Ugeskrift for laeger
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Many patients with major depression have elevated serum cortisol, which cannot be suppressed with dexamethasone. This points to a disturbance in the hypothalamus-pituitary-adrenal (HPA) axis, which might have pathogenetic importance. Recent investigations with MRI have shown an increased frequency of generalised, as well as localised atrophy in the brains of depressed patients. ⋯ There is evidence that the increased cortisol concentration is neurotoxic and may cause atrophy, as is known from Cushing's disease. This is supported by studies of the accumulated duration of depressive episodes, and also by the fact that drugs that dampen the HPA axis have proved to have antidepressant properties in clinical controlled, double-blind studies. This points to new principles in the treatment of major depression and underlines the importance of early intervention in order to prevent cerebral atrophy, which is probably reversible at the beginning of the disease process.
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Ugeskrift for laeger · Nov 2001
[The relevance of mirror examination in modern otorhinolaryngology].
The aim of this study was to investigate whether the teaching of mirror examination of the larynx and rhinopharynx is still relevant and to estimate whether it is still a reliable examination. ⋯ Routine mirror examination of the larynx adequately provides a reliable diagnosis in most patients. But in some, it is not adequate, and here fibrolaryngoscopy is a good alternative and a more reliable examination. Mirror examination of the rhinopharynx is difficult, so if a disease of the rhinopharynx is suspected, the patient must be given a fibroscopy and biopsy under general anaesthesia.
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Paediatric pulmonology (paediatric respiratory medicine) concerns such lung diseases in children as asthma, pneumonia, cystic fibrosis, primary ciliary dyskinesia, chronic interstitial pneumonia, bronchopulmonary dysplasia and congenital abnormalities. This specialty has been approved as an official subsection of the European Confederation of Specialists in Paediatrics (CESP) and acknowledged by the European Union of Medical Specialists (UEMS). ⋯ The training syllabus emphasises routine in the clinical diagnosis and treatment of the diseases, as well as methods such as lung function in all age groups, bronchoscopy, biopsy, and others. This article summarises the status of this specialty, and the training syllabus, and highlights key research questions.
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A survey was conducted over 13 months to measure the satisfaction level of relatives to patients, who had died in hospital. ⋯ Our survey shows that doctors' communication with the relatives of dying patients needs to be improved. There also seems to be a need for providing a better environment for the relatives of dying patients by reserving separate rooms for rest and conversation.