Søren Wistisen Rasmussen

Low molecular weight heparin (Innohep) as thromboprophylaxis in outpatients with a plaster cast: a venografic controlled study.

INTRODUCTION The aim of this study was to investigate the incidence of deep vein thrombosis (DVT) in patients immobilized in plaster cast and the possible efficacy of prophylaxis with low molecular weight heparin (LMWH). MATERIAL AND METHODS The study was a randomized, assessor-blinded, open multicenter (three centers) study. All patients over 18 years of age with planned plaster cast on a lower extremity of at least 3 weeks were eligible for participation. Written informed consent was obtained from 300 patients and they were randomized to either 3.500 IU anti-Xa of tinzaparin (Innohep) subcutaneously once daily or no prophylaxis. On the day the cast was removed, ascending unilateral venography was performed. Two experienced radiologists, unaware of treatment, assessed the pictures independently. The radiologist had to obtain consensus as to whether DVT was present or not. RESULTS 300 patients were included (148 in the treatment group and 152 in the control group). Ninety-five were subsequently withdrawn. DVT was diagnosed in 10/99 patients in the treatment group and in 18/106 patients in the control group. This difference is not significant (P=.15, chi(2) test) and the odds ratio was 0.55 (95% confidence interval=0.34-1.26). CONCLUSION DVT in legs after plaster casting is a big problem, with an incidence of almost 20%. An effective prophylactic regime is required. Once-daily dose of 3.500 IU anti-Xa of tinzaparin was not sufficient.

Ultrastructural studies of spermatogenesis in Drosophila melanogaster meigen

SummaryMeiosis in male Drosophila melanogaster was studied with the electron microscope. The number and the distribution of ring channels between individual members of a cluster of primary spermatocytes was determined from serial sections. The tubules with a diameter of 45 nm characteristic for meiotic prophase nuclei gave a chromatin type reaction, when treated with EDTA according to Bernhards technique, thus suggesting that these tubules contain DNA. A material resembling central regions of synaptinemal complexes was observed in the nucleolus of primary spermatocytes during the downward movement in the testis. It is suggested that they represent unused precursors to central components of synaptinemal complexes, which are absent at pachytene of Drosophila males. Up to six tail fibers (kinetosomes + axonemes) were observed in every primary spermatocyte prior to meiosis.

Brief hospitalizations of elderly patients

Background Crowded departments are a common problem in Danish hospitals, especially in departments of internal medicine, where a large proportion of the patients are elderly. We therefore chose to investigate the number and character of hospitalizations of elderly patients with a duration of less than 24 hours, as such short admissions could indicate that the patients had not been severely ill and that it might have been possible in these cases to avoid hospitalization.

Early Preoperative Thromboprophylaxis with Klexane® in Hip Fracture Surgery: A Placebo-Controlled Study

The aim of this study was to evaluate any possible benefits of early thromboprophylactic treatment in the preven tion of deep vein thrombosis (DVT) in high-risk hip fracture patients. Within 30 months, 239 patients were included in a double-blind placebo-controlled study. With the diagnosis of hip fracture confirmed, patients received either 40-mg Enoxa parin s.c. or placebo once daily until operation. Postoperatively, all patients received 40-mg Enoxaparin s.c. once daily until phlebography. Phlebography was first performed on the oper ated leg, and with no thrombosis detected, the other leg was investigated as well. The two groups did not differ demograph ically. Eighty-five patients were excluded. Eight patients died during the study period. The remaining 146 patients had as cending phlebography performed and 24 patients (16.4%) de veloped DVT. Nine (12%) of 75 patients in the Klexane® and 15 (21 %) of 72 patients in the placebo group developed DVT. The risk ratio was 0.58 (95% confidence limits 0.27-1.25) and p = .15 (X2 test). There was no difference in perioperative bleeding or transfusion requirements. We conclude that Klex ane® is an effective and safe thromboprophylactic agent in hip fracture patients. Key Words: Hip fracture—Thrombopro phylaxis—Low—molecular heparin.

