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This review highlights key aspects of treating chronic obstructive pulmonary disease (COPD) exacerbation, focusing on the optimisation of systemic corticosteroid and antibiotic use through personalised treatment using biomarkers. Eosinophil-guided therapy reduces corticosteroid usage which might reduce side effects, while procalcitonin-guided therapy contributes to reduced antibiotic consumption. These approaches, documented through well-conducted randomized controlled trials, suggest the possibility of enhancing COPD exacerbation management, reducing potential side effects, and addressing concerns related to antibiotic resistance., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

There are 320,000 diabetes patients in Denmark. Heart failure (HF) is a major cardiovascular complication to diabetes mellitus with increasing prevalence. HF occurs 2-4 times more frequently in diabetes patients, but patients may go undiagnosed for years. Diabetes patients typically suffer from diastolic dysfunction caused by myocardial hyper-trophy and "stiffness" of the left ventricle. This frequent finding has prompted the term "diabetic cardiomyopathy". Echocardiography is a key examination in diagnosing HF and may be warranted to a greater degree in diabetes patients at particular risk.

This is a case report of lymphogranuloma venereum (LGV) manifesting as haemorrhagic proctocolitis in a homosexual HIV-positive male. The primary symptom was a rectal abscess, which was initially surgically treated and subsequently insufficiently treated with single-dose tablet azithromycin. The patient's symptoms were successfully treated after a 21-day doxycycline regime. LGV is a se xually transmitted infection with a rising incidence among persons with risk behaviour. This case report underlines the importance, that all positive rectal screenings for Chlamydia trachomatis should be routinely serotyped.

Mycoplasma genitalium infection is sexually transmitted, and it is almost as common as chlamydia in most European settings. Symptoms are indistinguishable from those of chlamydia, and late sequelae are believed to be similar. Treatment of M. genitalium infection is complicated due to widespread antimicrobial resistance not only to first-line azithromycin but now also increasingly to second-line moxifloxacin, leaving no other antibiotics registered in Denmark available for effective treatment. In the absence of available antimicrobials, screening of asymptomatic individuals should be avoided.

This is a case report of lymphogranuloma venereum (LGV) manifesting as haemorrhagic proctocolitis in a homosexual HIV-positive male. The primary symptom was a rectal abscess, which was initially surgically treated and subsequently insufficiently treated with single-dose tablet azithromycin. The patient's symptoms were successfully treated after a 21-day doxycycline regime. LGV is a sexually transmitted infection with a rising incidence among persons with risk behaviour. This case report underlines the importance, that all positive rectal screenings for Chlamydia trachomatis should be routinely serotyped.

We present the rare case of a proximal oesophageal stricture caused by a combination of oesophageal lichen planus without any other manifestations and intramural pseudo-diverticulosis, resulting in significant dysphagia. The diagnosis was not reached until a second set of biopsies were performed after split-dose treatment with proton pump inhibitors. Although local corticosteroid treatment was unsuccessful and symptomatic relief was only achieved after endoscopic dilatation, this case emphasizes the importance of adequate biopsies in the diagnosis of oesophageal strictures.

A paranoid schizophrenic 34-year-old man presented with acute lower right abdominal pain. A periappendicular abscess was discovered and the septic patient was offered drainage - which he refused. He was found to be psychotic with auditory hallucinations and a lack of insight into the severity of his condition. In respect of the patient's wishes, conservative treatment was chosen. The patient's condition worsened and the abscess was then drained against his will in accordance with the Danish mental health law. After the drainage, he had a cardiac arrest, presumably from hypoxia following aspiration.

A 36 year-old female with a Mycoplasma pneumoniae (MP) infection was treated with azithromycin. She recovered transitory, but experienced a relapse a few days later. After ten days she visited her general practitioner again; she was tired and weakened, had a debilitating dry cough and a weight loss of 6 kg. A throat swab was positive for MP by a polymerase chain reaction (PCR). It was investigated by sequencing and a mutation corresponding to a A2063G transition in domain V of the 23S rRNA known to be associated with macrolide resistance was detected. Twenty-two days later, MP could still be detected by PCR on a nasopharyngeal secretion.

