Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Oct 1998
Review[Emotional and cognitive disorders in Parkinson disease].
The majority of patients with Parkinson's disease develop psychiatric symptoms. 40% of the patients suffer from symptoms of depression, severely affecting daily functioning, motor symptoms, cognition, and quality of life for both the patients and their spouses. Antidepressants may alleviate the depressive symptoms, but treatment is complicated by complex pharmacodynamic interactions. Hallucinations, with or without delusions, occur in 15-20% of patients, and are usually caused by dopaminergic treatment. ⋯ Dementia increases with the age at onset and the duration of Parkinson's disease. Subcortical dementia is the most commonly observed syndrome, but symptoms of cortical dementia are also observed. No treatment is available, although cholinergic agents may prove useful.
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Over a period of three years, 378 patients with objectively verified venous thromboembolism were treated at Aker University Hospital. Below the age of 60, men and women had about the same incidence of venous thromboembolism, but that age the incidence was significantly higher among men than among women. Incidence increased exponentially with age, from about 1:10,000 at age 20 to about 1:1,000 at age 50. ⋯ Seven women were on oral contraception, and 22 used postmenopausal hormone substitution. An obvious temporary precipitating factor was present in 42% of the patients, while 36% had a spontaneous venous thromboembolism. Hereditary thrombophilic disorder was found in 32% of patients below the age of 60.
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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.