Clinical experience with the saphena loop arteriovenous fistula on the thigh.

The increasing number of patients on regular dialysis treatment (RDT) for many years produces a number of problems, one of which is the vascular access procedure. When the internal subcutaneous fistula cannot be used either as the first procedure or after some years of treatment, alternative methods are necessary. We present here clinical experience with the saphenous vein arteriovenous fistula placed on the upper thigh in 8 patients. The function was insufficient with a flow rate of about 125 ml/min and the complication rate was very high with development of 5 haematomas, 1 thrombosis and 1 case of severe oedema. Far more serious, however, the recording of 2 fatal external bleeding episodes. According to the literature, clinical experience with this procedure is very limited in other centres. From our experience we would not recommend this procedure and from the 2 fatal bleeding episodes we would question the placement of any fistula on the upper thigh unless absolutely necessary.

[Attitudes to cholesterol measurement and intervention among general practitioners in Bornholm]. / Holdninger til kolesterolmåling og -intervention hos praktiserende laeger på Bornholm.

In 1985 an explanatory report was published about investigation and treatment of hyperlipidaemia. This report, together with a consensus report published subsequently, formed the background for a nationwide cholesterol campaign. The attitudes of general practitioners to measurement of cholesterol and intervention must be considered to have decisive influence on performance of the goal of the consensus report, viz, reduction of the incidence of ischaemic heart disease (IHD). By means of a nine-page questionnaire, an attempt was made to assess the attitudes to measurement of cholesterol and intervention among the general practitioners on Bornholm. Out of the 35 questionnaires sent, 27 were returned (77%). Just under 40% of the general practitioners would screen all men aged between 20 and 59 years. Approximately 25% would screen women in the same age group. Opinions were unanimous about screening patients with diabetes, hypertension or IHD. Attitudes towards intervention were, by and large, in agreement with the cholesterol limits recommended in the explanatory report. In general, the general practitioners had well balanced attitudes towards tracing and treatment of individuals with raised serum cholesterol with relevant consideration of cholesterol as an important risk factor in the development of IHD.

[Prognostic value of ECG on admission in patients with acute myocardial infarction]. / Prognostisk vaerdi af indlaeggelses-ekg hos patienter med akut myokardieinfarkt.

The initial ECG in acute myocardial infarction (AMI) was assessed in relation to the mortality during hospitalization and development of acute complications endangering life in 405 cases of AMI (345 patients) admitted during a period of three years. The initial ECG recordings were grouped as "positive" or "negative" according to meticulously defined criteria based on the morphology of the QRS complex, deviations of the ST segment and the polarity of the T waves. The ECG recordings were "positive" in 298 cases (86.4%) and "negative" in 47 cases (13.6%). The mortality during hospitalization in the group with "negative" ECG records was definitely lower than in the group with "positive" ECG records (p less than 0.001, chi 2 = 13.99). On the other hand, no definite differences were observed when the initial ECG was compared with the incidence of arrhythmias endangering life (ventricular fibrillation, ventricular tachycardia, asystoly and 3 degrees atrio-ventricular block) (0.10 less than p less than 0.20; chi 2 = 2.46). The authors thus cannot recommend that the initial ECG is given decisive value as to whether a patient with suspected AMI is to be observed in a coronary unit.

Rapid fluid extraction with the Gambro Ultradiffuser.

Four patients were given fourteen treatments with the Gambro Ultradiffuser. One hour of ultrafiltration without dialysate and with negative pressure on the dialysate side was followed by four hours of dialysis with negligible transmembrane pressure (TMP). Mean fluid removal was 2678 ml per ultrafiltration period and the mean ultrafiltration rate was 37 ml/min. During the dialysis period, TMP was about +30 mmHg giving an ultrafiltration rate of 4 ml/min. Pulse rate was unchanged. Hematocrit increased 3%, plasma protein increased 21% and plasma albumin increased 25%. Plasma values of potassium, sodium, urea, creatinine and osmolality were unchanged. One patient experienced a reversible hearing loss during two ultrafiltration periods and two patients had severe, yet reversible, cardiac arrhythmias. One patient had hypertension during the ultrafiltration period. Rapid extraction of fluid up to 49 ml/min was possible. The mean mean arterial pressure was unchanged thought it exhibited great variation and three patients developed side effects.