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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.

Background Severe pneumococcal infections contribute to increased mortality in patients with rheumatic diseases, and is preventable by vaccination against Streptococcus pneumoniae. EULAR recommends that pneumococcal vaccination should be strongly considered in patients with rheumatic diseases, however, need and timing of revaccination for this patient group remains unknown1. Since 2009, rheumatological patients from our department have been vaccinated against S. pneumoniae prior to initiation of bDMARD therapy, by use of the 23-valent pneumococcal polysaccharide vaccine (PPV23). To our knowledge, we are the only centre in Denmark to vaccinate these patients routinely. Objectives The aim of the study was to determine the prevalence of rheumatological patients receiving bDMARD therapy with a protective level of antibodies against S. pneumoniae, and to identify possible factors of relevance affecting antibody production. Methods Antibodies against 12 pneumoccocal serotypes were measured in the period of June to December 2017 in patients receiving bDMARD therapy initiated before March 1st 2017. A geometric mean level of all serotypes above 1 µg/ml was considered a protective antibody level. The patients had been diagnosed with rheumatoid arthritis, spondyloarthritis, psoriatic arthritis or juvenile idiopathic arthritis. The study group consisted of both vaccinated and unvaccinated individuals, where unvaccinated individuals initiated bDMARD therapy before vaccination occurred routinely. Differences in protection between vaccinated and unvaccinated patients were evaluated using the χ2 test. We included the following variables in a logistic regression model, to analyse factors of possible significance to the protective level of antibodies: age, sex, diagnosis, methotrexate (MTX) and/or prednisolone treatment at time of vaccination, and years since vaccination. Results A total of 319 patients were included in the study: 186 (58%) vaccinated and 133 (42%) unvaccinated patients. Among the vaccinated patients, 30% had a protective antibody level versus 0% of the unvaccinated patients (p Logistic regression analysis showed that a significantly smaller proportion of patients treated with MTX at time of vaccination had a protective antibody level compared with patients not treated with MTX (p=0.03; odds ratio: 2.3; 95% CI [1.1;4.7]). The same applied for advanced age at time of vaccination (p=0.04), whereas years since vaccination did not decrease antibody protection significantly (p=0.12). Conclusions Only one third of PPV23 vaccinated rheumatological patients treated with bDMARD were observed with a GML of pneumococcal antibodies above 1 µg/ml. This suggests that a majority of these patients are not protected adequately against pneumococcal disease in spite of vaccination. MTX treatment at time of vaccination and advanced age were both independently associated with lack of protective antibody level. Reference [1] van Assen S, Agmon-Levin N, Elkayam O, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis2011;70(3):414–422. Disclosure of Interest None declared

Instrument GRAS (Global Navigation Satellite System Receiver for Atmospheric Sounding) on-board of the Metop-A satellite was activated on 27 October 2006. Currently, Metop-A is a fully operational satellite with GRAS providing from 650–700 occultations per day. We describe our processing of GRAS data based on the modification of our OCC software, which was modified to become capable of reading and processing GRAS data. We perform a statistical comparison of bending angles and refractivities derived from GRAS data with those derived from ECMWF analyses. We conclude that GRAS data have error characteristics close to those of COSMIC data. In the height range 10–30 km, the systematic refractivity difference GRAS–ECMWF is of the order of 0.1–0.2 %, and the standard deviation is 0.3–0.6 %. In the lower troposphere GRAS refractivity and bending angle indicate a negative bias, which reaches its maximum value in the tropics. In particular the retrieved refractivity is biased by up to 2.5 %. The negative bias pattern is similar to that found in the statistical validation of COSMIC data. This makes it probable that the bias should not be attributed to the instrument design or hardware.

The Global Positioning System (GPS) radio occultation measurements obtained using the TurboRogue GPS receiver on the Danish satellite Orsted have been processed using the single frequency method. Atmospheric profiles of refractivity and temperature are derived and validated against numerical weather prediction data from the European Centre for Medium-Range Weather Forecast (ECMWF). Results from the Orsted GPS measurement campaign in February 2000 indicate that the single frequency method can provide retrievals with accuracy comparable to that of using two frequencies. From comparisons between measured dry temperature profiles and corresponding dry temperature profiles derived from ECMWF analysis fields, we find a mean difference of less than 0.5 K and a standard deviation of 2–4 K between 500 and 30 hPa in height. Above 30 hPa the impact of the ionosphere becomes more dominant and more difficult to eliminate using the single frequency method, and the results show degraded accuracy when compared to previous analysis results of occultation data from other missions using the dual frequency method. At latitudes less than 40° (denoted low latitudes), the standard deviation is generally smaller than at latitudes higher than 40° (denoted high latitudes). A small temperature bias is observed centered at 200 hPa for low latitudes and at 300 hPa for high latitudes. This indicates that the ECMWF analyses do not adequately resolve the tropopause temperature minimum. In the lowest part of the troposphere an observed warm bias is thought to be due to erroneous tracking of the GPS signal in cases of atmospheric multipath propagation.

