Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Physicians responding to emergency calls on board airliners in intercontinental traffic may not be aware of certain legal complications which may arise. For instance, the medical practitioner may hold a license valid in one country, the air carrier may be registered in another, and the patient may be a third state national. Legislation varies between nations, as do courts decisions. ⋯ Likewise, appraisal and use of medical equipment on board are discussed, as are issues concerning responsibility and liability when equipment is used in supposedly "trained hands". Main themes in the current international medico-legal debate are considered with emphasis on the "Good Samaritan Principle", the responsibility of commercial air carriers, and telemedicine with insurance against law suits. The article concludes with some practical advice to the travelling medical community.
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Recent research has lead to the conclusion that neonates and premature children do experience pain when undergoing painful procedures and that they should receive appropriate analgesics. It has earlier been argued that opioids should not be given to neonates because of their potentially dangerous adverse effects, e.g. respiratory depression and drug dependence. ⋯ Studies show that early pain experiences could have severe long-term effects, including altered sensitivity to pain. These effects appear to be different in neonates born at term compared to premature children.
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Tidsskr. Nor. Laegeforen. · Sep 1998
Case Reports[Cardiopulmonary complications in acute subarachnoid hemorrhage].
Pathologic electrocardiogram (ECG) may be present in more than 90% of patients with subarachnoid haemorrhage. The ECG findings are often transient and may mimic acute myocardial ischaemia or infarction. These ECG findings may cause diagnostic problems in patients with subarachnoid haemorrhage who are unconscious or who have atypical symptoms. ⋯ The myocardial dysfunction known as neurogenic stunned myocardium is reversible if the patient survives the acute phase, but it may lead to haemodynamic instability and contribute to the origin of neurogenic pulmonary oedema. The myocardial injury in subarachnoid haemorrhage may be due to a massive sympathetic stimulation of the myocardium in response to rapidly increasing intracranial pressure. We illustrate myocardial injury and dysfunction in a case report where a patient had subarachnoid haemorrhage with ventricular fibrillation, pulmonary oedema, left ventricular dysfunction and ST-segment elevation, initially thought to be acute myocardial infarction.
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Tidsskr. Nor. Laegeforen. · Sep 1998
Case Reports[Two patients with chlorhexidine allergy--anaphylactic reactions and eczema].
A 14 year-old girl experienced a combined delayed and immediate type of allergy to chlorhexidine. She first developed an eczematous reaction in the face following the long-term application of an antiacne preparation. Use test (repeated Open Application Test, ROAT) on the forearm was positive. ⋯ Prick tests were positive to 0.05% chlorhexidine gluconate and to 0.01% of the acetate solution. A 30 year-old man developed anaphylactic symptoms following treatment with an antiseptic dental gel containing 1% chlorhexidine gluconate. Prick test was positive to the gel and to chlorhexidine gluconate 0.5%.
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Tidsskr. Nor. Laegeforen. · Sep 1998
[Continuous intrathecal infusion of baclofen. A new therapeutic method for spasticity].
Intrathecal administration of baclofen is now generally accepted as a powerful treatment of spasticity caused by spinal lesions. 35 patients with severe spasticity, 29 of spinal origin and six of supraspinal origin resistant to conservative treatment, had a programmable pump (Synchromed, Medtronic) for continuous intrathecal baclofen infusion implanted. The patients were followed-up for an average of 29 months (0-68). The initial effect of the treatment was positive for all patients; spasms were less frequent, there was remission of pain caused by cramps, and in some cases improved ambulation. ⋯ Three patients died of the underlying disease. The majority of patients became accommodated to intrathecal baclofen and it was necessary to administer increasingly larger doses to maintain the clinical effect. Long-term control of spinal spasticity by intrathecal baclofen can be achieved in most patients, but close follow-up is necessary for assessing efficacy and refilling the pump.