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Acute aortic syndrome is a group of pathogenic conditions including aortic dissection, intramural haematoma, penetrating ulcer and aortic aneurysm. The syndrome is a challenging clinical diagnosis because the symptoms are numerous and diverse with similarity to other more common conditions. Delayed diagnosis and treatment can be fatal. Computed tomography angiography is the most important diagnostic tool and is the first choice when acute aortic syndrome is suspected. With this article, we wish to raise awareness of the incidence of acute aortic syndrome and the clinical features of the syndrome.

In rare cases herpes simplex virus (HSV) can cause disseminated and severe disease, especially in immunoincompetent patients. An apparently immunocompetent 27-year-old woman presented to a gynaecological ward with one week of unexplained abdominal pain. After some days of observation and tests, she underwent a diagnostic laparoscopy. Vesicular elements were seen on the bladder wall, and biopsies showed HSV type 2.

During the last two influenza seasons, one of the predominant influenza A types (H1N1) has developed complete resistance to oseltamivir, the primary treatment option. The virus does, however, remain sensitive to zanamavir and amantadine. There is no unequivocal explanation for this slide in the development of resistance. The best prevention strategy remains vaccination of the general population to avoid immunity. Future antiviral treatment calls for knowledge about resistance to existing types of influenza and the availability of all three types of antiviral medication.

Ménétrier's disease is a rare and poorly outlined disease, diagnosed in patients with giant gastric folds, dyspeptic symptoms and hypoalbuminaemia due to gastrointestinal protein loss. The etiology is unknown, but Ménétrier's disease is often associated with Helicobacter pylori (Hp) infection. Case reports and studies concerning the effect of eradication therapy in patients with Ménétrier's disease were reviewed. It was found that complete normalisation of the gastric mucosa and gastrointestinal protein loss following eradication therapy has been reported in several cases. In conclusion, we recommend patients with Ménétrier's disease to be tested for Hp, and treated with eradication therapy in case of infection.

Ventilator-induced lung injuries remain an important factor regarding morbidity and mortality in newborns requiring assisted ventilation. Numerous different modes of ventilation have been tried without achieving recognition. High-frequency oscillatory ventilation (HFO) is a new mode of ventilation which employs active inspiration and expiration at frequencies up to 20 Hz with a tidal volume below dead space. Progression of severe respiratory distress syndrome may be reduced by applying early HFO beside modern treatment modes. It has been demonstrated that immediate initial treatment of premature babies with high tidal volumes can cause lung damage. Clinical studies of HFO indicate, that it is possible to improve oxygenation, reduce short-term mortality, surfactant redosing, ventilator-time, use of extra corporeal membrane oxygenation (ECMO) and costs of hospitalization. Morbidity related to lung injury and cerebral damage is apparently unchanged compared to conventional mechanical ventilation. The use of HFO in milder cases awaits further clinical studies.

A questionnaire survey undertaken among 169 Danish primary school teachers revealed a comparatively good general understanding of epilepsy. Sixty-five percent had taught pupils with epilepsy and 78% had witnessed a child having a fit. Only 18% had attended courses on epilepsy, despite 63% stating a desire for training. Only 5% of the teachers judged their present knowledge on the subject as being sufficient. A considerable lack of confidence and knowledge on issues such as provoking factors, surveillance and management including medical treatment was found. The survey revealed a good understanding of restrictions that might be imposed on children with epilepsy. Only 18% of the teachers thought that children with epilepsy in general have learning problems. To achieve an optimal care for children with epilepsy a sufficient knowledge and confidence is necessary. It is recommended that education concerning epilepsy is introduced for teachers that have pupils with epilepsy in their classes. Such education might be provided by the local health services.

The anterior fontanel bone is a very rare true accessory bone. Radiographic demonstration is especially important in those babies suspected to have premature closure of the cranial sutures or fractures. The bone is considered as a normal variant. It does not interfere with cranial growth nor with the normal development of the child.

