An open-label randomized study was undertaken to compare a 2-dose regimen (Months 0 and 6) of hepatitis B surface antigen (HBsAg) vaccine formulated with a novel adjuvant (HBsAg/AS04) with a standard 3-dose regimen (Months 0, 1 and 6) of licensed recombinant HBsAg vaccine in terms of immunogenicity and reactogenicity when administered to healthy subjects aged between 15 and 40 y. At 1 and 6 months after the full vaccination course there was a 100% seroprotection rate (anti-HBs > or = 10 mIU/ml) with the HBsAg/AS04 vaccine, compared with a 99% response rate with the licensed vaccine. The corresponding geometric mean titres were significantly higher for the novel vaccine compared to the standard vaccine: 15,468 and 2,745 mIU/ml at Months 7 and 12 vs. 6,274 and 1,883 mIU/ml, respectively. There was a higher prevalence of local symptoms with the adjuvant vaccine (90% of doses) than with the standard vaccine (48% of doses). However, these symptoms (pain, swelling and redness) were predominantly of mild-to-moderate intensity and resolved rapidly without treatment. A 2-dose regimen of the new HBsAg/AS04 adjuvant vaccine therefore compared favourably to the standard regimen in healthy young adults. It is anticipated that the simplified vaccination schedule may improve compliance and reduce costs.
The aim of this study was quality assurance and to analyse the frequency of complications following thyroid surgery. The most dreaded surgical complications are permanent injury to the recurrent laryngeal nerve or persistent hypocalcaemia. Our surgical procedure included the use of the surgical microscope in connection with thyroid grand surgery. Our materiel includes 122 patients who underwent surgery for benign thyroid diseases in our department from 1990-1996. In nearly 50% of all cases a lobectomy was performed, reserving resections and subtotal thyroidectomy to special cases. Resections were primarily done in the beginning of the period. The surgical microscope was used as a standard procedure to identify and expose the recurrent laryngeal nerve and the parathyroid glands. Primary thyroid grand surgery in benign disease resulted in permanent unilateral laryngeal nerve palsy in one case or in 0.83% of the patients. When calculated as nerves at risk, the complication rate was reduced to 0.67%. In benign completion surgery the complication rate was 0%. No patient developed persistent hypocalcaemia.
Venous reconstructions after iatrogenic injuries are rarely performed and are associated with a relatively high risk of complications. We present our experiences with venous reconstructive surgery to the iliofemoral vein segment.
We reviewed ten patients with venous injuries evaluating clinical characteristics, operative and postoperative data including location and type of venous injury, operative repair and outcome. Venous injuries either occurred during varicose vein surgery or other kinds of procedures in the region. The injuries were repaired by interposition with a polytetrafluorethylene graft, and after surgery they were treated with an intermittent pneumatic compression device and anticoagulation medicine. Subsequently, patients were evaluated both clinically and by colour duplex scan.
The mean patient age was 42.5 years (range 26-61 years) with no reported co-morbidity. The median follow-up was 16 months (range 12-157 months). The 30-day patency rate was 70% and the morbidity rate 40%. At the latest follow-up, the venous patency rate was 90% after supplementary treatment.
The study shows a satisfactory outcome despite severe iatrogenic injuries to the iliofemoral vein segment. Venous reconstructive surgery should be a centralized task.
This paper describes some of the main findings from two separate studies on accident prediction models for urban junctions and urban road links described in [Uheldsmodel for bygader-Del1: Modeller for 3-og 4-benede kryds. Notat 22, The Danish Road Directorate, 1995; Uheldsmodel for bygader- Del2: Modeller for straekninger. Notat 59, The Danish Road Directorate, 1998] (Greibe and Hemdorff, 1995, 1988). The main objective for the studies was to establish simple, practicable accident models that can predict the expected number of accidents at urban junctions and road links as accurately as possible. The models can be used to identify factors affecting road safety and in relation to 'black spot' identification and network safety analysis undertaken by local road authorities. The accident prediction models are based on data from 1036 junctions and 142 km road links in urban areas. Generalised linear modelling techniques were used to relate accident frequencies to explanatory variables. The estimated accident prediction models for road links were capable of describing more than 60% of the systematic variation ('percentage-explained' value) while the models for junctions had lower values. This indicates that modelling accidents for road links is less complicated than for junctions, probably due to a more uniform accident pattern and a simpler traffic flow exposure or due to lack of adequate explanatory variables for junctions. Explanatory variables describing road design and road geometry proved to be significant for road link models but less important in junction models. The most powerful variable for all models was motor vehicle traffic flow.