Showing papers in "Ugeskrift for Læger in 1992"

Surfactant treatment of newborn infants with respiratory distress syndrome primarily treated with nasal continuous positive air pressure. A pilot study

Abstract: In this pilot study, Curosurf (200 mg/kg) was administrated to 34 patients with the respiratory distress syndrome in nasal-CPAP therapy with FiO2 requirements greater than 0.60 and/or TcPCO2 greater than 8 kPa. The surfactant was instilled during a short period of intubation or in a few cases via an intratracheal catheter (Ch. 6). The age of the patients on surfactant treatment ranged from two to 72 hours. Eighteen patients could be maintained on nasal-CPAP after treatment with Curosurf and only a few complications were seen in these infants. The other 16 patients subsequently required artificial ventilation and had a higher incidence of pulmonary and extrapulmonary complications. On the basis of these observations, we plan a randomized trial to investigate whether, administration of surfactant reduces the need for ventilator treatment and improves the odds for uneventful recovery in this category of patients.

Aluminum allergy caused by DTP vaccine

Abstract: All children referred to two private dermatological practices from 1 Jan. 1985 to 31 Dec. 1990 who had pruritus and subcutaneous infiltrates in the areas of immunization with Di-Te-Pol vaccine were patch tested with a Finn Chamber or with 2% aqueous aluminium chloride. Di-Te-Pol vaccine contains aluminium hydroxide. Contact allergy to aluminium was demonstrated in 32 children (20 girls and 12 boys). Of the three patch test methods used, testing with 2% AlCl3 occluded with a Finn Chamber proved to be the most sensitive. Immunization of children who have been shown to be allergic to aluminium should be carried out with vaccines which do not contain aluminium.

[Patients' activity and length of stay after hip arthroplasty with balanced analgesia and early mobilization].

Abstract: Thirteen consecutive patients were submitted to hip-replacement by Muller's method under epidural analgesia and were treated for postoperative pain with balanced analgesia by means of continuous epidural infusion of a mixture of bupivaine (0.625 mg/ml) and morphine (0.05 mg/ml) 4 ml hourly for 96 hours and supplemented by 600 mg ibuprofen every eight hour orally. The analgesic treatment was combined with intensive mobilization regime and altered postoperative care as regards early normalization of daily activities and reduced duration of hospitalization. The patients were found to be effectively relieved of pain during rest and also during mobilization and, together with suitable care and rehabilitation, this had the result that more than half of the patients were mobilized from bed for more than eight hours from the second postoperative day and that all of the patients were able to carry out ordinary everyday functions after the fourth postoperative day, with the assistance of the aids which the hip regimen required. Eleven of the patients were ready for discharge on the sixth postoperative day while two patients were not discharged until the eighth and ninth postoperative days on account of slight surgical complications. All of the patients were discharged to their homes and to outpatient rehabilitation for three weeks. Compared with the usual duration of hospitalization of approximately 13 days in corresponding patients, this pilot investigation appears to show that the analgesic regime employed was extremely effective but that traditional attitudes and routines in the postoperative care and mobilization must be revised if this is to be utilized for more rapid restitution and reduced duration of hospitalization.

[Foot zone therapy and bronchial asthma--a controlled clinical trial].

Abstract: Thirty patients with proved bronchial asthma receiving treatment with inhaled steroid in dosages of less than 1,000 micrograms daily were subdivided at random into two groups of 15 patients. One group received foot zone therapy and the other merely uniform clinical care but without "placebo foot zone therapy". The "active" group received a total of ten foot zone therapy sessions of one hour at intervals of one week. The asthmatic symptoms, consumption of medicine and the objective pulmonary function parameters were followed-up during the subsequent six months. Decrease in consumption of beta-2-agonists and increase in peak-flow levels were observed in the group which had received foot zone therapy, but the same changes were observed in the control group. The authors do not find that this investigation demonstrates that foot zone therapy is of effect on the disease bronchial asthma. They conclude, however, that the favourable effect in both of the groups are due to increased care and control which occurred in both patient groups.

