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Time from symptom onset to final treatment is crucial for survival. We present a case where prehospital diagnosis by the emergency physician in the ambulance was followed by a telemedicine conference and data transfer to the hospital. This was combined with bypassing of the emergency room and direct transfer to the thoracic surgical theatre, and time to treatment was reduced considerably. Obtaining a prehospital diagnosis in time-dependent life-threatening disease as basement for supportive treatment and transfer directly to treatment is very important.

Uncontrollable hemorrhage from esophageal varicose veins in portal hypertension and cirrhosis of the liver may be treated with a Sengstaken-Blakemore tube. A case of ventricular fibrillation caused by a misplaced Sengstaken-Blakemore tube is described. Patients with a Sengstaken-Blakemore tube in place should be checked by a trained nurse for early signs of misplacement of the tube.

The present study covers 375 consecutive patients referred to the three outpatient clinics at the Psychiatric department of Odense University Hospital from November 1995 to February 1997. The aim of the study was to describe differences in problem profiles for alcoholics with or without parental alcoholism. All patients were assessed by means of the Addiction Severity Index at admission. There was a tendency towards alcoholics with parental alcoholism having more severe alcohol problems than alcoholics without such a family history. Furthermore, alcoholics with parental alcoholism had a more complex problem profile, i.e. more legal problems, psychological problems and work-related problems, especially among the males. In sum, male alcoholics with a family history of alcoholism showed a problem profile almost as complex as that of female alcoholics in general.

In the County of Funen (population 460,000) 120 homeless people resided in shelters for homeless people during week 49, 1996. Of these homeless persons, 94 (or 78%) were examined using ICD-10 and the Addiction Severity Index. Ninety percent were men, 90% were aged 20-59 years, 98% were unmarried or separated/divorced. Seventy-one percent had lived alone during the past three years, only 2% were employed, and sources of income for 83% were public assistance or disability pensions. The population of homeless people was divided into three groups: 1) Psychoses were found in 13 cases or 14%--schizophrenia (4%), paranoid psychosis (4%) and affective disorder (5%). About 2/3 had double disorder, psychosis plus substance abuse. 2) Sixty-four or 68% were non-psychotic homeless people, who had alcohol/substance abuse (53 or 83%) and/or personality disorder (57 or 89%). 3) Seventeen or 18% had no mental illness. About 60% had been sentenced to prison at least once. About 20% needed psychiatric treatment.

The question has been raised whether the change from hospital to community psychiatry is accompanied by an increasing number of the mentally ill in institutions for homeless people. During week 49, 1996, the residents in institutions for homeless people in the County of Funen were interviewed and diagnosed according to ICD-8, and the results were compared with a similar study from week 47, 1990. The prevalence of psychoses was 11% in 1990 and 14% in 1996. This difference was not significant. Significantly fewer psychotic homeless people were treated for their psychotic disorders in 1996 compared with 1990. The prevalence of alcoholics had fallen by 35%, while the prevalence of narcotics and cannabis addicts had risen by 78% and 110%, respectively. These changes were statistically significant. There was still a high prevalence of personality disorders, 70% in 1990 and 60% in 1996. Even though the deinstitutionalization of the psychiatric service has not been accompanied by more psychotic patients in institutions for the homeless, the clientele is still heavily strained with psychosis, personality disorder and substance abuse.

The present study covers 375 consecutive patients referred to the three outpatient clinics at the Psychiatric Department of Odense University Hospital from November 1995 to February 1997. The aim of the study was to describe differences in problem profiles for men and women. All patients were assessed by means of the Addiction Severity Index at admission. All patients needed treatment for alcohol problems. Significantly more female alcoholics, however, had problems with mental health, physical health, drug use and family/social life. More men than women had legal problems. Almost half of the women had previously attempted to commit suicide, and almost one third of the women suffered from anxiety disorder at the time of admission. Significantly more women than men had partner who also had an alcohol problem.

