Acta chirurgica Scandinavica
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Case Reports
Life-threatening hypercalcemia in a case of thyrotoxicosis: clinical features and management. A case report.
Hypercalcemia of thyrotoxicosis is sometimes severe and may mask other symptoms of the disease. A case is presented in which hyperparathyroid crisis was initially suspected. ⋯ After 10 days the patient was normocalcemic on treatment with only antithyroid drugs. At thyroid resection, five months later, four normal parathyroid glands were found.
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The records of 220 consecutive trauma patients admitted to intensive care in the period 1974 through 1982 were reviewed in an attempt to find determinants of early adult respiratory distress syndrome (ARDS). All the patients were considered to be at risk of ARDS and had major fractures without concomitant severe injuries to brain, chest or abdomen. No patient died. ⋯ Chest radiography was indicative of ARDS in 21 cases, but in six it was normal despite hypoxaemia. In the cases with radiographic signs of ARDS there was generally good chronologic correspondence with hypoxaemia. Ventilation with positive end-expiratory pressure may prevent the classic radiographic picture of ARDS with alveolar densities.
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Obscure groin pain was investigated in 250 consecutive patients (including 171 males) with no palpable hernia or previous hernia operation. Herniography revealed nonpalpable but symptomatic hernia in 51% of the male and 21% of the female patients. Among the hernia patients with bilateral pain, 40% had unilateral hernia. ⋯ Further clinical investigations with a broad diagnostic approach gave a treatable diagnosis in 70% of the patients without hernia surgery. Spontaneous improvement occurred during the investigation in 25%, and the cause of groin pain remained unclear in 5% of the patients. Herniography is a valuable diagnostic tool in obscure groin pain and its use is justified at an early stage of investigation. "Blind" exploration can thus be avoided.
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The influence of prophylactic ventilator treatment was evaluated in a porcine model of early adult respiratory distress syndrome (ARDS) induced by endotoxaemia. Sixteen animals, controls, under continuous i.v. ketamine anaesthesia were either mechanically ventilated using intermittent positive pressure ventilation (IPPV; n = 6) with air or breathed air spontaneously (n = 10). Twenty animals under continuous i.v. ketamine anaesthesia and spontaneously breathing air were infused i.v. with E. coli endotoxin (10 micrograms X kg-1 X h-1) over 6 h. ⋯ Animals with IPPV also had an improved survival rate. The beneficial effects of mechanical ventilation on pulmonary gas exchange are not due to changes in extravascular lung water, but are caused by its influence in counteracting terminal airway and alveolar closure. These results indicate that mechanical ventilation, when instituted early in the course of human ARDS induced by septicaemia, might be of potential value in the prevention of severe pulmonary failure and death.
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Two hundred patients who consecutively underwent abdominal vascular surgery were retrospectively studied with regard to early (less than 30 days) postoperative complications. The mortality was 4% after elective surgery and 30% after emergency surgery, which was chiefly for aortic aneurysm. ⋯ Quantitatively, however (length of hospital stay), the foremost complications were local--haematoma, lymph fistula and necrosis in the incisions, especially in the groins. Against this background, the importance of scrupulous technique in vascular surgery is stressed.