Ugeskrift for laeger
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Ugeskrift for laeger · Sep 2015
Review[Patients with chronic obstructive pulmonary disease and heart disease can benefit from beta-blocker treatment].
Chronic obstructive pulmonary disease (COPD) and coronary heart disease share smoking as the most important common risk factor and there is a high prevalence of cardiovascular disease among COPD patients. Although cardioselective beta-blockers are safe in treatment of COPD, they are often withheld in these patients. In observational studies, beta-blocker treatment is associated with significantly reduced mortality and reduced risk of exacerbations of COPD. This effect may be caused by the beneficial effect of beta-blockers on heart failure, tachycardia and upregulation of beta-receptors in the airways.
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Ugeskrift for laeger · Sep 2015
Case Reports[Early diagnosis and treatment of Boerhaave's syndrome is pivotal for the prognosis].
Hydropneumothorax following oesophageal rupture is very rare and often lethal. We report case of a 78-year-old man with known Barret's oesophagus with increasing shortness of breath and right chest pain followed by increasing emesis. ⋯ Oesophageal perforation can lead to pneumothorax and pleural fluid. Early diagnosis is pivotal to reduce mortality.
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Ugeskrift for laeger · Aug 2015
Case Reports[Fatal intoxication with the new designer drug 25C-NBOMe].
This is a case report of a 22-year-old man, who snorted the content of three capsules of the new designer drug 25C-NBOMe (2-(4-chloro-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine). 1-2 hours after the intake he became unconscious with generalized seizures, so he was intubated prehospitally and brought to the local hospital. At admission he had acute renal failure and was severely metabolic acidotic with potassium 8.6 mmol/l, lactate 28 mmol/l and pH 6.69. Despite maximal therapy he died ten hours after admission. 25C-NBOMe is currently legal in most parts of the world, and fatal intoxication with the drug has not yet been described in Scandinavia.
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High-quality scientific evidence may be inadequate to support real world decision-making. Assessment of applicability and generalizability of medical scientific evidence is needed for the practitioner. ⋯ We present the difference between efficacy and effectiveness in connection with trial design and encourage critical evaluation of external validity. Pragmatic design of trials can be considered a preferred choice to limit the prevailing gap between current evidence and practice.
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Ugeskrift for laeger · Jul 2015
Review[The use of an inspiratory impedance valve during cardiopulmonary resuscitation does not improve long-term survival or neurologic outcome].
The impedance threshold device (ITD) works by increasing negative intrathoracic pressure, venous return and cardiac output during cardiopulmonary resuscitation. Although animal studies have shown promising results on haemodynamics, randomized studies and metaanalyses in humans have not shown better long-term survival or neurologic outcome. No studies have been done on the use of the ITD during in-hospital cardiac arrest. The ITD combined with active compression-decompression cardiopulmonary resuscitation may result in a better outcome.