer med at komme hjem efter rehabilitering på Vestdansk Center for Rygmarvsskade (VCR) ........................................................ 29

13. Patient participation in conference with team-members shortly after admission ........................................................ 30

14. Transverse myelitis in west Denmark – different treatment and increasing age? ......................................................... 31 15. A schematic outline of assessment tools used by PTs and OTs in rehabilitation of spinal cord injured persons in western Denmark 2013 ..................................................................................................... 32

16. Initiale resultater vedrørende potentielt hypertension fra den forebyggende undersøgelse for hjertekarsygdomme og diabetes hos kvinder .................................................................................................................... 33 17. Routine use of coronary CT angiography as initial diagnostisk test in patients with suspected coronary artery disease .................................................................................................................................... 34

18. Relationship between high coronary artery calcification and presence of hemodynamically significant stenosis ......................................................................................................... 35

19. The influence of the gastrointestinal tract and the liver on the serum levels of cystatin C ......................................... 36

20. Renal extraction of cystatin C, creatine and urea .................................................................................................................... 37

21. Self-reported knowledge and awareness about blood pressure and hypertension ...................................................... 38

22. High quality and quantity DNA extraction from frozen archival blood clots for genotyping of single nucleotide polymorphisms ..................................................................................................................... 39

23. A Danish cohort of tumor necrosis factor-α inhibitor treated patients with inflammatory bowel disease, a case-only design ........................................................................................................... 40

24. Anal sphincterruptur ved vaginal fødsel: Risikofaktorer, behandling og opfølgning ...................................................... 41

25. Diagnostisk imaging of patients with unspecific symptoms of potentially serious disease or malignancy: How we screen for occult cancer ................................................................................................................................................. 42

26. Fibrotic and inflammatory lesions in small intestinal stenoses assessed with imaging techniques CEUS and MRI to predict biomechanical wall properties in patients with CD (FLIP). Results from an accidentally measured fistula ........................................................................................................................ 43

27. Validation of point-of-care INR coagulometer in intensive care patients not on oral anticoagulation therapy ..... 44

28. Afprøvning af Lactate Scout™ under fødsler med truende asfyksi ..................................................................................... 45

29. Urine desmosine: A potential biomarker for abdominal aortic aneurysms ....................................................................... 46

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Foredrag på “Forskningens dag”SeSSIon I

1. Body fat, body fat distribution, lean body mass and atrial fibrillation. A Danish cohort study

Frost L, MD, PhD, DMSc; Benjamin EJ, MD, MSc; Fenger-Grøn M, MSc; Pedersen A, PhD; Christensen, AL, MSc; Tjønne-land A, MD, PhD, DMSc; Overvad K, MD, PhD

From the Department of Medicine, Silkeborg Hospital & Institute of Clinical Medicine (LF), Aarhus University Hospital, Aarhus, Denmark; Department of Medicine, School of Medicine and Department of Epidemiology, School of Public He-alth (E.J.B.), Boston University, Boston, MA, USA; Research Unit for General Practice (M.F.), Aarhus University, Aarhus, Denmark; Hammel Neurorehabilitation and Research Centre (A.P.), Hammel, Denmark; Department of Cardiology, Cen-ter for Cardiovascular Research (A.L.C.), Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark; Institute of Cancer Epidemiology, Danish Cancer Society(A.T.), Copenhagen, Denmark; and Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark, and Department of Cardiology, Center for Cardiovascular Re-search (K.O.), Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark

Correspondence to Lars Frost, Department of Medicine, Silkeborg Hospital, Falkevej 1-3, 8600 Silkeborg, Denmark. Larfrost@rm.dk

Background: It is well recognized that body height and weight are positively associated with risk of atrial fibrillation (AF) but it is unclear whether risk of AF is driven by body fat, body fat location, or lean body mass.

Methods: Danish population-based prospective cohort study, Diet, Cancer and Health, conducted from 1993 to 2009 among 55 273 men and women with a median age of 56.2 years without AF at baseline. We investigated the associa-tions between bioelectrical impedance derived measures of body composition in combination with anthropometric measures of body fat distribution and risk of AF in a large cohort of men and women. Participants were followed in the Danish National Registry of Patients and in the Danish Civil Registration System.

Results: During follow-up (median 13.5 years) AF developed in 1 669 men and 912 women. Higher body fat at any loca-tion was associated with a higher risk of AF. The adjusted hazard ratio (HR) (95 % confidence interval) per 1 sex-specific standard deviation (SD) increment in body fat mass was 1.29 (95% confidence interval [CI], 1.24-1.33). In addition, hig-her lean body mass was associated with an elevated risk of AF. The adjusted HR for 1 sex-specific SD increment was 1.40 (95% CI, 1.35-1.45).

Conclusion: Higher body fat as well as higher lean body mass were associated with an increased risk of AF in men and women. In a global population perspective even modest changes in such measurements may have a large impact on the incidence of AF.

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2. Beta blocker use and clinical outcomes after primary vascular surgery: A nationwide propensity-score matched study

Høgh A1, Lindholt JS3, Nielsen H2, Johnsen SP2

1Department of Vascular Surgery, Regionshospitalet Viborg, Denmark2Department of Clinical Epidemiology, Aarhus University Hospital, Denmark3Department of Vascular Surgery, Odense University Hospital

objective: The aim of this study was to explore the associations between beta-blocker use and clinical outcomes (de-ath, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction.

Methods: This study includes all patients who had primary vascular surgical reconstruction in Denmark between 1996 and 2007. We obtained data on filled prescriptions, clinical outcomes and confounding factors from population-based health care registries. Beta-blocker users were matched to non-users by propensity score matching followed by Cox-regression to estimate the adjusted hazard ratios (Adj. HRs). All medications were included as time-dependent varia-bles. Results: We included 16,945 matched patients (7,828 beta-blocker users and 9,117 non-users) with a median follow-up period of 582 days (range, 30 to 4379 days). The cumulative risks were as follows: all-cause mortality, 17.9%; MI, 5.3%; stroke, 5.6%; major amputation, 9.1%; and recurrent vascular surgery, 23.1%. When comparing beta-blocker use with non-use, we found the following Adj. HR: MI, 1.52 (95% CI, 1.31-1.78); stroke, 1.21 (95% CI, 1.03-1.43); and major am-putation, 0.80 (95% CI, 0.70 - 0.93). No differences were found between beta-blocker use and non-use with regard to all-cause mortality and recurrent vascular surgery.

Conclusion: Beta-blocker use after primary vascular surgery was associated with a lower risk of major amputation but an increased risk of hospitalisation with MI and stroke. No associations were found between beta-blocker use and all-cause mortality or the risk of recurrent vascular surgery.

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3. Undersøgelse af risikofaktorer for hjertekarsygdomme og diabetes blandt 60-75 årige danske kvinder. Præliminære resultater

Thomsen MD1 Frost L1, Klausen IC1, Lorentzen V2, Søgaard R3 Lindholt JS1

1Kardiovaskulær Forskningscenter, Hospitalsenhed Midt, 2Center For Sygeplejeforskning, 3Center for Folkesundhed Region Midt/ Aarhus Universitet

Baggrund: Ultimo 2011 startede er screeningsprogram af 60, 65, 70 og 75-årige kvinder i Viborg Kommune. Kvinderne screenes for abdominalt aorta aneurisme, perifer arteriosklerose, carotis plaque, hypertension, diabetes, hyperkole-sterolæmi/familiær hyperkolesterolæmi samt forekomst af atrieflimren. Desuden indhentes oplysninger om livsstil, sygdoms anamnese og familiær disposition. Kvinderne kendskab til eget blodtryk, kolesteroltal og blodsukker vurderes ved interview.

Formål: i) At klarlægge 60 – 75 årige kvinders risikoprofil for hjertekarsygdom og diabetes samt undersøge deres fore-komst at arteriosklerotiske stigmata. ii) At beskrive 60-75 årige kvinders kendskab til egen ’risikoprofil’ i forholdt til blodtryk, kolesteroltal og blodsukker samt tidspunkt for seneste måling.

Metode: Undersøgelsen baseres på et forsøgsvis screeningstilbud til alle 60, 65, 70 og 75-årige kvinder i Viborg Kom-mune (n=2000). Kvinder der ikke responder geninviteres én gang. I forbindelse med invitationen til screeningsunder-søgelsen medsendes et spørgeskema vedrørende rygevaner, sygehistorie, vanlig medicin, højde, vægt samt familiær disposition for hjertekarsygdom og diabetes.

Resultater: Præliminære resultater for de første ca. 1400 deltagere gennemgås. Fremmøde profilerne karakteriseres og forekomsten af risikofaktorer beskrives. Specielt fokuseres på forekomsten af ikke tidligere diagnosticeret hyper-tension, diabetes og familiær hyperkolesterolæmi. Endvidere karakteriseres kvindernes kendskab til egene risikofak-torer: blodtryk, kolesteroltal og blodsukker.

Diskussion og konklusion: Udebliverne fra screeningstilbud vides generelt at have højere dødsrisiko, hvilket også må formodes at gælde i nærværende undersøgelse. Disse forhold diskuteres sammen med indsamlede og analyserede foreløbige datasæt.

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4. Preadmission statin use and risk of rupture of abdominal aortic aneurysm: A nationwide, population-based study

Wemmelund, H.1,2,Høgh, A.1, Thomsen, R.W.2, Johnsen, S.P.2, Lindholt, J.1

1Cardiovascular Research Unit, Viborg Hospital2Department of Clinical Epidemiology, Aarhus University Hospital

objective: Rupture of abdominal aortic aneurysms (rAAA) is associated with high mortality. The size of the abdominal aortic aneurysm (AAA) is closely related to the risk of rAAA. Statins have been suggested to impair AAA expansion, however, the available data are inconclusive. In this study, we examined the association between preadmission statin use and the risk of rAAA.

Methods: Using Danish population-based registries we conducted a nested case-control study among all patients with an incident diagnosis of AAA in Denmark from 1996 through 2008.Cases: rAAA patients. Controls: Age- and gender-matched AAA-patients without rupture.We obtained data on all filled statin prescriptions prior to first admission with an AAA diagnosis. Risk of rAAA was cal-culated as odds ratios (ORs) with 95% confidence intervals (CI) using conditional logistic regression analysis. Results were adjusted for comorbidity, concomitant drug use and calendar year.

Results: We identified 4662 rAAA patients and 4662 matching AAA controls. Risk of rAAA was 34% lower in current sta-tin users compared to never-users (adjusted OR 0.66 (95% CI: 0.58 to 0.76)). When restricting analysis to AAA patients, who filled >1 statin prescription, the risk of AAA rupture was 38 % lower in current statin users compared to never users (adjusted OR 0.62 (95% CI: 0.54 to 0.72)). In contrast, we found no clear association with the risk of rAAA among former users with at least two years since last filled statin prescription.

Conclusion: Preadmission statin use seems to be associated with a markedly decreased risk of rAAA. Further analyses of possible causal mechanisms are warranted.

