Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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In the recent last decades, important advances have been made in the understanding of the mechanisms behind headache. This has resulted in more efficient treatment. ⋯ He should also be aware of the warning signals that should prompt further investigations or admission to hospital in search of underlying causes. The article describes the most important primary headaches and the current treatment, and discusses the problem of unclassifiable and untreatable headaches.
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Tidsskr. Nor. Laegeforen. · May 1995
[Minor head injuries. May early CT-scanning replace in-hospital observation?].
A one-year prospective study was undertaken to judge whether in-hospital observation after minor head injury could be partly replaced by early computerized tomography (CT), and if such a practice would save hospital resources. All 146 patients had a Glasgow Coma Score (GCS) > or = 14 and no neurological deficits. 128 had suffered loss of consciousness. CT of 97 (67%) patients revealed intracranial lesions in eight (contusions six, oedema one and epidural haematoma in one). ⋯ We observed no complications to the head injury in patients with normal CT. There is no need for hospitalization after minor head injury in patients with GCS > or = 14 with no neurological deficits and normal CT. We advocated wide use of early CT in cases of minor head injury, to allow early detection of intracranial haematomas, diagnoses of brain contusions and avoidance of unnecessary hospitalization.
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Tidsskr. Nor. Laegeforen. · May 1995
[Surgical treatment of acute head injuries, especially epidural hematomas. Current and future practice in Norway].
A survey among the 13 general county hospitals and the five regional neurosurgical units in Norway showed that 263 patients were operated on for acute head injuries in 1993. More than 80% of these operations took place in a neurosurgical unit, and most county hospitals had only 1-2 such surgical procedures each year. Most county hospitals also limited their surgical activities to extradural conditions. ⋯ One patient died. It is concluded that these good results probably reflect the standard of handling, diagnostic work and transport of the patient prior to surgery, rather than the surgery itself. It seems unreasonable to continue the infrequent practice of treating these conditions surgically in local hospitals.
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Tidsskr. Nor. Laegeforen. · May 1995
Case Reports[Malignant hyperthermia--still a current and dangerous problem].
Malignant hyperthermia is a potentially fatal condition inducible by volatile anaesthetics and/or suxamethonium in genetically susceptible individuals. A disturbed calcium homeostasis in skeletal muscle (possibly in the ryanodin receptor) results in elevated myoplasmatic calcium. The latter causes muscle contraction and a hypermetabolic state, clinically observed as rigidity, fever, hypercarbia, metabolic acidosis and hyperkalemia. ⋯ A fatal incident of probable malignant hyperthermia in a 13 year old boy is described and evaluated according to a multifactorial clinical grading scale. The value of the in vitro contracture test to diagnose malignant hyperthermia is discussed. Suggestions concerning the treatment of masseterspasm rigidity, an acute episode of malignant hyperthermia, and safe anaesthesia for susceptible patients are presented.