Colourectal cancer (CRC) is the fourth most common cause of death from cancer worldwide. While rates for CRC in adults age 50 and older have been declining, incidence rates in young adults, a population routinely not screened, has been increasing. We report a rare case of high-grade CRC in a previously healthy 27-year-old man, presented to us with symptoms of increasing abdominal pain and distension. Extensive diagnostic investigation revealed hepatomegaly with multiple processes, signs of vasculitis, extensive liver necrosis, enlarged retroperitoneal and mesenteric lymph nodes, splenomegaly, ascites and multiple vein thrombosis. The patient passed away shortly after admission due to treatment-resistant tumour lysis syndrome and multiple organ failure. Biopsy results revealed disseminated adenocarcinoma of the colon, with metastases to lymph nodes, liver, lungs and pleura. CRC in younger patients tend to present at a later stage and appears to be more aggressive, with a poorer pathological differentiation.
INTRODUCTION Patients' satisfaction with physician-staffed ambulances in Copenhagen had not previously been investigated. We therefore conducted a survey of patients' satisfaction with the Mobile Emergency Care Unit (MECU) in Copenhagen. MATERIALS AND METHODS The period of investigation was from 1 September 2003 to 31 December 2003. Patients with a diagnosis of COPD, asthma or a cardiac disease were eligible for inclusion. Patients were excluded if they had not yet been discharged from hospital, were registered as deceased, were under the age of 18, were without a known address or had previously been included. RESULTS During the period of investigation, 282 questionnaires were sent out; 225 were returned, for a response rate of 80%. The patients' mean age was 71 (18-99 years). On the part of 96% of the patients, the general impression of the MECU was very good or good, and 85% felt more confident when being treated by a physician in addition to the regular ambulance crew. The majority (80%) felt that the information given by the physician had been good, and 90% that the conduct of the physician had been satisfactory or better. In 11 questionnaires the patients, in their own words, described dissatisfaction with part of the MECU. In seven cases this concerned the conduct of or the information given by the ambulance crew. Most of the patients and physicians felt that the efforts of the MECU had improved the patient's condition. CONCLUSION We conclude that in general patients are satisfied with the service provided by the MECU. They are aware of, and feel more confident when being treated by, a physician in addition to the regular ambulance crew. Reasons for dissatisfaction were the conduct of and the information given by the physician.
Extensive weight loss has been docu-mented in intensive care unit (ICU) survivors, primarily as the result of muscle loss, leading to impaired physical function and reduced quality of life. The aim of the EAT-ICU trial is to test the effect of early goal-directed protein-energy nutrition based on measured requirements on short-term clinical outcomes and long-term physical quality of life in ICU patients.The EAT-ICU trial is a single-centre, randomised, parallel-group trial with concealed allocation and blinded outcome assessment. A total of 200 consecutive, acutely admitted, mechanically ventilated intensive care patients will be randomised 1:1 to early goal-directed nutrition versus standard of care to show a potential 15% relative risk reduction in the primary outcome measure (physical function) at six months (two-sided significance level α = 0.05; power β = 80%). Secondary outcomes include energy- and protein balances, metabolic control, new organ failure, use of life support, nosocomial infections, ICU- and hospital length of stay, mortality and cost analyses.The optimal nutrition strategy for ICU patients remains unsettled. The EAT-ICU trial will provide important data on the effects of early goal-directed protein-energy nutrition based on measured requirements in these patients.The EAT-ICU trial is funded by Copenhagen University Hospital, Rigshospitalet and Fresenius Kabi A/S and supported by The European Society for Clinical Nutrition and Metabolism (ESPEN).Clinicaltrials.gov identifier no. NCT01372176.
Ilofotase alfa is a human recombinant alkaline phosphatase with reno-protective effects that showed improved survival and reduced Major Adverse Kidney Events by 90 days (MAKE90) in sepsis-associated acute kidney injury (SA-AKI) patients. REVIVAL, was a phase-3 trial conducted to confirm its efficacy and safety. In this international double-blinded randomized-controlled trial, SA-AKI patients were enrolled < 72 h on vasopressor and < 24 h of AKI. The primary endpoint was 28-day all-cause mortality. The main secondary endpoint was MAKE90, other secondary endpoints were (i) days alive and free of organ support through day 28, (ii) days alive and out of the intensive care unit (ICU) through day 28, and (iii) time to death through day 90. Prior to unblinding, the statistical analysis plan was amended, including an updated MAKE90 definition. Six hundred fifty patients were treated and analyzed for safety; and 649 for efficacy data (ilofotase alfa n = 330; placebo n = 319). The observed mortality rates in the ilofotase alfa and placebo groups were 27.9% and 27.9% at 28 days, and 33.9% and 34.8% at 90 days. The trial was stopped for futility on the primary endpoint. The observed proportion of patients with MAKE90A and MAKE90B were 56.7% and 37.4% in the ilofotase alfa group vs. 64.6% and 42.8% in the placebo group. Median [interquartile range (IQR)] days alive and free of organ support were 17 [0–24] and 14 [0–24], number of days alive and discharged from the ICU through day 28 were 15 [0–22] and 10 [0–22] in the ilofotase alfa and placebo groups, respectively. Adverse events were reported in 67.9% and 75% patients in the ilofotase and placebo group. Among critically ill patients with SA-AKI, ilofotase alfa did not improve day 28 survival. There may, however, be reduced MAKE90 events. No safety concerns were identified.
Introduction We conducted a quality assurance project of The Mobile Emergency Care Unit (MECU) in the Capital Region of Denmark when dispatched to febrile convulsions. The study focuses on prehospital treatment, comparison between prehospital and in-hospital diagnoses and parents' perceptions of their child's febrile convulsions and their satisfaction with the MECU. Material and methods The period of investigation was from March 1st 2004 to March 31st 2005. Children with a diagnosis of febrile convulsions or relevant differential diagnoses were eligible for inclusion. Children were excluded if they had already been included, if their parents had no Danish address or if the questionnaire was not returned after a reminder was sent. Results In the period of investigation, 333 children were eligible for inclusion, 290 questionnaires were sent, and 235 were returned, giving a response rate of 81%. The median age was 1 year (range: 0-7 years). In general, parents were satisfied with the MECU. Reasons of dissatisfaction are described. Most children (76%) were admitted without physician escort. A total of 37 children (16%) received diazepam therapy, of whom 15 (6%) were given intravenous diazepam. In 90% of cases, the prehospital and in-hospital diagnosis were identical. Conclusion In general, parents appreciate the service provided by the MECU. Reasons of dissatisfaction are described. On several occasions, the prehospital physician administered intravenous anticonvulsants, but we discuss if the MECU should still be dispatched primarily to febrile convulsions.
