Läkartidningen
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The review included randomized controlled trials on patients with chronic obstructive pulmonary disease (COPD) receiving domiciliary long-term oxygen therapy (LTOT). The authors identified six articles concerning four randomized controlled trials but could not perform any meta-analysis due to the heterogenous patient populations and treatments. From these trials they conclude that LTOT improves survival in patients with severe hypoxemia (arterial PaO2 less than 8 kPa) but has no effect in patients desaturating only at night or in patients with moderate hypoxemia. ⋯ A more recently published trial supports the conclusion that domiciliary nocturnal oxygen therapy has no impact on survival in nocturnal desaturation without severe daytime hypoxemia. There is also new evidence that the type of oxygen equipment might have a decisive impact on the quality of life in mobile patients receiving LTOT--improved quality of life with liquid oxygen and poorer quality of life with concentrator and conventional (heavy) gas cylinder. The importance of optimum equipment selection for each patient has been overlooked but merits further investigation.
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New knowledge about accidental hypothermia acquired in recent years may simplify treatment and aid the evaluation of prognosis. Evidence of death or severe collapse due to the feared afterdrop has not been published. Afterdrop is a phenomenon of conductive heat loss. ⋯ In hypothermia the most important differential diagnosis is death. Patients who are cold and could be resuscitated must be differentiated from patients, who are cold because they are dead. Experience from abroad has shown that extreme hyperkalaemia may be a useful diagnostic tool.
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Earlier observations of increased plasma concentrations of immunoreactive calcitonin (32 amino acids) in sepsis and other non-tumorous conditions may be explained by increased secretion of procalcitonin, the 116-amino acid prohormone. At present, the site(s) of origin of procalcitonin in sepsis, the factors regulating its biosynthesis and release, the route(s) of its elimination from blood as well as its biological function(s) are unknown. The rapid increase in procalcitonin concentration in sepsis--in some patients earlier than that of C-reactive protein--and decrease upon successful chemotherapy makes procalcitonin a potentially important biomarker in monitoring patients with suspected or confirmed sepsis.
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The Swedish Armed Forces are presently undergoing the most extensive reorganization and downscaling in their history. In a new set of objectives for the Swedish Armed Forces Medical Service laid down by the Surgeon General, the aim is to provide combat casualty care with a quality on par with that of the civilian, peace-time health care system. This will be achieved by establishing advanced trauma care by specialist physicians and nurses closer to the point of injury, using armoured medical evacuation vehicles, and by introducing new treatment modalities such as intraosseous infusion using hyperoncotic solutions.