Ugeskrift for laeger
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Ugeskrift for laeger · Sep 1989
Review[Immunologic consequences of surgery, anesthesia and blood transfusion. Surgical immunosuppression].
On the basis of the literature and the authors own investigations, the present article provides a brief schematic review of the fraction of the physiological immune response which has hitherto been investigated in connection with surgical trauma. Surgery, anaesthesia and blood transfusion induce temporarily acquired immune suppression and thus a potentially increased risk for postoperative infectious complications and recurrence after cancer surgery. ⋯ The clinical sequelae of preoperative and postoperative immune suppression are increased morbidity and mortality rates. Future research in this field must, therefore, be focussed on detailed investigation of the mechanisms which lead to postoperative immune suppression and development of methods to prevent these.
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Ugeskrift for laeger · Sep 1989
[Long-term treatment with intrathecal morphine in severe painful cancer].
Intrathecal treatment with morphine was instituted in seven cancer patients with severe pain. All of the patients had already received treatment with epidural morphine and the reason for the change in treatment was insufficient effect, side effects and/or pain connected with the injections in the epidural form of therapy. The duration of treatment was 5-136 days (median 40 days). ⋯ One patient received accidentally too great a dose of morphine intrathecally as compared with the usual dose and required treatment for respiratory insufficiency. Apart from postural headache on account of leakage of cerebro-spinal fluid, which could be treated by epidural blood "patch", the method was without complications which could be attributed to the intrathecally placed catheter. Treatment of pain with opioids injected intrathecally may thus be recommended in the cases in which epidural treatment cannot be carried out on account of the reasons mentioned above.
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Ugeskrift for laeger · Sep 1989
[Danish physicians' attitude to capital punishment. A questionnaire study].
The attitudes of the Danish medical profession to capital punishment and participation in the procedure of capital punishment were illustrated by means of a questionnaire investigation. A total of 1,011 questionnaires were sent to a representative section of Danish doctors. Out of the 591 who replied, 474 considered that capital punishment is not an acceptable form of punishment while 76 considered that capital punishment is acceptable. Twenty doctors were willing to participate actively in executions although medical participation of this type has been condemned both by the Nordic Medical Associations and also by the World Medical Association.
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Ugeskrift for laeger · Sep 1989
Case Reports[Obstruction of a naso-tracheal tube by an avulsed nasal concha].
Avulsion of a nasal concha by a nasotracheal tube obstructed the tube in a valvelike manner. The result was increased intrapulmonary pressure, hemodynamic instability, alveolar rupture, pneumomediastinum and pneumoperitoneum without pneumothorax. The case was successfully managed by removal of the nasotracheal tube and immediate oral reintubation.
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Ugeskrift for laeger · Aug 1989
Review[Colloids versus crystalloids in the treatment of hypovolemic or septic shock].
The literature is reviewed with the aim of comparing the effect of resuscitation with colloid solutions with that of crystalloid solutions in the following patient categories: patients undergoing major elective abdominal surgery, patients in hypovolemic shock due to acute trauma and patients in septic shock. None of the clinical trials have documented that resuscitation with colloids is superior to that of crystalloids alone as regards mortality or frequency of complications. ⋯ Furthermore, resuscitation with colloids is about 50 times more expensive than resuscitation with crystalloids. On the basis of the clinical data and the higher cost of colloids, the authors recommend cessation of the use of colloids in the abovementioned conditions.