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The melanoma incidence is rising. Among pregnant women, melanoma is one of the most common cancers accounting for approximately 30% of all cancers. Timely diagnosis is critical, but management of pregnant women with melanoma lacks international consensus, and uncertainties may arise. Changes in an existing mole or the appearance of new suspicious moles during pregnancy warrant prompt evaluation, similar to moles in non-pregnant women. Our review summarises current knowledge and proposes a strategy for management., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Intramuscular injection of site enhancement oil is a cosmetic procedure used primarily in the bodybuilder environment to enlarge and reshape muscles. It comes with potential lifelong complications in the musculoskeletal system with scars, chronic wounds, pain, deformities of muscles and loss of muscle function. Magnetic resonance imaging is the best tool to diagnose and determine the propagation of the condition in the tissues. Treatment is complex and may consist of antibiotics, anti-inflammatories, compression therapy and surgical revision when possible. However, as stated in this review, prevention is crucial., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

We present a case report detailing therapeutic application of two lytic antipseudomonal bacteriophages to treat a chronic relapsing Pseudomonas aeruginosa infection of a prosthetic aortic graft. As there are currently no Danish laboratories offering phages for clinical therapy, and this case, to our knowledge represents the first applied phage therapy in Denmark, the practical and regulatory aspects of offering this treatment option in Denmark is briefly reviewed along with the clinical case., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Kidney stone disease is rapidly increasing with a strong relationship to metabolic syndrome. This review gives a brief overview of the current state and current treatment modalities. Increasing use of CT and ultrasound scans leads to increased diagnosis of asymptomatic kidney stones, which rarely require treatment. The trend in stone treatment goes towards endoscopic lithotripsy which together with ESWL enables a personalised approach. Obstructive stones with infection require urgent intervention to reduce mortality. Increased fluid intake, dietary changes as well as potassium citrate supplements are the most important elements in stone prevention in the common idiopathic stone disease.

Stem cells are multipotent cells exerting anti-inflammatory and immunomodulatory effects. Mesenchymal stem cells are the most well-known and used stem cells in orthopaedic surgery. In this review, we provide an overview of the current local use of stem cells in the treatment of osteoarthritis, bone defects, tendinopathy, and rotator cuff lesions. Conclusively, the future use of stem cells in orthopaedic treatments seems to have potential regarding not only pain relief, but also the possible curative effect of certain conditions.

An excessive consumption of licorice can cause pseudohyperaldosteronism, which can lead to severe hypokalaemia and hypertension. Glycyrrhizin in licorice root activates the renal mineralocorticoid receptor increasing sodium reabsorption and potassium excretion. In this case report, an otherwise healthy 43-year-old woman presented with severe hypokalaemia, rhabdomyolysis, electrocardiogram changes and focal paresis after having consumed 2-2,5 litres of licorice tea daily for approximately eight weeks.

Real-world evidence (RWE) is gaining traction in political and scientific debate. The RWE debate revitalises discussions about causal inference by challenging the randomised controlled trial as a gold standard for demonstrating drug efficacy and effectiveness. This article outlines methodological challenges and possibilities for using RWE in regulatory drug approval. We argue, that more precise terminology and methodological considerations about study designs and data quality is needed, if the RWE debate is to inform new standards for evidence-based decision-making.

Snakebite envenoming is a neglected tropical disease killing more than 100,000 people every year. Reducing the mortality and morbidity of snakebite envenoming depends on the accessibility of healthcare and antivenom, but also on sufficient knowledge on correct first aid treatment. In this review, we summarise the indications for antivenom treatment and which first-aid measures have proven effective, and which methods should be avoided, since many traditional methods of first-aid treatment of snakebites have been proven to be ineffective or even harmful.

Intra-operative hypotension is associated with increased risk of 30-day mortality and organ ischaemia. Thus, a reliable monitoring of blood pressure is desirable. New clinical studies indicate, that monitoring of middle arterial pressure with continuous non-invasive monitoring during stable haemodynamic conditioning provides accurate changes in blood pressure. The potential of continuous non-invasive monitoring is promising, but not fully developed.