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.

We discuss the processing of GRAS radio occultation (RO) data done at the GRAS Satellite Application Facility. The input data consists of operational near-real time bending angles from December 2010 from the Metop-A satellite operated by EUMETSAT. The data are processed by an Abel inversion algorithm in combination with statistical optimization based on a two-parameter fit to an MSIS climatology. We compare retrieved refractivity to analyses from ECMWF. It is found that for global averages, the mean differences to ECMWF analyses are smaller than 0.2% below 30 km (except near the surface), with standard deviations around 0.5% for altitudes between 8 and 25 km. The current processing is limited by several factors, which are discussed. In particular, the penetration depth for rising occultations is generally poor, which is related to the tracking of the L2 signal. Extrapolation of the difference between the L1 and L2 signals below the altitude where L2 is lost is possible and would generally allow deeper penetration of retrieved refractivity profiles into the lower troposphere.

The methylation status of B-hordein genes in the developing barley endosperm was analyzed by digestion with methylation-sensitive restriction enzymes. Southern blotting revealed specific demethylation of Hpa II sites in DNA from wild-type endosperm, whereas leaf DNA and lys3a mutant endosperm DNA were highly methylated at these sites. Similar methylation patterns were observed at an Ava I site situated at position -260 in the B-hordein promoter. This differential methylation was confirmed by genomic sequencing with ligation-mediated PCR. The analyzed sequence covers most of the B-hordein promoter and includes 10 CpGs from the promoter and 4 CpGs from the adjacent coding region. These sites were all hypomethylated in wild-type endosperm, whereas--except for three partially methylated sites--full methylation was seen in leaf DNA. The four sites in the coding region were partially methylated in lys3a endosperm DNA, but the promoter sites remained highly methylated. The possible role of methylation in the regulatory function of the Lys3 gene product is discussed.

The developments of an operational system for processing of radio occultations from the GRAS (Global navigation satellite system Receiver for Atmospheric Sounding) receiver onboard the future Metop satellite is the primary scope of the EUMETSAT project: GRAS Satellite Application Facility (SAF). The planned GRAS SAF data products and processing system is discussed together with a preliminary product validation based on statistical analysis of retrieved refractivity and temperature using radio occultation data from the German CHAMP (CHAllenging Minisatellite Payload) satellite. The CHAMP data from the first 8 weeks of 2003 have been processed using the GRAS SAF retrieval system and we present the results as compared to the ECMWF. The mean difference in refractivity is approx. 0.5% with standard deviations less than 1% between 8–25 km and approximately 2% both close to the surface and at 35 km.

The EUMETSAT network of Satellite Application Facilities (SAFs) will, to­gether with the EUMETSAT central facilities, constitute the future ground segments for the Meteosat Second Generation and EUMETSAT Polar System (EPS)/Metop satellites. SAFs are located in national meteorological offices or other approved institutes of EUMETSAT member states. The scope of the SAF activities will be to deliver products and/or software to derive these products, at the level of meteorological parameters, based primarily on the satellite data. The GRAS (Global Navigation Satellite System Receiver for Atmospheric Sounding) SAF will receive raw and pre-processed GPS radio occultation data from the GRAS instrument onboard the EPS/Metop satellite, process these into vertical profiles of refractivity, temperature, pressure, and humidity, and distribute these products continuously to numerical weather prediction and climate monitoring users. The GRAS SAF products promise globally distributed high-vertical resolution data on a 24 hour-basis, forming a considerable improvement on today’s measurement methods regarding coverage, vertical resolution, frequency, and cost. The accuracy requirements of the products vary with height. The expected root mean square error on temperature will be between 0.5 and 5 K, on pressure between 0.5 and 2 hPa, on specific humidity between 0.025 and 1 g/kg, and on refractivity between 0.1 and 2 %. Vertical resolution will be between 0.3 and 3 km in the vertical range covered from surface up to 50 km. A second objective of the GRAS SAF is to supply software for 4D-VAR assimilation of radio occultation data into Numerical Weather Prediction (NWP) models. The GRAS SAF is expected to distribute and archive atmospheric products from around 500 occultations per day at least through the expected project lifetime of 15 years. The main users of the GRAS SAF products will be meteorolo­gists doing NWP data assimilation, and users from the climate research and atmospheric science communities, needing comprehensive, globally distributed temperature, pressure, and humidity information. The products will come in two types: Near-Real Time Products (for NWP), disseminated less than three hours after acquisition, Offline Products (im­proved, for climate research), available less than 30 days after acquisition. The focus of this paper is on the design of the operational GRAS SAF facility. The GRAS SAF processing system and data products will be described and the user requirements for both Numerical Weather Prediction (NWP) and climate monitoring will be presented.

