Ugeskrift for laeger
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Ugeskrift for laeger · Oct 1996
Case Reports[Angiotensin-converting enzyme inhibitors and anesthesia].
The increasing usage of ACE-inhibitors in the treatment of hypertension and chronic heart failure may increase the incidence of adverse anaesthetic occurrences. Four such cases are described. In two of these cases, the patient reacted with severe hypotension when general anaesthesia was supplemented with epidural bupivacaine. ⋯ Preoperative discontinuation of ACEI-treatment is controversial. We present some of the issues involved. Most authors lean towards continuing ongoing treatment, even though there is firm evidence that this increases the risk of hypotensive episodes due to hypovolaemia, arguing that such events may be predicted and antagonized with fluid therapy.
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Over a three month investigation period, 1199 patients attended a psychiatric emergency-room. The sex ratio was 55.5% male/44.5% female, and the average age of the patients was 43.5 years. ⋯ Only 17% of the alcoholics were admitted to the psychiatric ward. Sixty-one percent of the long-term psychiatric patients were admitted, and only 13% left the emergency-room without any follow-up plan.
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Metastatic spinal cord compression (MSCC) is a disabling complication to cancer for which the optimal treatment of choice is not settled. An analysis was performed in patients with MSCC secondary to lung cancer in order to elucidate clinical symptoms and treatment results according to regression of neurological deficits and survival. The total series consisted of 102 retrospectively evaluated patients referred for treatment, in the Eastern part of Denmark in the period 1979-1988. ⋯ The group of patients treated with laminectomy followed by radiotherapy had a better survival (median value 3.5 months, range 0-132 months) than patients treated with either laminectomy (median value 1.5 months, range 0-32 months) or radiotherapy (median value 1 month, range 0-59 months) alone (p = .03, Log-Rank test). No significant difference was observed in survival between the various histological types of lung cancer (p = .18, Log-Rank test). Despite a short survival, early diagnosis and immediate treatment is crucial, since it may preserve the gait function in 97% of lung cancer patients developing malignant spinal cord compression.
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The purpose of the paper is to study methods for costing hospital services specifically in relation to multi-unit studies of activity, case-mix, severity-of-illness, outcome, and resource use in adult intensive care units. The article reviews 20 published cost studies of adult intensive care units. The studies are all published in English and are both European and American. ⋯ In addition, the costing methodology applied in the majority of the studies has been wrongly specified in relation to the purpose and the viewpoint of the studies. The article concludes that the methodologies for costing intensive care unit therapy are flawed and fail to provide correct answers. In addition, the study question is in most studies not adequately specified and the cost concept used in the studies is not tailored to the purposes of the studies.
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Ugeskrift for laeger · Sep 1996
Case Reports[Back pain, bone metastases and medullary compression].
A case of lung cancer and metastatic spinal cord compression is presented. Despite progressive backpain during two weeks and total loss of walking ability, the patient regained the ability to walk one week after radiotherapy for the malignant spinal cord compression. Guidelines for recommended diagnostic approaches are given.