Routine X-ray of the chest is not justified in staging of patients with primary breast cancer.

INTRODUCTION: Chest X-rays (CXRs) are performed routinely as part of staging of primary breast cancer patients in most breast units in Denmark. However, several international studies have found exceedingly low detection rates for occult pulmonary metastatic disease among breast cancer patients. Even so, no data have previously been published on Danish patients. METHODS: A retrospective study was conducted of all breast cancer patients undergoing CXRs at the Department of Breast Surgery, Herlev Hospital, from April 2016 to December 2017. The primary outcome was detection of pulmonary metastases on CXRs at the time of the patient's breast cancer diagnosis. The follow-up period was 12 months. RESULTS: A total of 1,014 patients were included in this study. Among these, 11 (1%) had a positive CXR and 1,003 (99%) had a negative CXR. Three (0.3%) patients were diagnosed with lung metastases but had false negative CXRs. The sensitivity was 0%, the specificity was 98.9%, the positive predictive value was 0% and the negative predictive value was 99.6%. CONCLUSION: Routine preoperative CXR did not impact staging or lead to changes in the treatment of breast cancer patients. Therefore, routine CXR cannot be justified and should be omitted. FUNDING: none. TRIAL REGISTRATION: The study was approved by the local hospital legal department (Herlev and Gentofte Hospital) as quality assurance research (workzone number: 19000557).

Diagnostic challenges of adenomyoepithelioma: A case report.

INTRODUCTION: Breast adenomyoepithelioma is a very uncommon tumor, which is generally considered to be benign, however malignant transformation has been reported. PRESENTATION OF CASE: We report two cases of two women with breast adenomyoepithelioma. CONCLUSION: Diagnosis of adenomyoepithelioma is challenging because tumor may mimic other breast diseases. It has neither specific clinical signs nor radiological features, and the diagnosis is based on histopathological examination of the lesion. The treatment of choice is surgery. The type of surgery depends on the tumor factors and breast size. In malignant cases treatment such as radiotherapy, chemotherapy, immunotherapy may be used as well. It is very important to give an adequate treatment, otherwise the risk of tumor recurrence, growth or even metastatic spread, when tumor has malignant potential, increases.

[Spontaneous bacterial peritonitis and bacteraemia caused by meningococci serogroup W clonal complex 11].

In recent years, the incidence of invasive meningococcal disease (IMD) caused by serogroup W (SG-W) has been rising, in particular SG-W within clonal complex 11 (cc11), which has caused epidemics and is believed to cause severe and atypical IMD. This is a case report of spon-taneous bacterial peritonitis and bacteraemia caused by meningococci SG-W cc11 in a 60-year-old female with systemic lupus erythematosus in prolonged remission as her only risk factor. Antibiotic therapy was initiated at admission, and peritoneal lavage was performed. The patient recovered successfully without sequelae.

Consequence of delegating medication-related tasks from physician to clinical pharmacist in an acute admission unit: an analytical study.

OBJECTIVES: Studies have shown that medication histories obtained by clinical pharmacists (CPs) are more complete, and that medication reviews by CPs reduce healthcare costs, drug-related readmissions and emergency readmissions. The aim of this study was to identify the consequences of delegating medication-related tasks from physicians to CPs. METHODS: An analytical study based on data from a prospective cluster randomised trial was performed. The intervention consisted of CPs obtaining medication history, performing medication reconciliation and medication review. The physician had to approve the prescriptions and assess changes proposed by the CP. The primary outcome measure was a comparison of changes in the Electronic Medication Module (EMM) and changes proposed by CPs. RESULTS: 232 and 216 patients were included on control days (n=63) and intervention days (n=63). In total, 1018 changes were made in the control group (by physicians). In the intervention group 2123 changes were made, 1808 by CPs and 315 by physicians. In particular, the number of substitutions, registration of drugs and change of instructions for use (eg, administration times) differed between physicians and pharmacists. CPs made 341 written proposals in the intervention group and, of these, 22.9% (95% CI 18.7% to 27.8%) and 50.9% (95% CI 45.5% to 56.2%) were accepted by a physician at discharge from the acute admission unit (AAU) and hospital, respectively. CONCLUSIONS: CPs updated the EMM more thoroughly than physicians, especially entering new prescriptions, substitutions and changing instructions for use. Half of the written proposals were accepted. The extent to which patients benefit from a CP intervention is unknown.