Of 181 alcoholics who consecutively sought treatment as out- or inpatients, 68 (37.6%) had attempted suicide at least once. Compared with non-attempters, the suicide attempters were significantly more likely to be female, have had a chaotic upbringing and to have known suicide attempts in the family and social circle. Significantly more attempters suffered from depressive disorder, feelings of hopelessness, anxiety attacks, agoraphobia, substance abuse or cluster B personality disorders (dissocial, impulsive, borderline, and histrionic). Also significantly more suicide attempters had committed crimes and received early pension. Assessment of coping showed that suicide attempters had a significantly lower tendency to make plans or to make the best of a stressful situation by growing from it. They were significantly more likely to show mental disengagement, to resort to denial and drink alcohol or take drugs when faced with stressful events or difficulties. When evaluated on the Addiction Severity Index Scale, the suicide attempters were found to have a significantly greater need of treatment.

A case of presumed interaction between warfarin and nalidixic acid is reported in an 84 year-old female in whom INR rose from 1.9 to 9.6 after start of treatment with nalidixic acid. The interaction may be caused by several factors: 1) Nalidixic acid may displace warfarin from plasma proteins and thereby increase the anticoagulant effect. 2) The fluoroquinolone drug enoxacin reduces the hepatic clearance of the R-stereomere of warfarin but without prolongation of the prothrombin time ratio. 3) Fluoroquinolones may affect the vitamin-K producing bacteria in the gut and thereby influence the vitamin-K: warfarin ratio in plasma. Only some patients develop hypoprothrombinaemia during concomitant therapy with warfarin and quinolone antimicrobials. It is hypothesized that the interaction may partly be related to age, sex or concomitant disease. Frequent control of INR in patients treated with both warfarin and quinolone antimicrobials is recommended.

Based on notifications to the Danish Committee on Adverse Drug Reactions and to the Central Death Register, 30 cases of fatal drug-induced anaphylactic shock were identified during the period 1968-1990. The most frequent causes were contrast media for X-ray examinations, antibiotics, and extracts of allergens. Nine cases occurred outside hospital; they were mainly caused by the use of allergen extracts of moulds for desensitization in general practice. Fatal drug-induced anaphylactic shock is rare, estimated in the present study at 0.3 cases per million inhabitants per year.

The purpose of this study has been to describe the course over ten years and prognosis for a cohort of patients who had been admitted to a psychiatric department following a suicide attempt. The cohort consisted of 207 patients who had been admitted in the period 1.10.1980-20.4.1981 to a department of psychiatry following a suicide attempt. At the index attempt 99 patients were randomly selected and interviewed. Information on the remainder was obtained from psychiatric case histories, casualty records and discharge reports. Ten years after the index attempt information concerning death, date and cause was collected. Of the 207 patients involved, 52 (25.1%) were dead. Twenty-five (12.1%) had committed suicide, the remainder had died of natural, accidental or unknown causes. Relative to the general population the death rate from suicide and other causes was extremely high. Predictors of suicidal outcome were substance abuse and dangerous index attempt. At least one of these two predictors was present for 72% of those who committed suicide and for 43% of those who did not commit suicide. Aging and previous suicide attempts were the only significant predictors of other causes of death.

The number of open heart surgery procedures using cardiopulmonary bypass increases each year. The objective of this review is to describe the frequency of cerebral complications to such open heart surgery in 18 retrospective and prospective studies published after 1980. In prospective studies the overall frequency of central nervous system complications was 5-61% and the frequency of stroke and transitory ischaemic attack (TIA) was 2-24%. A total of 1-12% suffered from prolonged encephalopathy. In retrospective studies the frequency of central nervous complications was 1-2%. At neuropsychological tests 30-79% showed significant deterioration at the seventh to ninth postoperative day. After six months 80% achieved the same test results as prior to surgery. It is difficult to compare the studies because of major differences in study design. Stroke and TIA seemed to occur more frequent in older studies, in prospective studies and in studies based on valve surgery. Most studies were uncontrolled. We conclude that the risk of central nervous system complications to open heart surgery needs to be re-evaluated in prospective studies of well-defined patients, including matched control groups and a long follow-up period.

