Ugeskrift for laeger
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Ugeskrift for laeger · Jan 2011
Review[Herpes zoster: clinical manifestation, diagnosis and treatment].
Herpes zoster (HZ) is a painful vesicular rash localized to one dermatome. Post-herpetic neuralgia (PHN) is persistent pain three months after the rash started. In recent years several Cochrane reviews and clinical studies on how to treat HZ and PHN have been published. These studies show that early recognition and treatment can reduce acute symptoms, that antiviral therapy and corticosteroids shorten the acute illness period, that opioids and anticonvulsants have effect on acute HZ pain and, finally, that tricyclic antidepressants, opioids and anticonvulsants all have proven efficiency in PHN therapy.
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Ugeskrift for laeger · Jan 2011
[Intravenous administration of lipids in poisoning caused by local analgesics].
To draw attention to the use of intravenous lipids in the treatment of cardiac arrests caused by overdosage of lipophilic drugs. Case reports and animal studies have shown beneficial use of lipids in severe intoxication. The literature is reviewed. ⋯ Lipids have a place in the treatment of severe cardiac events caused by local analgesics for regional anaesthesia. Lipids should be readily available when regional anaesthesia is performed. National guidelines should be prepared. Lipids may also be an option in the treatment of intoxication with other lipophilic drugs.
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Multiple mechanisms are responsible for persistent postherniotomy pain, including preoperative pain hypersensitivity, other chronic pain states and intraoperative nerve injury. Currently, the primary preventive techniques are intraoperative nerve identification/sparing in open surgery or use of laparoscopic surgery with non-fixed mesh. The choice between pharmacological intervention and re-exploration is debatable. A centralisation of the Danish patients with regard to evaluation and treatment is proposed.
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The course of acute pancreatitis is in the initial phase dominated by a systemic inflammatory response, later by local complications. A new classification defines three specific types of pancreatitis: 1) interstitial oedematous pancreatitis and 2) necrotizing pancreatitis with pancreatic parenchymal necrosis, or 3) peripancreatic necrosis alone. The classification also defines four types of collections: 1) Acute peripancreatic fluid collection, 2) pseudocyst, 3) acute post-necrotic collection, and 4) walled-off necrosis. This article summarizes the terminology of the revised Atlanta classification.
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Ugeskrift for laeger · Dec 2010
Case Reports[Metformin treatment causes persisting lactic acidosis after cardiac arrest].
Metformin associated lactic acidosis (MALA) is a rare condition with a prevalence of 3 per 100,000 patient-years. The reported mortality is about 50%. We describe a case of MALA in a 61-year-old obese, type II diabetic male who suffered a sudden cardiac arrest. ⋯ The patient died within seven days from multiorgan failure. MALA should be suspected in therapy-resistant lactic acidosis. Haemofiltration/haemodialysis will correct acidosis and clear metformin.