Ugeskrift for laeger
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Ugeskrift for laeger · Aug 1992
Case Reports[Total uterine rupture of a cesarean section scar during attempted vaginal delivery under epidural analgesia].
A case of complete uterine rupture and abruptio placentae during an attempt of vaginal delivery under epidural analgesia in a woman with previous caesarean section is described and discussed. When using epidural analgesia for such a patient during vaginal delivery it is imperative that newly developed pain should be ascribed to the uterine scar and the diagnosis of threatening uterine rupture be made immediately.
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Ugeskrift for laeger · Aug 1992
Case Reports[Cholesteatoma behind an intact ear drum--an overlooked disease?].
On the background of increasing international interest for early diagnosis, pathogenesis and treatment of cholesteatoma in children, a sub-group is described and termed primary cholesteatoma, congenital cholesteatoma in the middle ear or cholesteatoma in the middle ear behind an intact ear-drum. This review is based on a retrospective review of cholesteatoma in children submitted to operation in Hjørring Hospital during a period of five years from 1986 to 1991. ⋯ The symptomless congenital cholesteatoma in the middle ear is recognized clinically by otoscopy where it appears as a white shadow, most frequently in the anterior upper quadrant, behind an intact ear-drum. Early diagnosis is important and may be established by general practitioners, paediatricians and otologists at routine otoscopy.
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Ugeskrift for laeger · Jul 1992
Review[Ketamine as a broncholytic agent in status asthmaticus and as an anesthetic for patients with bronchial asthma].
Ketamine was introduced into clinical anaesthesia in 1965. Since then it has been demonstrated to lower airway resistance and to increase lung compliance in the asthmatic patient. It has also proved useful in anesthetizing asthmatic patients with or without symptoms. ⋯ Experiments with animals and with human preparations have suggested one or more of the following mechanisms of action: a sympathomimetic effect, a direct relaxant effect, an antagonism to histamine and acetylcholine and a membrane stabilizing effect as with local analgesics. Until investigations have been published ketamine is recommended as an anaesthetic for the asthmatic patient and for the patient who has previously reacted with bronchospasm when intubated or anaesthetized. Prospective clinical trials should be planned.
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Minor short-term depression of mental function is seen after anaesthesia and surgery. However, general anaesthesia does not seem to cause permanent damage or depress mental function beyond the first 2-4 postoperative days and no significant advantages of regional anaesthesia, as regards to cerebral function, are found after this period. ⋯ The risk of mental disturbance is increased in patients with psychiatric disease or presenile dementia and may be due to ongoing treatment with tricyclic antidepressant and neuroleptic drugs. Centrally acting cholinergic drugs, hypotension and hypoxia together with postoperative pain and sleep deprivation should be avoided.
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Ugeskrift for laeger · Jul 1992
Case Reports[Hypertrophic obstructive cardiomyopathy complicated with bacterial endocarditis].
A patient with hypertrophic obstructive cardiomyopathy (HOCM) and Staphylococcus aureus mitral valve endocarditis is reported. Bacterial endocarditis occurs with increased frequency and the prognosis is worse in these patients. All patients with HOCM should therefore be given antibiotic treatment every time they undergo invasive procedures to prevent potentially fatal bacteraemia.