The effect of low-energy laser therapy on shin splints was examined in a randomized study with an unblinded design. Constripts from the Jutland Dragoon regiment with shin splints were given either active laser treatment (40 mW in 60 sec per cm tender tibia edge) or placebo laser. All patients were exempted from normal duty concerning activities like running and march. Forty-nine patients participated in the study, 23 in the laser group and 26 in the control group. From the start the study was designed to be double-blind, but by accident the code was broken towards the end of the study. We found no significant differences between the groups regarding pain visual analog score and readiness to return to active duty after 14 days.

An anonymous questionnaire inquiry performed among 324 school teachers in the Randers area with the purpose of elucidating teachers' knowledge about asthma is presented. To a series of statements about asthma, the teachers should answer yes, no or don't know. A limited knowledge about asthma in children was found. The knowledge about medicamental treatment was particularly limited. Only 57 per cent knew that wheezing after physical exertion is a strong indicator of asthma. Only five per cent had received proper instruction. This latter group had a significantly better knowledge of medical treatment (p < 0.0001-0.05). It is recommended that instruction in children's diseases, especially asthma should be reintroduced in teachers' training colleges.

The penetrance of light through 21 different types of eye shields used in Danish neonatal care units was evaluated. A phototherapy unit (Dräger Phototherapiegerät 800) with a visual illuminance of 8317 Lux was placed in a distance of 39 cm from a photographic lightmeter (Minolta Autometer IIIF). The opening of the meter was covered by the various shields tested. The penetrance varied between 1.0 and 2886 Lux. The most effective shield was made of three layers of green, tightly woven cotton. A commercially made eye shield (Posey Eye Protector 4646) was able to reduce visual illuminance to 118 Lux (ambient light in our nursery was 20-139 Lux). A tubular stockinette covering was found to be ineffective as thicknesses of 1-16 layers was able to reduce penetrance to only 2886-1055 Lux. The use of an eye protector made of three layers of green cotton, sized 140 x 50 mm is recommended.

In a rural general practice with two doctors and 3.671 patients and employing a practice data system (APEX), a retrospective review was undertaken of the anxiolytic drugs (ATC gr NO5B) prescribed. A total of 376 persons received 3,556 prescriptions for a total of 121,111 DDD (Defined Daily Doses). Forty of these patients (approximately 10%) received half of the medicine involved and half of the patients received 5% of the medicine. 68% of the prescriptions were renewals without contact between doctor and patient. A total of 85 new users was observed and the number of new users/annum decreased significantly during the period. One hundred and fifty-two patients consumed < or = 50 DDD during the entire three-year period (short term users) while 168 consumed > 50 DDD during one or more years (long term users). The long term users received anxiolytic drugs more frequently on account of mental illness (46%) than did the short term users (12%). Long term users consulted the doctor twice as frequently and were admitted to psychiatric departments six times as frequently during the period. One fourth of the long term users received disability pensions and one fourth had now or had previous alcohol problems.

A 12-year retrospective study to elucidate the incidence of "fifth day fits" including 127 infants with neonatal convulsions was carried out in the Randers area of Denmark. The incidence of neonatal convulsions was 8.3/1,000 live-born infants. The etiology in 74 cases of latent and 53 cases of convulsive seizures was asphyxia (38%), intracranial hemorrhage (17%), hypoglycaemia (9%), hypocalcaemia (4%), infections (6%) and developmental defects (4%). In 28 cases (22%) the etiology was unknown. In only two of these cases, the seizures started on day 4-6, and no peak incidence was found.

A safe and easily employed method of removal of a blunt foreign body from the oesophagus is described. The present case was a newly born infant with Pierre Robin's syndrome and congenital heart disease. A nasal tube had become displaced and the clinical condition did not permit endoscopic removal. By means of an inflatable balloon catheter introduced through the tube to the stomach, the foreign body could be removed without difficulty.

