Ugeskrift for laeger
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Ugeskrift for laeger · Feb 2018
Review[Osteosynthesis of rib fractures, unstable chest wall, pseudoarthroses, and acquired defects of the chest wall].
Several patients suffer from rib fractures after traumas, and in severe cases it can be life-threatening. Until recently, attempts to perform surgical fixation in patients with instability have been unsuccessful. Chronic non-union causes persistent pain, disability and loss of quality of life. Implementation of surgical stabilization of rib fractures with tailored plates seems to improve pain relief, especially in cases of non-union but also in patients with instability of the chest wall after severe traumas, where advanced pain treatment (epidural catheter) is insufficient or weaning off fails.
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Chronic pulmonary aspergillosis (CPA) is an overlooked disease category in which delay of diagnosis and treatment is associated with increased mortality. A prerequisite for prognostic optimization of CPA is an increased focus on predisposing factors and patients at risk. Diagnosis of CPA is challenging and requires a systematic approach to assessment and interpretation of findings, both of which are necessary for correct disease classification and selection of targeted antifungal treatment and duration.
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Slipped capital femoral epiphysis (SCFE) is a serious orthopaedic hip disease in the adolescent population. It has a prevalence of 10.8 per 100.000 children and usually occurs in children 9-16 years of age. ⋯ An adolescent complaining of stress-related pain in the hip, groin, thigh or knee should be suspected of having SCFE, until an X-ray has excluded this diagnosis. Delayed diagnosis may have serious consequences in terms of further displacement of the femoral head and risk of increased avascular necrosis.
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Patients surviving severe critical illness commonly develop post intensive care syndrome (PICS). The syndrome consists of a constellation of cognitive dysfunction, depression, anxiety and post-traumatic stress disorder combined with physical weakness. ⋯ Furthermore, close family members of the patient are at risk of developing similar psychiatric manifestations. Focus should be on early preventive measures during hospitalization and post-ICU follow-up with a multidisciplinary approach.
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Ugeskrift for laeger · Oct 2017
Review[Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital refractory cardiac arrest].
Out-of-hospital cardiac arrest is associated with high mortality and morbidity. Treatment options remain few in refractory cases, but extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly applied to improve the outcome. This article summarizes the use, experience and outcome of eCPR focussing on current knowledge of criteria for selection of relevant patients for treatment.