Ugeskrift for laeger
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Ugeskrift for laeger · Jun 1991
Case Reports[Abducens paresis, a rare complication to spinal analgesia].
A case of paresis of the abducens nerve following spinal analgesia is described. Cranial nerve paresis is a rare complication of spinal analgesia although described for all cranial nerves except nos. 1, 9 and 10. It is very useful to know that cranial nerve paresis after spinal analgesia often occurs after a delay of several days, and that treatment is unnecessary because symptoms nearly always disappear spontaneously in about 2-4 months.
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Ugeskrift for laeger · May 1991
Review[Quality assurance in antenatal, perinatal and neonatal care. A medical audit].
Formalized quality assessment of prophylaxis, diagnosis, treatment, and care has recently been introduced in the Danish health service. A review is presented of quality assessment undertaken by the medical audit method and a model is described for quality assurance of prophylaxis, diagnosis, treatment and care during the ante-, peri and neonatal periods. The information is based partly on results from a medical audit project and also experience from work in a perinatal committee in the County of Copenhagen. ⋯ In addition, examples are quoted of criteria for satisfactory prophylaxis, diagnosis, treatment and care in the perinatal period and for how assessment by the specialists is carried out. A new classification of causes of death and review of the results of assessments of quality is presented. Finally, quality assessment as seen from the patients' point of view is discussed.
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Ugeskrift for laeger · May 1991
Case Reports[Hemolysis, elevated liver enzymes and thrombocytopenia: the HELLP syndrome--a manifestation of severe pre-eclampsia].
On the basis of a review of the literature and five case histories, the pathophysiological and clinical features in pregnant women with haemolysis, elevated liver enzymes and thrombocytopenia which together constitute the HELLP syndrome (haemolysis, elevated liver enzymes and low platelet count) are illustrated. This syndrome describes a complicated obstetric course with greatly increased neonatal and maternal morbidities. Hypertension/proteinuria are common but are not obligatory. ⋯ In exceptional cases cesarean section may be necessary. On the basis of the coagulation status, the defective plasma components may be supplied (e.g. fresh frozen plasma and antithrombin-III). Plasmapheresis and specific pharmacological intervention must be considered as experimental at present, although these present promising therapeutic possibilities.
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Arterial hypoxaemia is observed during operation and also in the recovery room. Hypoxaemia during operation may be due to altered pulmonary mechanical conditions, drug-induced physiological changes and technical errors. Early postoperative hypoxaemia is frequently observed after general anaesthesia and may, among other things, be due to diffusion hypoxaemia, hyperventilation-induced hypoventilation, residual curarization, hypoventilation induced by sedatives or analgesics and ventilation/perfusion alterations. The clinical significance of peroperative and early postoperative hypoxaemia is not yet elucidated and treatment consists primarily of increasing the oxygen concentration in the inspired air.
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A total of 243 medical students in the third term, phase I, the University of Copenhagen, completed a questionnaire about health, health behaviour, including smoking during autumn 1988 and spring 1989. This investigation aimed at elucidation of the smoking habits of the medical students and their attitudes to smoking in the medical profession. Attempts were made to test the following hypotheses: 1. ⋯ That smokers consider that smoking is the doctor's own business while non-smokers consider that doctors have a professional responsibility. The investigation shows that 36% of the smokers consider that smoking is the doctor's own business in contrast to 64% of the non-smokers. The main result of the analysis is that smokers and non-smokers resemble one another socially and as regards health behaviour in the majority of respects but that smokers, as a whole, have poorer health behaviour and poorer self-assessed health than non-smokers.