The launch of the Orsted satellite started a range of activities to verify GPS occultation measurements of the Earth atmosphere and ionosphere based on observations of GPS signal delay from a low Earth orbiting satellite. The Orsted satellite followed the GPS/MET satellite experiment as the second mission in space to perform these types of measurements. Now the CHAMP satellite and also the SAC-C satellite are producing GPS occultation measurements in large numbers in long time-series and the data are just available since November 2001. The aim of this paper is to present an overview of the retrieval techniques used on the observations with the TurboRogue receiver on Orsted and the results obtained both for the atmosphere and ionosphere. The results of CHAMP occultations using orsted processing tools will be presented and compared with Orsted.

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.

During investigations for infertility azoospermia was diagnosed in two men who were concomitantly using anabolic steroids for body-building. Following cessation of anabolic steroid use the semen quality was normalized. Suppression of spermatogenesis during treatment with testosterone and derivatives hereof is wellknown. Usage of anabolic steroids should be remembered as a cause of oligo- and azoospermia and asked about in cases of sperm counts approaching or at zero.

Many patients suffering from trauma or acute illness are in need of pain treatment in the prehospital phase, a treatment they seldom receive. In Denmark, it has been considered whether ambulance personnel should be allowed to administer pain treatment. Inhalation of 50% nitrous oxide and 50% oxygen has been administered for many years by non-physicians around the world. Therefore considerations concerning implementation of this treatment in Denmark are relevant. The aim of this paper was to evaluate the available knowledge about and experiences in using nitrous oxide outside the hospital for patients suffering from acute pain. The papers so far published are positive, but give no definite background for uncritical recommendation of prehospital pain treatment with nitrous oxide. There are no controlled studies concerning the effect of pain treatment in the prehospital phase. The few available controlled studies conducted inside the hospital have not shown significant pain-relieving effects of nitrous oxide for patients suffering from pain of acute medical of surgical origin when compared to other methods of pain treatment. Controlled studies of the effects of prehospital treatment with nitrous oxide need to be done. Technical problems and problems concerning indications, side effects, complications, pollution and possible addiction remain to be fully elucidated before prehospital treatment with nitrous oxide can be recommended for routine use in the Danish ambulances.

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)

Employment of pneumatic anti-shock (MAST) equipment is a therapeutic possibility in some countries for hypovolaemic and shocked patients. This treatment may be associated with particularly serious side effects and no documentation is available to prove that MAST is beneficial for the patients. The only meticulous clinically controlled investigation concludes that MAST is without effect in city regions with well-trained paramedical or medical staff and employment of MAST can thus not be recommended. The effect of MAST outside urban regions is unknown and should be assessed by means of a clinically controlled investigation.

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.

Clinical employment of magnetic resonance scanning presents great diagnostic possibilities, partly in the form of the quality of the imaging and also on account of the possibilities for carrying out spectroscopic measurements by mens of which in vivo non-invasive chemical analysis of drug concentrations in the tissues may be performed. In anticipation of the possibility of employing MR-scanning as an important diagnostic aid for assessing the causes of unconsciousness in patients in intensive care, attempts have been made to establish reliable and justifiable equipment for monitoring which can render possible investigation of unconscious or anaesthetized patients in scanners with magnetic fields of over 1.5 Tesla. The medical technical difficulties involved are mentioned and the solutions which are employed in the Danish scientific Centre for Magnetic Resonance in Hvidovre Hospital in Copenhagen are described. This monitoring includes continuous ECG recording, measurements of pulse and blood-pressure once per minute and continual monitoring of respiration including concentrations of carbon dioxide in the inspired and expired air and the concentration of oxygen in the inspired air. In addition, model solutions have be outlined for establishing mechanical ventilation with the servorespirator and the possibility of producing an employable pulse oxymeter is described. It is stated that, provided all of the elements in the above mentioned model solution for monitoring during anaesthesia in the MR laboratory have been carried out, it is considered justifiable to place all patients, including children, in the MR-scanner.

