Ugeskrift for laeger最新文献

Discontinuation of antidepressants can be a complex process which requires an understanding of underlying neurobiological mechanisms, withdrawal symptoms, and individual risk profiles. Current clinical guidelines provide limited details on tapering strategies. The new Maudsley Deprescribing Guidelines highlight two key aspects: withdrawal symptoms occur more frequently, are more severe, and persist longer than previously recognized; and these risks can be reduced through a slow, hyperbolic tapering process. The aim of this review is to present these principles for antidepressant tapering.

In this case report, we present an instance of an atypical femur fracture in a patient receiving denosumab treatment. Due to MRI-verified severe lateral recess stenosis, her symptoms are misinterpreted because of nerve root affection and treated as such with surgical decompression. Not until postoperatively was the atypical femur fracture of the left leg diagnosed and finally treated. With this case report, we aim to raise awareness of atypical femur fracture as a differential diagnosis for nerve root affection and explore the possible connection between denosumab and atypical femur fracture.

Small doses of NSAIDs can cause acute renal failure in healthy children. We present the case of a 15-year-old girl who developed acute tubulointerstitial nephritis after three days of treatment with NSAID. The patient presented with lower back pain, sore renal beds, vomiting and loss of appetite. Tests revealed affected kidney function with elevated creatinine levels and proteinuria. Final diagnosis happened through a kidney biopsy, which revealed acute tubulointerstitial nephritis. The patient was treated with prednisolone, and the paraclinical parameters were normalized.

Stress fractures (SF) are overuse injuries in athletes, often presenting with insidious, activity-related pain. Early diagnosis is essential to avoid complications. Initial X-rays are often normal, potentially delaying treatment. Point-of-care US is increasingly used to diagnose SF but the method is operator-dependent. MRI is the diagnostic gold standard. Clinical suspicion should be high in at-risk individuals, including those with low energy availability. Timely imaging and individual management improve outcomes, as argued in this review.

Catheter-based therapies such as catheter-direceted thrombolysis, ultrasound-assisted thrombolysis, and mechanical embolectomy are emerging as alternatives for intermediate-high risk pulmonary embolism, offering targeted treatment with reduced bleeding risk. Early studies show promising outcomes but evidence remains limited. Ongoing randomized trials, including HI-PEITHO and PEERLESS II, aim to clarify efficacy and safety. Until results are available, treatment should be guided by individual risk assessment, local expertise, and centre capabilities, as argued in this review.

A 70-year-old woman presented with morning stiffness, groin and knee pain, weight loss, and night sweats-initially suggestive of polymyalgia rheumatica (PMR). Laboratory tests showed elevated inflammatory markers, but imaging revealed a renal tumour. Following nephrectomy, symptoms resolved without sustained corticosteroid treatment. This case underscores the need to consider malignancy in patients with atypical or treatment-resistant PMR-like symptoms.

Stridor in young children is a clinical sign with many differential diagnoses, ranging from benign, self-limiting conditions to life-threatening airway obstruction. Thorough history-taking and clinical assessment are crucial for identifying children who require urgent evaluation. Key symptoms such as persistent stridor, respiratory distress, altered consciousness, or failure to thrive should always lead to further investigation. This review summarises the main causes of pediatric stridor and provides practical guidance on diagnostic approaches and indications for referral and treatment.

Subacute sclerosing panencephalitis (SSPE) is a rare, fatal complication of measles, manifesting years after infection due to persistent measles virus in the central nervous system. An 11-year-old Syrian boy with prior measles and measles - mumps - rubella (MMR) vaccination developed progressive encephalopathy and a vegetative state. MRI showed diffuse white matter, thalamic, and pontine changes; SSPE was confirmed post-mortem. This case emphasises the need for high MMR vaccine coverage and the importance of clinical awareness of rare infectious diseases in patients from crisis-affected countries.