Danish medical journal
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Danish medical journal · Jan 2014
Randomized Controlled Trial Multicenter Study Comparative StudyHydroxyethyl starch in sepsis.
Hydroxyethyl starch (HES) is a colloid that has been widely used for fluid resuscitation for decades. The newest generation of HES, tetrastarch, was believed to provide an efficient volume expansion without causing the side effects observed with former HES solutions. However, this belief was based on physiological models and small studies rather than on firm clinical evidence. Our aim was to assess the safety and efficacy of tetrastarch in a randomised clinical trial and in a systematic review. ⋯ Our randomised clinical trial is one of several high-quality trials in critically ill patients with and without sepsis that now provide evidence that the use of tetrastarch impairs kidney function and haemostasis and may even increase mortality. Whether the results can be extrapolated to other types of patients is unclear, but so far no group of patients with an overall benefit of HES beyond surrogate markers has been identified. In line with this, the European Medicines Agency's Pharmacovigilance Risk Assessment Committee now recommends that the marketing authorisations of all HES solutions are suspended in the European Union.
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Danish medical journal · Jan 2014
Randomized Controlled TrialTreatment and prognosis in peptic ulcer bleeding.
Peptic ulcer bleeding is a frequent cause of admission. Despite several advances in treatment the 30-day mortality seems unchanged at a level around 11%. Use of risk scoring systems is shown to be advantageous in the primary assessment of patients presenting with symptoms of peptic ulcer bleeding. ⋯ The underlying cause of 30-day mortality was in the majority of patients related to comorbidity. The main predictors for long-term mortality were old age, comorbidity, male sex, severe anaemia and tobacco use. Although severe anaemia predicted long-term mortality treatment with blood transfusion was not associated with long-term mortality per se.
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Danish medical journal · Jan 2014
Multicenter StudyCrohn's disease and ulcerative colitis. Occurrence, course and prognosis during the first year of disease in a European population-based inception cohort.
Inflammatory bowel diseases (IBD), consisting of Crohn's disease (CD) and ulcerative colitis (UC), are chronic immune mediated diseases of unknown aetiology. Traditionally, the highest occurrence of both UC and CD is found in North America and Europe, including Scandinavia and the United Kingdom, while the diseases remain rare in Eastern Europe. Until recently, few population-based cohort data were available on the epidemiology of IBD in Eastern Europe. ⋯ Biological therapy accounted for one fourth costs in Western European CD patients. Long-term follow-up of the EpiCom cohort is needed in order to assess whether the earlier and more frequent treatment with immunomodulators and biologicals observed in this study will change the natural disease course and phenotypes over time or merely postpone outcomes such as surgery. Furthermore, the question of if and how differences in treatment choices between Eastern and Western Europe impact on the disease course requires long-term follow-up.
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Danish medical journal · Jan 2014
Randomized Controlled TrialAssessment of postural balance in community-dwelling older adults - methodological aspects and effects of biofeedback-based Nintendo Wii training.
The overall purpose of this thesis was to examine selected methodological aspects and novel approaches for measuring postural balance older adults, and to examine the effects of biofeedback-based Nintendo Wii training on selected physiological, psychological and functional outcome variables in community-dwelling older adults. In Study I balance control was investigated using force plate analysis of Centre of Pressure (COP) excursion during static bilateral standing in 32 community-dwelling older adults at three different time-points (09:00, 12:30, and 16:00) throughout the day. An overall significant time-of-day effect was observed for all selected COP variables. ⋯ The results presented in this thesis suggest that strict control of time-of-day is an important methodological aspect when evaluating postural balance in older adults, and an assessment protocol using the Nintendo Wii-Balance Board is reproducible and valid. Biofeedback-based Nintendo Wii exercise intervention appeared unsuccessful in improving static bilateral postural balance, most likely due to a test ceiling effect in the selected outcome measures, but the intervention elicited marked positive changes in various key risk factors associated to fall accidents. Notably, Wii based biofeedback exercise was perceived by the older adults as a highly motivating type of training.
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Danish medical journal · Jan 2014
Mesenterico-portal vein resection in patients with pancreatico-duodenal cancer is safe and may increase survival.
Pancreatic cancer is one of the most serious gastrointestinal cancers, and in the US and Europe it is a leading cause of cancer-related mortality. Radical surgery is the only option available for long-term survival. The aim of this study was to describe the surgical technique and the results of portal vein/superior mesenteric vein resection in patients with pancreatic cancer. ⋯ not relevant.