[Acute haemodyalysis-requiring kidney failure due to massive intake of rhubarb stew].

This is a case report of a 75-year-old man with acute kidney failure caused by secondary oxalate nephropathy due to massive intake of rhubarb stew. The patient was admitted to hospital with tiredness, loss of appetite, weight loss and an elevated P-creatinine level. A kidney biopsy revealed oxalate nephropathy. The cause for this was most likely the excessive rhubarb stew intake over a period of 14 days, since rhubarb contains high levels of oxalic acid. Acute haemodialysis was initiated, and after fem months of weekly dialysis the patient had regained enough kidney function to stop the haemodialysis therapy for a period.

Antibiotic treatment adequacy and death among patients with Pseudomonas aeruginosa airway infection.

OBJECTIVE: The effect of antibiotics on survival in patients with pulmonary Pseudomonas aeruginosa is controversial. The aim of this study is to i) determine the prevalence of adequate antibiotic treatment of P. aeruginosa in an unselected group of adult non-cystic fibrosis patients and ii) to assess the overall mortality in study patients treated with adequate vs. non-adequate antibiotics. METHODS: Prospective, observational study of all adult patients with culture verified P. aeruginosa from 1 January 2010-31 December 2012 in Region Zealand, Denmark. Patients with cystic fibrosis were excluded. Adequate therapy was defined as any antibiotic treatment including at least one antipseudomonal beta-lactam for a duration of at least 10 days. Furthermore, P. aeruginosa had to be tested susceptible to the given antipseudomonal drug and treatment had to be approved by senior clinician to fulfil the adequate-criteria. RESULTS: A total of 250 patients were identified with pulmonary P. aeruginosa. The vast majority (80%) were treated with non-adequate antibiotic therapy. All-cause mortality rate after 12 months was 49% in adequate treatment group vs. 52% in non-adequate treatment group. Cox regression analysis adjusted for age, gender, bacteraemia, comorbidities and bronchiectasis showed no significant difference in mortality between treatment groups (adequate vs. non-adequate: hazard ratio 0.95, 95% CI 0.59-1.52, P = 0.82). CONCLUSION: Adequate antipseudomonal therapy was only provided in a minority of patients with pulmonary P. aeruginosa. Adequate therapy did not independently predict a favourable outcome. New research initiatives are needed to improve the prognosis of this vulnerable group of patients.

[Metastasis from breast cancer to the pituitary gland causing hyponatriaemia].

Breast cancer is the most common cancer in Danish women. Pituitary metastases are rare events. We report a 75-year-old woman with metastatic breast cancer who presented with pituitary insufficiency nine years after her initial cancer diagnosis. MRI of the pituitary region showed a parasellar mass and thickening of the infundibulum. Her condition progressed within months and deterioration of visual field and acuity developed. A transsphenoidal resection was performed to rescue her vision and pathology confirmed metastasis from a breast invasive ductal adenocarcinoma.