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Migraine is the most prevalent disabling neurological disorder. The management of patients with migraine has been hampered by lack of effective and well-tolerated acute and preventive therapies. Based on improved insights into the basic mechanisms of migraine, new and targeted treatments are currently undergoing large-scale testing. Among the most promising agents for migraine prevention are humanized antibodies against calcitonin gene-related peptide (CGRP) or the CGRP receptor. If proven effective, these new treatments may emerge to improve the lives of millions of individuals worldwide disabled by migraine.

Hepatic metastases (HM) are amongst the most important prognostic factors in patient survival from colorectal cancer. The diagnostic imaging techniques for accurate detection and characterization of colorectal metastases are therefore vital. In a review of the literature, MRI showed the highest sensitivity for detection of HM lesions < 1 cm, but the amount of MR scanners is insufficient. Contrast-enhanced ultrasound and computed tomography have similar sensitivity for detection of HM, but each method also have limitation such as operator dependency or enhanced risk of cancer due to ionizing radiation.

Central venous catheters (CVC) are most commonly used in patients undergoing major surgery, patients admitted to the intensive care unit and in haematological and oncological departments. The placement of a CVC allows life saving and life prolonging treatment. The choice of catheter depends on the disease of the patient, catheter requirement, intended treatment, local preferences and expected period of use. Complications associated with CVC can be severe and potentially life threatening. The incidence of infectious/thrombotic complications and catheter dysfunction increases with the number of indwelling days.

Magnetic resonance imaging (MRI) is one of the four imaging modalities used in radiology. In contrast to computed tomography (CT), it does not use radiation. MRI is still developing and the diagnostic capabilities are growing. There are many indications for MRI and in some fields it has replaced CT. With few exceptions MRI is used mainly for elective examinations, and because of the new techniques like diffusion and perfusion MRI in cancer imaging the use is increasing both with regard to work-up and follow-up. For non-malignant lesions MRI is increasingly used thanks to its great soft-tissue contrast capabilities.

Accelerated diagnostic evaluation of patients referred on suspicion of ischaemic heart disease was introduced at Vejle Hospital in 2007. This article describes the diagnostic algorithm used and the course of the 270 patients who were referred to the clinic. A total of 20% of the patients were found to have no need for further testing at the first examination, 32% were referred to coronary angiography, 33% to coronary CT angiography, 7% to myocardial perfusion imaging and 8% to exercise testing. 88% of patients achieved a diagnosis within 21 days from the first clinical examination.

Introduction: Coronary CT angiography (CTA) is a promising method used for diagnostic evaluation of patients suspected of coronary artery disease (CAD). CTA is increasingly used as an alternative to conventional coronary angiography. Information on the diagnostic and therapeutic consequences of using CTA in the diagnostic work-up of patients suspected of CAD is sparse., Material and Methods: Out-clinic patients (n = 215) with chest pain and an intermediate pre-test probability of CAD were referred to diagnostic evaluation by CTA., Results: CTA was not performed in 5% (11/215) due to extensive coronary calcification or arrhythmia, was non-conclusive in 7% (15/215) and was diagnostic in 88% (189/215) of the patients. CTA excluded CAD in 46% (99/215) of the patients. No further diagnostic or hospital follow-up after CTA was necessary in 73% (156/215) of the patients. CTA identified non-significant CAD in 27% (57/215) and significant CAD (>or= 50% stenosis) in 15% (33/215) of the patients. The proportion of patients with CAD in relevant antithrombotic and lipid-lowering medication increased following CTA. Further diagnostic evaluation with coronary angiography following CTA was indicated in 18% (39/215) of the patients due to obstructive CAD (n = 21), non-diagnostic examination (n = 7), or the presence of extensive coronary calcification or arrhythmia (n = 11)., Conclusion: CTA ruled-out CAD in 46% of the patients. No further diagnostic testing or hospital follow-up after CTA was necessary in 73% of the patients. CTA seems valuable in excluding CAD, and may prevent unnecessary invasive angiography in patients without CAD.

Introduction: Helicobacter pylori (HP) infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs)/acetyl salicylic acid (ASA) are risk factors for bleeding peptic ulcer. HP eradication reduces the risk of rebleeding. Antibiotics, proton pump inhibitors (PPI) and presence of blood in the stomach can affect the HP test. The objectives of this study were to determine the HP prevalence and NSAID/ASA use in patients with bleeding ulcer in a low-prevalence HP area, to determine the proportion of idiopathic ulcers and to estimate the proportion of initially false negative HP tests. In addition, the objective was to describe changes in the characteristics of the patients who were admitted with ulcer bleeding during the last two decades., Material and Methods: Retrospective review of the records of patients who were admitted with a bleeding ulcer in 2003 to 2006 at The Department of Medical Gastroenterology S, Odense University Hospital. Patients with initially negative or missing HP tests were offered a urea breath test. This population was compared with prospective registrations for the periods 1990-1992 and 2000., Results: A total of 264 patients were admitted in 2003-2006. The mean age was 72 years. The HP-prevalence was 34%, and 81% had used NSAID/ASA, as compared with 55% in 1990-1992. The proportion of idiopathic peptic ulcer disease was 6.6%. At admission, 19% and 17% of the patients were in treatment with PPI and antibiotics, respectively. Thirteen percent of the initially HP-negative patients were later found to be HP-positive., Conclusion: Compared to previous studies, we found a lower HP prevalence (34%) and a higher proportion of NSAID/ASA usage (81%) in 2003-2006. As we found 13% false negative HP-tests when factors that may affect the HP test were present, we advise that a retest be made where these factors are present and the initial HP test is negative.

