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OBJECTIVES: The aims of this cross-sectional study were to assess the pneumococcal antibody coverage in patients with autoimmune inflammatory rheumatic disease (AIRD) and to identify predictors associated with inadequate protective antibody levels.METHOD: Antibodies to 12 serotypes occurring in the commonly applied pneumococcal vaccines in Denmark were measured in AIRD patients with a diagnosis of rheumatoid arthritis, spondyloarthritis, or psoriatic arthritis attending the Department of Rheumatology at the North Denmark Regional Hospital. Immunization against pneumococcal infection was defined as a geometric mean level ≥ 1 μg antibodies/mL. Clinical information about vaccination status and disease/treatment history was retrieved from the medical file system.RESULTS: Results of antibody measurement and vaccination status were available from 346 AIRD patients, of whom 200 (58%) were registered as receiving pneumococcal vaccination, whereas the remaining 146 patients (42%) were not. Of all 346 patients, only 61 (18%) were measured with an adequate level of protective antibodies (30% vs 1%, respectively). Methotrexate treatment at the time of vaccination and increasing age were identified as predictors of poor vaccination outcome in multiple logistic regression analysis.CONCLUSIONS: This post-vaccination study showed that less than one-fifth of the AIRD patients are adequately protected against pneumococcal infection, although the immunization programme had been implemented in more than half of the study population. Development of improved vaccination strategies is required to achieve a higher immunization coverage rate and more efficient lasting antibody response.

The use of anaesthesiologists in prehospital emergency care is controversial. We wanted to assess the impact of an anaesthesiologist and a short time interval from acceptance of a mission to take-off at survival rates in a rural/urban emergency medical service. Prospectively registered data for 991 consecutive patients through a 12-month period were retrospectively evaluated by an independent foreign expert. Of all primary missions, 3.3% were considered probably lifesaving from site of injury to receiving hospital. Of these, the lifesaving result in 50% were dependent on both the qualifications of the anaesthesiologist and a short response time. Survival from hospital admission to discharge was 44%. All patients were discharged to their own homes, able to live a fully functional life. The consistent use of anaesthesiologists compared to less qualified personnel and the maintaining of response times below presently required minima doubles the potential for lives saved in services comparable to the one studied.

Background: Ventricular ectopy early after an acute myocardial infarction (AMI) has previously been demonstrated to predict mortality. Less information is available about the prognostic implications of ventricular ectopy occurring late after an AMI, and no information is available about the prognostic implication of the development of ventricular ectopy during the first year after an AMI. Hypothesis: The purpose of the present prospectively conducted trial, a part of the Danish Verapamil Infarction Trial II (DAVIT II), was to evaluate the prognostic implication of (1) ventricular premature complexes (VPCs) recorded by 24‐h Holter monitoring 1 week, 1 month, and 16 months after an AMI; and (2) development of > 10 VPCs/h or of any complex ventricular ectopy, that is, pairs, more than two types of VPCs, ventricular tachycardia, or > 10 VPCs/h during follow‐up after an AMI. Methods: Patients were monitored 1 week (n = 250), 1 month (n = 210), and 16 months (n = 201) after AMI. Results: Multivariate analyses based on history, clinical findings, and ventricular ectopy showed the following results: After 1 week, > 10 VPC(s)/h (p = 0.0006) and heart failure (p< 0.007); after 1 month, >10 VPC(s)/h (p = 0.003) and resting heart rate (p < 0.02); and after 16 months, ventricular tachycardia (p = 0.002) independently predicted long‐term mortality. Mortality was significantly predicted by the development of > 10 VPC(s)/h from 1 week to 1 month (p = 0.003) and 16 months (p = 0.03), and from 1 to 16 months (p = 0.007) after AMI, as well as by the development of any complex ventricular ectopy from 1 week to 1 month (p = 0.02) and 16 months (p = 0.01), and from 1 to 16 months (p = 0.04) after AMI. Conclusion: The present study demonstrated that 1 week and 1 month after an AMI the quantity of VPCs, that is, >10 VPCs/h, predicted mortality, whereas 16 months after an AMI the quality of VPCs, that is, ventricular tachycardia, predicted mortality.