Impact of clinical pharmacist intervention on length of stay in an acute admission unit: a cluster randomised study.

OBJECTIVES: Physicians in acute admission units (AAUs) are obliged to obtain medication history and perform medication reconciliation, which is time consuming and often incomplete. Studies show that clinical pharmacists (CPs) can obtain accurate medication histories, but so far no studies have investigated the effect of this on time measures. Therefore, the objective of the present study was to investigate the effect of a CP intervention on length of stay (LOS) in an AAU. METHODS: The study was designed as a prospective, cluster randomised study. Weekdays were randomised to control or intervention. CP intervention consisted of obtaining medication history and performing medication reconciliation and review. The primary outcome was LOS in the AAU. Secondary outcomes were other time-related measures-for example, physicians' self-reported time spent on medication topics. Finally, the number of documented medications per patient was established. RESULTS: 232 and 216 patients, respectively, were included on control (n=63) and intervention (n=63) days. The mean LOS was 342 (95% CI 323 to 362) min in the intervention group and 339 (95% CI 322 to 357) min in the control group, which was not statistically significantly different. Physicians spent on average 4.3 (95% CI 3.7 to 5.0) min in the intervention group and 7.5 (95% CI 6.6 to 8.5) min in the control group, corresponding to an overall reduction of 43.0% (95% CI 30.9% to 53.0%, p<0.001). The number of documented medications per patient was 10.0 (intervention group) and 8.8 (control group). CONCLUSIONS: This study indicates that LOS in the AAU was not affected by CP intervention; however, physicians reported a significant reduction in time spent on medication topics. TRIAL REGISTRATION NUMBER: Clinical Trial Gov: 1-16-02-379-13.

The unfolded protein response to endoplasmic reticulum stress in cultured astrocytes and rat brain during experimental diabetes.

Oxidative-nitrosative stress and inflammatory responses are associated with endoplasmic reticulum (ER) stress in diabetic retinopathy, raising the possibility that disturbances in ER protein processing may contribute to CNS dysfunction in diabetics. Upregulation of the unfolded protein response (UPR) is a homeostatic response to accumulation of abnormal proteins in the ER, and the present study tested the hypothesis that the UPR is upregulated in two models for diabetes, cultured astrocytes grown in 25mmol/L glucose for up to 4weeks and brain of streptozotocin (STZ)-treated rats with diabetes for 1-7months. Markers associated with translational blockade (phospho-eIF2α and apoptosis (CHOP), inflammatory response (inducible nitric oxide synthase, iNOS), and nitrosative stress (nuclear translocation of glyceraldehyde-3-phosphate dehydrogenase, GAPDH) were not detected in either model. Nrf2 was present in nuclei of low- and high-glucose cultures, consistent with oxidative stress. Astrocytic ATF4 expression was not altered by culture glucose concentration, whereas phospho-IRE and ATF6 levels were higher in low- compared with high-glucose cultures. The glucose-regulated chaperones, GRP78 and GRP94, were also expressed at higher levels in low- than high-glucose cultures, probably due to recurrent glucose depletion between feeding cycles. In STZ-rat cerebral cortex, ATF4 level was transiently reduced at 4months, and p-IRE levels were transiently elevated at 3months. However, GRP78 and GRP94 expression was not upregulated, and iNOS, amyloid-ß, and nuclear accumulation of GAPDH were not evident in STZ-diabetic brain. High-glucose cultured astrocytes and STZ-diabetic brain are relatively resistant to diabetes-induced ER stress, in sharp contrast with cultured retinal Müller cells and diabetic rodent retina.

[Gum chewing reduces duration of postoperative ileus]. / Brug af tyggegummi reducerer varigheden af postoperativ ileus.

Postoperative ileus (POI) after abdominal surgery is characterized by delayed passage of flatus and stool due to decreased bowel motility. Research has been performed in order to find new approaches such as fast track to reduce patient discomfort and durability of POI. One of the latest approaches attempting to reduce POI is gum chewing. Four controlled studies have been published on the subject and the results of two of these studies found a significant decrease in time until first passage of flatus and defaecation. The remaining two studies showed no significant difference, but a slight tendency towards a reduction of POI.