The effects of a preoperative beta-adrenoceptor antagonist, metoprolol, on peroperative anxiety, relaxation, general feeling, blood pressures and heart rate, were studied in patients undergoing orthopaedic surgery during epidural anesthesia. The study was double-blind and placebo controlled. Twenty non-consecutive patients were randomized to receive either metoprolol 100 mg or placebo orally 1-2 hours before anaesthesia. Patients receiving metoprolol scored statistically significantly better on anxiety, and general feeling. The average height of the epidural block was ThVIII. The average blood pressure was reduced by 5% during the first 45 minutes in both groups. The average maximum falls in mean blood pressure from preanaesthetic to the lowest measured after the epidural were 14% (metoprolol) and 7% (placebo). The heart rates were significantly lower after metoprolol. In conclusion, the patients felt subjectively better after metoprolol and no significant differences were found in blood pressure after metoprolol compared to placebo.

The purpose of the study was to investigate whether deinstitutionalization of psychiatric patients had produced a clientele of homeless mentally ill people which is not treated. During week 47, 1990, 94 of the 129 residents 73%) in the institutions for homeless people in the County of Funen (population 459,000) were examined for mental illness by a psychiatrist. Diagnoses were made using the ICD-8 classification. Social data were recorded. Eighty-nine per cent were men, 59% were aged 30-49 years, 93% were single, and source of incomes for 80% were public assistance or disability pensions. More than half had been sentenced for crime at least once. The majority suffered from severe psychosocial strain. In 91% a psychiatric diagnosis was established, the most frequent being alcoholism (73%) and personality or character disorder (70%). Psychoses were found in 10 cases or 11%. About 29% required psychiatric treatment. The conclusion was that deinstitutionalization in the County of Funen had not resulted in influx of psychotic persons to institutions for the homeless people.

The circumstances of life and the need for social support were investigated in 142 patients with prolonged psychiatric illness who sought help consecutively in the psychiatric casualty department or who were referred to the psychiatric department of Odense Hospital during the period 11 Sep. 1989-31 Dec. 1989. 80% of these were psychotic and 20% were borderline psychotic. Approximately 90% were young adults (20-49 years). Schizophrenic men predominated. More than 40% of all the patients had some form of addiction as a contributory diagnosis and 71% of the patients with borderline psychoses were addicts. Approximately 3/4 of the patients lived alone in flats. The level of occupational training was low as compared with the remainder of the population. The majority received early pensions. The majority lived in social isolation from the remainder of the community. Only a single patient had no fixed abode but suitable forms of residence where social support could be given were insufficient. Similarly, the requirements for possible employment and leisure activities were great.

During the period 23.11.1987-22.11.1989, a total of 7,906 patients attended the psychiatric outpatient department and observation section on 12,469 occasions. Sixty patients (0.8%) behaved violently on 85 occasions. None of these episodes of violence resulted in injuries to persons requiring medical attention. 90% of the violent patients were men and 70% were in the age group 20-39 years. Approximately 1/5 were psychotic and, of these, approximately half suffered from schizophrenia. Comparison with the non-violent patient revealed that the probability of violence was greater if the patient was a man under the influence of alcohol and who had the diagnoses of narcomania, drug abuse or personality disorders. Significantly fewer violent patients were admitted than non-violent patients. Over 80% of the violent patients had previously been admitted to psychiatric departments. Approximately 60% had behaved violently on previous consultations with the psychiatric outpatient department.

Chronic non-rheumatic atrial fibrillation is associated with a risk of thromboembolic complications of about 5% per year. Previous myocardial infarction seems to be a significant risk factor for development of thromboembolic complications in chronic atrial fibrillation, whereas paroxysmal atrial fibrillation and isolated atrial fibrillation in younger patients may be associated with a lower risk of emboli. Silent cerebral infarction occurs more often in chronic atrial fibrillation than among controls in sinus rhythm. Three prospective trials of patients with atrial fibrillation found effect of warfarin on the occurrence of thromboembolic complications. In one study aspirin 325 mg daily was effective in patients below 75 years of age, but not in patients above this age. The other trials revealed no effect of aspirin.

