Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Cardiogenic shock is a condition associated with high mortality. The evidence base for choice of treatment is insufficient, but new therapeutic options and new understanding have lead to some improvement in the prognosis. A new class of heart failure medication is now approved in Norway (calcium sensitizers). ⋯ A 46-year-old man with cardiogenic shock complicating myocardial infarction because of occlusion of the left-main coronary artery was treated with acute revascularization, intra-aortic balloon counterpulsation (IABP) and levosimendan. Early revascularization is a key factor in the treatment of cardiogenic shock; rapid transfer of patients to a revascularization centre is recommended. IABP should be considered after successful revascularization because of post-ischaemic dysfunction that persists despite restoration of epicardial blood flow. Beta-adrenergic stimulation of the heart should, if possible, be avoided, because of increased myocardial oxygen requirement, calcium overload of the cardiomyocytes, and increased mortality. Drug therapy using calcium sensitizers is promising, but more controlled clinical trials are needed.
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Tidsskr. Nor. Laegeforen. · May 2005
Comparative Study[Characteristics of solo and group practices in Norwegian general practice].
The article describes changes in the size of practices after the introduction of the new Norwegian list patient system for general practitioners (GPs) and how length of patient lists, number of consultations, working hours and waiting time for an appointment vary according to the number of physicians in the practice. ⋯ A lower service production per physician in large practices may partly be an effect of a relatively high proportion of women wanting to work fewer hours than their male colleagues. Irrespective of gender, group practices also attract GPs who want slightly reduced working hours.
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Blunt splenic injuries are increasingly being managed non-operatively. Consequently, radiological examinations in the follow up of these injuries must aim at detecting lesions like pseudoaneurysms that can cause delayed bleeding. Two patients are presented. ⋯ Pseudoaneurysms may not be detected at the initial CT scan and can cause delayed bleeding. Thus it seems wise to perform a CT scan in arterial and venous contrast phase 5-7 days after the injury. Interventional angiography should be offered haemodynamically stable adult patients with serious splenic injury and in the absence of other indications for laparotomy.
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Tidsskr. Nor. Laegeforen. · May 2005
Comparative Study[Deaths from traumatic brain injury in the Nordic countries, 1987-2000].
Traumatic brain injury (TBI) is the major cause of death among young adults in western countries. In the context of a joint Nordic initiative regarding future management of patients with severe TBI, it was of interest to look into the magnitude of the problem and the most recent developments. ⋯ Our findings imply that there are twice as many severe TBIs and related deaths in Finland compared with the other Nordic countries.
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Tidsskr. Nor. Laegeforen. · May 2005
Case Reports[A six-year-old girl with dyspnea following tracheocutaneous repair].
A few patients develop prominent scars combined with persistent fistula after the removal of a long-standing tracheostomy tube. The procedure needed to correct the condition is generally considered minor surgery, normally without any significant complications. We describe, however, a patient who developed a particularly complicated postoperative course. ⋯ Operative treatment of scarring after tracheostomy in which the surgeon also confronts a tracheocutaneous fistula or an opening into the tracheal lumen requires postoperative observation so that any severe complications can be managed.