[Cost-benefit analysis of electric stimulation of the spinal cord in the treatment of angina pectoris].

Abstract: Since August 1988, in Odense Hospital, electric spinal cord stimulation (SCS) has been employed for the treatment of pain in patients with confirmed ischaemic heart disease who suffer from incapacitating angina pectoris despite maximal medical/surgical treatment. The object of the present investigation was to assess not only the social economic consequences of SCS treatment (cost-utility analysis) but also altered quality of life in SCS patients (perception of pain, mobility, function in daily life and physical activity). Sixteen consecutive SCS patients all of whom were resident in the County of Funen and who were submitted to implantation of an SCS system during the period August 1988 to December 1989, participated in this investigation. The results are based on data from the year prior to SCS implantation compared with the subsequent time with SCS treatment. Saving was found at hospital level (reduction in number of admissions) og 40,200 Danish crowns/annum/patient (approximately IJ 3,000) (1989 prices), and for non-hospital related expenses a corresponding saving of 16,289 Danish crowns/annum/patient (approximately IJ 1,600) was found mainly on account of reduction in the amount of home nursing required. The total saving was found to constitute 56,489 Danish crowns/annum/patient (approximately IJ 5,600). In addition, improvements were registered in all respects which constituted assessment of the quality of life of the patients.

Extraintestinal manifestations of Salmonella infections illustrated by 2 cases of mycotic aortic aneurysm

Abstract: Following an increased number of cases of Salmonella bacteraemia during recent years, an increased number of extra-intestinal manifestations were observed. Early diagnosis and rapid institution of treatment (both surgical and antibiotic) is decisive for the prognosis. Peroperative antibiotic treatment should cover possible Salmonella infection.

Bilateral epidural hematomas

Abstract: Bilateral epidural haematomata are rare and comprise only approximately 2% of all the intracranial haematomata. The symptomatology frequently differs from that of unilateral haematomata in that lateralisation is frequently absent. Most commonly, protracted or secondary development of clouding of consciousness is encountered. In cases of head injury, the above mentioned symptoms are indications for emergency computed tomographic (CT) scanning. When operation is performed early, the prognosis is good.

Pelvic insufficiency during pregnancy. Is pelvic girdle relaxation an unambiguous concept

Abstract: Pelvic insufficiency during pregnancy, pelvic girdle relaxation, is defined as a condition with pain at the pubic symphysis and/or the sacroiliac joint developing in connection with pregnancy or delivery No unambiguous criteria for the diagnosis of pelvic girdle relaxation exist but the following findings occur: Direct tenderness at the pubic symphysis and/or sacroiliac joint, waddling gait, pain on change of position, positive Trendelenburg's sign, iliac compression test, iliac gapping test and sacral pressure test The frequency is 76-185 per 1000 deliveries The incidence is increased in multiparae and women with occupations which strain the back Recurrence occurs in 41-77% The condition appears for the first time usually in the 5th-8th months of pregnancy The majority of patients recover shortly after delivery but in some a condition of prolonged pain persists The cause of pelvic girdle relaxation is unknown Hormonal and biomechanical factors are considered to be of significance No increased mobility in the pelvic joints nor general hypermobility have been demonstrated Treatment is symptomatic and consists of information, instruction in relief and psychosocial support Exercises and a trochanter belt may be useful No controlled investigations of the value of treatment are available

Treatment of central facial nerve paralysis with electromyography biofeedback and taping of cheek. A controlled clinical trial

Abstract: We studied 35 patients with facial palsy after stroke, admitted to a rehabilitation hospital. We examined the patients on admission and after one, two and six months with 1) clinical evaluation of the facial function using a modified House-Brackmann scale, 2) photographs of patients with six different facial expressions; these photos were evaluated by "blinded" observers using the modified House-Brackmann scale, 3) questionnaire about patients emotional reactions to the facial paralysis and 4) facial sensation. No differences were found between a control group of 12 and a group of patients (23) training facial function 2-3 times a week, each session of 15 minutes, with EMG-biofeedback and cheek taped between training sessions. A significant improvement in facial function occurred spontaneously after one month in rehabilitation unit in the total group. After six months 2/3 of the patients had normal facial function or mild dysfunction. Patients with right-sided facial palsy showed a significantly better improvement at six months as compared to patients with left-sided facial palsy. The questionnaire showed that only half of the patients were aware of the asymmetric face. We cannot recommend training with EMG-biofeedback to patients with facial paralysis after stroke. Spontaneous remission is to be expected.