The goal when treating ischaemic apoplexy is a rapid, safe and effective recanalization. For some years, the main treatment has been the administration of IV thrombolysis, but due to several restrictions, lack of efficacy and a limited window of opportunity for treatment, an alternative method was needed. This formed the foundation for the develop-ment of endovascular thrombectomy. This review describes the development and the mechanisms involved as well as the results and treatment gains.

Little is known about patient-reported outcomes after major emergency abdominal surgery. Studies on patients undergoing major elective abdominal surgery and patients in the intensive care unit report significant challenges with chronic pain, functional impairment, quality of life, depression and post-traumatic stress disorder (PTSD). Approximately one out of three patients experience chronic pain and functional impairment after major emergency abdominal surgery. The magnitude of depression and PTSD after major emergency abdominal surgery have not been studied before.

Hypotension is a common event during surgery and can cause serious post-operative complication, but vasoactive drugs can stabilize the cardiovascular system and reduce the risk of post-operative complications. Norepinephrine is an ideal vasopressor. Due to the risk of extravasation and ischaemic tissue damage norepinephrine is often administered via a central venous catheter. Administration of norepinephrine via a peripheral venous catheter may be a safe alternative during surgery, if the drug is administered correctly.

Informed consent has been a legal right for patients participating in clinical research and an obligation for health professionals for a long time. A growing body of literature suggests that a considerable share of research participants do not read or understand the information they are given, or do not base their decisions on trial participation on the information. This article points out the challenges for health professionals arising from this situation and offers suggestions for how professionals can deal with the challenges.

Annually, several million patients undergoing non-cardiac surgery develop myocardial injury or a myocardial infarction in the perioperative period. This frequent complication is associated with a high mortality. Despite an increasing focus on the issue the pathophysiology and the treatment of perioperative myocardial injury and infarction still remains partly unclear. Recently a new risk stratification tool was developed, which allows physicians to identify patients at risk. This review offers insight into the prevalence, pathophysiology, diagnostics, risk stratification and treatment of perioperative myocardial injury and infarction.

Polycythaemia vera, essential thrombocytosis and primary myelofibrosis are closely related, clonal myeloproliferative neoplasms. Our knowledge of the underlying molecular mechanisms driving these diseases has increased dramatically during the latest ten years. Traditionally, treatment of these malignancies has focused on lowering their inherent thromboembolic risk but with the discovery of the JAK2-V617F mutation and most recently the calreticulin mutations new therapeutic options such as interferon-alpha, JAK2-inhibitors and statins are being contemplated. This article reviews these new treatment options.

Remote ischaemic preconditioning is a non-invasive intervention that is done by transient occlusion of the blood flow to a limb with a blood pressure cuff. The intervention initiates a systemic endogenous protective response, which may confer multi-organ protection against acute ischaemia reperfusion injury. Originally discovered as a therapeutic strategy in cardiac surgery for protecting the myocardium against ischaemia reperfusion injury, it has been discovered that remote ischaemic preconditioning may confer protection against surgical stress and reperfusion injury in non-cardiac surgery.

Cardiac arrest patients receive cardiopulmonary resuscitation. If resuscitated therapeutic hypothermia (TH) improves outcome. The following coagulopathy caused by TH, antithrombotic drugs and acidosis can induce severe haemorrhage from non-acknowledged organ lesions. This story illustrates a liver lesion caused by cardiac compressions. By coincidence the lesion was found on a computed tomography scan. The patient remained circulatory stabil during TH and was discharged in good cerebral state. However, should these patients rutinely be scanned?

This case report is about severe osteoporosis in a woman known with polycythaemia vera (PV). A 51-year-old woman with hereditary predisposition to osteoporosis had a dual X-ray absorptiometry scan without osteoporosis. Only one year later she was diagnosed with PV. Re-scan eight years later showed progression to severe osteoporosis. Whether this is secondary osteoporosis, initiated or accelerated by the presence of PV is not known. A recent Danish registry study has shown that PV patients have an increased incidence of fractures compared with the general population.

The proper timing of antiretroviral therapy (ART) to HIV-patients co-infected with tuberculosis has been debated. We review three studies on this matter. One study found a significant reduced mortality for patients with CD4+ T-cell counts (CD4+) ≤ 200 per mm3 who received ART early, whereas the other two studies found this difference for patients with CD4+ < 50 per mm3.The risk of immune reconstitution inflammatory syndrome was significantly increased for the patients receiving ART early, but this contributed only to a small fraction of deaths related to HIV after the initiation of ART.

