Ugeskrift for laeger
-
Ugeskrift for laeger · Nov 1993
Review[Indications for the use of differential ventilation and selective positive end-expiratory pressure].
In some cases of unilateral or bilateral severe lung disease, there is serious hypoxia despite a high level of oxygen in the inspiratory gas mixture. Disturbances in the ventilation/perfusion ratio (V/Q) is a major contributing factor to the hypoxia seen in acute lung disease. The use of positive end expiratory pressure (PEEP) has in some cases been shown to make this V/Q mismatch even worse, and the use of high levels of PEEP is known to increase the risk of barotrauma and to reduce cardiac output. ⋯ The patient has to be intubated with a double lumen endotracheal catheter. The gas is delivered by two ventilators synchronized by a master-slave cable. This method can also be used in the operating room, when surgical procedures have to take place in the lateral position, in order to counteract V/Q mismatch and hypoxia.
-
Ugeskrift for laeger · Nov 1993
Case Reports[Chylous ascites after surgery on the abdominal aorta].
Chylous ascites is a rare clinical condition and especially rare as a complication of surgical intervention. Its pathophysiology is poorly understood. We report a case of chylous ascites following aortic femoral bypass managed by conservative approaches involving multiple paracenteses, dietary restriction of fat and parenteral nutrition. We suggest that cases of surgically induced chylous ascites which do not respond to conservative treatment within a few weeks should have a laparatomy to close the fistula.
-
One hundred and twenty (120) women, taking contraceptive pills, underwent a structured interview with a view elucidating their knowledge of the physiology of menstruation, the action and side effects of contraceptive pills and their compliance in the taking of contraceptive pills. The most important sources of information were the medical letters in magazines and the women's own doctors, while the teaching in the Folkeskole (primary and lower secondary school) had not had any major influence on the level of information. Well over one third of the interviewed women knew the most important action mechanism of the contraceptive pill, and half of the women could give a satisfactory explanation of the physiology of menstruation. ⋯ There was high compliance among the women i.e. that their behavior was correct when they had forgotten to take one or two contraceptive pills, when bleeding was irregular, and when beginning on a new package of pills. Eighty-three percent (83%) had experienced side effects that could be related to contraceptive pills. The investigation shows that there is a need for more efficient information about the effects of the Pill and about the physiology of menstruation.
-
Cerebral dysfunction due to long-term treatment with opioids is a problem of increasing relevance because of the rapidly growing use of opioids. A review of psychomotor and cognitive test methods is given, including their application in patients on long-term opioid treatment. The findings of the most valid studies on cancer patients in long-term treatment with opioids are an increase in continuous reaction time and subjective sedation score regardless of the routes of administration. ⋯ According to recent studies, patients with chronic non-malignant pain conditions are responsible for the major part of the total opioid consumption. So far, no studies of cerebral dysfunction have been performed on this group of patients. Further research should concentrate on the use of few valid psychomotor and cognitive tests and should include patients with chronic non-malignant pain conditions.