Seal finger is an unusual infection in Denmark but is seen quite often in Greenland. A 69 year-old Danish man developed severe infection after cutting his finger on a sea urchin while handling a fishing net. Treatment with beta-lactam antibiotics had no effect. Standard culture from the lesion was negative. A Mycoplasma species was detected by PCR and DNA sequencing and subsequently cultured on special media. Specifically asked about exposure to sea mammals the patient could inform that a dead seal had also been trapped in the fishing net.

Increasing experimental evidence points to direct effects of glucagon-like peptide-1 (GLP-1) and its analogs on the heart and circulatory system, in addition to the well-established, antidiabetic actions of these agents on glucose and on the energy metabolism. These effects are primarily vasodilation, diminished heart muscle loss after myocardial infarction and a contractility increase of a weak left ventricle. A few, small patient trials appear to support the latter effect. Experimental results suggest the myocardium-saving effect following coronary occlusion and reperfusion as particularly suitable for clinical testing.

Chancroid is a sexually transmitted disease characterized by painful ulcers with a soft margin, necrotic base and purulent exudate. Previously, only sporadic, imported cases have been reported in Denmark. The bacterium is difficult to culture and novel polymerase chain reaction (PCR)-based methods for direct demonstration of bacterial DNA have facilitated rapid verification of the clinical diagnosis. We report two cases which demonstrate import and subsequent local transmission in Denmark. In both cases, the clinical diagnosis was rapidly verified by a combined PCR testing for multiple causes of venereal ulcers.

The role of triglycerides in the risk of ischemic stroke remains controversial. We tested the hypothesis that increased levels of nonfasting triglycerides are associated with ischemic stroke in the general population. Men with a nonfasting triglyceride level 5 mmol/l had a multivariable, adjusted hazard ratio for ischemic stroke of 2.5 (95% confidence interval: 1.3-4.8) compared with men with a nonfasting triglyceride level < 1 mmol/l. The corresponding value in women was 3.8 (1.3-11). We conclude that the level of nonfasting triglycerides is associated with risk of ischemic stroke.

Elevated levels of C reactive protein (CRP) are associated with increased risk of ischaemic vascular disease. We tested whether this is a causal association. CRP > 3 vs < 1 mg/l were associated with an increased risk of ischaemic heart- and cerebrovascular disease of 1.6 and 1.3, respectively. Four CRP polymorphisms were associated with a 64% increase in CRP levels, resulting in a theoretically predicted increased risk of 32% and 25% for ischemic heart- and ischemic cerebrovascular disease, respectively. However, these genotype combinations were not associated with an increased risk of ischaemic vascular disease.

Approximately 100 cases of meningococcal disease are reported annually in Denmark; 90% of these cases are confirmed by culture and serological methods. Real-time PCR was introduced in Denmark in 2005 as a diagnostic tool for meningococcal disease. We hereby report the first notified case of meningococcal sepsis in Denmark where real-time PCR was the primary positive microbiological result.

Population studies have indicated that a urinary albumin excretion above 5 microg/min confers increased relative risk of coronary heart disease similar to the relative risk associated with the metabolic syndrome. This is perhaps because microalbuminuria reflects the presence of subclinical atherosclerosis. In a series of pathophysiological studies microalbuminuria was not associated with systemic transvascular sieving of lipoproteins. Measurement of urinary albumin excretion may be useful for risk stratification in primary health care for prevention of coronary heart disease. Intervention trials should be conducted.