Serum creatine kinase isoenzyme MB and myoglobin in patients with acute myocardial infarction and coronary reperfusion

Abstract: Thrombolytic therapy in patients with acute myocardial infarction (AMI) changes the time-concentration curve of serum creatine kinase isoenzyme MB (CK-MB) and serum myoglobin In this study, 60 AMI patients received thrombolytic therapy and acute coronary arteriography, or conservative treatment Group one (n = 32) demonstrated a patent infarct-related artery after intravenous thrombolytic therapy; group two (n = 17) had an initially occluded coronary artery which became patent during catheterisation; group three (n = 11) did not receive thrombolytic therapy Frequent serum CK-MB and myoglobin measurements showed that patients with acute coronary reperfusion had a rapid increase, an earlier peak value and less total release of both CK-MB and myoglobin to blood compared to AMI patients treated conservatively The changes in serum myoglobin compared to CK-MB demonstrated an even more rapid, more uniform, and relatively greater increase Measurements of serum myoglobin may be a useful non-invasive method for evaluation of thrombolytic therapy in AMI patients

[Consumption of psilocybin-containing hallucinogenic mushrooms by young people].

Abstract: The aim of this questionnaire survey was to investigate the extent of hallucinogenic mushroom consumption among students from a high school in the county of Aarhus, Denmark and among students at the University of Aarhus and students from the Danish school of journalism in Aarhus, Denmark. 3% of the high school students had used psilocybine-containing mushrooms as a hallucinogen. Only 1% had experience with LSD. Of the students at the University of Aarhus, and students from the Danish school of journalism in Aarhus, 333 persons (83%) returned the anonymous questionnaire. 9% had experience with hallucinogenic psilocybine containing mushrooms while only 2% had LSD experience. The use of hallucinogenic mushrooms was surprisingly high. This suggest that mushrooms are the most commonly used hallucinogenic substance in Denmark and that the use has exceeded that of LSD. Compared to non-users mushrooms users had significant more friends with mushroom experience. Furthermore, the study shows that the intention to use mushroom is commoner in persons who have friends with HPS experience. We find that the use of mushroom takes place in minor groups known to each other. Compared to non-users, mushroom-users are significant more experienced with marijuana and other substances. Unfortunately, our data do not permit us to show whether mushroom users are more inclined to try other drugs or whether persons with a high drug experience use mushrooms as well. Further investigation on the subject is recommended.

Angina pectoris efter sumatriptan (Imigran).

Abstract: Developed for the treatment of migraine, sumatriptan is an agonist of 5-hydroxytryptamine-1-receptors. Though a pressure sensation is a common complaint, significant ECG changes have not been reported after subcutaneous administration of sumatriptan. A case history is given where angina pectoris after sumatriptan self-administration was experienced on two occasions by a 61-year old man with a history of minor myocardial infarction--without post-infarction angina--two years previously. The angina after sumatriptan was accompanied on both occasions by significant ST-segment depression on ECG-monitoring. An extracranial vasoconstrictor action of sumatriptan in patients with ischaemic heart disease is suggested.

Unconsciousness after ingestion of nail varnish

Abstract: Two males in their twenties lost consciousness after ingestion of 50 ml gamma-butyrolactone. Bradycardia was observed and treated during the first hours and they recovered after a few hours.

