Läkartidningen
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Status epilepticus, a condition with prolonged or repeated seizures, is a common neurological emergency with significant morbidity and mortality. This text outlines the treatment and initial work-up for convulsive and non-convulsive status epilepticus in adults and children. The most serious form is convulsive (tonic-clonic) status epilepticus, which requires rapid treatment and work-up. ⋯ For other forms of status epilepticus, the treatment depends on the type of seizures and the patient's general condition. Etiological work-up is essential in any case of status epilepticus. Effective treatment and work-up in status epilepticus requires a defined treatment protocol and multidisciplinary cooperation.
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Pulmonary hypertension (PH) is a serious complication to left heart disease (LHD), affecting a majority of the patients during the course of the disease. Initially, PH-LHD is caused by passive congestion of the pulmonary vessels due to increased left atrial pressures, a condition that is currently denoted as isolated post-capillary PH (Icp-PH). In the majority of patients the increased atrial pressure is a result of elevated left ventricular filling pressures. ⋯ Despite PH-LHD being common and serious, specific therapies are lacking for the pulmonary component. Instead, treatments focus on optimizing the underlying cause of PH-LHD and involve medical as well as surgical therapies. In the present review we presents, based on the new guidelines, current knowledge on pathophysiological and pathobiological mechanisms, epidemiology, investigation and treatment of PH-LHD.
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An eye for an eye? Lack of consensus in off-label use of medications leads to major regional differences in medical costs for the treatment of wet AMD in Sweden. The three ocular VEGF inhibitors available in Sweden have similar efficacy and safety. Only two are however registered for wet AMD. ⋯ In the three largest cities, it is not used at all. As a consequence, the yearly drug cost for a patient with wet AMD differs from 2 000 to 44 000 SEK. As this difference is not compatible with the Swedish law of "care on equal terms", increased efforts should be made to obtain a national consensus.
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Knot on the epidural catheter, a rare complication: a case report A 30-year 1-grava woman received an epidural for labor pain. Insertion was uncomplicated and she had an effective analgesia. The epidural was successfully converted to epidural anaesthesia for Caesarean section. ⋯ If the catheter is not easily removed; »gentle and steady traction« is recommended with the patient initially in a position as similar as possible to the one during insertion. If it is still not possible to remove, an X-ray or MRI is suggested to confirm that there isn't any nerve involvement, followed by pulling firmly again until the catheter comes out or breaks. A broken catheter should »in general« be left in place unless symptoms occur.