Introduction: Vaginal application of prostaglandins is well known and accepted for induction of labor. In this study we compared 50 microg misoprostol to 25 microg misoprostol and 3 mg Minprostin, applied as a single dose every 24 hours., Materials and Methods: Three periods in which three different prostaglandin preparations were given to induce labor were retrospectively evaluated., Results: The median time from induction to delivery showed 50 microg misoprostol (25 hours) to be more potent than 25 microg (38 hours) and Minprostin (35 hours). As a consequence, hyperstimulation was more frequent (10% vs. 4% & 1%), as well as caesarean section on the indication of foetus mortuus imminens. The advantages were fewer caesarean sections on the indication of dystocia and therefore no difference in the overall section rate. The oxytocin augmentation rate was also less frequent, as were the instrumental delivery rate, anal sphincter disruptions and postpartum hemorrhage., Conclusion: This study indicates that one must choose between a potent treatment, which implies a 10% risk of uterine hyperstimulation, and a less potent treatment with an enhanced risk of instrumental delivery and disruption of the anal sphincter.

Introduction: The importance of coronary heart disease risk factors may differ between individuals and community and by sex and age., Method: The Copenhagen City Heart Study followed for 21 years a random sample of 5599 men and 6478 women aged 30 to 79 years at baseline. The importance of risk factors in individuals and the community were evaluated as relative and population attributable risks., Results: We traced 2180 coronary events. In Cox regression analysis with ten risk factors entered simultaneously, relative risks for coronary heart disease in men ranged from 1.69 to 1.20 with the highest risks for diabetes, hypertension, smoking, and physical inactivity. In women, relative risks ranged from 2.74 to 1.19 with the highest risks for diabetes, smoking, hypertension, and physical inactivity. Population attributable risks in men ranged from 22 to 3% with the highest risks for smoking, hypertension, and no daily alcohol intake. In women, attributable risks ranged from 37 to 3% with the highest risks for smoking, hypertension, and hypercholesterolemia. Several of these rankings differed by age., Discussion: The importance of coronary heart disease risk factors may differ for individuals, the community, and by sex and age. Consequently, prevention strategies should be tailored accordingly.

Introduction: The urinary excretion of albumin is positively correlated to the presence of ischaemic heart disease and atherosclerotic risk factors in subjects with arterial hypertension. The aim of this population-based, follow-up study of hypertensive patients was to assess the predictive impact of a slightly elevated urinary excretion of albumin, i.e. microalbuminuria, on ischaemic heart disease., Material and Methods: In 1983-1984, blood pressure, the albumin/creatinine concentration ratio in a morning urine sample, total and HDL cholesterol in plasma, body mass index, and smoking habits were measured in a population of 2085 men and women aged 30-60 years. Exclusion criteria were ischaemic heart disease, diabetes mellitus, and renal or urinary tract disease. Untreated hypertension or borderline hypertension (a systolic blood pressure above 140 mmHg and/or a diastolic blood pressure above 90 mmHg) were found in 204 of the participants, who were followed up until 1993 with respect to the development of ischaemic heart disease through the Danish Hospital Register and Death Certificate Register., Results: Over 1978 person-years, 18 participants (9%) developed ischaemic heart disease. Microalbuminuria, defined as a urinary albumin/creatinine ratio above the upper decile in the hypertensive population under study (1.07 mg/mmol), was the strongest predictor of ischaemic heart disease with a relative risk (95% confidence interval) of 4.2 (1.5-11.9) (p = 0.006). When adjusted for all other variables, including age and sex, the relative risk was 3.5 (1.0-12.1) (p = 0.05)., Discussion: Microalbuminuria is associated with a fourfold increased risk of ischaemic heart disease in subjects with untreated hypertension or borderline hypertension. Urinary excretion of albumin should perhaps be monitored regularly in the hypertension clinic, and rigorous control of blood pressure and other modifiable atherosclerotic risk factors is to be recommended in hypertensive patients with microalbuminuria.