The records of 22 children (sex rate boy/girl 1.75, mean age 2 7/12 year) treated for intussusception in Randers Central Hospital during the period 1975-1989 were reviewed. In 27% of the cases this diagnosis was made before admission, gastroenteritis being the most frequent differential diagnosis (18%). The mean duration of symptoms before admission was 24 hours. No significant correlation between low age and late diagnosis was found. Symptoms were vomiting (100%), abdominal colic (95%), palpable abdominal tumour (73%), diarrhoea with blood and mucus (63%) and low-grade fever (64%). Treatment by barium enema had a low success-rate (29%); the best results were recorded in children with symptoms for less than 24 hours. The mean duration of the hospital stay was 3.5 days in children treated by barium reduction and 8.5 days in children treated surgically. Early diagnosis seems to increase the success-rate of non-operative treatment. Absence of the classical triad of paroxysmal pain, abdominal mass and red currant jelly stool (found in 41% of the cases) does not exclude the possibility of intussusception.

In Denmark 11-30 children and infants are killed every year in car accidents. In this country, there is no legislation concerning children under 3 years as car passengers, in spite of the fact that child restraints have proved effective in reducing the morbidity and mortality. Legislation concerning seat belts and chairs may reduce the frequency of injury and death by at least 25% and by 50% in children under one year. Children and infants are not "small adults" and require specially designed restraints. Only 83% use safety-chairs and belts, and in 63-74% the devices are incorrectly used. This reduces the effectiveness seriously and may even, per se, injure the children. The restraint systems (baby chair, child seat, cushion, belt and seat) are described together with the correct use and the possibilities for misuse. The use of rearfacing infant chairs on the back-seat for children under 4 years of age is recommended. Prevention by further information, legislation, rental programs, reduced taxes and a new design of seats is discussed. Profylactic information concerning the correct use of child restraint devices given by the family's general practitioner, is recommended.

The children were admitted over a 14-year period (1975-1988) from an admission area of average Danish population distribution. The incidence was 15.5/100,000 children per year. The area had endemics of meningococcal disease in the years 1983-1984. The etiology was meningococcal in 43%, Hemophilus influenzae in 33% and pneumococci in 9% of the patients. Regardless of etiology, the antibiotic schedule was ampicillin 400 mg/kg body weight/day. Resistance to ampicillin was not found in any of the bacterial cultures. Within two weeks before admission 59% of the children had experienced a febrile illness. The diagnosis of meningitis was missed before admission in 24% of the cases. On admission, 93% had typical clinical signs of meningitis. 87% were lethargic or comatose. 31% had convulsion and in 13% the peripheral circulation was compromised. Recrudescence was suspected in one patient. Sequelae were most commonly found in children with meningococcal meningitis and were persistent in 23% of all the children. Severe or less severe neurological handicaps were seen in 29% (psychomotor retardation, epilepsy, cerebral palsy and hearing loss). One patient with Waterhouse-Friederichsens syndrome died. Thus the overall mortality was 1.2%, which is low compared to treatment results reported by others.

Eighty-seven infants and children aged 1 month to 15 years admitted to the Pediatric Department, Randers Central Hospital 1975-1988 with bacterial meningitis were evaluated with special interest in the course of fever and its relation to sequelae. The children were treated with ampicillin (400 mg/kg/day). We found that 94% were afebrile after six days. 10% had persisting fever, 1% prolonged fever and 38% were found to develop secondary fever. Significantly more children infected with H. Influenzae had secondary fever. In most cases, no reason for secondary fever was found (46%). 18% had drug fever and only one case of relapse was found. 23% had severe sequelae. No significant relationships between persistent, prolonged or secondary fever and sequelae were found.

An unusual case of peritonsillar abscess in a six year old boy is presented. The abscess was initially treated with penicillin without success and afterwards with ampicillin and tonsillectomy. Cultivation of pus from the abscess revealed beta-lactamase producing Haemophilus influenzae. The patient was finally successfully treated with sulfamethizole.

