Tonsillectomy and risk of post-tonsillectomy haemorrhage - a protocol for a randomised clinical trial.

INTRODUCTION: Tonsillectomy is one of the most common procedures in the ear, nose and throat field, and 7.7% of the Danish population had undergone a tonsillectomy by the age 20 years in 2012. One feared complication is post-tonsillectomy haemorrhage (PTH), which in a Danish register-based study was found to increase from 3% in 1991 to 13% in 2012. PTH represents a significant risk and deaths are reported in the literature. The aim of the trial is to compare hot and cold haemostasis during tonsillectomy and assess, firstly, the risk of PTH and, secondly, the reported pain perception. METHODS: This is a single-centre, two-arm, interventional randomised controlled trial. The study targets patients > 12 years of age referred for tonsillectomy. Participants will have both tonsils removed; on one side cold haemostasis will be performed and on the other hot diathermia will secure haemostasis. The participants will subsequently receive three questionnaires in the course of a month concerning bleeding episodes and pain perception. Owing to the study design, patients and surgeons act as their own controls. CONCLUSIONS: The results of the study may guide future research and practice of tonsillectomy to reduce the risk of PTH. FUNDING: Lizzi and Mogens Staal Fonden and Nordsjællands Hospital. The funding sources had no influence on trial design, data collection, analysis or publication. CLINICALTRIALS: gov Identifier: NCT05161754. Registration date: 20042021; version 2: 20042021.

Sialendoscopy for pediatric salivary gland disorders: a study of safety and effect.

PURPOSE: Sialendoscopy has become the preferred modality for managing pediatric salivary gland disorders (PSGD) including juvenile recurrent parotitis (JRP) and sialolithiasis. The literature remains sparse, but several case series have reported good outcomes and few complications. The aim of this study was to investigate the safety and efficacy of sialendoscopy for PSGD in a Danish setting. METHODS: From a national sialendoscopy database, we included records of children who had undergone sialendoscopy for PSGD at our clinic over a 6-year period. Clinical and intraoperative data, follow-up and e-mail surveys after 1, 3 and 5 years were retrieved for analysis. RESULTS: We included 52 procedures on 50 glands (32 parotid, 18 submandibular) in 49 children. Of eligible patients, 90% attended clinical follow-up, 80% answered the survey after 1 year, 80% after 3 years and 60% after 5 years. JRP was diagnosed in 33 cases, obstructive causes in 18 cases. Complications noted were ductal perforation (2%), transient lingual nerve affection (4%) and infection (2%). For JRP patients, overall symptoms had improved for 96% after 3 months, 81% after 1 year and 83% after 3 years. For patients suffering from obstruction, overall symptoms were improved for 93% after 3 months and for 100% after 1 year. CONCLUSION: Sialendoscopy is a safe procedure for PSGD, and effective for sialolithiasis and symptom reduction in JRP.

Risk of adverse birth outcome after group B meningococcal disease: results from a Danish national cohort.

BACKGROUND: Group B meningococcal (GBM) disease induces antibodies that react in vitro with neural cell adhesion molecules in fetal brain tissue. Because IgG antibodies to GBM cross the placenta, the authors investigated whether women with a previous GBM disease had an increased risk of giving birth to preterm or to stillborn infants and whether the live-born children had an increased risk of birth defects. METHODS: Data were obtained from 4 national registries in the period 1974-2005 to form 2 cohorts: (1) 1422 women with confirmed GBM disease, and (2) their 502 firstborn children. RESULTS: Overall, there was no increased risk of preterm or stillbirths among the first cohort. Among the children, there was no increased risk of being born small for the gestational age, having birth defects (OR: 1.00; 95% CI: 0.53-1.90), diseases of the nervous system (HR: 0.38; 95% CI: 0.08-1.74), or any diseases within the first 3 years of life (HR: 1.06; 95% CI: 0.78-1.45) compared to births from a reference population with prior group C meningococcal disease. CONCLUSIONS: The results do not support the proposal that GBM is associated with immunoreactive disease that may affect the health of the offspring and are consistent with previous findings that GBM disease is not associated with an increased risk of autoimmune disease.

[Diagnosis of meningococcal sepsis by real-time polymerase chain reaction]. / Meningokoksepsis diagnosticeret ved realtids-polymerasekaedereaktion.

Approximately 100 cases of meningococcal disease are reported annually in Denmark; 90% of these cases are confirmed by culture and serological methods. Real-time PCR was introduced in Denmark in 2005 as a diagnostic tool for meningococcal disease. We hereby report the first notified case of meningococcal sepsis in Denmark where real-time PCR was the primary positive microbiological result.

[The economic impact of an epidemic of hepatitis A among men who have sex with men]. / Hvad koster et udbrud af hepatitis A blandt maend, der har sex med maend?

INTRODUCTION: In 2004 Denmark had an epidemic of hepatitis A among men who have sex with men (MSM). We estimate the size and the economic impact of the epidemic and discuss possibilities to prevent new epidemics. MATERIALS AND METHODS: The size of the outbreak was estimated from notifications received by the Department of Epidemiology and the number of hepatitis A IgM positive specimens sent to the Department of Virology at Statens Serum Institut. The economical impact was estimated according to data on cost of illness from the National Board of Health and the results of the outbreak investigation. RESULTS: In 2004, 165 cases of hepatitis A in men > 17 years of age were reported compared with a yearly average of 25 cases in the previous 10 years. The size of the outbreak, adjusted for an estimated underreporting of 60% was 220 cases. The economical impact was EUR 650,000, or EUR 3,000 per case. CONCLUSION: Outbreaks of hepatitis A among men who have sex with men are reported from major European cities almost on an annual basis. In the case of an outbreak, we suggest the response should include a targeted information campaign in the MSM media, hygiene control at gay saunas, sex clubs and darkrooms and a free vaccination offer to MSM with frequent partners at locations frequented by MSM. Before an outbreak we propose that vaccination against hepatitis A be recommended to MSM with frequent partners.