[Hydrothorax caused by intravasal triple-lumen subclavian catheter]. / Hydrothorax pga. intravasalt beliggende triple lumen-subclaviakateter.

A case in which a patient developed right-sided hydrothorax due to extravasal infusion of total parenteral nutrition (TPN) is reported. The catheter was a triluminal catheter and the tip was shown to be correctly placed in the superior vene cava by x-ray after injection of radio-opaque contrast. The most proximal injection port located 4.5 cm from the tip of the catheter was documented to be sited in the superior mediastinum outside the vena cava. The infusion was given through the proximal port of the catheter. The mechanisms underlying this complication are discussed. The case emphazises the need to control the position of all infusion ports regularly when using central venous catheters with more than one lumen.

[Psychiatric service in Denmark]. / Psykiatriske tilsyn i Danmark.

The aim of the study was to assess the present psychiatric services in somatic departments in Denmark. A questionnaire was sent to all psychiatric departments in Denmark. All questionnaires were returned. During 1996 11,602 adult psychiatric consultations covering 87% of all beds in general hospitals in Denmark were performed. Mean and SD of the consultancy frequency, i.e. consultations/somatic bed/year, were 0.62 (0.34). The consultancy frequency was significantly higher, when the service included somatic emergency rooms or outpatients, or if the consultant performed the consultation together with a team member. Furthermore, it was significantly higher, when the consultant attended treatment conferences at the somatic departments or yielded supervision. The frequency of the psychiatric consultations performed by the staff from the former State Mental Hospitals was half of the frequency of the psychiatric departments at General Hospitals.

Oxygenation and release of inflammatory mediators after off-pump compared with after on-pump coronary artery bypass surgery.

BACKGROUND: In a previous study, we showed that oxygenation was impaired for up to 5 day after conventional coronary artery bypass grafting (CABG). As cardiopulmonary bypass (CPB) may have a detrimental effect on pulmonary function, we hypothesized that coronary revascularization grafting without the use of CPB (OPCAB) would affect post-operative oxygenation and release of inflammatory mediators less compared with CABG. METHODS: Low-risk patients scheduled for elective coronary revascularization were randomly assigned to one of two groups (CABG, n = 17 or OPCAB, n = 18). Two parameters of oxygenation, shunt (%) and ventilation-perfusions mismatch, described as DeltaPO(2) (kPa), were estimated for up to 5 days post-operatively. Systemic release of interleukin (IL)-6, -8 and -10, C-reactive protein (CRP) and neutrophils were measured in peripheral blood samples for up to 3 days post-operatively. The lungs participation in the cytokine response was evaluated from mixed venous blood samples taken within the first 16 h post-operatively. RESULTS: OPCAB was followed by a higher shunt (P = 0.047), with no difference (P = 0.47) in the deterioration of DeltaPO(2) between the groups. OPCAB was followed by an attenuated systemic release of IL-8 (P = 0.041) and IL-10 (P = 0.006), while the release of IL-6 (P = 0.94), CRP (P = 0.121) and neutrophils (P = 0.078) did not differ between the groups. Indications of an uptake of cytokines in the lungs were found after OPCAB. CONCLUSIONS: When comparing OPCAB with CABG, oxygenation was more affected and only part of the systemic inflammatory response was attenuated.

Single-dose spinal anaesthesia versus incremental dosing for lower limb vascular surgery.

BACKGROUND: In patients scheduled for vascular surgery, atherosclerotic disease is highly prevalent. Haemodynamic reactions are often aggravated when spinal analgesia is used in this population. No randomized studies have been conducted comparing single shot (SS) with continuous spinal analgesia (CSA) for vascular patients. We did a prospective randomized study comparing haemodynamics when SS versus CSA was performed. METHODS: Sixty patients were randomized to have SS or CSA. The power of the study was 0.90. Patients in the SS group received 17.5 mg bupivacaine and in the CSA group 5 mg was given initially and incremental doses of 2.5 mg were given until an analgesic level of T-11 was reached. Mean arterial pressures (MAP) were measured invasively. ST-analysis was done continuously. Postoperatively, the patients were interviewed using a standardized questionnaire. Back pain, neurologic sequelae and post-dural puncture headache (PDPH) were investigated. RESULTS: There was no significant difference between the analgesic levels (T-7/T-8), the decrease in MAP, the number of patients needing ephedrine and the total amount of ephedrine given in the two groups. The motor blockade was more pronounced in the SS group (P < 0.001) and the total amount of bupivacaine used was 17.5 mg compared to 7.5 mg (5-17.5) in the CSA group (P < 0.001). One patient suffered PDPH which was slight and responded to a nonsteroidal anti-inflammatory drug. Two patients in each group had transient paraesthesias in the legs. There were technical problems with the spinal catheter in 4 patients, and these were excluded from the study. CONCLUSION: In this study we found no difference in the haemodynamic response to SS or CSA in patients scheduled for vascular surgery of the legs. SS is easier to apply and is recommended when the duration of surgery allows for it.

Patient and relative education in community psychiatry: a randomized controlled trial regarding its effectiveness.

BACKGROUND: Family psychoeducation has a well-documented effect on the short-term prognosis in schizophrenia. Less is known about the effectiveness of shorter programmes with the main focus on information for patients (patient education) or for patients and relatives (family education). METHODS: A randomized study of the effectiveness of an eight-session psychoeducational programme for patients with schizophrenia and for their relatives was conducted in two community mental health centres, in Arhus and Viborg (Denmark). Patient outcome measures were knowledge, relapse, compliance, insight and satisfaction, and relative outcome measures were knowledge and satisfaction. Post-intervention outcome and follow-up evaluation 1 year after the start of the intervention are presented. RESULTS: A statistically significant increase in knowledge of schizophrenia in both relatives and patients was demonstrated at postintervention and a non-significant trend at 1-year follow-up. Statistically significant changes in the Verona Service Satisfaction Scale Scores in the subdimension of satisfaction with Relatives involvement were demonstrated both for patients and relatives postintervention and for patients at 1-year follow-up. There was a tendency that time-to-relapse increased in the intervention group at postintervention and that the schizophrenia subscore of the Brief Psychiatric Rating Scale was reduced in the intervention group at 1-year follow-up. No differences were found between the groups regarding compliance, insight into psychosis, psychosocial function (General Assessment of Function) or in relatives' expressed emotion scores postintervention or at 1-year follow-up. CONCLUSIONS: A short patient and relative education programme seems to be able to influence knowledge and some aspects of satisfaction, but does not seem to be sufficient to influence important variables such as relapse, compliance, psychopathology, insight or psychosocial functioning.