Injuries due to fireworks

Abstract: This investigation is a review of the injuries due to fireworks seen in five casualty departments in Denmark over a period of four years. These casualty departments have a total catchment population of 675,000 (13% of the population of Denmark). The review is based on data from the Danish section of EHLASS-project. (Europea Home and Leisure Accident surveillance system). During the period of observation, 358 injuries due to fireworks were observed. 60% of the injuries occurred in persons under the age of 18 years. In 51%, the mechanism of the injury consisted of direct heat while 33% of the patients were hit by flying fireworks and 10% had small foreign bodies in the eye. The regions most frequently injured were the hands/fingers (40%) or the eyes (24%). 6% of the patients required admission to hospital. The estimated number of injuries due to fireworks in Denmark is 690 annually. The majority of injuries due to fireworks were due to incorrect use of fireworks of absence of protective measures.

[Transfusion-associated graft-vs-host disease].

Abstract: Transfusion-associated graft-versus-host disease (TA-GVHD) is a serious, often fatal complication to the transfusion of blood components. TA-GVHD is caused primarily by donor T lymphocytes reacting towards recipient MHC antigens. The diagnosis TA-GVHD should be considered when patients, within a month of receiving blood transfusion, develop sudden, unexpected high fever and erythematous rash, possibly accompanied by gastrointestinal symptoms and/or pancytopenia. Congenital (cellular) immune defect, intrauterine transfusion, bone marrow transplantation, Hodgkin's disease, and directed transfusions (especially from first degree relatives) all carry high risk of developing TA-GVHD. Since mortality exceeds 90% irrespective of any treatment, prevention is essential. Pretransfusion gamma-irradiation of blood components with a 25 Gy dose effectively prevents TA-GVHD, and it is therefore recommended that all blood components be irradiated prior to transfusion to patients belonging to defined groups-at-risk.

[Colchicine treatment of recurrent steroid-dependent pericarditis in a patient with post-myocardial-infarction syndrome (Dressler's syndrome)].

Abstract: The usual treatment of pericarditis consists of non-steroid anti-inflammatory agents. In cases where the symptoms and/or the pericardial effusion persist or progress, the disease can be arrested in the majority of cases by employing steroids. In some patients, it may prove difficult to conclude steroid treatment as gradual withdrawal results in recurrence and it may, therefore, be necessary to continue with large doses of steroid for prolonged periods. There is, however, a possibility for another form of treatment. The present authors present the case history of a patient with pericarditis on the basis of the post-myocardial-infarction syndrome and in whom the symptoms recurred several times during attempts at gradual withdrawal of prednisolone. Treatment with colchicine was commenced. The patient rapidly became symptom free and has now been symptom free for 45 weeks without prednisolone. Colchicine was withdrawn after 33 weeks without recurrence. It is considered that trial of colchicine treatment can be recommended in cases of recurring pericarditis particularly when there are problems (recurrence) on attempted withdrawal of steroid treatment. Naturally, it is important to exclude specific causes requiring other forms of treatment as the cause of the pericarditis (e.g. malignant disease, tuberculosis, systemic disease etc.).

[Use of thermotherapy, ultrasound and laser by practising physiotherapists. Physiotherapists' choice of treatment].

Abstract: The purpose of this examination was to examine the practising physiotherapist's way of treating patients with nine selected diagnoses (fibrosites, osteoarthritis, rheumatoid arthritis, cervical slipped disc, lumbar slipped disc, generalized lumbar/back pain, generalized bursitis, generalized tendinitis, and sprains). In addition, nine different forms of therapy were examined (hot packs, infra-red light, ice packs, short waves, microwaves, diadynamic current, ultrasound, transcutaneous electric nerve stimulation and laser). All in all, 41 clinics with 2,018 treatment confrontations in the examination period, the last week of March 1990, took part in the survey. The majority of therapists were in possession of short wave, hot packs, ultrasound and laser which are also the four forms of therapy most frequently used for treatment. Compared to a Swedish examination from 1979, there is a doubling in ultrasound treatments from 24% to 48%, while the amount of short wave and microwave treatment remained unchanged. There was a remarkable variation in the physiotherapist's choice of therapy in each different diagnosed case. This can be due to the lack of specification of the diagnosis, so that different symptoms, course and stage of illness changed the treatment pattern elected.

