Diagnostic property of direct referral from general practitioners to contrast-enhanced thoracoabdominal CT in patients with serious but non-specific symptoms or signs of cancer: a retrospective cohort study on cancer prevalence after 12 months.

OBJECTIVES: To describe the diagnostic properties of thoracoabdominal contrast-enhanced CT (ceCT), when general practitioners (GPs) managed referral to ceCT through the non-specific symptoms or signs of cancer-cancer patient pathway (NSSC-CPP). DESIGN: Retrospective cohort study including patients from a part of Denmark. SETTING: Department of Internal Medicine at a university hospital. PARTICIPANTS: In total, 529 patients underwent ceCT. PRIMARY AND SECONDARY OUTCOMES: Our primary objective was to estimate the negative and positive likelihood ratios for being diagnosed with cancer within 1 year after ceCT. Our secondary outcomes were prevalence and final diagnoses of malignancy (including temporal trends since implementation of NSSC-CPP in 2012), the prevalence of revision of CT scans and referral patterns based on ceCT results. RESULTS: In total, 529 subjects underwent ceCT and malignancy was identified in 104 (19.7%) patients; 101 (97.1%) during initial workup and 3 patients during the subsequent 12 months follow-up.Eleven patients had a false-negative ceCT, and revision classified the ceCT as 'probable/possible malignancy' in eight (73%) patients. The negative predictive value was 98% and positive predictive value 63%. Negative and positive likelihood ratios for malignancy was 0.1 and 7.9, respectively. CONCLUSION: Our study shows that ceCT as part of GP-coordinated workup has a low negative likelihood ratio for identifying malignancy; this is important since identifying patients for further workup is vital.

[Surgical treatment of diabetes mellitus type 2]. / Kirurgisk behandling af type 2-diabetes.

The resolution of diabetes after gastric bypass is already observed during the first days after the operation, while the control of diabetes after gastric banding occurs after weight loss. Other mechanisms than weight loss must therefore explain the improved glucose tolerance. Focus has been on appetite-regulating gut hormone, particularly peptide YY and glucagon-like peptide-1. Nevertheless, other unknown hormones or mechanisms may be involved in the dramatic changes in the glucose metabolism. Development of new drugs and treatments based on the endocrine changes observed after bariatric surgery with the aim of curing type 2-diabetes are warranted.

[The treatment of post stroke-depression and emotionalism in clinical practice]. / Antidepressionsbehandling i klinisk praksis på apopleksiafsnit.

INTRODUCTION: Depression and emotionalism are major consequences of stroke. The aim of this study was to assess the treatment of post stroke depression and emotionalism in clinical practice. MATERIALS AND METHODS: Retrospective cohort study based on consecutive series of patients with acute stroke admitted to a specialized stroke unit. RESULTS: 180 patients were identified (f/m: 92/88; age: 73 +/- 20 years, median length of stay; 18 days). At admission 29 patients (16%) were already receiving medical treatment for depression. During hospitalization a further 24 (16%; CI 10-22%) initially untreated patients started treatment. The indication to treat was referred to in 19 cases (13: depression, 6: emotionalism). Formal psychiatric examination or rating was not applied. In one case the treatment was stopped because of side effects. The dose of medicine was adjusted in one case due to insufficient effect of treatment. None of the discharge summaries indicated the expected duration of treatment. CONCLUSIONS: The number of patients being treated during hospitalization was less than expected compared to the expected incidence of post stroke depression and emotionalism. The indication to treat, the duration of treatment and the incidence of side effects was not sufficiently documented. Prescription practice and evaluation of treatment effect may therefore be far from optimal.