Introduction: Chlamydia is the most common sexually transmitted bacterial infection in Denmark. Each year 13-14,000 cases are diagnosed; of these about 3000 occur in men. In order to describe the prevalence of chlamydia among young men, screening for chlamydia was conducted in those liable for military service and coming before the medical board., Materials and Methods: Of 2500 men coming before the medical boards in North Jutland State County, Arhus State County, and Copenhagen County during the winter of 1996-97, 1345 men aged 17-32 (median 18 years) were entered in the study. The participants sent a urine sample and a filled-in questionnaire to Statens Serum Institut. The urine samples were analysed by an in-house PCR and the test results were sent to the participant; if permission had been granted, the positive test results were further sent to the general practitioner, along with a second questionnaire., Results: Chlamydia was found in 4.8% (65/1345) of all participants and in 6.9% of those sexually active. In North Jutland State County 7.1 and 9.8%, respectively, had chlamydia, whereas the corresponding figures for Arhus State County and Copenhagen County were about 4% and 6%. Two-thirds of the patients had no symptoms of urethritis., Discussion: The results of this study indicate that a considerable reservoir of unrecognised chlamydia must exist in young men. The prevalence of chlamydia was higher in North Jutland State County than in the other two districts. One explanation could be that there is more focus on sexually transmitted infections and contact tracing in the largest cities than in the rest of the country.

We investigated an outbreak of fever most likely due to a contaminated whirlpool among nine adults and six children visiting a holiday home. The outbreak was characterized by a high attack rate, short incubation periods, influenza-like symptoms and rapid recoveries typical of Pontiac fever. The children, however, experienced less characteristic symptoms and no sequelae compared to the adults. Evidence and presumptive evidence of Legionella (L) infection was found in eleven cases; in one case by isolation of L. pneumophila serogroup 1, in two cases by positive test for Legionella by PCR and in eleven cases with seroconversion. In contrast, two adult non-users of the whirlpool had no symptoms and no serological evidence of infection. This investigation demonstrates differences between adults and children in the clinical picture of Pontiac fever, furthermore it shows that culture and PCR of tracheal aspirate for legionellae can be used in a hospital setting for rapid diagnosis although their sensitivities are low.

The aim of this follow-up study was to assess whether slightly elevated urinary albumin excretion, i.e., microalbuminuria, precedes development of atherosclerotic vascular disease in IDDM. Out of 259 IDDM-patients 30 developed vascular disease during 2,457 person-years. Microalbuminuria was significantly predictive of vascular disease (hazard ratio (95% confidence interval) 1.06 (1.02-1.18) per 5 mg/24 hours increase in urinary albumin excretion; p = 0.002). The predictive effect was independent of age, sex, blood pressure, tobacco smoking, serum concentrations of total-cholesterol, HDL-cholesterol, sialic acid, and von Willebrand factor, and of haemoglobin A1c, insulin dose, diabetes duration, and diabetic nephropathy (hazard ratio (95% confidence interval) 1.04 (1.01-1.08) per 5 mg/24 hours increase in urinary albumin excretion; p = 0.03). It is concluded that slightly elevated urinary albumin excretion is an independent predictor of atherosclerotic vascular disease in insulin-dependent diabetes mellitus.

The concept of microalbuminuria is reviewed. Measuring the urinary albumin excretion rate and testing for microalbuminuria is well established in the control and treatment of patients with insulin-dependent diabetes mellitus. Microalbuminuria predicts nephropathy and early cardiovascular death. In the presence of microalbuminuria, frequent examinations are warranted for early detection of retinopathy, hypertension and for optimizing the glycaemic control. In patients with non-insulin dependent diabetes, the independent value of microalbuminuria as a cardiovascular risk factor is not yet clarified. The urinary albumin excretion rate should be measured at diagnosis, because the indications are that presence of microalbuminuria reinforces the urge to intervene against other well-documented cardiovascular risk-factors (hypertension, dyslipidemia, tobacco and obesity). In the non-diabetic population there is accumulating evidence that an elevated urinary albumin excretion rate is associated with early cardiovascular morbidity and mortality. Large scale cross-sectional and prospective studies are needed in order to further clarify the role of microalbuminuria as an independent risk factor in the background population.

