Successful resuscitation after drowning with severe hypernatraemia and prolonged time to return of spontaneous circulation.

We describe the successful resuscitation of a 23-year-old previously healthy man who had drowned. After prolonged submersion, hypothermia, severe hypernatraemia, a prolonged time to return of spontaneous circulation was possible using a combination of extracorporal life support and early continuous veno-venous haemofiltration. This combination of clinical circumstances is rarely associated with positive outcomes, but this case demonstrates the utility of extracorporeal life support and haemofiltration in patients drowned in saltwater.

Intravenous Infusion of Nitroglycerine Leads to Increased Permeability on Dynamic Contrast-Enhanced MR Imaging in Pig Brains.

BACKGROUND AND PURPOSE: It has been suggested that off-label use of transdermal nitroglycerine patches to prevent frostbite may lead to severe acute mountain sickness and ataxia. The aim of this study was to investigate the effect of nitroglycerine on brain vascular permeability by using dynamic contrast-enhanced MR imaging in a swine model. MATERIALS AND METHODS: Eight Danish Landrace-Yorkshire-Danish Landrace pigs of approximately 20-25 kg were scanned with a dynamic contrast-enhanced MR perfusion protocol with and without nitroglycerine intravenous infusion. Compartmental analysis was performed on the basis of the Tofts model, and voxel-based quantitative values of the volume transfer constants from the vascular to the extracellular space were determined. RESULTS: The scan with nitroglycerine infusion resulted in significantly higher volume transfer constant values than values derived from the first scan without nitroglycerine infusion. Increased volume transfer constant values were observed in 6 of 8 animals. CONCLUSIONS: Infusion of nitroglycerine increases the vascular permeability of the swine brain on the basis of the transfer constant estimated from dynamic contrast-enhanced MR imaging.

A mobile system for the treatment of accidental hypothermia with extracorporeal circulation.

When deep accidental hypothermia causes circulatory failure, the best chance of survival is treatment with extracorporeal circulation (ECC) and warming of the blood. This may be difficult to achieve if the patient is first admitted to a hospital without a department of thoracic surgery. Our aim was to test a lightweight mobile system for ECC. The equipment could be transported almost anywhere, making it possible to start ECC on the spot and during transfer. The system was tested on six hypothermic pigs, two of the pigs at the institute laboratory, two of the pigs in a normal ambulance, and two of the pigs in an air force rescue helicopter. All of the pigs were transported back to the institute for warming to normal temperature. After warming, and the ECC stopped, all the pigs were in sinus rhythm and had an obviously satisfactory circulation. It is possible to bring a lightweight ECC system to the unstable patient. Treatment is possible in any hospital, ambulance or helicopter.

The superiority of rectal thermometry to oral thermometry with regard to accuracy.

Electronic oral thermometry is performed routinely in most medical centres. From the studies available on this subject it seems difficult to find any documentation for this practice. We have conducted clinically controlled studies in which the accuracy of electronic oral thermometry (CRAFTEMP and TERUMO WCT) and that of electronic rectal thermometry (TERUMO WCT) were tested. Rectal glass mercury thermometry was used as a reference method. Two studies were designed. In study 1, 184 patients (72 women, 112 men), median age 70 (18-95) years were investigated. In study 2, 91 patients (41 women, 50 men), median age 59 (18-96) years were investigated. Electronic oral thermometry was found unacceptably inaccurate under daily routine conditions. Electronic rectal thermometry was found to be accurate. Calculations of mean temperature difference between reference measurements and test measurements (mean +/- SD) were found to be: routine oral CRAFTEMP at 0.70 +/- 0.50 degrees C, optimum oral TERUMO WCT at 0.75 +/- 0.74 degrees C, routine rectal TERUMO WCT at 0.08 +/- 0.26 degrees C and optimum rectal TERUMO WCT at 0.02 +/- 0.17. In the screening procedure for fever oral thermometry showed low sensitivity (routine CTAFTEMP 0.47 and optimum TERUMO WCT 0.59) whereas rectal thermometry showed high sensitivity (routine TERUMO WCT 0.74 and optimum TERUMO WCT 0.91). It was concluded that rectal thermometry must be preferred to oral thermometry for daily routine measurements.

Prevention of urethral stricture recurrence using clean intermittent self-catheterization.