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5. Targeting nocturnal hypertension in type 2 diabetes

Rossen NB1-2, Knudsen ST2, Ebbehøj E2, Poulsen PL2, Hansen KW1

1Department of Medicine, Silkeborg Regional Hospital, 2Department of Endocrinology and Internal Medicine, Aarhus University Hospital

Background and aim: Hypertension and diabetes are well-established risk factors for the development of atherosc-lerosis and cardiovascular disease. In recent years, several studies have suggested increased nighttime blood pres-sure (BP) as an independent risk factor. Therefore, new strategies to treat increased nighttime BP are warranted. In a population of type 2 diabetic patients with nocturnal hypertension, our aim was to investigate whether bedtime dosing of once-daily antihypertensive drugs will reduce nighttime BP without an increase in daytime BP.

Methods: We included 41 type 2 diabetic patients with nocturnal hypertension (nighttime BP > 120 mmHg) in an open-label, cross-over study. Patients were randomized to 8 weeks of either morning or bedtime dosing of all once-daily antihypertensive drugs, followed by 8 weeks of switched treatment regimen. At baseline and after each of the two 8-week periods, patients underwent ambulatory blood pressure monitoring, measurements of arterial stiffness, and blood and urine testing.

Results: Compared to morning dosing, patients receiving antihypertensive drugs at bedtime had a decrease in systolic nighttime, daytime and 24-h BP of 7.5 mmHg (p<0.001), 1.3 mmHg (p=0.34), and 3.1 mmHg (p=0.014), respectively. The same pattern of significant decrease in nighttime and 24-h BP and insignificant decrease in daytime BP was found for diastolic BP, mean arterial pressure and pulse pressure. Morning surge was not significantly different between treat-ment regimens. Analyses of renin-angiotensin-aldosterone parameters, markers of endothelial dysfunction, and urine albumin/creatinine ratio showed no significant changes. However, urine sodium/creatinine ratio was significantly in-creased with bedtime dosing.

Conclusion: We found a significant decrease in nighttime BP and, importantly, also a significant decrease in 24-h BP with bedtime dosing. Despite lower nighttime BP, bedtime dosing did not result in higher morning surge. In patients with type 2 diabetes and nocturnal hypertension, dosing of antihypertensive drugs at bedtime may be favorable.

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6. Genetic determinants of increased expression of Toll-like receptors and tumor necrosis factor alpha (TnF-α) are associated with response to TnF-α inhibitor treatment in a Danish cohort of inflammatory bowel disease

Steffen Bank1, Paal Skytt Andersen7, Bjørn Andersen Nexø2, Ulla Vogel5,6 and Vibeke Andersen1,3,4

1Medical Department, Viborg Regional Hospital, Viborg, Denmark, 2Institute of Biomedicine, University of Aarhus, Aarhus, Denmark, 3Medical Department, SHS Aabenraa, Aabenraa, Denmark, 4Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark, 5National Research Centre for the Working Environment, Copen-hagen, Denmark, 6Department of Micro- and Nanotechnology, Technical University of Denmark, Lyngby, Denmark, 7De-partment for Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark

Background: Tumor necrosis factor-α (TNF-α) inhibitors are used for treatment of severe inflammatory bowel disease (IBD). However, one-third of the patients do not respond to treatment. Genetic markers may predict individual respon-se to treatment with TNF-α inhibitors.

Method: Thirty nine functional single nucleotide polymorphisms (SNPs) in 26 genes involved in inflammation and in particular the NFkB pathway were assessed in 738 prior TNF-α naive Danish patients with IBD. The results were analy-sed using logistic regression (crude and adjusted for age, gender and smoking status).

Results: Functional polymorphisms which modify the expression of Toll-like receptors (TLRs) (TLR2 (rs3804099, rs11938228), TLR4 (rs5030728, rs1554973), MD-2 (rs11465996) and TLR9 (rs187084)), TNF-α (TNF-α (rs1800630, rs1799724, rs361525), TNFR1 (rs4149570), TNFAIP3 (rs6927172), IL-1b (rs4848306), IL6 (rs10499563) and IFN-γ (rs2430561)) or are involved in the non-canonical NFkB pathway (NIK/MAP3K14 (rs7222094)) were associated with response to TNF-α inhibitor treatment in patients with IBD (p < 0.05).

Conclusion: The results indicate that patients with IBD with a genetically determined high TNF-α level were responsive to TNF-α inhibitor treatment. Furtheremore, the results suggest that other cytokines like IL-1b and IL-6 may be poten-tial targets for treating patients with IBD who do not respond to TNF-α inhibitors.

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Foredrag på “Forskningens dag”SeSSIon II

1. The influence of assistive devices and movement restrictions after fast-track total hip replacement

Mikkelsen LR1, Søballe K2, Petersen MK3, Mikkelsen S1, Mechlenburg I2

1Department of orthopaedic surgery, Silkeborg Regional Hospital, 2Department of orthopaedic surgery, Aarhus Univer-sity Hospital, 3Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Skejby/ Institute of Public Health, Aarhus University

Corresponding author:Lone Ramer Mikkelsen, PhD student, MSc, Head of physiotherapeutic reseach, Dept of orthopaedic surgery, Silkeborg Regional Hospital, Falkevej 1-3, 8600 Silkeborg, lonemike@rm.dk

Background and purpose: Improvements in surgical techniques and increase of femoral head size in hip implants might have changed the rationale for movement restrictions after total hip replacement (THR). The purpose of this trial was to evaluate the influence of assistive devices and movement restrictions during rehabilitation after fast track THR on patient recovery.

Methods: 365 patients (mean age 68.7 ±10 years, 52% males) with primary THR for osteoarthritis were consecutively included. Patients included the three initial months underwent rehabilitation with restrictions in hip movement (re-stricted group, RG). This group was compared to the patients included the following three months with less restriction in hip movement (unrestricted group, UG). Questionnaires on function, pain, quality of life (HOOS) and anxiety (HADS) were administered before THR (baseline), three (F1) and six weeks (F2) after.

Results: The HOOS function score at the three measurement times was (scale 0-100 worst-best), UG: 46±17 - 76±9 - 83±14 compared to RG: 43±16 – 81±14 - 83±13 (p=0.004, multivariate repeated measurement ANOVA). Discharge on the first postoperative day was 79% in the UG versus 67% in the RG (p=0.01). Independency in ADL (activities in daily living) functions in the UG compared to RG at F1 (18-31% difference in favour of UG, p<0.005). Return to work at F2, UG compared to RG: 53% versus 32% of the working age people (p=0.045). No significant differences between groups in HOOS (pain, symptoms, QOL), anxiety, hip dislocations and patient satisfaction.

Conclusions: This study finds beneficial effects in early discharge from the hospital, early return to work, independence in ADL functions, while dislocation rates and anxiety was comparable to the RG. Results are inconclusive regarding HOOS function due to missing values. More research is needed addressing the risk of hip dislocation and patient eva-luated outcomes.

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2. Implementation of nurse-led atrial fibrillation clinics in Denmark

1Ina Qvist RN, MHS, 2Leif Spange Mortensen, M.Sc., 3Søren Paaske Johnsen, MD, PhD, 4Jeroen Hendriks RN, MSc, PhD, 1Lars Frost MD, PhD, DMSc

1Department of Medicine and Cardiovascular Research Center Silkeborg and Viborg Hospital & Institute of Clinical Me-dicine, Aarhus University Hospital; 2Spange Statistic; 3Department of Clinical Epidemiology, Aarhus University Hospital; 4Department of Cardiology, Maastricht University Medical Centre, The Netherlands & Department of Health Services Research Focusing on Chronic Care and Ageing, School for Public Health and Primary Care (CAPHRI), Maastricht Uni-versity Medical Centre, Maastricht, The Netherlands

Corresponding author:Ina Qvist, Department of Medicine M1, Diagnostic Centre, Silkeborg Hospital, Falkevej 1-3, 8600 Silkeborg, Denmark. E-mail: inaqvist@rm.dk

Background: Globally atrial fibrillation (AF) affects millions of people. AF is associated with risk of heart failure, demen-tia, stroke and mortality. Evidence-based knowledge from The Netherlands shows that nurse-led AF clinic versus usual care of patients with AF is superior to usual care provided by a cardiologist in terms of less cardiovascular hospitaliza-tions, stroke and cardiovascular mortality. The first Danish nurse-led AF clinic was established in Silkeborg Hospital on January 1th, 2012.We report results from the first 14 month of operations of the AF-clinic in Silkeborg Hospital.

Results: One hundred and eleven (111) patients were seen, 79 men and 32 women with a mean age (SD) of 65.6 years (8.9). Ninety (90) patients had paroxysmal AF and 21 patients permanent AF. During follow-up until March, 2013, 14 patients were hospitalized overnight because of chest pain, or AF, and one patient due to high INR. One patient went to the emergency room because of nose bleed. There have been no cases of incident stroke and no patient has died.

Conclusion: Results are encouraging. Further evidence is needed to firmly conclude that a nurse led-AF clinic is supe-rior to usual care.

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3. Detections and costs of combined population screening for abdominal aortic aneurysm and peripheral arterial disease: The Viborg Vascular (VIVA) screening trial

Nikolaj Grøndal1, Rikke Søgaard2, Jes S. Lindholt 3,1

1Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark2Center for Applied Health Service Research and Technology Assesment (CAST), Institute for Public Health, University of Southern Denmark3Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark

Introduction: Screening for abdominal aortic aneurysm (AAA) of men aged 65-74 years reduces the AAA-related mor-tality and is generally considered cost effective. Around 10% of men in this group have peripheral arterial disease (PAD) defined by an ankle brachial systolic blood pressure index (ABI) below 0.9 resulting in an increased mortality-rate of 25-30%. The costs and benefits of a combined population-based AAA and PAD screening program have never been established.

Methods: 50,309 Danish men aged 65-74 were randomized 1:1 to a vascular screening program. Patients with AAA and PAD were offered secondary prophylaxis and patients with suspected undiagnosed hypertension was referred to their local general practitioner.

Results: 25,098 men were offered screening with a primary attendance of 18,734 (75%) men. 615 (3.3%) AAA in men aged 65-74 was diagnosed and 2,073(11%) had PAD. Additionally, 1,963 (10%) had possible un-detected hypertension. Lipid-lowering and/or antiplatelet treatment was initiated in 867 (35%). The program cost per invited was estimated to 44 € and from an activity based model to 35 €.

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4. Lever HbA1c analysen op til sin nye rolle som diagnostisk markør for diabetes?

Søvsø I, Ladegaard IJ, Pedersen KS, Christensen L, Østergaard M

Klinisk Biokemisk Afdeling, Hospitalsenhed Midt

Baggrund: Fra januar 2012 har glykeret hæmoglobin (HbA1c) været anvendt som diagnostisk markør for type 2 diabe-tes i Danmark.

Formål: Vi ønskede at evaluere HbA1c analysen på følgende punkter: 1) Lever analysekvaliteten op til de kliniske krav? 2) Får man de samme HbA1c værdier på KBA i Viborg (HPLC metode på Tosoh G8), i Silkeborg (immunkemisk metode

på Cobas 6000), eller på point-of-care (POC) udstyr (immunoassay på DCA Vantage)? 3) Identificerer HbA1c de samme diabetespatienter som tidligere blev fundet ved en oral glukosebelastning (OGTT)

eller en faste plasma glukose (FPG)?

