[Mortality among victims of traffic accidents with multiple injuries. A descriptive study 1986-1990]. / Mortaliteten hos multitraumatiserede trafiktilskadekomne. Deskriptiv undersøgelse 1986-1990.

In the period 1986-1990, 16,307 patients were injured in road traffic accidents in the city of Odense, Denmark. 251 had multiple injuries according to the definition: AIS > or = 3 in at least two body regions. Overall mortality was 41%, while the mortality in hospital was 20%. 19 patients died within the first 24 hours after admission mainly due to brain damage, while 18 patients died later than 24 hours mainly from complications. These patients also had a higher average age (55 years) than the rest (34 years). The median Injury Sverity Score (ISS) was 26 for the whole series, and 19 for survivors. Median ISS was 59 for patients who were dead on arrival, whereafter it fell to 43 for patients who died within the first 24 hours after admission, with a further decrease to 29 for patients who died after 24 hours. 50% of all serious injuries were located in the thorax, 27% in the brain and 22% in the abdomen. The litterature on the subject is reviewed.

Variation in the binding affinity of warfarin and phenprocoumon to human serum albumin in relation to surgery.

The binding equilibria of warfarin and phenprocoumon with defatted human serum albumin were studied by equilibrium dialysis in 33 mM sodium phosphate buffer, pH 7.4, 37 degrees C. The binding isotherms for both ligands were consistent with binding to two similar and independent sites in the albumin molecule. The binding affinity of warfarin was markedly increased on adding palmitic acid up to palmitate 4 mol per mol albumin and then it decreased. The binding affinity of phenprocoumon varied similarly but to a lesser degree. Serum samples were obtained from 14 patients undergoing knee joint surgery, six consecutive samples from each patient. The binding affinity of warfarin and phenprocoumon added in low concentrations to the serum samples was consistently less than to purified albumin. The binding affinity for warfarin increased slightly with increasing fatty acid concentrations during surgery, but the increase was much less than expected from the in vitro studies. The binding of phenprocoumon in the serum samples was not influenced by changing fatty acid concentration. The binding affinity for both drugs decreased markedly during the three days following surgery.

The influence of tourniquet ischaemia on post-operative degranulation of polymorphonuclear granulocytes.

Degranulation of polymorphonuclear granulocytes following minor surgery and the contributory role of temporary tissue ischaemia in a limb were examined in 22 otherwise healthy patients undergoing elective arthroscopy under general anaesthesia with and without tourniquet. Apart from an increase in lactate levels following tourniquet release there was no difference in complement split product C3d, cortisol, leukocyte or creatinine kinase levels between the two groups. There was a post-operative increase in the plasma E alpha 1-proteinase inhibitor concentration, whereas lactoferrin values decreased 4 h following tourniquet deflation. Anaesthesia and minor surgery are followed by post-operative release of polymorphonuclear neutrophil elastase. This release is not related to complement activation and is apparently unaffected by 50 min of lower limb ischaemia. Anaesthesia and minor surgery do not cause lactoferrin release.

[Accidents with power chain saws]. / Ulykker med motorkaedesave.

During the three-year period 1987-1989, 80 persons were registered with lesions following accidents with chain saws. The information in the casualty department records was supplemented by an interview questionnaire. Sale of chain saws increased from the middle of the nineteen eighties although no appreciable increase in the number of accidents was registered. One of the reasons for this may be the legislation concerning safety equipment which was introduced in the middle of the nineteen eighties. Further efforts are still required to reduce the number of accidents. On the basis of the results of the investigation, the following suggestions are made: 1. Written information about personal protective equipment should be issued to every purchaser of a chain saw. 2. An informative campaign about the correct use of the chain saw and the personal protective equipment. 3. Compulsory issue of personal protective equipment in connection with hire of a chain saw. 4. Safety gloves should be included in the safety requirements.

Evaluation of intensified prehospital treatment in out-of-hospital cardiac arrest: survival and cerebral prognosis. The Odense ambulance study.