OBJECTIVE: To investigate the effect of clean intermittent catheterization (CIC) on prevention of urethral stricture recurrence after internal urethrotomy. PATIENTS AND METHODS: Of 55 men who were randomly selected, 43 completed the investigation. Of these, 21 patients performed CIC weekly for 1 year following Sachse's operation for urethral stricture and 22 patients formed the control group after the same operation. All had an objective examination for urethral stricture every 2 months after surgery. RESULTS: Significantly fewer (P < 0.01) patients developed recurrence of urethral stricture within the first postoperative year in the CIC group (n = 4) compared with the control group (n = 15). No CIC complications were seen, and patients who completed the CIC programme considered the method fully acceptable. CONCLUSION: Weekly CIC is a simple method of reducing the frequency of urethral stricture recurrence after internal urethrotomy.

[Use and misuse of an outpatient casualty department]. / Brug og fejlbrug af åben skadestue.

During periods of five weeks before and five weeks after distribution of a pamphlet entitled "Before you go to your doctor or to the casualty department" which was distributed to all households, the patterns of attendance at a casualty department were investigated with subdivision into degrees of indication for attendance. A significant decrease in the number of attendances was observed after distribution of the pamphlet. Patients with lesser indications remained away. It was estimated that at least 56% of the cases could have been treated in the primary sector. 37% of the attendances outside normal working hours were considered as being postponable until daytime.

[Treatment with low-dose vaginal estradiol in post-menopausal women. A double-blind controlled trial]. / Behandling med lavdosis vaginal østradiol hos postmenopausale kvinder. En dobbeltblind kontrolleret undersøgelse.

Twenty-three postmenopausal women with recurrent cystitis were allorted at random to treatment for five months with local oestrogen in the vagina or placebo treatment with the object of assessing the local effect on the vaginal epithelium and on the tendency to recurrent cystitis. The therapeutic group and the placebo group were entirely comparable prior to treatment. In the therapeutic group, the oestrogen index in vaginal scrapings was significantly higher after treatment than in the placebo group (p less than 0.01). The number of positive urine cultures and the patients/satisfaction with treatment wee not significantly different in the two groups.

[Chlamydia trachomatis in at-risk groups in legal abortion in the first trimester]. / Chlamydia trachomatis risikogrupper ved legalt provokeret abort i 1. trimester.

Examination for the presence of C. Trachomatis in the cervix and urethra and bacteriological examination of the cervix were performed in a material of 224 patients for legal abortion in the first trimester of pregnancy. Chlamydia was demonstrated in 8.9% of the patients, Neisseria gonorrhoeae in 0.5% and, in 41%, growth of Gardnerella vaginalis predominated. It proved possible to define a group at risk for the presence of Chlamydia consisting of all the patients under the age of 25 years and nulliparae aged 25-29 years. 17% in this group had positive Chlamydia tests as compared with 1.7% in the patients in other groups. Patients in the above mentioned risk group should be examined for C. trachomatis in cases of legal termination of pregnancy so that appropriate treatment can be administered prior to evacuation.

[Should electronic mouth thermometers be used in routine everyday hospital practice? Usefulness of mouth thermometers]. / Bør elektroniske mundhuletermometre anvendes i dagligt rutinemaessigt afdelingsarbejde?

An oral electronic thermometer was compared with Hg-thermometer used rectally in the daily clinical routine. The rectal temperatures were, on an average, 0.7 degrees C higher than the oral temperatures. In 27% of the cases, the difference between rectal and oral measurement was more than 1 degree C. The variations between the differences of oral and rectal temperature measurement were unacceptable. It is concluded that the precision of oral electronic thermometers was not found to be satisfactory, and employment of this apparatus can not be recommended in daily clinical work.

[JJ-catheters for internal urinary diversion]. / JJ-Katetre til intern urinafledning.

Sixty-four patients with obstruction or lesions of the ureter were, on 115 therapeutic sessions, submitted to internal diversion of urine employing JJ-catheters. Prior to the first treatment, 53% of the patients had been treated with nephrostomy catheters on account of postrenal obstruction. In 12% of the therapeutic sessions, the patients developed pyrexia of over 38.5 degrees C (101.3 degrees F) in the 24 hours immediately after introduction of the catheter. Only few patients had complications in the form of macroscopic haematuria, migration of the catheter, incrustations and perforation of the ureter. It is concluded that JJ-catheters provide a good and gentle method of relieving obstruction in the upper urinary passages. Bacteriological investigation and treatment of urinary infection is recommended prior to introduction of the catheter.