[Pattern of choice in preparation of attempted suicide by poisoning--with particular reference to changes in the pattern of prescriptions].

Abstract: This investigation was initiated in 1990 to investigate the choice of preparation in cases of attempted suicide treated in the Emergency Unit in Odense University Hospital during the past decade. The results show that 1) an increase has occurred particularly among young women in the use of analgesics obtainable without prescription (e.g. 13% of young women employed paracetamol as the toxic agent), 2) the number of persons employed dextropropoxyphene did not decrease and 3) a great increase was observed in the number of cases of poisoning with ketobemodoni chloridum. In 1985, several barbiturates were withdrawn from the Danish Medical Codex and this was followed by a decrease in the number of cases of poisoning among women but not among men. At present, approximately 10% of men who poison themselves still employ barbiturates. The number of cases of poisoning with barbiturates in men is thus not reduced but phenobarbital is the preparation of choice. The authors conclude that more attention and care should be paid when prescribing dextropropoxyphene, ketobemodoni chloridum and phenobarbital and the availability of paracetamol without prescription must be debated critically.

Benign pneumoperitoneum and scrotal emphysema after colonoscopy

Abstract: A case of benign pneumoperitoneum and subcutaneous emphysema of the scrotum after elective colonoscopy with polypectomy is reported. The development and treatment of benign pneumoperitoneum is discussed.

Quality assurance in psychiatry

Abstract: The need for ensuring quality in psychiatry and the elements in the structure, process and outcome are described together with the terminology employed in this field. The internal and external methods of ensuring quality in psychiatry are mentioned and an example of "time monitoring" of the physician's time devoted to patient-related work in a psychiatric department is presented. This example shows that each patient can obtain ten minutes of direct contact during each working day at the very most. It is concluded that it is possible to establish standards for structure and the processes employed in treatment of psychiatric patients but that it is much more difficult to establish standards for the outcome. Establishment of quality ensurance programmes at local level is recommended but The Public Health Board, Danish Psychiatric Association and possibly the consumers' association should develop and assess the necessary methods.

Ultrasonically guided pericardiocentesis

Abstract: Ultrasonically guided pericardiocentesis was performed on 25 occasions in 23 consecutive patients. Incipient cardiac tamponade was present in 22 patients and the procedure was performed for diagnostic purposes in one patient. In 21 cases, 5.7 French pig-tail catheters were employed and 1.2 mm lumbar puncture needles in four cases. In 19 out of 22 patients (86%) with incipient cardiac tamponade the ultrasonically guided pericardiocentesis was considered successful. In one patient, the catheter was misplaced in the right atrium, one patient developed pyopericardium and one patient developed transient tachycardia. In two cases, no material could be obtained. Ultrasonically guided pericardiocentesis is preferable to "blind" puncture and the procedure should be carried out by physicians with experience in interventional ultrasound.

[Prognosis and risk factors in acute dialysis-requiring renal failure after open-heart surgery].

Abstract: Of 1988 patients who underwent open-heart surgery from 1980 through 1988, 68 (3.4%) developed postoperative acute renal failure requiring dialysis (2.5% of adult and 8.3% of pediatric patients). Isolated aortocoronary bypass grafting was the operation with lowest incidence of this complication (0.6%). Acute renal failure usually appeared during the first 3 postoperative days. It carried a mortality rate of 63%, with half of the deaths occurring during the first few postoperative days, due to low cardiac output and progressive multiple organ failure. Logistic regression analysis in cases of aortic valve replacement demonstrated that significant independent preoperative risk factors for acute renal failure were renal insufficiency (serum creatinine greater than 110 mumol/l in greater than or equal to 2 samples) and increased cardiothoracic index/left ventricular end-diastolic dimension. Data from the literature indicated no time-related trend towards reduction of acute renal failure incidence or mortality. Prevention of low cardiac output is of major importance in these respects. Operative intervention before development of advanced disease with left ventricular dilatation and secondary kidney failure is advocated.