To measure blood levels of morphine and additional drugs in patients suspected of intravenous (i.v.) heroin abuse and to evaluate the effects of antidote treatment.Prehospital blood sampling in 52 patients.Forty-five patients were blood-positive for heroin, eight of whom were hospitalized. Forty-one patients also had abused additional drugs: minor tranquilizers, ethanol, amphetamine, cocaine, and/or carbamazepine. Seven patients had taken either only methadone or ketobemidione: one was admitted. Treatment with increasing doses of naloxone indicated a necessity for hospitalization. Six of 14 patients treated with naloxone (1.8 mg were hospitalized. Seven patients had an extremely high blood level of morphine (0.2 mg/kg), that could be reverted with naloxone in moderate doses.This study indicates that under prehospital conditions, it is difficult to identify a patient intoxicated only with intravenous heroin. Nearly all patients treated were cases of multiple drug/alcohol overdoses. Even the symptoms associated with extremely high blood levels of morphine could be reversed with naloxone in moderate doses.

The objective of the study was to evaluate the predictive value of pulse oximetry before treatment of acute asthma in the prehospital setting. Unfavorable outcome was defined as need for mechanical ventilation during the acute attack. The study was carried out prospectively. The patients were divided into two groups: SpO280% and SpO2or = 80%. The study group consisted of 44 patients with 47 asthmatic attacks. Eleven patients had SpO280%, of whom two required mechanical ventilation. Thirty-three patients with 36 attacks had SpO2or = 80%, none required mechanical ventilation. Oximetry before treatment with a cut off point of80% had a specificity of 18% and a sensitivity of 100% for prediction of unfavourable outcome. We conclude at SpO280% in the acute asthmatic attack is a serious prognostic sign which should warn the physician that the patient's condition is lifethreatening.

We report 3 cases of 31P and 1H MR spectroscopy (MRS) performed at different stages on patients with clinical signs of near or fulminant incarceration of the brain. The measurements were made on a whole body, 1.5 T scanner. 1H-MRS was obtained with the STEAM sequence and 31P-spectra were obtained using the chemical shift imaging technique. Medical treatment including controlled ventilation and sedation of the patients was carried out during the examination. The first patient was evaluated on days 6 and 10 after evacuation of an acute subdural haematoma. An intracranial pressure of 35 mm Hg was registered during the first examination. The 2nd patient had suffered a spontaneous intracerebral haemorrhage and showed clinical signs of imminent incarceration during the examination. The 3rd patient showed clinical signs of incarceration just prior to the examination. In the 1st patient 1H-MRS showed a 3-fold increase in the concentration of choline-containing compounds and a small decrease in N-acetyl aspartate from the 1st to the 2nd examination, which we interpret as a loss of neurones. In case 2 only small changes in metabolism could be detected, indicating that, despite signs of imminent clinical incarceration, the energy supply to the brain was substantial. 1H-MRS of the 3rd patient showed massive lactate concentration, and 31P-MRS revealed the total absence of high-energy phosphorous compounds leaving only one single peak of inorganic phosphate, indicating irreversible brain death.

The present study was a prospectively planned subset of the postinfarction, double blind, randomized, multicenter, placebo controlled trial of verapamil, DAVIT II. Patients had 24 hours of Holter monitoring before randomization, i.e., second week after infarction (placebo, n = 122; verapamil, n = 128), after 1 month (placebo, n = 108; verapamil, n = 94) and after 16 months (placebo, n = 75; verapamil, n = 63) of treatment. The purpose was to evaluate the effect of verapamil on the prevalence and changes over time of arrhythmias and heart rate. In patients monitored twice, a significant increase of average ventricular premature complexes (VPC) per hour from before to 1 month (p = 0.0007) and 16 months (p = 0.02) after was demonstrated in the placebo group, and from before to 1 months (p = 0.01) after in the verapamil group. Average VPC/hr did not change from 1 to 16 months of treatment. A significant increment of10 VPC/hr was found after 1 (p = 0.03) and 16 months (p = 0.05) compared to prerandomization in the placebo, but not in the verapamil group. A significant increase of supraventricular arrhythmias after 1 month compared with prerandomization was found in the placebo group (p = 0.003) but not in the verapamil group. The prevalence of VPC and supraventricular tachycardia was significantly lower in the verapamil compared with the placebo group after 1 month of treatment. At 16 months no significant difference was found between the two groups. The 24 hour mean heart rate was significantly lower, 3 beats/min, in the verapamil compared with placebo after 1 and 16 months of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