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.

This article is a review of presented subsets of the Danish Verapamil Infarction Trial II (DAVIT II) regarding the effect of verapamil on postinfarction ischemia, ventricular arrhythmias, and heart rate (HR), and the prognostic implications of these findings. Patients underwent Holter monitoring for 24-48 h at 1 week, i.e., before randomization to long-term treatment with placebo or verapamil, and after 1 month and about 1 year of study treatment. Ischemia: 18% of the patients had transient ST-segment deviation before randomization; 24% of the placebo- and 8% of the verapamil-treated patients (p = 0.04) showed ischemia after 1 month; and after 1 year, the figures were 26 and 4%, respectively (p = 0.02). The 18-month major event rate, i.e., first reinfarction or death, in patients with ischemia before randomization were 40 and 23.8% in patients without ischemia (p = 0.06). Arrhythmias: In the placebo group the prevalence and incidence of many ventricular ectopic beats (VEBs), i.e., more than 10 VEBs/h, increased significantly during the first years after infarction; this was not the case in the verapamil patients group. The mean HR was significantly reduced by verapamil treatment after 1 month and after 16 months of treatment. Multivariate analysis demonstrated the presence of more than 10 VEBs/h only early (i.e., 1 week) but not late (i.e., 1 month) after infarction, to be an independent predictor of major events during 18 months' follow-up observation. A HR above 80 beats/min independently predicted major events when appearing both early and late after infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

In eight patients undergoing cardiac surgery for aortic and/or mitral valvular disease, mean arterial blood pressure (MAP), central venous pressure (CVP), cardiac index (CI), stroke index (SI), pulmonary capillary wedge pressure (PCWP), and pulmonary arterial mean pressure (PAMP) were measured after premedications with diazepam-scopolamine (I), after breathing 100% oxygen (II), and on controlled respiration (III) after induction of anaesthesia with enflurane-O2, and endotracheal intubation facilitated by succinylcholine. All measurements were done prior to surgery. Enflurane anaesthesia was found not to affect cardiac index. The average SI decreased by 27%, but was compensated for by an average increase in heart rate (HR) of 33%. The average systemic vascular resistance (SVR) decreased by 14%. All other measured parameters were found to be unaffected by enflurane-O2 anaesthesia. It is concluded that the cardiovascular stability observed in healthy young normals during enflurane anaesthesia is preserved in patients with moderate to severe heart failure, making enflurane an anaesthetic agent well suited for patients with cardiac disease.

Organisatory and therapeutic characteristics for selected pre-hospital medical treatment systems are described. It is emphasized that all of the links in the therapeutic chain must function optimally to achieve effective treatment of acute disease and injuries. The importance of rapid decision-making by highly qualified medical staff is emphasized. On the basis of experience from Denmark and from abroad, a model for up-to-date pre-hospital treatment in Denmark is outlined.

We present the central haemodynamic data obtained during halothane/nitrous oxide anaesthesia in a patient under antihypertensive treatment with propranolol who underwent surgery for intracranial aneurysms in sodium nitroprusside-induced hypotension. Cardiac output remained unchanged when hypotension was induced. Pulmonary capillary wedge pressure decreased. There was a slight increase in heart rate, as well as a minor decrease in stroke volume. Systemic vascular resistance decreased, but pulmonary vascular resistance remained unchanged. The response observed is discussed.

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.

In 37 patients without cardiopulmonary insufficiency, postoperative changes in blood volume have been correlated to changes in the systemic and the central circulation. Postoperatively, the blood volume had decreased an average of 8 per cent, and diastolic blood pressure, 7 per cent, while cardiac index had increased 14 per cent and heart rate, 16 per cent. No significant changes could be demonstrated in pulmonary artery pressures, central venous pressure or invascular resistance. A highly significant correlation between the blood volume and pulmonary artery pressures and a significant correlation between the blood volume and central venous pressure were noted. Hematocrit was negatively correlated to vascular resistance. It is concluded that an unchanged blood volume during the first postoperative hours results in increased pulmonary artery pressures and central venous pressure. Therefore, in patients suspected of having increased pulmonary artery pressures, complete restoration of blood volume should take place over some hours postoperatively. An increase in hematocrit over normal values should be avoided.