The frequency of depressive illness was investigated in 195 patients who had been referred consecutively after attempted suicide during the period 15. February 1989-15, October 1989. A total of 130 of these patients were admitted to hospital while the remainder were treated in the psychiatric emergency room or admission department. Registration of depressive symptoms on admission revealed that 85% had depressed mood and other depressive symptoms. According to the criteria established by Feighner et al. 51% suffered from definite depressive disease on admission. According to Zung's Depression Scale, 60% were depressed. On the basis of observations during hospitalization, 25% suffered from depressive disease according to the criteria established by Feighner et al. 19% of these patients suffered from endogenic depression according to the Newcastle I scale which corresponds to 5% of all the hospitalized patients with attempted suicide. Approximately 10% were treated with antidepressives. Only 8% were discharged with the diagnoses of endogenic or reactive psychoses (ICD-8). It is concluded that depressive symptoms occur in the majority of patients with attempted suicide but that slight non-endogenic depressive states are most commonly concerned and that many of these improve rapidly during hospitalization without medicinal treatment. Restraint should be observed in prescription of antidepressive medicine to patients with attempted suicide until the diagnosis of depressive disease is verified.

Approximately 7% of the Danish population are so called poor metabolizers (PM) as regards the model compound sparteine. These individuals lack the P450 isozyme which is mainly responsible for elimination of at least 20 different medicaments including nortriptyline. A woman aged 42 years suffering from depression was treated with 100 mg nortriptyline daily and, during the course of treatment, she developed a toxic serum nortriptyline level (approximately 2,100 nM). Treatment was withdrawn temporarily on account of severe side-effects. The depression recurred. During the medicine-free period, a sparteine test was performed and this demonstrated that the patient was a poor metabolizer. Scarcely two months after hospitalization, treatment was recommenced with 25 mg nortriptyline daily after which the patient's depression disappeared completely without any side-effects of note.

An investigation was performed to compare the Animec infusion warmer with the Fenwall infusion warmer. The maximal increase in temperature for the Animec infusion warmer was 8.9 degrees C and this was recorded with a flow of 395 ml/hour. The values for the Fenwall infusion warmer were 12.0 degrees C with a flow of 1,527 ml/hour. An estimate is made of the reduced energy deficit with employment of the two infusion warmers. It is concluded that supply of energy to the infusion warmers. It is concluded that supply of energy to the infusion fluid depends on the flow of fluid through the infusion warmer and the capacity of the infusion warmer. Great differences were observed in the capacities of the two infusion warmers to compensate for the peroperative energy deficit at the rates of flow normally recommended.

In perioperative hypothermia, a central temperature of less than 36 degrees C develops in connection with anaesthesia and operation. Perioperative hypothermia constitutes a daily problem which results in increased morbidity and mortality in risk groups. The influence of anaesthetic agents on temperature regulation is reviewed. The postoperative hypothermic phase with increased oxygen requirement on rewarming increases the risk of development of complications, including cardiac complications. The risk groups and prophylactic methods for hypothermia are mentioned. Higher temperatures in the anaesthetic room, prewarming of infusion fluids and employment of infusion warmers should be employed with all anaesthetics. In patients in risk groups, extensive employment of combined methods of prevention of hypothermia is recommended.

This investigation is a retrospective registration on the basis of the case histories of 290 patients with the main diagnosis dementia who were admitted to a psychiatric hospital in the years 1982 and 1983. The average age was 77 years. Patients with their own homes comprized 61% but only 28% were admitted from their own homes. More than 70% of the patients admitted were described as suffering from moderate or severe dementia on admission. 93% were admitted voluntarily and 91% during the daytime. The reason for admission most frequently registered was the patient's suffering. In 66% of the cases, the general practitioner had attempted treatment prior to admission. During hospitalization the majority of the patients received medicinal treatment. At the conclusion of treatment, 52% were found to be improved and 34% unchanged. 46% of the patients were assessed as requiring maximum nursing-home treatment and 29% were considered to need psychiatric nursing-home treatment. 8% could be discharged to their own homes. The average durations of hospitalization, duration of treatment and waiting-time were reviewed. It is noteworthy that the waiting-time, 311 days, was found to be nearly as long as the duration of treatment, 316 days. In addition, the waiting-times for nursing-homes with maximum care were calculated to be 229 days on an average and for psychiatric nursing homes 596 days.

A controlled double-blind investigation was undertaken in which ten patients with painful bone metastases were treated with intravenous lignocaine in a dosage of 5 mg/kg body-weight infused over a period of 30 minutes or the same volume of isotonic saline. None of the patients experienced prolonged pain relief but five patients experienced considerable pain relief immediately and/or one hour after the infusion of lignocaine.