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Individuals with a self-evaluated risk of malignant melanoma were invited to an "open house" where trained dermatologists examined suspected lesions. The attendants filled in a short questionnaire relating to skin cancer risk factors. Persons with skin changes suspected for malignancy were referred for excision in the dermatological department. The clinical evaluation included dermatoscopy. Nine hundred and eleven individuals attended. Among 16 individuals referred for excision one malignant melanoma, one lentigo maligna melanoma and two in situ melanomas were histologically verified. Furthermore, 21 basal cell carcinomas were identified clinically. The most frequent clinical diagnoses were melanocytic naevi and seborrhoic keratoses.

At joint replacement operations local air suction is used to reduce the air pollution from organic solvents in the operation theatre during insertion of cement and prosthesis. In order to find out whether the local suction in an ultraclean-air operation theatre with laminar airflow influenced the number of colony forming units (cfu) of bacterial in vicinity of the wound, one m3 of air was sampled 20 cm and one metre from the wound before, during and after use of local suction during insertion of cement and prosthesis using a Sartorius membrane filter sampler. There was no significant difference between the groups in the numbers of cfu of bacteria found. It is concluded that use of local air suction over the operative area while cementing hip prosthesis does not affect the number of bacteria in the vicinity of the operation.

In this retrospective study we evaluated the frequency of complications in 108 patients with acetaminophen poisoning admitted to the Department of Hepatology, Rigshospitalet, Copenhagen from 1.10.1990-30.9.1993. Twenty-five patients (23%) developed hepatic encephalopathy grade II-IV, with a survival rate of 44%. In patients who developed grade IV encephalopathy the median time from intoxication to INR > 3.7 was 60 hours. At a median of only five hours later grade II encephalopathy was present, and grade IV at a median of a further 20 hours later. Ninety-three patients were re-evaluated according to the nomogram indicated by Prescott (6). If the initial position was in the "very severe" area the risk of developing encephalopathy was 34% (20-51%), if not the risk was 6% (1-16%). Serum creatinine above 200 microM at admission indicated a risk of hepatic encephalopathy of 64% (35-87%). INR > 1.54 was associated with a 35% risk of hepatic encephalopathy. Patients in the "very severe" area should be referred to a unit where liver transplantation is possible, even if other factors known to indicate poor prognosis are not present.

The study describes consumption of and poisoning by analgesic drugs in Denmark during the period 1979-1992. During this period, fatal poisonings from analgesics almost doubled to 200 deaths per year (40% of all drug related deaths in Denmark). The annual consumption of opioids increased at the beginning of the period, but during 1985-1992 it was relatively constant at 20 million defined daily doses (DDD) and associated with 600 hospital admissions and 150-170 deaths due to poisoning per year. Within the opioid group dextropropoxyphene consumption and poisonings decreased following a National Board of Health initiative in 1985-1987. As for the weak analgesics, consisting mainly of paracetamol or salicylates, the total consumption increased gradually and reached 145 million DDD in 1992, corresponding to 160 tablets per inhabitant per year. This consumption was associated with approximately 750 hospital admissions and 40 deaths due to poisoning. As judged from the mortality per dose the weak analgesics are 20-30 times safer than the opioids.

The impact of liver transplantation on the survival in fulminant hepatic failure was evaluated in a retrospective study including 87 patients admitted to Rigshospitalet over a three and a half year period before and a three and a half year period after the Danish liver transplantation programme was started. The number of admissions increased by 178% in the second period. Fifty-two percent of the patients had acetaminophen induced liver failure, which over the last seven years has become the most common cause of severe acute liver disease in Denmark. In about half of the patients high volume plasmapheresis was used as liver-assist either alone or in combination with liver transplantation. Three patients in grade 4 hepatic coma (one with Hepatitis B, two with acetaminophen intoxication) were withdrawn from the waiting list for emergency liver transplantation after high volume plasmapheresis due to recovery. In patients with an estimated survival chance of less than 5-10% liver transplantation was performed with a survival rate of 60%. The survival rate for the non-liver transplanted patients was 49% in the same period compared to 30% in the three and a half year period before liver transplantation started.

An interview study of 11 children and their parents was carried out in connection with a more comprehensive retrospective review of the records concerning children who in 1990 had been placed outside their homes. The aim of the study was to describe how children and parents experience the process of placement in order to adjust placement criteria if necessary. At the time of interview the age of the children was 12-19 years (mean 16.2 years), there were five boys and six girls. Five of the children were still placed outside the home. All the children had an intellectual understanding of the reason why they did not live at home. However, none of them had reached a corresponding emotional understanding and clarification. It was found that there were two different ways of managing separation. Those children who experienced attuned separation seemed to manage best. In these cases the problems of separation were worked through by parents and children. Some of these parents also expressed the view that their child was not really placed outside the home, but was still implicitly a member of the family. The opposite was true in non-attuned separations. The authors recommend a revision of the criteria on which the social authorities base their evaluation as to where and when a placement should be made--especially concerning children exposed to non-attuned separation.

A retrospective study was made of the records of 112 children and adolescents who had been placed outside their homes in 1990 in accordance with Section 66 of the Social Assistance Act. The children had been placed either in foster homes, boarding schools, group homes or youth homes. The aim of the study was to examine the social circumstances relevant to placement of the children. It was found that the parents' marital status, their means of income and the recorded problems of both children and parents, all of which were considered to be contributing factors to placement of the children, corresponded with results from previous studies. However, incest and physical abuse were not recorded as a cause of placement. Only a few children were placed directly from their own homes; most of them were transferred from one form of institution or school to another. In more than 90% of the cases, extensive measures of social support had previously been established in an attempt to avoid the first placement outside the home. Although the children received social support during placement, the support given to the parents is still considered insufficient. This is especially the case for parents of children below school age. Compared to the total sample this group seems to have the highest number of recorded parental problems.

Fulminant hepatic failure is a rare disorder with a high lethality. It is characterized by the development of acute hepatic symptoms and encephalopathy, in the absence of underlying chronic liver disease. The main causes are viruses, adverse drug effects and toxins. The major causes of death in patients with fulminant hepatic failure are cerebral edema, infections, gastrointestinal hemorrhage and renal failure, or a combination of these. Treatment of fulminant hepatic failure with a variety of medical therapies has hitherto been found to have little overall influence on outcome. With high volume plasmapheresis the clinical condition of the patients improves, and if there is no sign of spontaneous regeneration, emergency liver transplantation is the only solution.

The authors undertook a prospective double-blind, controlled trial to investigate the effect of prophylactic low-dose heparin/dihydroergotamine, low-molecular heparin/dihydroergotamine and a placebo on the blood pressure and postural hypotension on postoperative mobilization. A material of 120 patients admitted for hip surgery was subdivided at random into three groups. Examination for postural hypotension was undertaken on the fifth postoperative day. No significant differences were present between the three groups as regards age distribution, systolic and diastolic blood pressures and pulse rates. This investigation did not reveal any significant effect of the antithrombotic combined treatment with heparin/dihydroergotamine on the blood pressure or postural hypotension on postoperative mobilization following elective hip surgery. No cases of ischaemic side effects were observed. However, this investigation cannot disprove a slight hypotensive effect and, for this reason, this treatment should be contraindicated in patients with circulatory disturbances.