Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Preeclampsia is characterized by hypertension and proteinuria with or without oedema. ⋯ We focus on early signs and close clinical surveillance. The diastolic blood pressure should be estimated with Korotkoffs' phase V. Patients with early onset preeclampsia should be hospitalized, as should women with hypertension and newly developed proteinuria. Antihypertensive treatment is discussed. Cases with reduced fetal growth and those with severe preeclampsia should in most cases be delivered preterm. Vaginal delivery is preferable. Labour may be induced by oxtocin, following cervical prostaglandin stimulation as indicated. In such cases cardiotocography surveillance during labour should be performed. Caesarean section may be performed in selected cases. Patients with mild preeclampsia can await spontaneous vaginal delivery at term, but delivery should be induced if they proceed past term.
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The HELLP syndrome (H = hemolysis, EL = elevated liver enzymes, LP = low platelets) is a pregnancy complication which affects 10-20% of cases of severe preeclampsia. ⋯ A mother with a classic HELLP syndrome should be delivered after stabilisation of the clinical condition. A partial HELLP syndrome can be observed. Treatment with corticosteroids is beneficial.
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Tidsskr. Nor. Laegeforen. · Apr 2000
Case Reports[Intracranial aneurysms associated with cerebral arteriovenous malformations].
Patients known to harbour a cerebral arteriovenous malformation that is inaccessible to therapy may have a second bleeding into the subarachnoid space, but from another source. ⋯ Patients harbouring an intracranial arteriovenous malformation are much more likely to develop an associated intracranial aneurysm than patients without such malformations, and a second bleeding in these patients will more often arise from the associated aneurysm. The cause of the frequent association of an aneurysm is probably haemodynamic stress due to the increased blood flow through the feeding artery. These patients suffer subarachnoid haemorrhage more often than patients with either an aneurysm or a malformation alone. The therapeutic strategy should be carefully individualized and the aneurysm should more often have priority.
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Tidsskr. Nor. Laegeforen. · Apr 2000
Biography Historical Article[Alexander Pushkin's duel--biographic and medical aspects].
The great Russian poet Aleksandr Pushkin (1799-1837) died 46 hours after being wounded by a pistol shot in a duel. The bullet penetrated the right pelvic bone, continued through the lower abdomen, and crushed the right part of the sacral bone. Biographical events leading to the duel are presented in the article, which also reviews articles in Russian medical journals describing the extent of the trauma and discussing the treatment possibilities at the time of the duel as well as present-day treatment. It is concluded that death was caused by peritonitis and that only modern extensive abdominal and orthopaedic surgery combined with antibiotic treatment could have saved the poet's life.