Validation of the PHEEM instrument in a Danish hospital setting.

The Postgraduate Hospital Educational Environment Measure (PHEEM) has been translated into Danish and then validated with good internal consistency by 342 Danish junior and senior hospital doctors. Four of the 40 items are culturally dependent in the Danish hospital setting. Factor analysis demonstrated that seven items are interconnected. This information can be used to shorten the instrument by perhaps another three items.

[Ultrasonically guided intraperitoneal catheterization for ascites drainage or intraperitoneal chemotherapy]. / Ultralydvejledt anlaeggelse af intraperitonealt kateter til ascitesdraenage eller intraperitoneal kemoterapi.

A new method for drainage of ascites is presented: ultrasound guided intraperitoneal catheterization. Forty-six drainages were performed in 17 patients. The duration of drainage was from one to 12 days. Two patients had slight complications during drainage. Puncture was easily done even in cases of difficult or impossible conventional puncture. The method provided very effective drainage. Further, we present ultrasound guided intraperitoneal catheterization for chemotherapy in ovarian cancer. In eight patients 51 catheterizations were performed. Three punctures were primarily unsuccessful, but successful on the second attempt. There were no complications in these or in other cases.

[Adenomyomatosis vesicae felleae]. / Adenomyomatosis vesicae felleae.

Adenomyomatosis of the gall bladder is a condition of benign hyperplasia of unknown etiology. Characteristic of the condition is local or diffuse thickening of the muscular layer with invagination of the epithelium forming the so-called Rokitansky-Aschoff's sinus. The prevalence is unknown. In a prospective autopsy material, localized adenomyomatosis, adenomyoma, was found in 7%. This is considered to be the lowest value for the prevalence in the older age groups. Cholecystography and cholecystectomy materials show varying frequencies of adenomyomatosis, 2-33%. There is no definite proof that adenomyomatosis is a symptom-producing condition but several studies suggest that it may be and that in selected cases it may be treated by cholecystectomy. Selection depends upon the duration and severity of the symptoms. Routine diagnosis may be made with the aid of ultrasonic scanning. In more obscure cases with symptoms from the biliary tract, oral cholecystegraphy may be recommended possibly including exposures after a meal rich in fats or after administration of cholecystokinine.

[The post-thrombotic syndrome. Description and comparison of diagnostic methods: clinical examination, venous return time, phlebography and ultrasonography]. / Det posttrombotiske syndrom. Beskrivelse og sammenligning af diagnostiske undersøgelsesmetoder: Klinisk undersøgelse, venøs returtid, flebografi og ultralyd.

Thirty-one patients with deep vein thrombosis (DVT) confirmed by phlebography 5-11 years previously were examined for the post-thrombotic syndrome (PTS). Where all of the patients were concerned, the examination included crossing-off of their symptoms of PTS on a special chart and clinical examination carried out by four doctors independently of one another, for 29 patients also determination of the venous return time by strain gauge pletysmography and for 29 patients also secondary phlebography (SF) and B-method ultrasonic scanning (UL). The degree of severity of PTS was determined by means of a scoring value which was calculated on the bases of four observers assessment of the clinical symptoms and findings. Significant differences were found for the clinical scores for legs with and without previous DVT, which shows that the method is of value despite a not inconsiderable interobserver variation. In the form employed here, pletysmography was found unsuitable for quantitating of PTS. In 60% of the patients, agreement was present between the clinical assessment, SF and UL. The necessity of agreement both as regards the diagnostic clinical criteria and as a measure for the degree of severity of PTS is emphasized. UL is recommended as a screening investigation for changes after DVT. Phlebography is only considered to be indicated in cases where detailed knowledge of the anatomical conditions is desired e.g. prior to venous surgery.

Computed tomography in the assessment of seizure-induced supratentorial neuron loss.

Epilepsy patients develop atrophy of the hippocampus and the cerebellum. Because reports exist, in which diffuse atrophy of the CNS of epilepsy patients is mentioned, we wanted to investigate if computed tomography (CT) can demonstrate a decrease of the cerebral volume correlated with the length of time during which the patients have had seizures. We measured the bifrontal ratio, the bicaudate ratio, the lateral ventricular brain ratio, and the sylvian fissure ratio of the CT images of 124 neurologically intact patients with a duration of epilepsy from 3 months to 39 years. Multiple regression analysis revealed no correlation between the CT indices and the seizure types or the time elapsed from the first seizure to CT. The well-known decrease of the CT measures with advancing age was confirmed: among the women by all four measurements; the men only exhibited significant increases of the sylvian fissure and the bicaudate ratios. If diffuse cerebral atrophy occurs as a complication of epilepsy, it does not reach a degree, which allows it to be visualized by CT.