Ugeskrift for laeger
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Ugeskrift for laeger · Dec 1990
Comparative Study[The quality of a manual method for the identification of the lumbar vertebrae].
In order to identify the spinous processes in the lumbar region, we employ the following rule: that "the line between the iliac crests passes through the spinous process of L4 or the intervertebral space between the 4th and 5th lumbar vertebrae". Three anaesthetists (two junior staff and one consultant) identified a spinous process marked by lead-shot in 33 patients prior to radiological examination. No significant differences were found between the estimates made by the junior staff and the consultant and none of the following factors were of significance for the estimates: height, weight, weight index, sex or age of the patients. ⋯ The differences were significant. It is concluded that 40% of the estimates were incorrect but never by more than one segment. The method may be employed where unreliability of one segment is acceptable.
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Ugeskrift for laeger · Dec 1990
[Metastatic spinal compression syndrome. Symptoms, diagnosis, treatment and prognosis].
A retrospective study of 398 patients suffering from metastatic compression of the spinal cord or cauda equina is presented. The study comprised almost all relevant medical records of patients admitted to hospital in the eastern part of Denmark in the period 1979 through 1985. Carcinoma of the lung, prostate, breast and kidney were the most frequent primary malignancies causing spinal compression. ⋯ But if the patients' motor function and primary tumour were taken into account, no significant difference between the treatments was observed. The efficacy of treatment depended upon the symptoms when the diagnosis was established, and accordingly early diagnosis is of the utmost importance. The incidence of metastatic compression increased during the period covered by the study, and since this condition must not go untreated, awareness of the symptoms, primarily pain, is essential.
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Intensive research during recent years concerning treatment of postoperative pain has demonstrated that the majority of operation patients can be rendered free from pain but that this is far from being the case in clinical practice. This article reviews the physiological mechanisms of acute pain and the methods available for treatment of pain related to acute physiology of pain. Postoperative treatment of pain should be aggressive with the object of preventing pain and normalizing the vital functions with the object of reducing the perioperative morbidity and mortality. A series of recommendations are given for treatment of pain after surgical intervention.
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Ugeskrift for laeger · Oct 1990
Comparative Study[Proctoscopic versus histologic diagnosis of rectal polyps].
On the basis of the endoscopic appearance, 71 rectal polyps were assessed as adenomata or non-neoplastic polyps, after which the endoscopic diagnosis was compared with the results of histological examination. The diagnosis based on macroscopic examination of the polyps proved correct in only 62% of the cases. It is concluded that the diagnosis of adenoma cannot be established solely on the proctoscopic appearance of a polyp and, as adenomata are premalignant, removal of all polyps found at proctoscopy is recommended.
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With the object of investigating the occurrence of pain and dysaesthesiae in the scar following mastectomy, 120 were interviewed by a standard questionnaire in a prospective study. These women had commenced postoperative control or treatment in the Department of Oncology in the University Hospital of Aarhus consecutively during a one-year period. One hundred and ten of these women were interviewed again one year later. ⋯ Twenty-seven patients (23%) had dysaesthesiae at the first interview while 29 patients experienced these continually one year after operation. Both the intensity and the duration of the scar pain diminished with the elapse of time. This held also true where dysaesthesiae were concerned but was not so marked.