Metoder: 1) Den kombinerede usikkerhed CVkomb (inkluderer kalibreringsusikkerhed og dag-til-dag analyseusikkerhed), beregnes og sammenholdes med den af Dansk Selskab for Klinisk Biokemi (DSKB) anbefalede maksimale værdi på 2,5 %. 2) Resultaterne fra parallelle analyser af patientprøver på hhv. Tosoh G8 og Cobas 6000 (60 prøver), og på Tosoh G8 og DCA Vantage (i alt 65 prøver i forbindelse med kontrol af DCA Vantage udstyr) sammenlignes. 3) På baggrund af udtræk fra LABKAII sammenholdes det diagnostiske udfald efter en glukose måling (diagnostisk cut-off for OGTT: 11,1 mmol/l og for FPG; 7,0 mmol/l) med udfaldet af en HbA1c måling (diagnostisk cut-off: 48 mmol/mol eller 6,5%) foreta-get senest 3 måneder efter glukose måling.

Resultater: Tosoh G8 apparatet lever med en CVkomb på 1,8% op til DSKB´s anbefalede krav. Der er ingen forskel i målte

værdier mellem Tosoh G8 og Cobas 6000. Dog gav to ud af tre hæmoglobinvarianter observeret på Tosoh G8 følgende forskelle i målt værdi: 0,5 % (HbArya) og -4,75 % (HbTyne) (Tredje variant: 0,3 % (HbS)). Resultaterne på Tosoh G8 og DCA Vantage er sammenlignelige omkring 6,5% HbA1c (48 mmol/mol), dog overestimerer POC apparaterne på lave værdier og underestimerer på høje værdier. Færre patienter får stillet diagnosen diabetes ud fra HbA1c end ud fra OGTT eller FPG.

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5. The role of the mural thrombus in the progression of abdominal aortic aneurysms – a large population-based prospective cohort study

Behr-Rasmussen C1, Grøndal N1, Bramsen MB1,Thomsen MD1, Lindholt JS1,2

1Vascular Research Unit, Dept. of Vascular Surgery, Viborg Hospital, DenmarkHeibergs Alle 4, 8800 Viborg, Phone: +45 784456602Department of Thoracic, Heart, and Vascular Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, University of Southern Denmark

objectives: To investigate whether the relative size of the intraluminal thrombus (ILT) in abdominal aortic aneurysms (AAA) is associated with AAA growth.

Design and Methods: Large observational study based on randomized population-based screening trial. 615 AAAs were diagnosed, men only aged 65-74 year old. The relative cross sectional area covered by mural thrombus, at base-line, is estimated by a semi automated method using the ultrasound equipments facility to measure the area of ellipses adapting an inner ellipse (IA) to the luminal border of the thrombus and the outer ellipse as the area inside the media-border (OA). The relative thrombus area is then calculated as: (OA-IA)/OU. The growth rate was calculated from values in the VIVA database.

Results: Mean size of the AAA was 40.6 mm and mean observation time 1.78 years. In the AAA-size group of 30-34 mm, 42% had an ILT, with a mean relative size of 12% of the outer area increasing to 100% in AAA above 64 mm with a mean relative size of 70% of the outer area. Univariately, the relative ILT size, aortic diameter, smoking, and diastolic blood pressure was significantly, positively associated with growth rate, while the presence of diabetes mellitus and peripheral arterial disease were significantly, negatively associated with growth rate. The baseline relative ILT size re-mained significantly positively associated with growth rate after multivariate linear regression adjusting for potential confounders.

Conclusion: Although the correlation was weak, it is likely to be underestimated. The findings suggest the ILT is inde-pendently associated in the progression of AAA.

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6. Discharge from hospital and readmission - an active element in rehabilitation?

Hansen, RM, M.D, Nielsen SB O.T., Johannesen, IL , M.D.

Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg Regional Hospital, Denmark

Introduction: In our experience patients with Spinal Cord Injury (SCI), who have been discharged for a shorter pe-riod during their initial rehabilitation stay, seem more focused in their program when readmitted. We wanted to study whether discharge from hospital and readmission could be used as active parts of the rehabilitation process.

Methods: Retrospective hospital based study. All patients who had their initial and the six months follow-up admission at the Spinal Cord Unit during the period January 1st 2010 to July 1st 2011 were included. Age of admission, gender, Spinal Cord Independence Measure (SCIM) of admission, half-way through the stay, at discharge and at follow up; ASIA (American Spinal Injury Association) at admission, discharge and follow up were recorded.

Results: 24 patients were included, 68% paraplegic, 79% incomplete, mean age at admission 53 years, ♀/♂-ratio 1:1.4, average length of stay : 99,8 (35-167) days. Mean SCIM-gain from initial admission to discharge: 24.5 points, and from discharge to six months after discharge: 3.4 points.There was a trend of increased SCIM from discharge to follow-up among patients younger than 55 years.Mean Δ SCIM (discharge-follow-up) ‹55 years = 5.22 ± 4.0 (1–9) n=9 vs Mean Δ SCIM (discharge-follow-up) ≥ 55 years = 0 ± 7.4 (-10–15) n=15 (p=0.07)

Discussion: The results do not clarify whether discharge and readmission can be used as active parts of the rehabili-tation. The number of patients is small, and further studies are needed especially in of patients younger than 55 years of age.

Oral presentation International Spinal Cord Injury meeting in London 2012

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Øvrige indleverede abstracts til “Forskningens dag”1. Does Dynamic Contrast-enhanced Magnetic Resonance (DCe-MRI) Aid The Diagnosis of early Rheuma-toid Arthritis In the Wrist?

Medrud L., Nielsen A.H.

Diagnostic Centre, Silkeborg Region Hospital

Backgound: The aim of the present study is to determine whether dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) evaluated using semi-automatic image processing software Dynamika® may aid the radiological evaluation of arthritis in the wrist joint, compared to RAMRIS scoring alone.

Methods: 16 patients suspected for arthritis were referred to standard-MRI and DCE- MRI of the most affected hand.The MRI pictures were obtained on a 1.5 T Siemens Avanto Magnetom, using the following sequences for RAMRIS: co-ronal and axial T1w TSE and STIR T2 coronal. For the DCE-MRI: T1 VIBE 3D, perfusion study with contrast (Dotarem 0,2 ml /kg). Standard contrast enhanced images were obtained five minutes after contrast injection (T1 VIBE). RAMRIS scores of the wrist, was done by an experienced radiologist. DCE-MRI was analyzed using Dynamika®(v.4.4), a software using voxel by voxel model based classification. Signal in-tensity/ time curves were extracted and four different enhancement curves are automatically made by the software.

Results: In 5 patients both RAMRIS and Dynamika® showed active arthritis of the wrist. In 2 patients neither RAMRIS nor Dynamika® could find arthritis of the wrist.In 1 patient there was no agreement between RAMRIS and Dynamika®.In 8 patients RAMRIS could not establish definite signs of arthritis. Dynamika® classified 6 of the patients as having no active arthritis and 2 patients showed active arthritis.

Conclusion: We found good agreement between typical arthritis/ no arthritis scored by RAMRIS and Dynamika®. Furthermore Dynamika® confirmed the diagnosis of arthritis in equivocal cases where RAMRIS could not define arthri-tis.

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2. Fast-track-diagnostics: An anthropological study exploring how fast-track diagnostic cancer path-ways frame clinical encounters and the configuring of patients and health professionals

Aarhus Rikke1, Andersen Rikke Sand2, Tarp Britta1, Tjørnhøj-Thomsen Tine3, Vedsted Peter2

1Diagnostic Center, Silkeborg Region Hospital. 2The Research Centre for Cancer Diagnosis in Primary Care, The Re-search Unit for General Practice, Aarhus University. 3The Danish National Institute of Public Health

Aim: The aim of the PhD project is to explore how fast-track diagnostics, with an inherent notion of time, frame clinical encounters, experiences and the configuring of patients and health professionals in fast-track cancer pathways.

Background: Fast-track cancer pathways were implemented to increase survival rates of cancer patients and ensure a timely and evidence-based treatment. Pathways contain standardized procedures with time as a structuring ele-ment. While the notion of time is confirmed important from a biomedical view, knowledge of how time shapes clinical encounters and experiences is sparse.

Methods: The project is carried out as a multi-sited, long-term anthropological fieldwork in the diagnostic phase of three different cancer pathways. The main methods applied are observations (participant and direct), unstructured in-terviews and semi-structured in-depth interviews. Observations primarily take place at two hospitals and eight clinics of general practitioners. While patients will be followed through their diagnostic encounters at the hospitals, clinical encounters in general will be observed at general practitioners’ clinics. Interviews are held with a minimum of 17 he-alth professionals and a minimum of 10 patients (and their relatives). Group interviews with general practitioners and hospital-based health professionals will also be held.

Perspectives: Fast-track pathways have become an integrated part of the Danish healthcare system with early and fast-track diagnostics as emergent concepts. The project will contribute to the existing body of research on fast-track cancer pathways, in particular it will add to our knowledge on the significance and meaning of time for clinical en-counters, health related identities and experiences of patients and health professionals. In addition, it will add to our knowledge of the interplay between standardized treatment procedures and patient-centered care.

Contact: Rikke Aarhus, MA Anthropology, Pre-PhD fellow, Diagnostic Center, Silkeborg Region Hospital, rikke.aarhus@midt.rm.dk / 7841 7815

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3. Har højre-venstreskelnen betydning for effekten af spejlbehandling til apopleksipatienter? et kohor-testudie

Lundquist CB¹, Feldbæk Nielsen J²

¹Fysioterapeut, cand.scient.san., Regionshospital Viborg og Skive; ²Overlæge, forskningsansvarlig, Hammel Neurocen-ter

Formål: Hovedformålet var, at undersøge sammenhængen mellem evnen til at højre-venstreskelne inden opstart af spejlbehandling og graden af behandlingseffekt, målt som en ændring af funktion og følesans i arm og hånd hos apo-pleksipatienter. Delformålet var, at beskrive eventuelle bivirkninger ved spejlbehandling.

Baggrund: Spejlbehandling bruges hos apopleksipatienter i behandlingen af den paretiske arm og hånd. Der er teorier, der peger på, at effekten af spejlbehandling hænger sammen med evnen til at genkende og adskille højre hånd fra venstre. Denne evne kaldes højre-venstreskelnen.

Metode: Studiet var et prospektivt kohortestudie og blev gennemført i perioden september 2011-marts 2012 på Skive Neurorehabilitering. Der blev inkluderet apopleksipatienter i den sub-akutte fase, over 18 år, med parese af arm og hånd.Eksponering var patientens evne til at højre-venstreskelne. Eksponering blev testet inden opstart af spejlbehandling ved hjælp af genkendelse af højre og venstre hånd på fotografier. Effektparameter for motorisk funktion var Motor Assessment Scale (MAS) og effektparameter for følesans var to-punkts diskrimination (2PD). Patienterne blev testet før og efter interventionen på MAS og 2PD, og ændringen på de to effektparametre blev registreret. Associationen mellem højre-venstreskelnen og ændring på henholdsvis MAS og 2PD blev testet med Spearman’s Rank Korrelation.

Resultater: Enogtredive patienter gennemførte interventionen. Evnen til at højre-venstreskelne inden opstart af spejlbehandling var ikke statistisk signifikant associeret med en ændring på henholdsvis MAS eller 2PD. Der var ingen bivirkninger ved spejlbehandling.

