Ugeskrift for laeger
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Ugeskrift for laeger · Apr 1993
[Paraclinical examination programs in Danish hospitals prior to minor surgical procedures].
Using a questionnaire, paraclinical test programs prior to minor surgery were recorded for Danish hospitals. Sixty-one out of 66 departments of surgery completed the questionnaire. Most of the departments used a basic test program for younger subjects and an extended one for elderly subjects. ⋯ The number of tests ranged from zero to nine (median three) for younger patients and from two to ten (median six) for elderly subjects. The estimated costs of the programs ranged from zero to 1092 Danish crowns (109 pounds) (median 185) for younger patients and from 71 to 1676 Danish crowns (167 pounds) (median 714) for elderly patients. In conclusion, the variation in the extent and estimated costs of preoperative test programs used in Danish hospitals is considerable.
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We studied 75 patients aged 15-40 years who received spinal anaesthesia with the Sprotte 24-gauge spinal needle. The incidence of post dural puncture headache was 4%. ⋯ The patient acceptance was high. We conclude that spinal anaesthesia is easy to perform with a 24-gauge Sprotte needle and is associated with a low incidence of post dural puncture headache.
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In order to introduce intravenous patient-controlled analgesia (PCA) in children in the Department of Anaesthesiology and Intensive Care, Odense University Hospital, we evaluated the technique in 13 children following major orthopaedic or abdominal surgery. The pump (Pharmacia-Deltec, CADD-PCA) was loaded with 1 mg/ml morphine in a 50 milliliters cassette. A bolus dose of 25 micrograms/kg and a lock-out interval of eight minutes were the initial settings. ⋯ Morphine requirements averaged 9.5 microgram/kg/hour (range 5.4-15.6 microgram/kg/hour). Pain control was good and side effects were few and of minor nature. PCA is an effective and safe means of providing good quality analgesia in children.
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The current clinical and biological knowledge about radiation myelopathy is reviewed. Transient myelopathy with Lhermitte's sign develops within months after irradiation. Symptoms generally disappear within months without treatment. ⋯ There is no effective treatment. Analysis of clinical reports shows that the risk of developing chronic myelopathy is less than 2% after 55 Gy, given in 2 Gy daily fractions. Other important radiobiological risk factors (dose per fraction, interfraction interval and volume) are discussed.