Danish medical journal
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Danish medical journal · Feb 2017
ReviewMultiparametric MRI in detection and staging of prostate cancer.
Prostate cancer (PCa) is the second leading cause of cancer-related mortality and the most frequently diagnosed male malignant disease among men in the Nordic countries. The manifestation of PCa ranges from indolent to highly aggressive disease and due to this high variation in PCa progression, the diagnosis and subsequent treatment planning can be challenging. The current diagnostic approach with PSA testing and digital rectal examination followed by transrectal ultrasound biopsies (TRUS-bx) lack in both sensitivity and specificity in PCa detection and offers limited information about the aggressiveness and stage of the cancer. Scientific work supports the rapidly growing use of multiparametric magnetic resonance imaging (mp-MRI) as the most sensitive and specific imaging tool for detection, lesion characterisation and staging of PCa. However, the experience with mp-MRI in PCa management in Denmark has been very limited. Therefore, we carried out this PhD project based on three original studies to evaluate the use of mp-MRI in detection, assessment of biological aggression and staging of PCa in a Danish setup with limited experience in mp-MRI prostate diagnostics. The aim was to assess whether mp-MRI could 1) improve the overall detection rate of clinically significant PCa previously missed by TRUS-bx, 2) identify patients with extracapsular tumour extension and 3) categorize the histopathological aggressiveness based on diffusion-weighted imaging. ⋯ Mp-MRI prior to repeated biopsies can improve the detection rate of clinically significant PCa and allow for a more accurate GS by combining standard TRUS-bx with mp-MRI-targeted biopsies under visual TRUS-guidance. Mp-MRI can provide valuable information about the histopathological aggressiveness of a PCa lesion and the tumour stage with possible ECE can be assessed in the pre-therapeutic setting providing important additional information for optimal patient-tailored treatment planning.
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Danish medical journal · Dec 2016
ReviewSudden cardiac death: a nationwide cohort study among the young.
Sudden cardiac death (SCD) is a tragic event affecting millions of individuals worldwide. Although several studies have investigated the epidemiology of SCD, these studies may have been affected by reporting and referral biases, which are reflected in the very different incidence rates and causes of deaths that have previously been reported. Among SCD victims aged < 36 years, inherited cardiac diseases are well known to play an important role. ⋯ Future research should investigate the extent to which CAD among individuals younger than 50 years of age is caused by inherited cardiac conditions such as familial hypercholesterolemia. The extent to which medication use prior to death may contribute to SCD and SUD should also be evaluated. Finally, with the availability of dried blood spot samples from all infants in Denmark, future research should also investigate the genetic substrate of SCD and SUD.
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Danish medical journal · Nov 2016
Patient are satisfied one year after decompression surgery for lumbar spinal stenosis.
Lumbar spinal stenosis (LSS) is a clinical syndrome of buttock or lower extremity pain, which may occur with or without back pain. The syndrome is associated with diminished space available for the neural and vascular elements in the lumbar spine. LSS is typically seen in elderly patients, its prevalence is estimated to be 47% in people over the age 60 years. LSS is the most common reason for spine surgery in Denmark and the number of surgical procedures is likely to increase due to demographic changes. The purpose of this study was to evaluate the patient-reported outcomes and perioperative complications of spinal decompression surgery in LSS patients. ⋯ none.
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Danish medical journal · Oct 2016
ReviewResistance in human pathogenic yeasts and filamentous fungi: prevalence, underlying molecular mechanisms and link to the use of antifungals in humans and the environment.
Antifungal drug resistance is a multifaceted clinical challenge, and when present, a primary cause of treatment failure in patients with severe fungal infections. Changing epidemiology, increasing resistance rates and a narrow antifungal armamentarium may further underline the required attention on resistance particularly within the most prevalent invasive fungal infections caused by Candida yeasts and Aspergillus moulds. In Denmark, the resistance epidemiology remains to be fully elucidated. ⋯ For A. fumigatus, the concern is the emergence of azole resistant strains in the environment, displaying cross-resistance to clinical azoles, and thus posing unforeseen clinical challenges in the management of invasive aspergillosis. Collectively, these findings call for an increased awareness especially at clinical microbiology laboratories, which ideally would lead to susceptibility testing of all clinically relevant isolates by reference or validated methods. Moreover, novel diagnostic approaches for non-culturable pathogens are warranted and especially DNA-based detection by PCR may serve as a solid complimentary tool for improved diagnostics of invasive fungal infections.
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The hormone, melatonin is produced with circadian rhythm by the pineal gland in humans. The melatonin rhythm provides an endogenous synchronizer, modulating e.g. blood pressure, body temperature, cortisol rhythm, sleep-awake-cycle, immune function and anti-oxidative defence. Interestingly, a number of experimental animal studies demonstrate significant dose-dependent anti-nociceptive effects of exogenous melatonin. ⋯ High-quality randomized experimental- and clinical studies are still needed to establish a "genuine" analgesic effect of the drug in humans. Other perioperative effects of exogenous melatonin should also be investigated, before melatonin can be introduced for clinical routine use in surgical patients. Despite promising experimental and clinical findings, several unanswered questions also relate to optimal dosage, timing of administration and administration route of exogenous melatonin.