Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Mar 2000
Review Comparative Study[Use of angiotensin II receptor blockaders in heart failure].
Angiotensin converting enzyme (ACE) inhibitors and diuretics represent the first line of therapy in patients with symptomatic heart failure. Inhibition of angiotensin II production is, however, incomplete with ACE inhibitors, due to non-ACE dependent conversion pathways. Moreover, some patients are intolerant to ACE inhibitors due to side effects or renal insufficiency. ⋯ Reduced morbidity and mortality have also been found with losartan treatment, as compared to the ACE inhibitor captopril. This paper discusses the role of angiotensin II receptor blockers in the treatment of heart failure. Some results from published studies and a short description of ongoing trials are presented.
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This article presents the new guidelines for resuscitation of the newborn from the European Resuscitation Council. It is estimated that, potentially, 800,000 newborns can be saved each year by simple airways manoeuvres. Personnel trained in basic resuscitation should be present at all deliveries and personnel trained in advanced resuscitation at deliveries with known risk factors. ⋯ Chest compressions--1/3 of the anteroposterior diameter of the chest--should be provided if the heart rate is absent or remains < below 60 per minute despite adequate assisted ventilation for 30 seconds. Chest compressions should be coordinated with ventilation at a ratio of 3:1 and a rate of 120 "events" per minute to achieve approximately 90 compressions and 30 rescue breaths per minute. Adrenalin should be given if the heart rate remains below 60 per minute despite 30 seconds of effective ventilation and chest compression.
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Animal experiments suggest that hyperproduction of nitric oxide (NO) by the inducible isoform of the enzyme NO synthase (iNOS) may contribute to hypotension, cardiodepression and vascular hyporeactivity in septic shock. Lipopolysaccarides and cytokines, like tumor necrosis factor, interleukin-1 and interferon-gamma, have been shown to induce iNOS in the endothelium, vascular smooth muscle cells, macrophages and different parenchymal cells. In several animal models of septic shock, treatment with inhibitors of NO synthesis has been shown to improve haemodynamic variables and survival. ⋯ The aim of this review is to discuss the role of NO in sepsis and the potential therapeutic implications of NO as a target in treatment of human septic shock. We emphasize that many septic patients have preexisting endothelial dysfunction or lung diseases, which may predispose to severe adverse effects during systemic inhibition of NO synthesis. We also focus on the lack of direct evidence for iNOS expression in human septic shock and on the discrepancy between animal and human data.
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Accidental human injury due to ionizing radiation is rare. Industrial accidents are comparatively the most common. Life saving procedures should always have priority to any concern about radiation injury or contamination. ⋯ Damage to the bone marrow and gut are the most important. Local radiation injuries to the hands are common in industrial accidents. The Norwegian Radiation Protection Authority should always be called when a potential ionizing radiation accident takes place within Norway.
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This article deals with the phenomenon of hope in seriously ill and dying patients. Uncertainty is seen as a prerequisite for hope, fear as the "negative" side of hope. A scheme involving three particular kinds of hope is introduced: Hope on a daily basis; hope concerning a possible eternity; and hope based upon unrealistic premises. ⋯ It should be directed against the physical aspects of the disease, as well as the psychological, social, spiritual and existential dimensions of life. There are two fundamental questions patients with terminal cancer disease almost always ask: "Will the disease eventually cause my death?"; and, "Am I going to experience great pain and suffering?" These questions are clearly marked by hope. The hope that there will be little pain, for example, may not only relate to physical pain but to psychological and social pain as well.