Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Dec 2005
Biography Historical Article[Neurosurgery in antique medicine].
Trepanation and craniotomy are two of the oldest surgical procedures known, and extensive archaeological evidence of trepanation exists in ancient cultures. However, the first descriptions of the surgical techniques are from Greek and Roman medicine, where cranial surgery was used to treat head trauma. This article concerns neurosurgery in ancient medicine, with an emphasis on "De Medicina" by Aulus Cornelius Celsus (25 BC-50 AD) and the Corpus Hippocraticum (about 400 BC). These texts are further considered in the light of excavated surgical instruments from Pompeii.
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Tidsskr. Nor. Laegeforen. · Dec 2005
Review Comparative Study[Alternative emergency interventions in adult mental health care].
The objectives of this study were to review the literature on alternatives to traditional treatment of acute mental disorders and to describe the effects of these interventions. The main emphasis is on crisis resolution teams (CRT) because there are governmental plans to implement these in all Norwegian community mental health centres. ⋯ The identified alternative interventions were: emergency residential/domestic care, emergency day centres, and crisis resolution teams (or assertive/out-reach/mobile crisis teams). Studies of acute day hospitals showed that this treatment is associated with reduced hospitalisation, faster recovery and reduced costs compared with treatment in traditional hospital acute wards. Because of insufficient research, it was not possible to draw conclusions on the effects of residential or domestic care. We identified six randomized controlled studies and four quasiexperimental studies of Crisis Resolution Teams. These studies indicate that Crisis Resolution Teams or other forms of assertive homebased mobile/outreach treatment, is an acceptable alternative to hospitalization for many patients. The clinical effect of such treatment seems to be comparable with traditional treatment, and are associated with reduced hospitalizations and rehospitalizations, and with reduced costs. None of the reviewed treatment can replace traditional acute hospital treatment. Although studies of alternatives to acute hospitalization have congruent results, there are few studies and methodological weaknesses make it difficult to draw firm scientific conclusions about the effect of such interventions.
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Tidsskr. Nor. Laegeforen. · Nov 2005
Comparative Study[Postoperative cardiovascular complications].
It has been estimated that up to 25% of non-cardiac surgical procedures carry a significant risk of perioperative cardiovascular morbidity and mortality. A thorough preoperative evaluation with subsequent relevant diagnostic or therapeutic action can reduce the risk of postoperative complications in high-risk patients. The purpose of the present study was to compare clinical practice in a medium-sized Norwegian hospital with international recommendations regarding perioperative evaluation and care. ⋯ The registration indicates that there is a potential for improving clinical practice in order to reduce the number of postoperative complications.
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Tidsskr. Nor. Laegeforen. · Nov 2005
Comparative Study[Carotid endarterectomy in patients with coronary heart disease].
Patients with coexistent coronary and carotid artery disease are at high risk of developing stroke following coronary artery bypass grafting (CABG) and at the same time at increased risk of myocardial infarction when subjected to carotid endarterectomy (CEA). In patients with pronounced symptoms from both vascular territories, some institutions advocate a combined approach, with both CABG and CEA performed during the same period of anaesthesia. ⋯ Patients with coexistent atherosclerosis of the coronary and carotid arteries who underwent the combined procedure seem to have the same perioperative risk as patients with coronary artery disease who underwent isolated CEA, in spite of the fact that the former had a more generalised atherosclerotic disease.
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Tidsskr. Nor. Laegeforen. · Nov 2005
Case Reports[Fluid management and the risk of cerebral oedema in children with diabetic ketoacidosis].
Cerebral oedema is a rare but life-threatening complication of diabetic ketoacidosis in children. ⋯ Intracellular swelling of the brain seems to be caused by water moving along osmotic gradients. In diabetic ketoacidosis, sodium and glucose are the dominant osmotic forces. It is important to understand the relation between serum osmolarity, sodium and glucose, as appropriate fluid treatment might prevent this potentially fatal complication.