Whole-body magnetic resonance angiography (WB-MRA) is a new approach for diagnosing atherosclerosis. Through utilisation of fast whole-body MRI systems, the arterial system, excluding the intracranial and coronary arteries, can be investigated in one examination. WB-MRA has the potential of replacing conventional catheter-based angiography in the diagnostic workup of patients with atherosclerotic disease. Developments in MRI contrast agents and MRI systems may further improve WB-MRA.

The clinical use of anti-thrombotic agents has shifted towards more aggressive therapy and towards regimes with more than one drug. Data on the risk of upper gastrointestinal bleedings (UGB) with combined anti-thrombotic therapy are scarce. In the period 2000 through 2004, 1,443 cases of serious UGB and 57,720 control subjects were identified in Funen County. Anti-thrombotic therapy is becoming increasingly aggressive. Combined anti-thrombotic therapy confers particular risk and is associated with high incidence rates of GI bleeding.

A 69-year-old man presented with anaemia, swelling of the legs and scrotum, weight gain and fatigue. MR scan and laboratory findings initiated a search for cancer, but eventually retroperitoneal fibrosis (RF) was suspected. A medical review revealed that an ergoline-based drug known to be associated with RF had been used for eight years. The drug was withdrawn, and in short time the patient substantially recovered, with the disappearance of almost all abnormal findings. This case emphasises the importance of awareness of side effects of drug therapy.

Introduction: The clinical behaviour of General Practitioners (GPs) can best be influenced by identifying their incitements and barriers in the first place. The purpose of this paper was to describe a model for the outreach visits, in which the purpose was to facilitate and evaluate the desired changes in the clinical behaviour of the GPs. We demonstrate the usefulness and workability of the model as a tool to be used in future implementations., Materials and Methods: A total of 41 GPs in the Counties of Aarhus and Vejle participated in the spring of 2000 in an advanced educational programme about how to diagnose and treat patients with functional disorders. All participating GPs received an invitation for a six-month follow-up visit. The purpose of the follow-up visit was to facilitate and evaluate their educational benefits and experience in using psychiatric rating scales. The strategy of the visit was to structure the dialogue with reference to identifying incitements and barriers and to emphasize their strengths, weaknesses, opportunities and threats in connection with the change of their clinical behaviour., Results: Thirty-eight (93%) of the GPs participated in the follow-up outreach visits. The chosen strategy proved to be useful in primary care settings. We identified several areas in which the motivation of the GPs and their possibilities to implement the desired behavioural changes could be strengthened., Conclusion: The results suggest that the incitements and barriers of the GPs to change their clinical behaviour can be identified using the strategy described. We suggest that the strategy should form part of the development and evaluation of outreach visits in Denmark.

In this paper different perceptions of disease and illness in general practice and possible implications of these perceptions for the GP's clinical work are described and discussed. The focus is on patients with medically unexplained symptoms and on the question whether the illness perception of the GP to some extent can explain the often inappropriate treatment of these patients.

We report here a 72-year-old man with severe, persistent, iron deficiency anaemia. Upper gastrointestinal endoscopy revealed red stripes radiating to the pylorus, characteristic of watermelon stomach (gastric antral vascular ectasia). The patient was found to have scleroderma with calcinosis, sclerodactyly, and telangiectasias, but neither Raynaud's phenomenon nor oesophageal dysmotility. The patient was treated with endoscopic Argon laser therapy, repeated six times, but this did not control the bleeding. Altogether the patient received 62 units of blood transfusions. The patient died after 9 months.

Introduction: The study aimed to describe the postgraduate training of the general practitioners (GPs) in communication and psychiatric counselling., Material and Methods: GPs in Aarhus County, Denmark, received a mailed questionnaire about psychiatric hospital training, participation in courses and Balint groups (psychiatric supervision), and their need for further training., Results and Discussion: The questionnaire was returned by 320 (74.4%) GPs. Almost all GPs had received some kind of postgraduate training although to a very varying extent. Almost half had taken courses of more than three days' duration, and half were members of a psychiatric supervision group. Two-thirds of the GPs thought they needed further training. The need was independent of the GP's evaluation of his/her own psychiatric education.

There is evidence for an antiarrhythmic effect of n-3 polyunsaturated fatty acids (n-3 PUFA) in animals. The aim of the present study was to investigate the effect of dietary n-3 PUFA on ventricular arrhythmias and heart rate variability (HRV) in patients with a previous myocardial infarction. Fifty-five patients were randomized to receive either 5.2 g of n-3 PUFA daily for 12 weeks or placebo in a double blind, placebo-controlled study. Prior to randomization a 24-hour Holter recording was obtained, and this was repeated at the end of the study. The major end-points were the number of ventricular extrasystoles (VE)/24 hours and the 24-hour HRV. A non-significant decrease in VE/24 hours was found in both the n-3 PUFA group and among controls after dietary supplementation, whereas HRV significantly increased after n-3 PUFA compared to both baseline values (p = 0.04) and to controls (p = 0.01). The present study therefore supports the hypothesis that n-3 PUFA may have an anti-arrhythmic effect in humans.

A case of systemic allergic reaction following barium enema is described. The reaction was most probably provoked by a latex balloon on the rectal catheter.