Konklusion: Der var ingen sammenhæng mellem evnen til at højre-venstreskelne inden opstart af spejlbehandling og graden af behandlingseffekt. Højre-venstreskelnen har altså ingen betydning for effekten af spejlbehandling. På bag-grund af nærværende studie, er der ikke grund til at teste apopleksipatienters evne til at højre-venstreskelne inden opstart af spejlbehandling.

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4. A minimal invasive case study: Arthroscopic-assisted stabilization of fractures of the patella

Karlsson MM, MD - Jensen SS, MD

Sports Medicine Clinic, Dept. of Orthopedics, the Regional Hospital of Viborg, Denmark

Background: Fractures of the patella constitute almost 1% of all skeletal injuries. Most of the fractures are transverse involving the middle third of the patella. Open surgery of comminuted and/or displaced patella fractures with diastase of more than 2-3mm is gold standard. Few studies have shown that using arthroscopic-assisted surgery could be an al-ternative method of treating patients with this variety of fractures. Advantages in using this minimal invasive method are less postoperative wound infection, short hospitalization, less peri-wound numbness, good functional outcome, less disturbance of vascularization of the patella and early postoperative rehabilitation. For the surgeon this technique offers ideal visualization of the joint-near side of the fracture.

Purpose: To present an arthroscopic-assisted technique used in treating a fracture of the patella, and to present an alternative to open surgery.

Materials and Methods: A 15-year-old male suffered a fracture of patella in a snowboard accident. The closed fracture was longitudinal with displacement in two planes. There were no injuries to the musculature of the quadriceps or patella-tendon.Preoperative treatment was a locked knee-brace. Standard arthroscopy equipment was used to visua-lize the fracture and reduce this. It was stabilized with cannulated screws. Postoperative treatment was a standard locked knee-brace.

Findings: There were no perioperative complications. The patient is still in treatment, and at first control 14 days postoperative the wounds were healed, the knee a bit swollen, and with a passive movement from zero to 45 degrees. The knee appears with less swelling and irritation compared to open surgery.

Conclusion: Arthroscopic-assisted stabilization of fractures of the patella can be done and seems of benefit to the patient and it should be considered in patients having this variety of fractures. There is low risk of complications, the postoperative rehabilitation is good, and the method gives ideal conditions for the surgeon.

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5. A novel technique: Preliminary clinical results of cement augmentation of intertrochanteric fractures stabilized with an intramedullary nail

Skjaerbaek, M. S., Hansen, F.

Department of Orthopaedic Surgery, The Regional Hospital of Viborg, Denmark

Background: Osteosynthesis of intertrochanteric fractures in patients with poor bone quality is a challenge for orthop-edic surgeons, implant failure and especially cut-out are well known complications.

Purpose/aim of study: The aim of this study is to investigate effects and complications when using augmentation of intertrochanteric fractures stabilized with an intramedullary nail.

Methods and material: 6 (5 female) patients with a mean age of 88 years (range 68-98) comprised the population. All patients had an intratrochanteric fracture and were pre- or peroperative considered having a high risk for cut-out. In the period of November 2011- April 2012 all patients underwent osteosynthesis with a Proximal Femoral Nail Anti-rotation (PFNA) with perforated blade cement augmentation. In all cases high-viscosity cement was used, which was injected through the perforated blade to enlarge the load-bearing surface and to diminish the stresses on the trabecu-lar bone. Cement augmentation was in these cases considered being a salvage procedure. The mean time of postope-rative observation was 92 days (range 10-178). Results: No postoperative complications have been observed. For this short period of observation no cut-out or migra-tion of the blade has been observed in the population.

Conclusions: Cement augmentation of intertrochanteric fractures stabilized with an intramedullary nail in patients with a high risk for cut-out seems to be a serviceable technique. Studies are needed to determine when this technique is advisable.

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6. Responsiveness of the Danish version of the disabilities of arm, shoulder and hand (DASH)

Lundquist CB, fysioterapeut, cand.scient.san.

Fysio- og Ergoterapien, Regionshospitalet Viborg og Skive

Introduction: Reliable and valid patient-reported outcome measures are considered important in the assessment of shoulder pain. The measurement properties of a questionnaire may vary between populations in different countries. As a consequence any evaluation of a questionnaire should be conducted within the population and setting in which it will be utilized. The DASH is a widespread self-administered questionnaire that can be used for shoulder assessment. It is region specific, i.e. specific to the arm, and the DASH stands out as an instrument positioned between the gene-ric (as, for example EQ-5D) and the shoulder-specific measures (as, for example the SPADI). The DASH consists of 30 items, six items about symptoms and 24 about function. Responsiveness of the Danish version of DASH is not established. Responsiveness is defined as the ability of an instru-ment to accurately detect a clinically meaningful change.The aim of the present study was to assess the responsiveness of the DASH.

Methods: Eligible patients for this study were patients with a shoulder pathology referred to the Department of Ort-hopedic Surgery, Viborg Regional Hospital Denmark, between October and November 2012. Eighty-four patients were consecutively enrolled. Patients filled in a baseline data collection form comprising information about the study, questions regarding demo-graphics and history of shoulder problems. At baseline and at follow-up set of questionnaires including the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), EQ-5D and EQ-VAS questionnaires was filled in. Follow-up que-stionnaires were mailed to the patients. At follow-up the patients also filled in a question about global impression of change.

Statistical analysis: Responsiveness was assessed using two different strategies; correlation analysis for the change scores and ROC curve statistics using anchor based method.

Results: ….. Data currently being analyzed.

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7. A novel technique of minimally invasive procedure in treating fractures in a osteoporotic patient

Jensen, S.S., Stroem, J.

Department of Orthopaedic Surgery, The Regional Hospital of Viborg, Denmark

Purpose: Treating osteoporotic fractures in elderly patients can be a challenging task for orthopedic surgeons. With an aging population contributing to the growing number of fracture incidences, there is a compelling need for a new met-hod of fracture repair, to successfully mend fractures in osteoporotic bone. We here present the first case in Denmark using Illuminos, a novel technique, which can be used in even severely osteoporotic bone and delicate soft tissue, to stabilize the fracture during healing process.

Methods and material: A 98-year-old woman suffered a fracture of the distal tibia and fibula. The illuminoss photo-dynamic bone stabilization system was used in treating the fractures, through small incisions at the lower end of the malleolus. The bony canal was prepared using small reamers, and the flexible balloon catheter was inserted into the bone. A proprietary liquid monomer was then infused into the catheter, expanding the balloon that assists in alignment of the fractured bone. A light source was then used to illuminate the monomer inside the balloon, converting it into a hardened polymer implant. The result was a customized implant which was determined by the bonecanal itself and that provides strength and stabilization during bone healing. The OR-time was approximately30 minutes.

Results: It was possible to successfully treat this fracture and the patient regained mobility as prior to the fracture within a few days after the procedure, without the need of a cast. At the outpatient visit 6 weeks after operation the fracture seemed healed in acceptable position.

Conclusion: This novel technic might provide the possibility to treat fractures in severely osteoporotic bone, where other methods fail. Furthermore this technic can be used with a minimal invasive approach rather than traditional highly intrusive and time-intensive surgery. Ongoing experiences with the product are necessary in order to confirm benefits.

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8. Selvstyret læring hos medicinstuderende i klinisk ophold

Rønholt AM, Balslev T

Børneafdelingen, Regionshospitalet Viborg

Formål: Selvstyret læring, dvs. evnen til at undre sig mens man arbejder, og søge ny relevant viden, er ønskeligt hos medicinstuderende.

Beskrivelse af undersøgelsen: Vi har på børneafdelingen indført en obligatorisk opgave for de medicinstuderende. De skal hver især finde en autentisk klinisk problemstilling, som ikke har en umiddelbart entydig løsning, belyse den vha. evidens i litteraturen og fremlægge resultatet verbalt på 5 minutter til en morgenkonference, støttet af max. 5 Power Point slides.

Metode: Via fokusgruppe interview vil vi klarlægge fordele og ulemper ved initiativet set fra såvel speciallægernes, uddannelseslægernes og de medicinstuderendes synspunkt. Fokusgruppe interview er en anerkendt metode, der ud-nytter den dynamik som naturligt opstår i en gruppe. Interviewene transskriberes og analyseres ud fra tema opdeling.

Resultater: Såvel speciallægerne, uddannelseslægerne og de medicinstuderende nævnte, at de medicinstuderende lærte at søge konkret viden, når behovet opstod dvs. selvstyret læring. Samtidig fik de erfaring i litteratursøgning og formidling af nyanskaffet viden overfor kommende kolleger. Deres selvtillid blev øget, når de erfarede, at andre lærte noget af deres oplæg. Nogle af afdelingens uddannelsessøgende læger og speciallæger nævnte, at der ofte kom en ny vinkel på en problemstilling, der stimulerede dem til selv at læse noget mere om emnet. Speciallægerne var klar over, at de har en særlig rolle for at skabe tryghed for de studerende, samt vægte tilbagemel-dingerne rigtigt. De studerende angav at, de var trygge ved oplægget, fordi børneafdelingen prioriterer et positivt ud-dannelsesmiljø. Flere nævnte, at opgaven kunne være tidskrævende og relevant feedback nødvendig.

Konklusion: Både medicinstuderende og lægerne fandt at de medicinstuderende havde udviklet deres evner til selv-styret læring. Det styrkede de medicinstuderendes selvtillid, at fremlægge aktuel, relevant viden for lægerne. Det er en forudsætning, at der er et støttende og positivt uddannelsesmiljø.

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9. Does size matter? Report on a popliteal catastrophe

Grøndal N, Fasting H , Iversen L and Lomholt M

Vascular department Viborg Hospital, Denmark

objective: The management of popliteal aneurysms has through decades remained a controversy in vascular surgery. Several aspects have traditionally been taken into account, including size, peripheral circulation, thrombus formation and status of symptoms. However consensus regarding expectation versus intervention is still to be achieved.

Method: We report a case with a fatal rupture of a popliteal aneurysm with a diameter of 3 cm. and review the literature on management of popliteal aneurysms in relation to known predictors.

Case story: A 66-year old male was examined in a vascular clinic because of a painless pulsative mass in the right popli-teal region and an asymptomatic popliteal aneurysm of approximately 2.5 cm was suspected. A wait-and-see approach was chosen. The patient remained asymptomatic until he was admitted at our institution in severe pain. A tender pulsative mass in the right popliteal fossa was seen and bedside ultrasonagraphy demonstrated a ruptured popliteal aneurysm. Operative findings indicated rupture to the posterior and anterior crural compartments with significant tissue-loss and despite of an attempt of revascularization the patient was amputated at femoral level.

Conclusion: This fatal case reflects the divergent strategies that exist in the treatment of popliteal aneurysms as in the literature. Regarding symptomatic aneurysms agreement in the literature exists that they should be treated but when it comes to asymptomatic aneurysms evidence is inconsistent.

