Ugeskrift for laeger
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Ugeskrift for laeger · Aug 1993
Review[Ingestion of caustic agents. Epidemiology, pathogenesis, course, complications and prognosis].
The incidence of caustic ingestion varies with the availability of caustic products and preventive measures. A transient increase was seen in the US round 1970, in Denmark in the late seventies. Diagnosis and treatment of caustic ingestion injuries remains controversial, and must to a high degree be based on retrospective studies and animal studies, especially concerning the pathology and clinical course of the disease. ⋯ Approximately 33% of all patients admitted with (suspected) caustic injury reveal oesophageal damage. This leads to subsequent oesophageal stricture in 10-15%. Mortality is less than 10% in unselected groups.
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Back pain is a typical symptom of abdominal aortic aneurysm. Symptoms of root compression may also be present if the aneurysm has caused changes to the vertebral column. A typical case is presented. The condition is life-threatening and requires vascular reconstruction.
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Three cases of iatrogenic infection following the insertion and subsequent use of an epidural catheter are described. The development, symptoms, diagnostic possibilities and treatment of epidural abscess are described. It is stressed that patients with decreased immunological defences are more prone to infection. ⋯ Despite neurosurgical intervention both patients developed paralysis of the lower extremities, bladder and intestinal function, in one of them irreversibly. We also describe one patient who developed meningitis following eight attempts to insert an epidural catheter. The importance of quick diagnosis and intervention is stressed as well as the importance of strict sterility while inserting and using epidural catheters.
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Ugeskrift for laeger · Jul 1993
Case Reports[Spontaneous bladder perforation--a rare complication of neurogenic bladder dysfunction].
Spontaneous rupture of the urinary bladder which is not associated with trauma is uncommon. A case of spontaneous bladder perforation (triggered by an episode of urinary retention) and peritonitis in a 69-year old male patient with neurogenic bladder dysfunction is reported. ⋯ The diagnosis spontaneous bladder perforation should be considered in patients with non-characteristic acute abdominal conditions and voiding symptoms, especially if they have neurogenic bladder dysfunction and a history of recurrent lower urinary tract infections and/or bladder calculi. We recommend that bladder stones should be removed--also in asymptomatic cases.
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Ugeskrift for laeger · Jul 1993
Review Historical Article[Combined spinal and epidural anesthesia. A review of the method].
Combined spinal epidural anaesthesia (CSE) offers the fast and profound neural blockade of spinal anaesthesia, but provides the possibilities of extension of the block and post-operative pain control. On the basis of a historical review, the advantages and drawbacks of CSE are discussed, and purpose-designed needles (Eldor 1 and 2, E-SP, T-A, Braun, Mediziv) are described. The dosage problems inherent in the technique and a possible solution to the "test dose" question are described. ⋯ CSE is a valuable alternative to established regional anaesthetic techniques. The Mediziv needle offers several advantages, but a comparative study of the different needle types is needed.