[Examination of young women with recurrent symptoms of cystitis]. / Undersøgelse af yngre kvinder med recidiverende cystitsymptomer.

Fifty women with recurrent symptoms of cystitis (urgent onset of painful and frequent voiding) were extensively examined bacteriologically. All were submitted to intravenous urography, cystoscopy, gynaecological and urodynamic examination and the urine was examined cytologically and by culture. A control group of 10 healthy women were submitted to the same bacteriologic examinations. Only in a few cases did the investigations give an explanation of the condition but, generally, the examination programme did not contribute to the etiology. Chlamydia trachomatis was found in 6%, which was comparable to the normal population. Gardnerella vaginalis must be considered as part of the normal flora. The extensive examination programme cannot be recommended as a routine.

The clinical significance of the genital microbiologic flora at vacuum aspiration following miscarriage.

85 women undergoing vacuum aspiration following miscarriage were studied. At the time of vacuum aspiration, immunofluorescent stainings for detection of C. trachomatis proved positive in 5.9% of the patients. Group B streptococci were isolated in 7.5%, coliforms in 3.5%, and Gardnerella vaginalis in 51% of the patients. The overall frequency of postabortal pelvic inflammatory disease (PID) was 3.5%, whereas 40% of chlamydia-positive women contracted postabortal PID (p less than 0.05). No significant relation between other microorganisms and postabortal PID was observed. The duration of postabortal bleeding was unrelated to the genital microbiologic flora. Based on anamnestic information about previous pregnancies and duration of preoperative bleeding it was possible to define subgroups at risk of harboring C. trachomatis and coliforms. The clinical significance of this is unknown.

Prophylactic one-dose treatment with clindamycin and gentamicin in transurethral prostatic resection. A double-blind placebo controlled study.

One hundred and sixty-eight patients scheduled for transurethral prostatic resection were randomly assigned to treatment either with a combination of clindamycin and gentamycin or with placebo, administered preoperatively as a single bolus infusion. The patients were stratified into a group of 35 with preoperative bacteriuria, and a group of 133 with preoperative sterile urine. Postoperatively the frequency of bacteriuria and bacteriaemia, the maximum body temperature measured, the number of patients with antibiotic therapy instituted, and the duration of hospitalization were significantly lower in the treated than in the placebo group. This applied both to the group with preoperative sterile urine and to the group with preoperative bacteriuria.

Prazosin, an adrenergic blocking agent inadequate as male contraceptive pill.

The purpose of this study was to investigate the efficacy and the acceptability of Prazosin as a male contraceptive pill. Acceptable antifertility drugs for men are proving difficult to produce, and the possibility of using pharmacological agents to block selectively or to inhibit normal sperm transport through the male genital tract is an interesting approach. Prazosin administered in doses up to 10 mg/day did not cause azoospermia following ejaculation. In conclusion, we have not been able to confirm either the efficacy or the acceptability of the alpha 1-adrenoceptor antagonist Prazosin as a male contraceptive drug. Homonnai et al. confirmed the fact that phenoxybenzamine blocks ejaculation, but it should be noted that although both drugs are alpha 1-adrenoceptor blocking agents, they are not chemically identical.

PIP: The efficacy and acceptability of the adrenoceptive-blocking agent, Prazosin, as a male contraceptive pill were investigated in 10 healthy men who had been referred for sexual sterilization. Prazosin was administered by mouth twice a day at a dosage that was increased from 0.5 mg to a maximum of 5.0 mg for an average of 40 days (range 5-110 days). No significant differences were recorded in pretreatment and post-treatment values for semen volume or sperm concentration. Nor were there any significant changes in sperm penetration or motility as a result of treatment with Prazosin. No changes were noted in either blood chemistry or blood pressure. Postejaculation urine collected to detect possible signs of retrograde ejaculation contained no spermatozoa. 5 (50%) of volunteers complained of side effects, including minor vertigo, palpitation, and generalized discomfort. Overall these findings failed to confirm either the efficacy or the acceptability of Prazosin as a male contraceptive drug. Another adrenoceptive antagonist, phenoxybenzamine, has been shown to be an effective antifertility agent without significant side effects at doses as high as 30 mg/day. However, it should be noted that this agent is not chemically identical to Prazosin.