Ugeskrift for laeger
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Ugeskrift for laeger · Jun 2005
[Fibrinogen substitution. Use in the treatment of bleeding due to lack of fibrinogen].
Fibrinogen is critically important in haemostasis. The concentration of fibrinogen in plasma is usually between 2 and 4 g/l (6-13 micromol/l). ⋯ Acquired fibrinogen deficiency may occur with a variety of underlying pathologies. Fibrinogen substitution may be done with fresh-frozen plasma, cryoprecipitate and virally inactivated concentrates of fibrinogen.
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The aim of this study was to describe the cholecystectomy rate in Denmark in the last 15 years, since the introduction of laparoscopic cholecystectomy might have had an influence on it. ⋯ The increasing cholecystectomy rate in Denmark from 1989 to 2003 is probably due to the fact that more patients are having surgery for painful gallbladder stones.
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The aim of the study was to describe the treatment of gallstone pancreatitis in Denmark and to compare it to the recommendations given in the National Reference Programme for the treatment of patients with gallstone disease. ⋯ In agreement with the recommendations given in the National Reference Programme, the majority of Danish surgical departments used laparoscopic cholecystectomy in the treatment of patients with gallstone pancreatitis who had not undergone ERCP with sphincterotomy. To avoid the high recurrence of gallstone pancreatitis, laparoscopic cholecystectomy during the same admission is recommended. This recommendation was, however, followed by less than half of the surgical departments.
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Ugeskrift for laeger · Jun 2005
[Effect of laparoscopic cholecystectomy on the quality of life of patients with uncomplicated socially disabling gallstone disease].
The indication for cholecystectomy in symptomatic, uncomplicated gallstone disease varies in the literature, and there is no international consensus. In Denmark, laparoscopic cholecystectomy is recommended for patients with uncomplicated cholecystolithiasis and socially disabling pain. Postoperative health-related quality of life on this indication is unknown. ⋯ Laparoscopic cholecystectomy improves the health-related quality of life six weeks after the operation in patients with socially disabling, uncomplicated cholecystolithiasis.
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The characteristics of early pain after laparoscopic cholecystectomy are complex and should be treated in a multimodal fashion. A critical procedure-specific analysis of the evidence suggests a prophylactic analgesic regimen including routine use of preoperative steroids, incisional local anaesthetics and NSAIDs (or COX2-inhibitors) combined with paracetamol for three to four days. Minor modifications of surgical techniques (low insufflation pressure and downsizing of trocars) and preoperative information about the characteristics of early pain after laparoscopic cholecystectomy will add further analgesic benefits to the regimen.