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10. epidemiology of microscopic colitis – a 10-year nationwide Danish cohort study

Tanja Wigh, Medical department, Regionalhospital Randers, Randers, DenmarkMorten Fenger-Grøn, Research Unit for General Practice, Aarhus University, and Department of Clinical Epidemiology, Aarhus University HospitalGunnar Lauge Nielsen, Medical department, Hospital Himmerland, Hobro, DenmarkOle K Bonderup, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg, Denmark

Background: Microscopic colitis includes two types of colitis: collagenous colitis (CC) and lymphocytic colitis (LC). Pre-vious studies have investigated the epidemiology of microscopic colitis and found an increasing incidence during the period 1990 - 2000. These studies are mainly based on regional registries and we found it of interest to study the epi-demiology based on a comprehensive nationwide cohort.

Aims: In a nationwide cohort study based on Danish national registries to estimate the incidence and demographic data of microscopic colitis in Denmark during a ten-year period from 2002-2011.

Methods: The cohort consisted of all patients with a recorded diagnosis of either CC or LC registered in the Danish Pathology Register during the period January 2002 to December 2011. The register is used by the pathologists in the daily diagnostic process and covers all pathology data in Denmark.

Results: The cohort consisted of a total of 7.777 patients, hereof 4.749 (61%) with CC and 3.028 (39%) with LC. In the 10-year period the annual incidence of diagnosed cases of CC increased from 2.9/100.000 to 14.9/100.000 and of LC from 1.7/100.000 to 9.8/100.000. There was no observed change in the distribution of CC and LC during the period. The female:male ratio was 3:1 for CC and 1.8:1for LC. The mean age at diagnosis was 67 years for CC and 64 years for LC.

Conclusion: In a nationwide cohort study the incidence of CC and LC was increasing in a ten-year period from 2002 to 2011. A combined incidence of microscopic colitis of 24.7/100.000 in 2011was found. There was no change in the distri-bution of gender or age of diagnosis in the period.

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11. Isolation, identification, cultivation and differentiation of porcine cardiac stem cells - In pursuit of cardiac regeneration therapies

Mogensen SL1, Hokland M2, Young JF3 and Rolighed Larsen J1, 4

1Department of Anesthesiology and Operations, RH Viborg, RegionMidt2Institute of Biomedicine, Aarhus University (AU)3Institute of Food Science, Foulum (AU)4Institute of Clinical Medicine (AU)

Background: Heart failure is one of the leading causes of death in the Western World and results in loss of cardiac tissue. Cardiac stem cells have shown some promise in both endogenous and exogenous therapy, but elucidation of procedures for harvesting, isolation, identification, cultivation and differentiation is needed before their full potential can be understood and implemented.

Aims: In this study we will describe 1) isolation, 2) identification 3) cultivation and 4) differentiation of porcine cardiac stem cells and produce a “famlily tree” of these pCSC’s.

Methods: pCSC’s are isolated from porcine heart biopsies using collagenase and Percoll-gradient centrifugation. Cul-tivation is done by seeding cells onto Matrigel and Laminin coated dishes in growth media and differentiation is con-trolled by varying serum concentrations. These cells are characterized by the application of monoclonal antibodies (incl. CD45 and CD117a.o.), as well as identification of intracellular proteins. Advanced multi-panel flow cytometry and confocal microscopy are used and description of differentiation of the pCSC’s is then feasible.

Results: A profound description of pCSC’s throughout differentiation will elucidate our understanding of CSC’s, be of use in future endogenous and exogenous therapy and provides a platform to study more in-depth both cardiac de-velopment and the effects of drugs on cardiomyocytes in vitro. Because of the profound resemblance of the porcine to the human heart, we anticipate these results can be extrapolated to preclinical studies. Research year thesis to commence June 2013.

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12. ”At komme hjem” - en interviewundersøgelse af rygmarvsskadede patienters erfaringer med at komme hjem efter rehabilitering på Vestdansk Center for Rygmarvsskade (VCR)

Bjørnshave Noe B1, Johannesen IL2, Hagen EM3

1Adjunkt, ph.d. (hovedforfatter) Forskningsenheden ved Vestdansk Center for Rygmarvsskade Hospitalsenhed Midt og Institut for Folkesundhed, Aarhus Universitet 2Klinikchef og 3Forskningsoverlæge, Forskningsenheden ved Vestdansk Center for Rygmarvsskade Hospitalsenhed Midt

Baggrund og formål:Højt specialiseret rehabilitering efter rygmarvsskade er en kompleks målrettet proces med henblik på uafhængighed og reintegration. Tiden omkring udskrivning er særlig vanskelig, fordi den enkelte bliver konfronteret med de forhin-dringer, der kan opstå efter hjemkomst. Patienttilfredshedsundersøgelser fra VCR viser, at en stor andel af patienterne er utryg ved udskrivning og studier tyder på en række barrierer. Dertil kommer usikkerhed om jobmuligheder og for-sørgelse.Der er generelt i det danske sundhedsvæsen fokus på sammenhængende rehabiliteringsforløb, men indenfor ryg-marvsskadeområdet i Danmark er der ikke gennemført en systematisk undersøgelse af, hvordan overgangen fra hospi-tal til hjem erfares. Der er derfor behov for en systematisk undersøgelse af, hvordan overgang fra rehabiliteringsenhed til hjem fungerer, set fra patienterne perspektiv. Aktuel interviewundersøgelse har til formål at afdække rygmarvsskadedes forventninger til at komme hjem og under-søge, hvad de rygmarvsskadede erfarer, når de kommer hjem, samt hvordan de klarer sig og kommer sig.

Metode:Der gennemføres kvalitative interviews på forskellige tidspunkter i relation til udskrivning fra Vestdansk Center for Rygmarvsskade.Hver informant interviewes: 1) Umiddelbart før udskrivning. 2) En måned efter udskrivning.3) Ni til 12 måneder efter udskrivning.Der foretages tematisk analyse med reference til International Classification of Functioning

Resultater:I løbet af foråret 2013 foreligger der resultater fra første og anden interviewrunde, som kan præsenteres til forsknin-gens døgn.

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13. Patient participation in conference with team-members shortly after admission

Eilenberger RM, Johannesen IL, MD

The Spinal Cord Unit, Regional Hospital of Viborg, Skive, Hammel, Silkeborg, Denmark

Aim: As a new step towards more patient participation and shared goal-setting patients were invited to attend a multi-disciplinary conference with their team members and a close relative. The conference took place within fourteen days of admission. The aim of this study was to document and evaluate the experience of the patients to determine if they found the conference relevant and if the initiative should continue in the present form.

Methods: Out of the 73 spinal cord injured patients admitted at Spinal Cord Injury Center of Western Denmark (VCR) in the period of 2010-2012 who were asked, 42 (58%)completed a questionnaire related to the setting, content and per-sonal experience of the conference. The questionnaire was handed out by a nurse outside the team and was answered anonymously.

Results: 52% found the content of the conference very relevant. 41 % found the content to have some degree of rele-vancy and 7% considered it less relevant. 88% felt it was good or very good to participate in the conference and only 3 % would have preferred not to participate.The study also showed that it is important that patients receive a written agenda prior to the conference and have time to prepare themselves.

Conclusion: Patient participation in a conference with team-members close to admission is viewed positively by the patients and the content is considered relevant. However it is important that the patients are informed about the form, content and setting in advance.

Accepted as poster Nordic Spinal Cord Society Helsinki 2013

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14. Transverse Myelitis in west Denmark - different treatment and increasing age?

Hansen, RM, M.D, Hagen, EM, MD, Ph.D.

The Spinal Cord Unit, Regional Hospital of Viborg, Skive, Hammel, Silkeborg, Denmark

Aim: A sudden rise in the number of patients with myelitis admitted to the Spinal Cord Unit initiated this study. Our observation was that the patients had received different medical treatments. We wanted to explore this further.

Methods: Retrospective hospital based study. All patients with idiopathic myelitis admitted to the Spinal Cord Unit for rehabilitation in the period January 1st 2012 to February 15th 2013 were included in the study.

Results: Nine patients were admitted in the period. Incidence 2,9 mill/year. F/M-ratio : 4/5. Median age: 55 y (15-70y). Median age male: 59y, women: 48 y. Time of year for onset of symptoms: Spring: two ,summer: One autumn: Four, win-ter: two .Time from onset of symptoms to admission at hospital ranged from few hours to six months.At admission six patients were tetraplegic, three paraplegic. One patient had a complete SCI (AIS A), one AIS B, two AIS C, and five AIS D. Mean SCIM at admission: 48,2 (11,0 + 19,7 +17,4).All patients had taken a sample from CSF all had MR of the column done.All patients were in treatment with steroids as tablets when admitted at the spinal cord unit. There was a big diffe-rence in variation in scaling down the dose of steroid treatment ranging from 2 mg every fourteen days to sixteen mg every seven days. Two patients were treated with plasmapheresis before arriving to the spinal Cord Unit. Azathioprine treatment was instituted in two patients.

Conclusion: Our results showed that the incidence was not higher, but the median age was higher than reported in other studies, and male median age being 11 years higher than females. 2/3 of the patients were tetraplegic and the vast majority had an incomplete SCI. There was tendency to higher incidence in the autumn. Further studies need to be done regarding investigation regime, treatment regime and outcome.

Accepted as poster Nordic Spinal Cord Society Helsinki 2013

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15. A schematic outline of assessment tools used by PTs and oTs in rehabilitation of spinal cord injured persons in western Denmark 2013

Hoffmann, Dorte Dahl, Johannesen, Inger Lauge

Spinal Cord Injury Centre of Western Denmark, DENMARK

Aims: The aim of the schematic outline was to ensure that the most appropriate tests are used and that the specific performance of each test is carried out in accordance with international guidelines. In the long term we want to reach a national agreement on selection and performance of tests.

Methods: All the tests were described in relation to: Name of the test, who is in charge of performing the test, indica-tion for testing, when should we test, scientific references to SCI, is there a test manual? Tests described in the sche-matic overview: MMT, PROM, AROM, Sollerman Hand Function Test, Biometrics Dynamometer and Pinchmeter, SCIM III, COPM, AMPS, MAS, measurement of Peak Flow and FVC, 10MWT, 6MWT, TUG, BBS, Wisci II, L-Force, 6-MAT and Astrand 6 minute Cycle Test.

Results: The schematic outline has led to professional discussions and reflections on the quality and justification of our choice of tests and the actual performance of them. It has allowed visibility to the other professionals, which hop-efully leads to a larger interdisciplinary understanding and collaboration of working with the tests, both in terms of more experienced professionals and in relation to new recruits. Finally, it has led us to consider implementing more tests: GRT, GRASSP and the PSFS.

Conclusions: There is a need for continuous monitoring of tests in order to ensure the quality of the clinical effort and in relation to the opportunity to contribute to international research on the area. The intention is to keep the schematic outline updated and kept electronically accessible for all professions at the Spinal Cord Injury Centre.

Accepted as poster Nordic Spinal Cord Society Helsinki 2013

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16. Initiale resultater vedrørende potentielt hypertension fra den forebyggende undersøgelse for hjer-tekarsygdomme og diabetes hos kvinder

Thomsen MD1, Frost L1, Klausen IC1, Lorentzen V2, Søgaard R3 Lindholt JS1

1Kardiovaskulær Forskningscenter, Hospitalsenhed Midt, 2Center for Sygeplejeforskning, 3Center for Folkesundhed Region Midt/Aarhus Universitet

Baggrund: Ultimo 2011 startede et forebyggende screeningsprogram af 60, 65, 70 og 75-årige kvinder i Viborg Kom-mune. Kvinderne screenes for abdominalt aortaaneurisme, perifer arteriosklerose, carotis plaque, hypertension, dia-betes, hyperkolesterolæmi/familiær hyperkolesterolæmi samt atrieflimren.