During a period of 3 years three different types of emergency medical service (EMS) systems were evaluated in a city with about 238,000 inhabitants/population density of 570/km2. Included were 393 out-of-hospital cardiac arrest patients in whom prehospital cardiopulmonary resuscitation was provided by personnel on basic, intermediate, or advanced care training. When ordinary ambulances (basic EMS) were used, 8 (5%) patients were discharged alive. When ambulances with specially trained paramedics (intermediate EMS) were used, 2 (1%) patients were discharged. Finally medically staffed ambulances with doctors collaborating (advanced EMS) were used, and 11 (13%) patients were discharged. The intermediate EMS system was used in another area with 45,000 inhabitants/population density of 340/km2, and in this area 20 (18%) patients were discharged. Among the survivors a psychological assessment in form of a test for dementia was assessed in long-term survivors (n = 30) together with 28 patients surviving acute myocardial infarction and 11 control persons. The results of the investigation demonstrate that the more intensive the prehospital treatment of out-of-hospital cardiac arrest, the more patients survive and the more patients survive with good cerebral function. However, the ambulances with specially trained paramedics were only effective in the area with 340 inhabitants/km2.

[Prehospital treatment. The Odense ambulance project. A prospective study]. / Praehospital behandling. Ambulance-projektet Odense. En prospektiv undersøgelse.

No legislation exists about ambulance services in Denmark. The present Danish prehospital treatment is undertaken by Falcks Redningskorps A/S and the municipal fire services. During a period of 12 months (1.2.1988-31.1.1989) a prospective investigation was carried out in Odense concerning the effect of medical support to the ambulance service, partly in the form of a medically staffed ambulance, partly in the form of an arrangement in which an independent doctor's car (rendez-vous arrangement) was sent together with the nearest ambulance. In addition, the heart ambulance model as recommended by the Danish National Board of Health was also tested. Experience from abroad and recent Danish trial arrangements demonstrate the positive effect of extended professional prehospital treatment. The authors consider, therefore, that an ambulance law is required as this would ensure better and more uniform prehospital treatment in Denmark. Planning of the future prehospital treatment of acute and injured patients including the extent of the training, equipment and treatment must be established on the basis of a healtheconomical assessment of the Danish arrangements.

[Out-of-hospital heart arrest. Prospective study of various types of expanded prehospital treatment in Odense]. / Hjertestop uden for hospital. Prospektiv undersøgelse af forskellige typer af udvidet praehospital behandling i Odense.

During the period 1.2.1988-31.1.1989, a prospective investigation was undertaken of the intensive prehospital treatment in Odense. Comparison was undertaken between a medically staffed ambulance (2 months), a motorized doctor (rendez-vous, model 4 months) and the heart ambulance (recommended by the Danish National Board of Health (6 months]. Out of 28 patients brought in by the medically staffed ambulance, two (7%) were discharged alive. Out of 57 patients brought in the phase with the motorized doctor nine (16%) were discharged alive. Out of 78 patients brought in by heart ambulance one (1%) was discharged alive. The results of this investigation reveal that the prehospital treatment of cardiac arrest in Odense can be improved by participation of a doctor in the treatment, (particularly the rendezvous model). Suggested improvements consist of 1) improved alarm system, 2) intensification of training laymen in treatment of cardiac arrest and 3) increased information to the population.

[Intensified prehospital treatment of heart arrest increases the number of survivors with good cerebral function]. / Intensivering af praehospital hjertestopbehandling øger antallet af overlevende med god cerebral funktion.

Psychological assessment in the form of a test for dementia was carried out in 69 individuals. Thirty of these were survivors of cardiac arrest outside hospital. Seven of these were brought to hospital in ordinary emergency ambulances, 14 in heart ambulances and nine in medically staffed ambulances. In addition, 28 patients with acute myocardial infarction (AMI) and 11 control persons were examined. The result of the investigation demonstrates that the more intensive the prehospital treatment of cardiac arrest, the more patients survive with good cerebral function. In particular, the percentage of cerebral damage was least in cases where a medically staffed ambulance was employed.

Selection of amputation level in ischemia. Skin blood flow and perfusion pressure equally predictive.

