Ugeskrift for laeger
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Ugeskrift for laeger · Sep 1993
Review[Bupivacaine in spinal anesthesia. The spread of analgesia--dependence on baricity, positioning, dosage, technique of injection and patient characteristics].
The spread of sensory blockade during spinal analgesia using bupivacaine is influenced by a number of factors concerning baricity, positioning, dosage, technique of injection and patient characteristics. The glucose-free 0.5%-solution acts as a hypobaric solution. The interaction of baricity and posture during and immediately after the injection of this solution is of utmost importance. ⋯ Of modest importance is patient age, irrespective of baricity, while obesity and injection level only matter when the glucose-free solution is used. Injection speed seems of modest importance, while barbotage and direction of the needle have no or minimal clinical importance. The problem of unpredictability of the sensory blockade, a major one in spinal analgesia, is yet to be solved.
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Ugeskrift for laeger · Sep 1993
[Laparatomy in patients aged 80 years and older. A prospective analysis of morbidity during 1 year in the county of Ringkøbing].
All patients aged 80 years or more admitted to the departments of general surgery in Ringkøbing county, Denmark, during one year were studied prospectively in order to investigate morbidity and mortality following laparotomy in this patient group. A laparotomy was performed in 94 patients (67% women), in 73% as emergency cases. More than half of the patients had important coexisting diseases, and in half of the patients the cause of laparotomy was malignant disease, mostly colorectal cancer, while perforated or bleeding ulcer, cholecystitis, appendicitis, diverticulitis and incarcerated hernias were the most common benign causes of laparotomy. ⋯ In conclusion, laparotomy carries a high risk in elderly patients, particularly in the emergency situation. Efforts must be made in these patients to correct and treat any coexisting medical disorder prior to surgery, and when possible to perform early surgery before an elective operation turns into an emergency problem. Also, the development of new surgical procedures with lower morbidity must be encouraged.
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Ugeskrift for laeger · Sep 1993
[Effects of reducing the number of general practitioners on call on the pattern of the use of ambulances and emergency services].
The aim of the study was to evaluate the effect of a reduction of the number of general practitioners on call on the use of ambulance emergency service. A prospective registration of all ambulance emergency activity in the county of Ringkøbing over an eight week period was made before and after the reduction of the number of general practitioners on call, together with a 4 + 4 week prospective registration of persons who claimed that contact to the general practitioners service was impossible, therefore resulting in a contact to the emergency central or the accident and emergency department. ⋯ The number of patients, who claimed that contact to the general practitioner service was impossible was unchanged. We conclude that a reduction of the number of general practitioners on call has resulted in a reduction in the relative number of ambulance services resulting in hospital admission of the patient, which suggests a decline in the threshold of the population for calling an ambulance.
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Ugeskrift for laeger · Sep 1993
[Unsatisfactory results after repeated revision of hip alloplasties].
Sixty one cemented second revision total hip arthroplasties and 18 cemented third revision total hip arthroplasties were studied with emphasis on cause of failure, complications, risk of further revision, and clinical and radiographic outcome of surviving, not further revised patients. Aseptic loosening was the major reason for both second and third revisions followed by recurrent dislocations. Twenty one second revisions failed again. ⋯ Clinical and radiographic outcome was favorable, but must be seen in the light of the high rate of further revisions. In 33/53 second revisions and in 5/13 third revisions left for evaluation, the overall outcome was considered unsatisfactory. Reoperations for failed arthroplasties should be the prerogative of highly experienced centers.