Formål: At klarlægge prævalensen af ikke diagnosticerede hypertonikere. Tillige klarlægges om kvinderne kender deres blodtryk samt tidspunkt for sidste blodtryksmåling.

Metode: Prævalensundersøgelsen baseres på et forsøgsvis screeningstilbud til alle 60, 65, 70 og 75-årige kvinder i Vi-borg Kommune. Kvinder der ikke responderer geninviteres én gang. I alt inviteres ca. 2000.Ved screeningsundersøgelsen måles blodtrykket i begge arme og blodtrykket måles yderligere 3 gange i armen med højeste blodtryksværdi. Ved blodtryk over 145/90 mmHg udføres hjemmeblodtryksmåling via projektet eller egen læge. Ved indikation for intervention henvises videre til egen læge. Kvinder der henvises til praktiserende læge kontaktes ef-terfølgende telefonisk mhp opfølgning af blodtryksmålingen og evt iværksat livsstils- og/eller medicinsk intervention.

Resultater: Præliminære resultater for de første ca. 1400 deltagere gennemgås vedr. antal inviterede, fremmødehyp-pighed, hyppighed af potentielt ikke-erkendt hypertension, andel med white coat hypertension, grad inddeling af hy-pertension og antal der opstartes i medicinsk behandling. Endvidere gennemgås fund i forhold til om kvinderne kendte deres blodtryk før screeningsundersøgelsen og i givet fald tidspunkt for sidste blodtryksmåling.

Diskussion og konklusion: Observerede hyppigheder diskuteres ud fra forventede fund. Udebliverne fra screenings-tilbud vides generelt at have højere dødsrisiko, hvilket også må formodes at gælde i nærværende undersøgelse. Disse forhold diskuteres sammen med indsamlede og analyserede foreløbige datasæt.

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17. Routine use of coronary CT angiography as initial diagnostic test in patients with suspected coronary artery disease

Grazina Urbonaviciene1,3, Sigitas Urbonavicius2,3, Jørgen Buhl1,3, Jane Kirk1,3, Christin Isaksen1,3, Agnete Disirèe Nielsen1,3, Lars Frost1,3

1Diagnostic Center, Regional Hospital Silkeborg , Denmark 2Department of Vascular Surgery, Regional Hospital Viborg, Denmark3Cardiovascular Research Centre, Silkeborg & Viborg Regional Hospitals

Background: With a reduction in radiation doses, coronary computed tomography angiogram (CTA) becomes an important tool in the diagnostic evaluation of patients with suspected coronary artery disease (CAD). We aimed to investigate the clini-cal applications of coronary CTA in patients at low to intermediate pre-test probability of CAD.

Methods and Results:We retrospectively analyzed the data of 1194 patients (age 58.9+/-10.8) without known CAD who underwent prospec-tive ECG-gated 320-row coronary CTA in 2012 at Silkeborg hospital. Logistic regression was used to estimate the rela-tionship between cardiovascular risk factors and results of coronary CTA. In 623 patients CAC score was zero. Obstructive CAD was detected in 17 patients (2.7%). According to CAC score the patients were classified into four groups: <100, 100-400, 400-1000, and >1000. Obstructive CAD was detected in 26 pa-tients (12.3%) of 211 with low CAC score (<100), in 90 patients (48,1%) of 187 with moderate CAC score (101-400), and in 85 patients (75.8%) of 112 with high CAC score (400-1000). A markedly elevated CAC score (>1000) was determined in 60 patients. These patients were referred to invasive angiography. In 723 patients were found normal coronary arteries. Coronary CTA showed diffuse arteriosclerosis in 193 patients, and obstructive CAD - in 218. Using univariate logistic-regression analysis, we found that male gender, age greater than 60 years, CAC score>400, diabetes mellitus, hypercholesterolemia, and hypertension were associated with obstructive CAD. However, multivari-ate analysis showed that only age greater than 60 years, CAC score above 400, and diabetes mellitus were independent factors associated with obstructive CAD (Table 1).

Conclusions:Our results indicate that significant CAD is unlikely in patients with CAC score of zero. Obstructive CAD on CT angio-graphy was significantly and independently related to older age of the patients, severe CAC score, and the presence of diabetes mellitus.

Table 1. Results of logistic regression analysis of independent risk factors associated withobstructive CAD on coronary CTA.

Risk factor Crude oR (95% CI) Adjusted oR (95% CI)CAC* score>400 ............................................31.8 (20.2-50.1) ..................................23.9 (14.9-38.2)Age >60 years ...............................................3.87 (2.86-5.24) ..................................2.67 (1.86-3.83)Male gender ..................................................1.46 (1.11-1.93) ..................................1.28 (0.91-1.83)Diabetes mellitus .........................................2.17 (1.44-3.21) ..................................1.73 (1.01-2.97)Hypertension ................................................1.64 (1.29-2.01) .................................1.12 (0.81-1.56)Hypercholesterolemia ................................1.68 (1.3-2.16) ...................................1.23 (0.87-1.74)

*CAC – Coronary Artery Calcium

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18. Relationship between high coronary artery calcification and presence of hemodynamically signifi-cant stenosis

Grazina Urbonaviciene1,3, Sigitas Urbonavicius2,3, Jes Lindholt4, Jørgen Buhl1,3, Lars Frost1,3

1Diagnostic Center, Regional Hospital Silkeborg , Denmark 2Department of Vascular Surgery, Regional Hospital Viborg, Denmark3Cardiovascular Research Centre, Silkeborg & Viborg Regional Hospitals4Department of Vascular Surgery, Odense University Hospital, Odense, Denmark

Background: It is well known that coronary artery calcium (CAC) score has high sensitivity but only moderate specificity for the detection obstructive coronary artery disease (CAD). We aimed to investigate the prevalence of hemodynami-cally significant stenosis evaluated by invasive coronary angiography (ICA) in patients with high CAC score.

Methods: We retrospectively analyzed the data of 171 patients (age 66.5 (62; 71) years) without known CAD, and CAC score>400 who underwent prospective-ECG-gated 320-row coronary CTA in 2012 at Silkeborg hospital. Logistic re-gression analysis, and area under the receiver-operating characteristic curve (AUC) was used to estimate the relati-onship between high CAC score and hemodynamically significant stenosis on ICA.

Results: In 23 of 111 patients with CAC score at 400 to 1000, diffuse arteriosclerosis was found on coronary CTA. Eighty-eight patients underwent ICA due to significant stenosis on coronary CTA. Only in 29 (33%) patients was hemodynami-cally significant CAD confirmed by ICA, and 23 patients had percutaneous coronary interventions (PCI), and 6 coronary artery bypass grafting (CABG).CAC score >1000 was found in 60 patients, and 57 of them were referred to ICA. In 29 of 57 patients (51%), ICA revealed hemodynamically significant stenoses, and 16 PCI, and 9 CABG were performed. Diffuse arteriosclerosis was detected in 28 patients (49%).Logistic-regression analysis showed that only CAC score>1000 was associated with hemodynamically significant CAD on ICA (crude OR=2.12, 95% CI 1.06-4.17; adjusted age and gender OR=2.03, 95% CI 1.02-4.07). However, AUC of CAC score>1000 for prediction of hemodynamically significant CAD was only 0.60 [0.506-0.693].

Conclusions: Although CAC score>1000 was significantly associated with hemodynamically significant CAD on ICA, the AUC was poor. The decision to perform ICA in patients with severe calcification should depend on functional assess-ment. Cardiac MRI perfusion holds great promise as a method to reduce the number of unnecessary ICA.

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19. The influence of the gastrointestinal tract and the liver on the serum levels of cystatin C

Erlandsen EJ1 and Abrahamsen J2

Departments of 1Clinical Biochemistry and 2Clinical Physiology, Viborg Regional Hospital, Viborg, Denmark

Aim: The purpose of the present human study was to examine the influence of the gastrointestinal tract and the liver on the serum levels of cystatin C.

Materials and methods: Eighteen healthy volunteers and 28 patients suspected of chronic intestinal ischemia under-went catheterization of the abdominal aorta and the central hepatic vein. Blood samples were taken simultaneously from the abdominal aorta and the central hepatic vein 60, 90 and 120 minutes after the start of the investigation. After the first blood sample a standard liquid meal was ingested. Measurement of splanchnic blood flow was performed using the Fick principle. Angiography was performed at the end of the investigation.

Results: The splanchnic blood flow increased significantly postprandial in healthy volunteers and in patients with nor-mal angiography on average by 0.613-0.698 L/min, and non-significantly in patients with abnormal angiography (n=5) on average by 0.135 L/min. There was a trend towards higher levels of cystatin C (0.01-0.03 mg/L), creatinine (-1-3 µmol/L) and urea (0.1-0.3 mmol/L) in the central hepatic vein relative to the abdominal aorta both fasting and post-prandial. The serum levels of cystatin C, creatinine and urea in the central hepatic vein and the abdominal aorta were independent of the splanchnic blood flow.

Conclusion: The results indicate that the liver and the gastrointestinal tract contribute to a small increase in the serum levels of cystatin C, creatinine and urea in the central hepatic vein in relation to the abdominal aorta. There was no indication of hepatic elimination of cystatin C.

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20. Renal extraction of cystatin C, creatinine and urea

Erlandsen EJ1 and Abrahamsen J2

Departments of 1Clinical Biochemistry and 2Clinical Physiology, Viborg Regional Hospital, Viborg, Denmark

Aim: To measure the renal extraction ratio of cystatin C, creatinine, and urea in the human kidney.

Materials and methods: The study comprised 20 hypertensive patients with suspected renal artery stenosis. All pa-tients underwent catheterization of the aorta and the renal veins. Blood samples were drawn simultaneously from the aorta and the renal veins. Twenty minutes later this procedure was repeated. Before each blood sampling the correct positioning of the catheters was confirmed by X-ray fluoroscopy control and oxygen saturation measurement. The re-nal extraction ratio of cystatin C and creatinine were calculated as ([A]-[V])/[A], in which [A] is the serum concentration of the compound from the aorta and [V] is the serum concentration of the compound in the renal vein.

Results: The extraction ratios (mean ± SD) in the right kidney of cystatin C, creatinine and urea were 0.12 ± 0.07, 0.16 ± 0.08, and 0.05 ± 0.03 respectively, and in the left kidney 0.14 ± 0.04, 0.18 ± 0.04, and 0.04 ± 0.04 respectively. The extrac-tion ratios of cystatin C, creatinine and urea were independent of the concentrations of the compounds in the aorta in the studied concentration range; cystatin C (0.6-2.0 mg/L), creatinine (60-240 µmol/L), and urea (3-13 mmol/L). The extraction ratio of creatinine was significantly higher than the extraction ratio of cystatin C.

Conclusion: In average 12-14% of the plasma volume was cleared for cystatin C, 16 - 18% for creatinine, and 4-5% for urea through the passage in the kidneys.

