Criteria for brain death in Denmark.

In 1990, the Danish brain death legislation was adopted by the Danish Parliament. Each year, around 100 patients in Denmark fulfil criteria for brain death/death by neurological criteria (BD/DNC). In this review of current Danish criteria including the indication for ancillary investigation, which in Denmark is digital subtraction angiography (DSA), we conclude that the time has come to revise the national BD/DNC criteria. We propose that visible anoxic-ischaemic encephalopathy on brain CT after cardiac arrest does not require evaluation by ancillary testing, and that CT-angiography can be used instead of DSA.

[Treatment of cardiac arrest in potential organ donors creates ethical conflicts]. / Hjertestopbehandling af potentielle organdonorer skaber etiske konflikter.

This article describes the results of an interview study on the ethical issues related to treating cardiac arrest in potential organ donors in Denmark. The medical background and the Danish guidelines relevant to the issue are described. The results from the interview study are then summarized and analyzed from an ethical perspective in order to clarify the ethical issues and value conflicts experienced by health personnel in this situation. It is recommended that the ethical components in the decision-making process and the dilemmatic nature of the situation are made transparent.

Initial experience with the Codman Certas adjustable valve in the management of patients with hydrocephalus.

BACKGROUND: A new adjustable valve, the Codman CertasTM valve for treatment of hydrocephalus was introduced into clinical practice in January 2011. It has 8 different settings with an opening pressure varying from 36 to over 400 mm H2O at a flow rate of 20 mL/h. The 8th setting is designed to provide a "virtual off" function. The objective of this report is to describe the initial clinical experience with the CertasTM valve and evaluate clinical usage with the main focus on the portable adjustment device - Therapeutic Management System (TMS), the "virtual off" setting and compatibility with magnetic resonance imaging (MRI). FINDINGS: Forty-two patients with hydrocephalus from different etiologies were treated with the CertasTM adjustable shunt system. Data regarding implantation procedures, the use of the TMS system, x-ray imaging, and MRI procedures were recorded prospectively. All patients had clinical follow-up at four weeks after implantation and every three months until a stable clinical condition was obtained.The mean time for follow-up was 8.6 months (1-16.6). Seventy-one adjustments were performed with the TMS, 12 were problematic. Twenty-nine MRI procedures were performed and did not cause accidental resetting. Five patients were treated with the "virtual off" function for a period. CONCLUSIONS: We found the CertasTM valve valuable in the treatment of hydrocephalus, usability of the TMS was high because it is small and portable, but in some cases we experienced adjustment problems with the first procedures performed by a surgeon, indicating that there is a learning curve. The "virtual off" function provided a possibility of treating over-drainage without the need for shunt ligation or other invasive procedures.

Shunting to the cranial venous sinus using the SinuShunt.

INTRODUCTION: A new shunting principle taking advantage of the knowledge of normal CSF dynamics has been developed. EXPERIENCE AND OUTCOME: The shunt has been used in more than 150 patients. The final version has shown a stable function in 45 patients. The physiological shunting principle has an expected and immediate clinical effect. We have not seen any over-drainage and any symptoms or signs of thrombosis or occlusion of the sinus. The ventricular system decreases only slightly. The shunt has been used in children and adults and in all types of hydrocephalus. The shunt can be implanted using local anaesthesia. The implantation in the transverse sinus has proven to be simple and safe.