Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · May 1997
Case Reports[Anaphylactic reaction to N-acetylcysteine after poisoning with paracetamol].
Paracetamol is among the most common substances consumed in self-poisoning attempts. The recommended treatment is intravenous N-acetylcysteine. Adverse reactions to this treatment are relatively common, but are rarely serious. ⋯ This reaction was most probably an acute toxic effect of N-acetylcysteine, and not a result of an immunologic hypersensitivity reaction. Reducing the infusion rate of the initial loading dose might reduce the risk of adverse reactions. Recent guidelines recommend giving the loading dose over 60 minutes, instead of 15 minutes.
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Tidsskr. Nor. Laegeforen. · May 1997
Case Reports[Practical problems associated with long-term opioid therapy].
Long-term opioid therapy results in physical dependency. Therefore abrupt cessation of opioid treatment may cause acute abstinence symptoms. The doses of opioids should always be reduced gradually, even when other treatment options give good pain relief. ⋯ Inappropriate use of naloxone in these patients can also result in acute abstinence symptoms. Opioid treatment is limited by toxic side effects, and the problem can be solved by changing the opioid. The author describes three cases to illustrate these problems.
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A common sign of distal small fibre neuropathy is dysesthesias, especially burning sensation distally in the extremities. These symptoms are often difficult to treat with conventional analgesics. In the course of the disease, the patient may become less sensitive to pain and changes in temperature, but clinical signs may nevertheless be minor and often difficult to detect by clinical examination. ⋯ Common causes are diabetes mellitus, alcoholism, and amyloidosis. Abnormalities in small diameter fibres may be detected by quantitative sensory testing of temperature and pain thresholds, and by autonomic tests. We describe four patients with polyneuropathy with a predominance of small fibre involvement.
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Tidsskr. Nor. Laegeforen. · Apr 1997
Comparative Study[Expectations from a system of personal general practitioners. A questionnaire study among general practitioners in the municipality of Bergen].
Four municipalities in Norway have tested out a system of personal general practitioners, where all inhabitants aged 12 or more could choose their personal doctor. The doctor's responsibility, work-load and economy were determined by his/her specified list of patients. ⋯ Data from the survey indicated that a larger share of women than men had low expectations concerning a system of personal general practitioners. Only 19 out of 101 general practitioners were positive to introducing such a system.