The numbers of patients admitted with burns, as an expression of the incidence of burns, registered in the Burns Unit, Odense University Hospital were compared for two ten-year periods: 1968-1977 and 1978-1987. A total of 1,548 hospitalized patients were involved. The etiology of the accidents, distributed according to sex, age and degree of severity and the number of deaths were calculated. A significant decrease in the total number of burning accidents was demonstrated, mainly due to the decrease in children aged 0-5 years and 6-15 years. Where the youngest children were concerned, this decrease was due to a decline in the number of scalds but also because of reductions in the number of contact burns and electrical and corrosive injuries. This was corrected for the altered age distribution with relatively fewer children during the second decade.

The purpose is to examine retrospectively the circumstances, clinical course and sequelae in 37 children (32 boys, 5 girls) admitted with acute alcohol intoxication during the 11 years 1978-1988. It is concluded, that the number of admissions has increased. Two distinct populations are found: 0-3 and 8-15 years. Strong spirits were usually involved, excessive amounts ingested because of inexperience and not at home. Admission is within two hours from last ingestion and most often at week-ends. 24% had histories of chronic behaviour problems. 32% had minor injuries. The maximal alcohol concentration found was 2.9%. None of the patients were found to be hypoglycaemic or had long term sequelae.

The purpose of this review is to describe the diagnosis, emergency treatment and further observation and complications. Alcohol poisoning and complications are underdiagnosed problems. Intoxication in young children is accidental and due to lack of experience in older children. Strong spirits are usually involved. The speed of elimination is greater than in adults and presumably 3-8 mmol/l/h. Fatal cases with alcohol concentrations less than 3.0% have been reported. The lethal dose is presumably 3 g/kg. Symptoms are as in adults but appear at lower concentrations. Infants do not reach a stage of exitation. Children are more prone to develop complications such as hypothermia, acidosis, electrolyte disturbance and trauma. Hypoglycaemia develops in 24-50% of cases, more frequently in infants and after starvation. The treatment is aspiration, admission to hospital, close observation, determination of core temperature, alcohol concentration, blood glucose-concentration and determination of serum-electrolytes. Blood glucose should be monitored. Treatment is conservative but severely intoxicated children may require dialysis.

A case of near-drowning in an 11 year old child with severe epilepsy (myoclone-astatic) is described. The child was left alone in a indoor swimming-pool and was found lifeless on the bottom 1-2 minutes later presumably after an epileptic seizure. Resuscitation was instituted immediately and the child survived without sequelae. Leaving children with seizure phenomena without observation in the neighbourhood of swimming pools, is warned against.

Absorption of solutions containing 17-beta-oestradiol (E2) in absolute alcohol and progesterone (P) in absolute alcohol was investigated in six postmenopausal women. These preparations were applied to the skin of the forearm and the abdomen. 1 mg E2 was applied twice daily to the left forearm (RAS) for 28 days. After an interval of one week, the treatment was continued with 1 mg E2 twice daily for 28 days in the epigastric region (RE). From the 14th to the 28th day, this treatment was supplemented by 10 mg P twice daily partly on the right forearm and partly on the epigastrium. The 24-hour absorptions of E2 and P were investigated: E2 on the first and fourteenth days and P on the fourteenth day in both periods. On days 1, 7, 14, 21 and 28, plasma E2, oestrone (E1) and oestrone sulphate (E1SO4) were investigated for hormone application. Statistically significant absorption of E2 was found after 24 hours (p less than 0.05) and significantly greater absorption from RAS than RE (p less than 0.005). No systematic variation in plasma E2 was found during the period of investigation on RAS or RE. P was not absorbed. No local side effects were registered. It is concluded that E2 dissolved in absolute alcohol is clinically employable for treatment of postmenopausal women but that P is of no value in the dosage employed here. Further investigations of transcutaneous absorption of P are desirable.

The use, constitution and identification of commercially available button batteries are described. Most cases of button battery ingestion in children are asymptomatic and without complications. Possible complications are reviewed. Most cases described are due to burns in the esophagus or leakage of contents. The danger of intoxication is presumably only present in the case of mercury cells and, even here, it is minimal. If passage of esophagus (for the bigger types pylorus) can is confirmed by x-ray, treatment is conservative observation. If the button battery is present in the esophagus, acute surgical/endoscopic removal are indicated. Possibilities for prevention is described.