[Balint's syndrome--visual disorientation].

Abstract: The three major components of the Balint's syndrome are described: 1) visual disorientation or simultanagnosia, ie the inability to perceive the visual field as a whole, 2) ocular apraxia, a deficit of visual scanning and 3) optic ataxia, an impairment of pointing and reaching under visual guidance Our description of the syndrome is illustrated by three case histories The complete syndrome is rare, and partial syndromes have been reported more frequently Sudden and severe hypotension resulting in bilateral borderzone infarction in the occipito-parietal region is reported to be the most frequent cause of complete Balint's syndrome Lack of awareness of the syndrome may lead to misdiagnosis such as blindness, psychosis, or dementia

[Effect of 0-(beta-hydroxyethyl)-rutoside (Venoruton) on symptomatic venous insufficiency in the lower limbs].

Abstract: Forty-three patients recruited from general practice with symptom-producing chronic venous insufficiency in the lower limbs participated in a randomized double-blind clinical trial with Venoruton (300 mg x 3) or a placebo for 28 days. Twenty-eight patients were treated with Venoruton and 19 with a placebo. None of the patients received other forms of treatment for chronic venous insufficiency. No differences were observed between the two groups as regards changes in symptoms (swelling, pain, heaviness, restlessness, itching and cramps) the subjective assessment of the discomfort in the extremities or the circumference of the limbs. Venoruton does not appear to have any effect on chronic venous insufficiency in the lower limbs.

[Axillary dissection in primary surgical treatment of breast cancer: risk of false-negative axillary status].

Abstract: The present study evaluates the extent of axillary dissection as part of the primary surgical treatment of operable breast cancer. Data are from the period January 1979 to August 1990 and were collected prospectively as part of the Danish Breast Cancer Cooperative Group protocols for low-risk mammary carcinoma. The series consists of 6774 breast cancer patients aged 69 years or younger. The number of axillary lymph nodes removed was related to the frequency of ipsilateral axillary recurrence, recurrence-free survival, and overall survival after a median of five years follow-up, respectively. The recurrence-free survival and overall survival rate were directly related to the number of axillary lymph nodes removed. The difference in outcome is believed to be caused by false-negative classification of axillary-positive high-risk patients in groups of patients where only a few axillary lymph nodes were removed.

Emphysematous pyelonephritis. A serious complication of diabetes mellitus

Abstract: Pyelonephritis emphysematous (PE) is a life threatening renal infection which is observed practically exclusively as a serious complication of diabetes mellitus. 95% of the 73 cases which have been reviewed were found in diabetic patients. The symptomatology resembles that of severe acute pyelonephritis but the disease differs from this in that, in PE, emphysema develops in the actual renal parenchyma and/or in the perirenal tissues. The most important single factor in the etiology appears to be ischaemia of the tissues which are employed as growth media for the microorganisms involved. Infections with E. coli, Klebsiella pneumoniae, Aerobacter and Proteus are the most commonly found. Isolated cases with Candida and Cryptococcus neoformans have been observed. The mortality in untreated cases of PE is 100%. With medical treatment alone, the mortality decreases to 73% while, when combined medical and surgical intervention is employed, the mortality can be reduced to 30%.

[Epidemiological studies on scalded children admitted to the burns unit at the Hvidovre hospital during 1981-1990].

Abstract: During the ten year period 1981 to 1990, a total of 436 children aged 0-5 years were admitted for scalds at the Burns Unit of Hvidovre Hospital. We did not find any reduction in the number of admissions during this period nor was any change in the patterns of scalds found. Water, tea and coffee were the main causal agents of scalds and the dominant group of scalded children was between the ages one to two years. In 37% of cases, the scalds required grafting and the average stay in hospital was 16 days. The background for this unchanged pattern could be that the prophylactive campaigns have been insufficient. Language: da