Ugeskrift for laeger
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Crush syndrome or traumatic rhabdomyolysis constitutes the systemic changes seen after crush injury, i.e. the damages seen after a prolonged period of pressure on a muscle group. The pressure causes necrosis of muscle, and during revascularisation diffusion of calcium, sodium and water into the damaged muscle cells is seen, together with loss of potassium, phosphate, lactic acid, myoglobin and creatinine kinase. Untreated these changes can lead to: hyperkalaemia, acidosis, acute renal failure and hypovolaemic shock. ⋯ The crush injuries are treated conservatively without fasciotomy, despite high or increasing intracompartmental pressure. The only indications for fasciotomy are lack of a distal pulse or open lesions. If fasciotomy is performed, radical removal of all necrotic muscle is essential.
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This review article highlights the prerequisites and consequences of a possible implementation of trauma systems in Denmark. Denmark is a small densely populated country, with a population of approximately 5 mill. people. ⋯ A successful reorganisation of Danish trauma care depends on respect for the present national advantages and internalisation of international experiences. The author recommends a nationally co-ordinated reorganisation in accordance with the guidelines of American College of Surgeons Committee on Trauma.
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Ugeskrift for laeger · Jan 1998
Review[Genetic and environmental factors in Graves disease. A review].
The aetiology of Graves' disease fits a multifactorial pattern of inheritance, where an interplay of genetic and environmental factors is necessary for the development of autoimmune hyperthyroidism. Family studies, twin studies and studies of genetic markers all confirm the existence of one or more genetic factors in the aetiology of Graves' disease. Since the familial occurrence of Graves' disease cannot be fully explained by the distribution of genetic markers, there may also exist one or more environmental factors in the aetiology of Graves' disease. ⋯ There is no evidence of an environmental factor as a causative factor in Graves' disease. Future studies should be carried out prospectively involving both patients with Graves' disease and genetically predisposed persons, e.g. the families of patients with Graves' disease. Prospective population-based studies among monozygotic twins discordant for Graves' disease offer unique opportunities to clarify the role of environmental factors in the aetiology of Graves' disease.