Dan Med Bull
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There is increasing evidence to support the use of intravenous lipid emulsion (ILE) in the management of local anaesthetic systemic toxicity (LAST) and non-local anaesthetic lipophilic-drug poisoning. This trend is supported by the Association of Anaesthetists of Great Britain and Ireland's latest guidelines on LAST treatment. Similar national guidelines have yet to be introduced in Denmark. The aim of the present study was to study the adoption of lipid rescue therapy in Denmark. ⋯ Patients with toxic reactions who could potentially benefit from ILE will not be offered lipid rescue therapy in 26 of 34 hospitals (76%)--either because the AA is not aware of this treatment modality, or due to absence of either guidelines or ILE. To improve the availability of lipid rescue therapy, more hospitals need to develop emergency packs containing ILE and guidelines. Introduction of national guidelines on lipid rescue therapy would probably accelerate this process.
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Randomized Controlled Trial
Investigation of carbachol and PACAP38 in a human model of migraine.
The parasympathetic signalling molecules acetylcholine, pituitary adenylate cyclase activating peptide-38 (PACAP38) and vasoactive intestinal peptide (VIP) may be released from parasympathetic fibres and activate sensory nerve fibres during migraine attacks. Recently, it was shown that VIP does not induce migraine-like attacks in migraine patients. Interestingly, PACAP38 activates the same VPAC receptors as VIP, but also specifically activates the PAC1 receptor. ⋯ In conclusion, we found that carbachol infusion was not a good model for experimental migraine provocation, probably because the maximal dose was insufficient to produce enough nitric oxide to trigger migraine. PACAP38 infusion is a new pathway for migraine induction and the results from study IV suggest that neurogenic inflammation and mast cell degranulation are unlikely to cause PACAP38 induced migraine. The present thesis contributes to our knowledge on migraine pathophysiology and suggests PAC1 receptor antagonism as a new target for migraine treatment.
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An increasing number of studies have shown that circadian variation in the excretion of hormones, the sleep wake circle, the core body temperature rhythm, the tone of the autonomic nervous system and the activity rhythm are important both in health and in disease processes. An increasing attention has also been directed towards the circadian variation in endogenous rhythms in relation to surgery. The attention has been directed to the question whether the circadian variation in endogenous rhythms can affect postoperative recovery, morbidity and mortality. ⋯ Correlation exists between circadian rhythm parameters and measures of postoperative sleep quality and recovery. However, oral melatonin treatment in the first three nights after surgery, cannot yet be generally recommended for improvement of sleep quality or other recovery parameters based on the available results. It may be indicated in subgroups or if other perioperative treatment algorithms were used, but this has to be investigated in future trials.
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Multicenter Study
Room for improvement in the treatment of hip fractures in Denmark.
Treatment of hip fractures has evolved since the introduction of fast-track surgical programs in the late 1990s. The aim of our study was to describe the quality of treatment and care related to fast-track hip fracture surgery in Denmark by external audit of patient records. ⋯ Although the principles for fast-track surgery have been adapted to some extent at all departments in Denmark with an annual treatment of at least 50 patients with hip fractures, no single department has implemented the whole package. Hospital stay has been reduced since the introduction of fast-track regimes, and improvements were seen in many of the quality indicators. Implications for future practice include better adherence to clinical guidelines, a more homogeneous documentation system in nursing, promotion of evidence-based standards, and improved treatment and care of the physical and psychological consequences of hospitalization.
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Ph.D. project performed at Copenhagen University Hospital Herlev in the period 2007-2010. ⋯ Body coil acquisition 3T WB-MRA is technically feasible using both a blood-pool and a standard non-specific extracellular contrast agent. However, the method is limited by low sensitivities for arterial stenoses. Hybrid examination technique and use of steady-state MRA are methods of improving WB-MRA. Patient acceptance of WB-MRA is superior to that of DSA. The rationale of using WB-MRA as diagnostic method in PAD patients is shown by the high prevalence of concomitant arterial stenosis outside the peripheral arteries.