A 12-year-old girl with an upper respiratory infection deteriorated suddenly with a severe headache and declining level of consciousness, and was brought to the ER on suspicion of meningitis. On arrival, the girl had a Glascow Coma Scale score of 6 and a dilated pupil that was not reactive to light. A computed tomography of the cerebrum showed a large intracerebral haematoma, which was surgically removed. The bleeding was due to an AV-malformation. The girl survived with a homonym hemianopsis as the only sequela. Stroke is one of the top ten causes of death in children. This case illustrates that adequate diagnosing and treatment can save lives and reduce disabilities.

We describe the risk factors and treatment recommendations of intracerebral haemorrhage, arterial ischaemic stroke, and cerebral sinovenous thrombosis in childhood. The aetiology in children differ a lot from the aetiology in adults, hence guidelines specifically for children have been written. These guidelines build mainly on expert opinions, since only few evidence-based studies exist. Paediatric stroke is one of the major causes of lifelong disability, and the high costs to the families and the society make further research very important.

This paper describes the hectic work as a doctor at the Trauma Unit of Charlotte Maxeke Johannesburg Academic Hospital, a highly regarded and well-visited trauma unit worldwide. A trauma junior doctor is followed on a 24-hour-call through a full casualty to urgent operations and complicated postoperative management of the trauma patient. In a diary fashion the paper describes the evidence-based guidelines of management of certain trauma cases brought into the trauma unit during the 24-hour-shift.

Introduction: Patients in septic shock have a 33-42% 30-day mortality, but characteristics and outcome have not been assessed in Danish intensive care units (ICUs)., Material and Methods: This is a cohort study with prospective registration over a 3-month period of all patients suffering from septic shock at six Danish ICUs. We registered admission-, disease- and treatment characteristics during the first day after the diagnosis and 30- and 90-day mortality., Results: A total of 132 patients with a median age of 64 years (range 15-92 years) were included. Patients were primarily admitted from general wards (n = 56), operation- (31) and emergency rooms (25) and other hospitals (19). Most were diagnosed at ICU admittance. Abdominal focus of infection was most frequent (n = 47) followed by pneumonia (45), soft tissue (14), urinary tract (8), other (6) and unknown (11). Most patients were resuscitated with a combination of crystalloids and colloids (98) and noradrenalin (119), and 100 had broad-spectrum antibiotics prior to the diagnosis, while 27 received such medication 120 (2-450) mins. after diagnosis. Mortality at 30 and 90 days was 33 and 41%, respectively - and highest for patients with abdominal infection 42 and 55%, respectively., Conclusion: Patients in septic shock in Danish ICUs are admitted from different hospital locations, have abdominal or pulmonary foci, but the treatment is relatively uniform. The mortality is high, but at par with the best results from other countries.

Addison's disease, or primary adrenocortical insufficiency, is a diagnosis that may often be overlooked. A case is presented of a 28-year-old male who, within a six-month period, was admitted on three occasions with symptoms mimicking sepsis, for which no microbiological etiology could be established. Each time he recovered, however, on antibiotic treatment. Not until the third admission was Addison's disease suspected.

Introduction: The aim of this study was to determine the prevalence of delirium based on the CAM scale in a geriatric ward in a university hospital. This paper describes the numbers of predisposing and precipitating factors are compared with the development of delirium. Finally, we present a discussion about treatment and prophylaxis., Materials and Methods: Over a period of eight weeks, all newly admitted patients were interviewed and scored with CAM. The numbers of predisposing and precipitating factors were registered. Finally, the treatment was focused upon., Results: 270 patients were admitted, 222 patients were interviewed and 48 patients were excluded. The prevalence of delirium was 7%. We were unable to find a correlation between risk factors or precipitating factors and delirium for this population., Conclusion: The prevalence of 7% is a satisfying result. There is a discrepancy between diagnosing delirium with CAM and the doctors' routine. All patients must be considered as high-risk patients. Treatment has not been completely standardised.