A retrospective study concerning prehospital treatment of 180 consecutive patients with severe hypoglycaemia, treated by the Mobile intensive care unit (MICU) in Copenhagen was performed. A total of 113 (63%) were male. Of these 104 patients had blood-glucose concentrations less than 2 mmol/l. Eleven patients had blood-glucose concentrations between 2 and 4 mmol/l. After treatment with 50% glucose solution: (25-50 ml I.V.), 131 patients could remain at home. During the 24 hour period after the initial event, two patients needed a second treatment by the mobile intensive care unit on account of secondary hypoglycaemia. Four further patients were admitted to hospital; none of these suffered secondary hypoglycaemic events. One case was registered as "life-saving" on account of treatment of severe airway obstruction. It seems that prehospital treatment of severe hypoglycaemia is beneficial mainly because transportation of delirious, abusive patients can be avoided and the workload of emergency-rooms can be reduced. 69% of patients suffering a severe hypoglycaemic event, were treated prehospitally without subsequent transportation to hospital.

A retrospective study was performed concerning prehospital cardiac arrest. This revealed that 177 consecutive patients received advanced medical resuscitation by an anaesthesiologist at the site of the accident during the period 01.01.1988-31.12.1988. A total of 61 (35%) were admitted to hospital and 24 of these (14%) survived for more than 30 days. All 24 were discharged to their homes without major cerebral sequelae. After one year, 21 were still alive. Compared with the results of previous studies in Copenhagen, this study reveals that the overall survival rate may have improved and that cerebral function after cardiac arrest seems to have been improved by the introduction of prehospital medically staffed ambulances.

A retrospective study was undertaken of prehospital cardiac arrest and revealed that mechanical ventilation was employed in 132 consecutive patients after resuscitation. A total of 24 of these survived for more than three months; 14 were discharged to their homes while ten were discharged to nursing homes on account of cerebral sequelae. No patients in whom the cardiac arrest had lasted more than 25 minutes survived for more than three months and patients with cerebral sequelae were more frequently mechanically ventilated for longer than 48 hours. The total cost of treatment for the 132 patients was estimated to be 10,500,000 Danish crowns (approximately 954,000 pounds). A total of 7% of the patients survived with cerebral sequelae but these were responsible for more than 60% of the expenses.

The effect on cerebral haemodynamics of arterial hypotension induced by sodium nitroprusside infusion was studied in nine patients at the end of operations for intracranial aneurysms under N2O-O2-halothane anaesthesia. Cerebral blood flow (CBF), using the intraarterial 133Xe injection method, and cerebral jugular venous blood gases were monitored before, during and after the induced hypotension. CBF and jugular venous oxygen tension (PvO2) remained constant during the hypotensive period. Following its termination, a 13% increase in CBF occurred (P less than 0.05) and PvO2 showed the same trend, a 5% increase (P less than 0.30). Regional CBF recordings (rCBF) in 16 small areas within the cerebral hemisphere were obtained at each measurement. In four of the patients, rCBF abnormalities were present in the form of hyperaemic regions, probably induced by the operation or the disease itself. The focal abnormalities were not accentuated during hypotension nor were ischaemic regions disclosed. It is concluded that sodium nitroprusside has only a minor influence on cerebral haemodynamics in the anaesthetized state.

Twenty patients with impaired left ventricular function during exercise, who underwent major vascular surgery for arteriosclerotic disease, were randomly digitalized in the immediate postoperative period. All patients had a smooth postoperative course. Haemodynamic measurements showed improved left ventricular function in those who received digitalis, since 60 min after full digitalization the digitalized patients had a highly significant decrease in pulmonary capillary wedge pressure (PCWP) with unchanged stroke volume index (SVI) and left ventricular stroke work index (LVSWI). The same improvement in cardiac function was present the next morning. The present study provides haemodynamic data in support of clinical studies showing a beneficial effect of prophylactic digitalization in surgical patients with clinical signs of arteriosclerotic heart disease, though not in overt failure.