Ugeskrift for laeger
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Ugeskrift for laeger · Sep 2018
Review[Intra-operative continuous non-invasive blood pressure monitoring].
Intra-operative hypotension is associated with increased risk of 30-day mortality and organ ischaemia. Thus, a reliable monitoring of blood pressure is desirable. New clinical studies indicate, that monitoring of middle arterial pressure with continuous non-invasive monitoring during stable haemodynamic conditioning provides accurate changes in blood pressure. The potential of continuous non-invasive monitoring is promising, but not fully developed.
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The sleep-wake regulatory system and the circadian rhythm generating system are two brain networks integrated in the classical two-process model. These processes interact continuously, and to obtain an optimal sleep they must be correctly aligned. The suprachiasmatic nucleus located in the hypothalamus is crucial in the regulation of circadian rhythms, and the hypothalamus is a key component of the sleep-wake regulatory system in association with the thalamus, basal forebrain and brainstem. Alterations of these processes can result in a variety of sleep disturbances or sleep disorders.
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Circadian disturbances in relation to surgery have been extensively researched through the latest couple of decades. Surgery has been shown to affect melatonin rhythm, core body temperature, cortisol rhythm, activity rhythm and sleep in the perioperative period. The changes translate into both subjective patients' discomfort, prolonging convalescence and clinical effects on morbidity and mortality. Future research should be performed to show effect across different surgical procedures and to investigate potential interventions to alleviate harmful effects of circadian disturbances.
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Sarcoidosis is a multisystem granulomatous disease of unknown cause, histologically characterised by non-caseating granulomas. Sarcoidosis most commonly affects the lungs, but all organs can be involved, and there is a variable natural course from an asymptomatic state to a progressive disease. Sarcoidosis is a diagnosis of exclusion, and CT scan, endobronchial ultrasound-guided trans-bronchial needle aspiration and fluorodeoxyglucose positron emission tomography facilitate the diagnostic workup. Patients with severe symptoms or threatening organ damage require systemic treatment.
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Acute abdomen is a common cause of admission to hospital. Emergency laparotomy is associated with a significant morbidity and mortality due to deranged physiology and surgery-induced stress. Damage control laparotomy is on the rise as an operative strategy for the septic abdomen as well as for trauma laparotomy but lacks definition in the non-trauma setting. Principles of perioperative care in elective surgery are currently applied to the emergency abdominal surgery patients and should be further studied in the future to reduce morbidity and mortality.