Ugeskrift for laeger
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Ugeskrift for laeger · Nov 2005
[Surgical treatment of skeletal metastases in the pelvis and extremities].
In choosing a surgical treatment for skeletal metastases, an assessment of the individual patient's prognosis fis essential. The aim of surgical treatment is to alleviate pain and maintain function, thus improving the patient's quality of life. We analysed the survival of patients with skeletal metastases who had been surgically treated at the University Hospital in Aarhus from September 1999 to March 2003. ⋯ Most patients with two or three independent negative prognostic factors have an extremely short survival time, whereas patients with no negative prognostic factors may have a good prognosis. Surgical and reconstruction procedures should be chosen to minimise the risk of long-term failure in patients with a good prognosis and be as simple as possible in patients with a poor prognosis.
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Multimodal rehabilitation with preoperative information, reduction of surgical stress responses, optimised dynamic pain relief and early mobilisation and oral nutrition reduce hospital stay, morbidity and convalescence in colorectal procedures. In addition, the results of fast-track colonic surgery suggest that postoperative pulmonary, cardiovascular and muscle function are improved and body composition preserved. Consequently, the hospital stay may be reduced to about two to four days. Preliminary studies suggest similar improvements in more complex colorectal procedures.
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It is estimated that at least one billion passengers travel by air every year. It is predicted that this number will double in the future, including an increasing number of aged passengers. It is further estimated that for every ten million passengers, 225 acute in-flight incidents and one death will occur. ⋯ Travel by air is, however, safe and can be tolerated by most people. Each aircraft is equipped with emergency oxygen and medical kits, the crew is trained in advanced first aid, and a link to a ground-based medical centre often exists. Ill and elderly people can have their journey specifically prepared for by communication between their physician and the medical service of the particular company, providing the best opportunity for a smooth journey.