Dan Med Bull
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Allogeneic hematopoietic cell transplantation (HCT) represents a potentially curative treatment modality in a range of hematologic malignancies. High-dose myeloablative radio-chemotherapy has conventionally been used as part of the preparative regimen before HCT for two reasons: it has a profound immunosuppressive effect on the host, limiting the ability to reject the graft and it has substantial anti-tumor efficacy. Graft rejection is an example of alloreactivity as alloreactivity denotes the immunologic reactions that occur when tissues are transplanted between two individuals within the same species. ⋯ However, many issues such as whom to transplant and when the transplant should be performed remain to be clarified. Large prospective studies, involving collaboration between centers, are needed to define the role of HCT with nonmyeloablative conditioning along with other treatment modalities. In addition, it is important to continue to elucidate the immunologic mechanisms that are responsible for GVHD and the GVT effect.
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Elective surgical repair of an inguinal or femoral hernia is one of the most common surgical procedures. The treatment, however, presents several challenges regarding anaesthesia for the procedure, the postoperative analgesic therapy and convalescence, as well as planning of the procedure. Local, general, and regional anaesthesia are all used for hernia repair, but to different degrees, primarily depending on traditions and whether the institution has specific interest in hernia surgery. ⋯ Despite this, the fraction of patients operated in a day-case surgical set-up varies from 6% in France to 83% in US, and in Denmark 60% of patients have their hernia repair as a day-case procedure. A day-case hernia surgery service should be organised with standardised patient records, including descriptions of surgery performed as well as letters of discharge for the general practitioner. If clinical data are stored electronically, the basis is created for valuable clinical databases like the one behind the present thesis, and they can be used both for scientific purposes and for quality control and improvement.
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Normal function of the hepatic low-density lipoprotein (LDL) receptor is obligate for normal levels of plasma LDL cholesterol. The LDL receptor regulates the concentration of plasma LDL cholesterol by internalizing apolipoprotein B-100- and apolipoprotein E-containing lipoproteins by receptor-mediated endocytosis. Mutations in the gene encoding the LDL receptor protein give rise to one of the most common classical autosomal dominant inherited disorders in man, familial hypercholesterolemia (FH). ⋯ Familial defective apolipoprotein B (FDB) caused by the R3500Q apolipoprotein B gene mutation may mimic FH but the clinical course, however, is often milder than that seen in patients with LDL receptor gene mutations. A newly discovered third major locus at chromosome 1 may also be of future diagnostic importance although the exact gene remains to be identified. The overall molecular genetic knowledge obtained about FH in Denmark forms the basis for the implementation and use of molecular genetic diagnostics of FH in daily clinical practice.