Microalbuminuria, defined as a urinary albumin excretion rate of 20-200 micrograms/min, predicts diabetic nephropathy and cardiovascular disease in diabetic patients. An increased urinary albumin excretion rate is probably also associated with cardiovascular disease in non-diabetic subjects. Thus, screening for microalbuminuria is of major importance. A semi-quantitative urinary dipstick method, Micral-Test, has been developed for this purpose. In a urine sample collected overnight from each of 1359 subjects the Micral-Test was evaluated with a quantitative ELISA-method as the standard. Sensitivity, specificity and diagnostic specificity in detecting microalbuminuria was 92, 58 and 12% respectively. The prevalence of microalbuminuria was 5.6%. In conclusion, the Micral-Test is highly sensitive in detecting microalbuminuria, but at the expense of a relatively high number of false positive tests.

Sixty one cemented second revision total hip arthroplasties and 18 cemented third revision total hip arthroplasties were studied with emphasis on cause of failure, complications, risk of further revision, and clinical and radiographic outcome of surviving, not further revised patients. Aseptic loosening was the major reason for both second and third revisions followed by recurrent dislocations. Twenty one second revisions failed again. Postoperative dislocation was the major complication, entered in 10/61 second revisions and in 4/18 third revisions. Ten second revisions were reoperated on without exchange of components, but for reasons related to the implant. Clinical and radiographic outcome was favorable, but must be seen in the light of the high rate of further revisions. In 33/53 second revisions and in 5/13 third revisions left for evaluation, the overall outcome was considered unsatisfactory. Reoperations for failed arthroplasties should be the prerogative of highly experienced centers.

A questionnaire investigation to evaluate the results of surgery for penile angulation by plicature of tunica albuginea by Ebbehøj's method is presented. In 31 patients with congenital penile angulation, 24 (77%) were satisfied with the functional result and 20 (65%) with the cosmetic result of the operation. In 14 patients with Peyronie's disease, eight (57%) were satisfied with the functional result and six (43%) with the cosmetic result of the operation. This is in accordance with previously published surveys of the results of surgery using this method. However, a high prevalence of late sequelae was observed, especially penile shortening and pain. In conclusion, the method yields acceptable functional and cosmetic results and is easy to perform. However, optimal surgical technique is imperative to reduce the prevalence of late sequelae which also necessitate detailed preoperative information and restrictive indications for surgery.

Thirty three patients with carcinoma in situ (CIS) or/and numerous recurrences of superficial bladder tumor were treated with intravesical BCG after transurethral resection. 63% of patients with CIS were free of recurrence after two years, two underwent cystectomy and one died because of progression. Patients with Ta and concomitant CIS responded well to BCG, while the patient with T1 tumor and CIS was free from recurrence for 15 months. Dysplasia of grade II disappeared after BCG. 62% of patients with Ta tumor were without recurrence after one year, but after two years 86% of the patients had recurrences. Patients with T1 tumor were free from recurrence for eight months, after which 25% had progression. The side effects of BCG were transient: urinary frequency in 48%, malaise in 39%, dysuria in 36%, haematuria, bladder pain and fever in 24%. 15% of the patients required isoniazid treatment. It is concluded that intravesical BCG is beneficial in CIS and superficial bladder tumors.

At all ages, Staphylococcus aureus is the most common microorganism responsible for septic arthritis, but in children below five years of age Haemophilus influenzae is frequently found. In about 1/3 of the cases cultures are negative, primarily because of initiation of antibiotic therapy prior to sampling. A distended joint should be treated as infection until otherwise proved. Today repeated aspirations of the infected joint are recommended as initial treatment, if possible with additional joint lavage, together with systemic antibiotic therapy. In case with no clinical response within 2-4 days, surgical debridement of the joint with synovectomy is of utmost importance. Exercises without weight-bearing are initiated at an early stage and weight-bearing avoided for six weeks.

A retrospective investigation was undertaken to assess the value of bone scintigraphy with 99mtechnetium methylene-diphosphonate in patients referred with hip pain after total hip replacement. The material comprized 68 patients with a total of 68 prostheses. This review revealed that 10/25 of the patients with pathological scintigrams and 6/28 of the patients with normal scintigrams were submitted to replacement of the prostheses. In the way in which it was carried out and interpreted in this department, scintigraphy was of limited value in selection of the patients who required replacement of the prostheses.