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21. Self-reported knowledge and awareness about blood pressure and hypertension

1,3Ina Qvist, RN, MHS, 2,3Marie D. Thomsen, RN, MScN, 2,3,4Jes S. Lindholt, MD, PhD, DMSc, 5Hans Ibsen, MD, DMSc, 6Jeroen M. L.Hendriks, RN, MSc, PhD student, 1,3Lars Frost MD, PhD, DMSc

1Department of Medicine and 2Department of Vascular Surgery, 3Cardiovascular Research Center Silkeborg and Viborg Hospital & Institute of Clinical Medicine, Aarhus University Hospital , 4Centre of Individualized Medicine in Arterial Di-seases, Department of Cardiothoracic and Vascular Department T, Odense University Hospital 5Departement of Medi-cine, Holbæk Hospital, Denmark, 6Department of Cardiology, Maastricht University Medical Centre, The Netherlands

Corresponding author:Ina Qvist, Department of Medicine M1, Diagnostic Centre, Silkeborg Hospital, Falkevej 1-3, 8600 Silkeborg, Denmark. E-mail: inaqvist@rm.dk

Background: Increasing blood pressure is associated with an increased risk of cardiovascular and renal disease. Inter-ventions to prevent hypertension and cardiovascular disease have been effective and health promoting programmes have been actively encouraged by health authorities for many years. The prevalence of hypertension increases with age. Surprisingly, knowledge and awareness about blood pressure and hypertension among elderly people is largely unknown. We examined self-reported knowledge about blood pressure and hypertension in a random sample of people aged 60-74 years. We hypothesised that knowledge about blood pressure and hypertension would be better among individuals with self-reported hypertension compared to subjects without self-reported hypertension.

Methods: A cross sectional study. We mailed a questionnaire specifically designed for our survey to a random sample of 1,000 subjects, aged 60-74 years living in the municipality of Silkeborg, Denmark. The study sample was drawn from the Central Person Registry.

Results: The response rate was 72%. Forty-three percent of responders had self-reported hypertension. People with self-reported hypertension were older, had a lower education level, had higher self-reported blood cholesterol levels, had higher body weight and more often had a family history of hypertension. More than 80% reported that overweight and obesity increases blood pressure. More than 60% reported that untreated hypertension may cause heart disease or stroke. More than half of the responders did not know their blood pressure and only 21% knew that hypertension can occur without symptoms. Subjects with self-reported hypertension had a slightly better knowledge about diseases caused by hypertension and had better awareness about their blood pressure.

Conclusion: General knowledge about blood pressure and hypertension was reasonable, but there is still room for im-provement in elderly people’s knowledge and awareness of blood pressure.

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22. High quality and quantity DnA extraction from frozen archival blood clots for genotyping of single nucleotide polymorphisms

Steffen Bank1,2, Bjørn Andersen Nexø2, Vibeke Andersen1,3,4, Ulla Vogel5,6 and Paal Skytt Andersen7

1Medical Department, Viborg Regional Hospital, Viborg, Denmark2Institute of Biomedicine, University of Aarhus, Aarhus, Denmark 3Medical Department, SHS Aabenraa, Aabenraa, Denmark 4Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark 5National Research Centre for the Working Environment, Copenhagen, Denmark 6Department of Micro- and Nanotechnology, Technical University of Denmark, Lyngby, Denmark7Department for Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark

Background: The recovery of biological samples for genetic epidemiological studies can be cumbersome. Blood clots are routinely collected for serological examinations. However, the extraction of DNA from blood clots can be difficult and often result in low yields.

Aim: The aim was to compare the efficiency of commercial purification kits for extracting DNA from long-term frozen clotted blood.

Methods: Serum tubes with clotted blood were stored at -20°C for 1 to 2.5 years before DNA extraction. DNA was ex-tracted from 10 blood clot samples using PureGene (Qiagen) with and without glycogen, QIAamp DNA Micro kit (Qiagen) and Nucleospin 96 Blood kit (Macherey-Nagel). Furthermore, blood clots from 1055 inflammatory bowel disease (IBD) patients were purified using the Maxwell 16 Blood purification kit (Promega). The DNA was extracted according to the manufacturers` instructions and real-time PCR and A

260/A280 ratio were used to evaluate the quality of the extracted DNA.

Results: The highest DNA yield was obtained by Maxwell 16 Blood purification kit (Promega) with a median of 4.90 µg (range 0.8-25 µg) pr 300 µl total blood. PureGene with glycogen (Qiagen) had the second highest yield with a median of 0.65 µg (range 0.5-2.6 µg) pr 300 µl total blood.

Conclusion: The yield obtained by the different commercial kits varied considerably. Our work demonstrates that high quality and quantity DNA can be extracted with the Maxwell 16 Blood purification kit (Promega) from cryopreserved blood clots, even after prolonged storage. The recovered DNA served as a reliable PCR template for single nucleotide polymorphism (SNP) assays.

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23. A Danish cohort of tumor necrosis factor-α inhibitor treated patients with inflammatory bowel di-sease, a case-only design

Steffen Bank1,2, Bjørn Andersen Nexø2, Johan Burisch3, Natalia Pedersen3, Stine Roug4, Julie Galsgaard5, Stine Ydegaard Turino6, Jacob Broder Brodersen7, Shaista Rashid8, Britt Kaiser Rasmussen9, Sara Avlund10, Thomas Bastholm Olesen11, Hans Jürgen Hoffmann12, Marianne Kragh Thomsen13, Ulla Vogel14, Paal Skytt Andersen15 and Vibeke Andersen1,16,17

1Medical Department, Viborg Regional Hospital, Viborg, Denmark2Institute of Human Genetics, University of Aarhus, Aarhus, Denmark3Department of Gastroenterology, Herlev Hospital, Herlev, Denmark4Department of Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark 5Medical Department, Køge Hospital, Køge, Denmark6Medical Department, Hillerød Hospital, Hillerød, Denmark7Medical Department, Sydvestjysk Hospital, Esbjerg, Denmark8Medical Department, Bispebjerg Hospital, Bispebjerg, Denmark9Medical Department, Nykøbing Falster Hospital, Nykøbing Falster, Denmark10Medical Department V, Aarhus University Hospital, Aarhus, Denmark11Medical Department, Slagelse Hospital, Slagelse, Denmark12Department of Respiratory Diseases B, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark13Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark14National Research Centre for the Working Environment, Copenhagen, Denmark 15Department for Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark 16Medical Department, Hospital of Southern Jutland Aabenraa, Aabenraa, Denmark17Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark

Background: Tumor necrosis factor-α (TNF-α) inhibitors are used for treatment of inflammatory bowel diseases (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC). However, one-third of the patients do not respond to the treatment.

objective: To establish a cohort for studies on genetic predictors for treatment response of TNF-α inhibitors in pa-tients with IBD.

Methods: Blood samples used for tuberculosis antigen testing were collected from Danish laboratories from 01.09.2009 to 30.03.2011 (9217 individuals). Patients with intestinal diseases (ICD-10 code K50-K63) were identified by linkage with the National Patient Registry using the unique personal identification number of Danish citizens (CPR-number) (2659 cases). Patient records from 18 medical departments were examined (1378 cases). Among patients identified with IBD (1095 cases), 808 were previously naive to TNF-α inhibitor treatment. Treatment efficacy reflected the maxi-mum response within 22 weeks after initiation.

Results: Treatment efficacy was available for 759 patients. Among 492 patients with CD and 267 with UC, 74%/13%/14% and 65%/12%/24% were responders, partial responders and non-responders, respectively. Patients with UC were more frequently non-responders compared to patients with CD (OR: 1.96, 95% CI: 1.34-2.87, p = 0.001). Smoking > 10 cigarettes per day was associated with non-response (OR: 2.33, 95% CI: 1.13-4.81, p = 0.03).

Conclusion: Patients with UC and patients smoking > 10 cigarettes per day had a high rate of non-response to TNF-α inhibitor treatment. Furtheremore, the study confirms that younger age at treatment initiation and CRP > 20 mg/L was associated with response.

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24. Anal sphincterruptur ved vaginal fødsel : Risikofaktorer, behandling og opfølgning

M. Z. Bayoumi, H. Majeed

Kvindeafdelingen, Regionshospitalet Viborg

Formål: Kvalitetssikringsprojekt for at undersøge behandling og opfølgning af anal sphincterruptur ved vaginal fødsel på kvindeafdelingen, Regionshospitalet Viborg, i perioden (1. oktober 2011 - 31. september 2012).

Baggrund: Den anale sphincter er et muskelkompleks bestående af den interne anale sphincter, der udgøres af glat muskulatur samt den eksterne anale sphincter. Begge muskler bidrager til den anale kontinensmekanisme, evnen til at tilbageholde luft og afføring i tarmen. Anal sphincterruptur (grade 3 og 4/ inkomplete og komplete sphincter ruptur) i forbindelse med vaginal fødsel er sjælden men kan være årsag til risiko for fækal – og flatusinkontinens, urgency, soi-ling, dyspareuni samt andre underlivssmerter hos kvinder efter fødselen. Andelen af sphincterruptur i Danmark er ca. 6 % hos førstegangsfødende, og 1,4% hos flergangsfødende. Anal sphincterruptur er en meget vigtig kvalitetsindikator i obstetrik.

Metode: Retrospektiv undersøgelse ved journalgennemgang af alle vaginale fødsler med anal sphincterruptur (grade 3 og 4), i perioden (1. oktober 2011- 31. september 2012).

Resultat: Ud af 2409 kvinder fik 53 diagnosticeret sphincterruptur (2,2 %). 47 førstegangsfødende (88%) og 6 fler-egangsfødende (11%). Det svarer til en risiko på omkring 5% hos første gangsfødende og < 1% hos flere gangsfødende. 16 kvinder fødte ved instrumental forløsning (14 med vacuum ekstraktion, og 2 ved tang forløsning). I denne periode der blev anlagt 119 vacuum ekstraktion, hvor 11,7% (14/119) af kvinder fik en sphincterruptur.Alle kvinder blev kontrolleret 6 uger postpartum ved en fysioterapeut, og 5 måneder efter ved en telefonsamtale. Ca. 28% af kvinderne havde smerter og dysparuni ved 6 ugers versus 13% ved 5 månderskontrol, 15% var inkontinente for flatus ved 6 ugers kontrol versus 4% ved 5 måneders kontrol. 8% af kvinder havde soiling for tynd afførning ved både 6 ugers og fem månders kontrol og blev henvist videre til Aarhus.

Konklusion: Risikoen for sphincterurptur stiger hos førstegangsfødende og ved instrumental forløsning. De fleste kvinder har ingen gener ved 5 månders kontrol, og kun få patienter kræver yderligere behandling.

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25. Diagnostic imaging of patients with unspecific symptoms of potentially serious disease or malignan-cy: How we screen for occult cancer

Wilkens R1,2, Ingeman M3, Fredberg U2, Næser E2, Nielsen AH1, Vedsted P3

1Regional Hospital Central Jutland, Diagnostic Center, Radiology Department2Regional Hospital Central Jutland, Diagnostic Center, Medical Department3Department of Public Health – Research Unit for General Practice

Background/AIM: Specific cancer packages (SCP) was introduced in 2008 and did improve both diagnostics and survi-val1. However, many cancer forms do not present clinical symptoms that fits exactly into the criteria for a SCP, leading to prolonged time to diagnosis and subsequently therapeutic options and survival2. This lead to the introduction of another non-specific diagnostic cancer package: Diagnostic package for serious disease that can be cancer. We will describe this cancer package, patient population and diagnostic approach.

