Frostbite treated with hyperbaric oxygen.

This is a case report of a 39-year-old man who participated in a cross-country skiing race in Alaska. A few minutes with a glove-free hand resulted in frostbites. Medical assistance arrived 24 hours later and enoxaparine was administered. After seven days, hyperbaric oxygen therapy (HBOT) was initiated in Denmark. After 90 days the distal part of the second finger was removed due to mummification. Compared with the original extent of the injury the amputated part was significantly smaller. HBOT as treatment has not yet been described in Danish patients and is only used on an experimental basis worldwide.

[Post-endoscopic retrograde cholangiopancreatography with descending abscess to knee level].

In this case report, a 67-year-old woman underwent an endoscopic retrograde cholangiopancreatography (ERCP). The following day she was admitted to hospital due to abdominal pain. Blood tests showed amylase of 500 U/l and C-reactive protein of 300 mg/l, and suspicion of post-ERCP pancreatitis was raised. A CT scan of the abdomen showed signs of acute pancreatitis. After ten days the lower right leg started to swell. Deep venous thrombosis was ruled out, and a control CT-scan four weeks after admission showed abscesses in the right lower fossa and the lower right leg at knee level. Punctures had contents of amylase. Everything was interpreted as descending abscesses retroperitoneal from pancreas due to acute pancreatitis as an ERCP complication.

Economic benefits of treating medication-overuse headache - results from the multicenter COMOESTAS project.

BACKGROUND: Medication-overuse headache is a costly disease for individuals and society. OBJECTIVE: To estimate the impact of medication-overuse headache treatment on direct and indirect headache-related health care costs. METHODS: This prospective longitudinal study was part of the COMOESTAS project (COntinuous MOnitoring of Medication Overuse Headache in Europe and Latin America: development and STAndardization of an Alert and decision support System). Patients with medication-overuse headache were included from four European and two Latin American headache centers. Costs of acute medication, costs of health care services, and measurements of productivity were calculated at baseline and at 6-month follow-up Treatment consisted of overused drug withdrawal with optional preventive medication. RESULTS: A total of 475 patients (71%) completed treatment and were followed up for 6 months. Direct health care costs were on average reduced significantly by 52% ( p < 0.001) for the total study population. Significant reductions were seen in both number of consumed tablets (-71%, p < 0.001) and number of visits to physicians (-43%, p < 0.001). Fifty percent of patients reduced their number of consumed tablets ≥ 80%. Headache-related productivity loss, calculated either as absence from work or ≥ 50% reduction of productivity during the workday, were reduced by 21% and 34%, respectively ( p < 0.001). CONCLUSION: Standardized treatment of medication-overuse headache in six countries significantly reduced direct health care costs and increased productivity. This emphasizes the importance of increasing awareness of the value of treating medication-overuse headache. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov (no. NCT02435056).

[Throat pain after colonoscopy].

A 38-year-old man known with inflammatory bowel disease, received an ileostomy and a blinded colon. Eight years later the patient underwent a painful colonoscopy, performed under suspicion of malignancy in the blinded colon. Two days later the patient was admitted due to hoarseness, throat pain and a feeling of neck swelling but no abdominal pain. A chest X-ray showed subcutaneous emphysema in the neck region and pneumoperitoneum. We conclude, that colonoscopies can give a variety of complications, such as perforation in the colon with secondary subcutaneous emphysema in the neck and throat region.