In 33 patients who had major amputation for ischemia of the lower extremity, skin blood flow and perfusion pressure were compared in terms of prediction of amputation level. Skin blood pressure was measured photoelectrically. Only the blood flow was known to the surgeon. The primary amputation was performed below the level of the knee in 15 patients, through-knee in 14, and above the knee in only 4 patients. Primary healing was achieved in 27 patients, 5 patients had delayed healing at the same level, and 1 patient was reamputated. The same amputation level was predicted in 24 patients (primary healing/secondary healing/failure = 20/3/1) and a different one in 9 patients. In 4 patients the perfusion pressure suggested a more proximal amputation (2/2/0) and in 5 patients a more distal amputation (all primary healing). There was no difference between the two methods in predicting wound healing.

[Hidden statistics of traffic accidents]. / Faerdselsuheldsstatistikkens daekningsgrad.

Only 19% of the 3,071 injured persons who were treated in the casualty department of Odense Hospital following traffic accidents in 1987 could be found again in the police registers of traffic accidents from the same region. All of the registrations from the police registers from the central region could be found again in the casualty department. In 1971, the corresponding coverage was 36%. The degree of coverage is particularly low for single bicycle accidents, other bicycle accidents, other single accidents and the hours immediately after midnight. Considerable disagreement exists concerning registration of the use of safety belts and crash helmets. In Odense, the municipal road authorities utilize the localization of the accidents reported by the casualty department. The decrease in the degree of coverage is due mainly to an increasing proportion of bicycle accidents. Where casualties require admission to hospital, the coverage is approximately 75%. This has remained unchanged throughout the years and it is therefore suggested that this proportion should be employed as indicator of the effect of the majority of prophylactic measures. In addition, proposals are made for simplification of the police registration forms.

[Cardiac arrest outside of hospital. A retrospective study in Odense]. / Hjertestop uden for hospital. Retrospektiv undersøgelse i Odense.

During the period 1.10.1986-30.9.1987, all patients with cardiac arrest outside hospital brought to the casualty department in Odense Hospital were registered. Out of 160 patients, 133 (83%) could be primarily resuscitated, 19 (12%) were resuscitated but died later in hospital and eight patients (5%) were resuscitated and could be discharged alive from hospital. Out of the eight patients who were discharged alive, only two (1%) had retained reasonable cerebral function as assessed by dementia testing. Treatment of the cardiac arrest prior to the arrival of the ambulance, duration of the cardiac arrest for less than six minutes and staffing of the ambulance with three first-aid men were factors of decisive importance for survival of the patients. The results of this investigation demonstrate that treatment of cardiac arrest outside hospital is unsatisfactory. Proposals for improvement of treatment include: 1. Information to the population. 2. Training of first-aid staff in treatment of cardiac arrest. 3. Quicker arrival of ambulances and 4. Better staffing and training of ambulance staff in the use of a defibrillator possibly with participation of a doctor.

Bone formation induced in an infant by systemic prostaglandin-E2 administration.

We report a case of long-term systemic administration of prostaglandin E2 (PGE2) to a newborn infant with ductus-dependent congenital heart disease. After 46 days of treatment, radiography showed cortical hyperostosis of the long bones. The child died 62 days after discontinuation of prostaglandin treatment. Histologic examination of tubular bones showed hyperostosis presumably due to prostaglandin-induced rapid formation of primitive bone. The additional finding of extensive resorption of the outer cortical surface and bone formation at the inner surface suggested a reversible phase after discontinuation of treatment.

Myoglobin release after tourniquet ischemia.

The concentration of myoglobin in plasma was assessed before and up to 68 hours after tourniquet release in 27 patients who underwent elective operations with no incision into skeletal muscle. The duration of ischemia was 1-3 hours. A control group underwent the same kind of surgery without the use of tourniquet. There was a minimal elevation in myoglobin values after 65 and 90 minutes of ischemia, and a marked elevation after more than 150 minutes of ischemia. Maximum values were reached 8 to 10 hours after tourniquet release, and preoperative values after 50 to 60 hours.