Materials and methods: Patient population was defined as all patients referred to Silkeborg Regional Hospital for evaluation for occult cancer (OC) who initially underwent an OC start packages (OCSP) in the period of January 2011 to December 2012. Referral criteria: Overall evaluation by the general practitioner that finds that the patient could be seriously ill. If the symptoms are consistent with a SCP, the patient should be referred that way. OCSP consist of a broad lab. screening, thorax x-ray and a comprehensive ultrasound scan covering the abdominal organs. All examinations were performed on the same day within 48 hours (2 working days) of telephonic referral. The radiologist then decided whether the patient was eligible for a CT scan.

Results: 1559 patients underwent the OCSP from 2011-12. 54% had a CT-scan of which half of those were decided by the radiologist at time of OCSP. 87% of US-scans and 71% of CT–scans were performed within 2 workdays. Time from US until written result were 95% same day and for CT 92% within 2 workdays. If the radiologist decided to perform a CT-scan 34 % had a written CT result 2 workdays after OCSP phone-referral compared to 15% where initial examinati-ons were normal.

Conclusion: OCSP are quickly performed at our site and if radiologists decide to act on important findings, total exami-nation time reduces further.

References:1. Storm, H. H., Kejs, A. M. T. & Engholm, G. Improved survival of Danish cancer patients 2007-2009 compared with

earlier periods. Danish medical bulletin 58, A4346 (2011).2. Sundhedsstyrelsen DIAGNOSTISK PAKKEFORLØB for patienter med uspecifikke symptomer på alvorlig sygdom, der

kunne være kræft. (2012).

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26. Fibrotic and inflammatory lesions in small intestinal stenoses assessed with imaging techniques CeUS and MRI to predict biomechanical wall properties in patients with CD (FLIP). Results from an ac-cidentally measured fistula

Wilkens R1,2,4, Glerup H1, Nielsen AH2, Tøttrup A3, Krogh K4

1Regional Hospital Central Jutland, Diagnostic Center, Medical Department2Regional Hospital Central Jutland, Diagnostic Center, Radiology Department3Aarhus University Hospital, Department of Surgery4Aarhus University Hospital, Hepatology and Gastroenterology Department

Background: Crohn’s Disease is a relapsing chronic transmural and sometimes stricturing1 inflammatory bowel di-sease. It is thought that an inflammatory stenosis can be treated with drugs whereas fibrostenosis only can be cured with surgery2. The elastic features of stenosis in CD have only been studied in animal models before3.

Aim: Our aim is to test the biomechanical properties of the stenotic bowel segment in 25 CD patients undergoing elec-tive surgery, and compare them with preoperative imaging techniques.

Methods: All patients in our study must undergo a standard laparoscopic or laparotomy operation by highly specialized IBD surgeons at Aarhus University Hospital. The intestinal stenosis is identified intraoperativly and marked with sutu-res in vivo. The specimen is fixated in both ends and placed in a Krebs Solution with a constant pH and temperature. An EndoFLIP probe with an adjustable fluid container serving as a pressure column is blindly inserted into the cleansed specimen. Cross Sectional Area was measured. Concurrently the specimen is scanned with an ultrasound system at a center suture. An ultrasound still picture where obtained for measurement of intestinal wall thickness at six pressure intervals from 0 to 105 mmH

2O.

Results: So far, only one patient was examined using this method. After the procedure the pathologist found that, a fistula were present between to loops of the terminal ileum with short proximity to the caecum. This were also found on the preceding ultrasound and MRI scans, but not at surgery. The EndoFLIP catheter had been inserted into this fistula. The results shows that the fistula lumen are not expanding even under maximum pressure (105 cmH2O) and are kept with a diameter <4 mm.

Conclusion: This is the first time an intestinal fistula is examined for biomechanical properties.

References:1. Satsangi, J., Silverberg, M. S., Vermeire, S. & Colombel, J.-F. The Montreal classification of inflammatory bowel di-

sease: controversies, consensus, and implications. Gut 55, 749–53 (2006).2. Coelho, J. et al. [Management of ileal stenosis in patients with Crohn’s disease]. Gastroentérologie clinique et biolo-

gique 33, F75–81 (2009).3. Storkholm, J. H. et al. Biomechanical remodeling of the chronically obstructed Guinea pig small intestine. Digestive

diseases and sciences 52, 336–46 (2007).

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27. Validation of a Point-of-Care InR coagulometer in intensive care patients not on oral anticoagulant therapy

Jørgensen B,1 Dalgaard K,2 Ravn T,2 Knudsen KK2

Departments of Clinical Biochemistry1 and Intensive Care,2 Viborg Regional Hospital, Viborg, Denmark

Background: Point-of-Care (POC) INR determination is widely used for monitoring oral anticoagulant therapy (OAT) in general practice and by patient self testing. Short assay turn-around time is desirable especially in intensive care units (ICU), including rapid INR results. As most ICU patients are not on OAT, validation of POC INR in this setting is required prior to clinical use.

objective: To validate the CoaguChek XS Plus™ (CCXS+, Roche Diagnostics) in ICU patients not on OAT.

Methods: Blood samples were drawn from a Vamp System (Edwards Lifesciences) connected to arterial lines in 76 ICU patients. Blood was immediately applied onto two CCXS+, and a citrate tube was collected for routine INR determina-tion on Sysmex CS-2100i (Siemens). A single lotno. CCXS+ test strips was used. Analytical coefficient of variation (CVa) was calculated from normalized differences in the duplicates. Method comparison was based on CCXS+/Routine ratios. Validation involved quality specifications for POC INR/Routine ratios in general practice set forth by the Danish Society of Clinical Biochemistry and the Organization of General Practitioners in Denmark.

Results: CCXS+ INR’s averaged 1.5 (range 0.9-4.5). CVa was 1.9%. The CCXS+/Routine ratio averaged -1.3% (SD 13.3%, range -29.4% to 34.1%). 72/76 (95%) of ratios met the preset quality specification of ±26%. Low molecular weight he-parin prophylaxis in 55 patients did not influence the CCXS+ results.

Conclusions: CCXS+ is useful in ICU patients not on OAT, and performs in such patients with the same analytical quality as is known from a vast number of patients on OAT monitored in general practice.

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28. Afprøvning af Lactate Scout™ under fødsler med truende asfyksi

Kolding L,1 Zidek AS,2 Farlie R,1 Jørgensen B2

Kvindeafdeling Y1 & Klinisk Biokemisk Afdeling2, Regionshospitalet Viborg

Baggrund: Under fødsel anvendes pH i blodprøver fra barnets skalp til vurdering af truende asfyksi. pH <7,20 medfører umiddelbar forløsning. På fødegangen, RH Viborg, måles skalp-pH med ABL800 Flex (Radiometer Medical Aps). Det kan være teknisk vanskeligt at udtage tilstrækkeligt blod (mindst 50 µL), hvorfor måling jævnligt svigter. Alternativt kan måles skalp-laktat, idet laktat >4,8 mmol/L medfører umiddelbar forløsning. Vi afprøvede apparatet Lactate Scout™ (LS, HaemoMedtec), som kun kræver 0,5 µL blod til analysering og afgiver svar på få sekunder.

Materiale og metode: 12 assistenter fra fødegangen blev oplært på KBA i brug af LS. Skalp-prøver blev taget ved 90 konsekutive fødsler, hvor der var påvirket CTG og/eller grønt fostervand. Prøver blev udtaget rutinemæssigt af læge ved hjælp af 100 µL kapillærrør efter snit i barnets skalp. Kapillærrør blev omgående bragt til ABL, der er placeret i et rum udenfor fødestuerne. Prøve blev påsat LS og straks derefter ABL. Laktatværdierne blev ikke anvendt i beslut-ningsprocessen.

Resultater: Der blev udtaget 218 skalp-prøver svarende til 2,4 pr. fødsel (spændvidde 1-8). 14 (6,4%) prøver blev ikke målt med LS. Ti grundet travlhed på fødestuen, to fordi LS var slukket, en fordi brugeren ødelagde målestrimlen og en fordi brugeren påsatte for lidt blod. 53 (24,3%) prøver blev ikke målt med ABL. 27 af disse svigt beroede på utilstrække-ligt prøvemateriale, resten på koaguleret eller lufttilblandet blod i kapillærrøret. Alle pH var 7,29±0,06 (middel±SD) og alle laktat var 3,26±1,28 mmol/L. Hverken pH eller laktat viste signifikant forskel før og under presseperioden. Laktat var højere (3,61 mmol/L) under ve end uden ve (3,02 mmol/L, p=0,01), mens ve ikke påvirkede pH (7,28 under ve, 7,29 uden ve).

Konklusion: Lactate Scout™ er let at betjene, giver omgående svar og kan anvendes direkte på fødestuen. Apparatet gav flere brugbare resultater end ABL grundet et langt mindre prøvevolumen til analysering.

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29. Urine Desmosine: A potential biomarker for abdominal aortic aneurysms

Bramsen MB1,2, Frystyk J2, Lindholt JS3

1Regionshospitalet Viborg, 2Aarhus Universitet, 3Syddansk Universitet

Aims: The aim of this preliminary study is to evaluate urine desmosine as a potential biomarker for AAA.

Methods: Elastin is a vital extracellular matrix (ECM) protein that stabilizes and provides flexibility to elastin rich tis-sues, such as lungs and large arteries. Mature elastin is formed from crosslinking troboelasin chains in ECM and the crosslinking structure of desmosine (DES) are unique to mature elastin. Elastin degradation plays a key role in the development of both chronic obstructive lung disorder (COLD and abdominal aortic aneurysm (AAA). In this preliminary study, urine samples from 20 randomly selected patients with 30-49 mm wide AAA, and 20 gender- and agematched without AAA but with PAD diagnosed in the populationbased randomized vascular screening trial (VIVA) were used. Samples were collected at the screening session and immediately frozen at -80 degree celcius untill analysis. Urine levels of desmosine was measured using a competitive ELISA. Desmosine concentrations were divided by U-creatinine to adjust for urine concentration. Samples were analysed twice and the mean concentration was used for analysis. U-desmosine is correlated to the presence of AAA, AAA diameter and AAA growth rate.

Findings: U-Desmosine were significantly higher in AAA(n=20) cases versus PAD(n=20) controls (137.1 +/-36.51 vs 35.3 +/- 15.2, p<0.001) . The AUC was 1.00, with an optimal cutpoint at 70 units. All samples below didn´t had AAA, and all above had AAA causing a sensitivity and specificity of 100% both (p<0.001). U-desmosine correlated strongly and signi-ficantly with maximal aortic diameter (r= 0,75, p<0.001).

Conclusion: U-desmosine shows very strong correlation with the presence AAA and AAA size.

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Heibergs Allé 48800 Viborg

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Forskningensdag2013_Abstracts.indd04-2013 • 200 • 115 g