Ugeskrift for laeger
-
Three cases of iatrogenic infection following the insertion and subsequent use of an epidural catheter are described. The development, symptoms, diagnostic possibilities and treatment of epidural abscess are described. It is stressed that patients with decreased immunological defences are more prone to infection. ⋯ Despite neurosurgical intervention both patients developed paralysis of the lower extremities, bladder and intestinal function, in one of them irreversibly. We also describe one patient who developed meningitis following eight attempts to insert an epidural catheter. The importance of quick diagnosis and intervention is stressed as well as the importance of strict sterility while inserting and using epidural catheters.
-
Ugeskrift for laeger · Jul 1993
Case Reports[Spontaneous bladder perforation--a rare complication of neurogenic bladder dysfunction].
Spontaneous rupture of the urinary bladder which is not associated with trauma is uncommon. A case of spontaneous bladder perforation (triggered by an episode of urinary retention) and peritonitis in a 69-year old male patient with neurogenic bladder dysfunction is reported. ⋯ The diagnosis spontaneous bladder perforation should be considered in patients with non-characteristic acute abdominal conditions and voiding symptoms, especially if they have neurogenic bladder dysfunction and a history of recurrent lower urinary tract infections and/or bladder calculi. We recommend that bladder stones should be removed--also in asymptomatic cases.
-
Ugeskrift for laeger · Jul 1993
Review Historical Article[Combined spinal and epidural anesthesia. A review of the method].
Combined spinal epidural anaesthesia (CSE) offers the fast and profound neural blockade of spinal anaesthesia, but provides the possibilities of extension of the block and post-operative pain control. On the basis of a historical review, the advantages and drawbacks of CSE are discussed, and purpose-designed needles (Eldor 1 and 2, E-SP, T-A, Braun, Mediziv) are described. The dosage problems inherent in the technique and a possible solution to the "test dose" question are described. ⋯ CSE is a valuable alternative to established regional anaesthetic techniques. The Mediziv needle offers several advantages, but a comparative study of the different needle types is needed.
-
Ugeskrift for laeger · Jul 1993
[Admissions and ambulatory treatment before and after establishment of a community psychiatric center in Copenhagen].
The purpose was to measure the use of psychiatric treatment before and after the start of community psychiatry in a part of Copenhagen. The use was measured during the two years before and after starting for the first 45 patients entering the treatment facility. Number of patients taken in for in-patient treatment, of intakes, of in-patient days, of emergencyroom visits and out-patient attendances were measured. ⋯ Use of medicine per day was the same, but total use increased because of the more stable contact. No difference in in-patient treatment use was seen according to the case manager's professional education. It is concluded that community psychiatry by increased use of outreach, patient contact, and psychological treatments can increase the stability of the contact and reduce the use of in-patient days.
-
Ugeskrift for laeger · Jul 1993
Case Reports[Presumed anaphylactic shock after infusion of Lipofundin].
A case of anaphylactic shock in a 45 year old man with Hodgkin's disease following Lipofundin infusion is described. Lipofundin is a soybean oil based preparation for parenteral nutrition. ⋯ Soy-protein, in small quantities, can be detected in soy-oil. A possible connection between the patient's reaction and soy-allergy is discussed.