External compression of forearm nonunion: A report on 6 cases

We treated 6 patients with 7 cases of aseptic nonunion of the forearm with external fixation and compression (Orthofix) without open reduction and bone grafting. By turning a screw on the side of the bar, compression was carried out until the nonunion gap with radiographically obliterated, usually within 2 weeks. After compression had stopped, the external fixator was retained during the following period of healing and bone remodeling. Healing of the nonunions was seen after 7 (4-11) weeks. 5 patients obtained normal mobility, while 1 had slightly restricted supination and pronation.

The Use of Dextran 70 as a Plasma Expander Increases the Intraoperative Bleeding in Total Hip Replacement

In total hip replacement (THR) dextran 70 is widely used as a plasma expander and as a thromboprophylactic agent. In a rec-hirudin multicenter dose-finding study approximately one third of the patients in our center received dextran 70 as a plasma expander at the beginning of the operation, the remainder received Haemaccel preoperatively. The average intraoperative bleeding was 1,572 ml (770-3,950 ml) in group 1 (dextran) and 1,160 ml (500-2,400 ml) in group 2. This difference is statistically significant (p = 0.002). The average postoperative bleeding was in group 1,273 ml (50-675 ml) and in group 2, 229 ml (0-870 ml), the difference is not significant. Total bleeding was in average 1,846 ml (850-4,250 ml) in group 1 and 1,451 ml (620-2,810 ml) in group 2; this difference is statistically significant (p = 0.012). Regarding the transfusion requirement measured in units; a median of 2, 5 units (0-8 units) were used in group 1 as opposed to 1.7 units (0-7 units) in group 2 (p = 0.055). The use of dextran 70 as a plasma expander led to significantly increased intraoperative bleeding. Key Words: Bleeding—Dextran—Hiparthroplasty.

Treatment of transfusion requiring anemia in a Quick Diagnostic Unit integrated in an Emergency Department Setting

Results We found 108 patients. 71% was referred to hospital by their general practitioner and 18% of the patients came from oncological departments. In the given period we treated around 4 patients each week. 25 patients were admitted more than once, on average they came every 42nd day. Two thirds of the patients only stayed for a few hours. 55 patients had a diagnosed cancer, 29 were men and 26 were women. 53 patients had a nonmalignant disease, 26 were men and 27 were women. The mean age for oncological patients was 73.8 ± 1.3 (n = 55) years and for nonmalignant patients 75 ± 1.8 years (n = 53) (p > 0.6). Oncological patients were given SAG-M transfusions at a Hb level of 5.0 ± 0.09 mMol/L (80.4 ± 1.4 g/L). Nonmalignant patients received SAG-M at a Hb level of 4.7 ± 0.07 mMol/L (75.7 ± 1.1 g/L) (p <0.05). On average patients with malignant disease tended to receive less blod than patients with nonmalignant diseases (p=0.06), i.e. 2.2 ± 0.1 vs. 2.5 ± 0.1 SAG-M per contact. This however in clinical practice amounts to 2 SAG-M for both patient categories.

Massive underreporting of type II Diabetes in emergency department admissions

Background The prevalence of type 2 diabetes mellitus (T2DM) has continued to increase in developed and developing countries in past decades. T2DM is the most frequent chronic disease in Denmark with a prevalence of 4 %, with an equal estimated prevalence of undiagnosed cases. T2DM is associated with several complications that can lead to acute deterioration and need of acute admittance to the hospital. Every day 10 patients die from T2DM-related complications in Denmark. The objectives of this study were: 1) to establish the number of patients with T2DM referred to the Department of Internal Medicine via the Emergency Department and the number of patients who were diagnosed with T2DM upon referral; 2) to report which anti-diabetics they used at the time of admittance.

Quality assessment of an Emergency Department

Methods We evaluated the following: The percentage of mis-referrals to stationary wards, i. e. transferals to another specialty than the one chosen by the emergency department within 24 hours. The percentage of re-admitted patients within 30 days after discharge. For assessment we searched the National Patient Registry for all patients admitted to the ED during 2010 compared to 2008, i.e. the year before the ED was established.

POCT is a true asset in the emergency department.

Background To determine patient priority and degree of urgency with an objective high-quality evaluation, general Point of Care testing (POCT) was established as a novel facility in the Emergency department at Holbaek Hospital. The hardware consists of AQT-90 Flex (CRP, D-dimer), ABL-800 (Na, K, Hgb, BG etc.) and HemoCue (Leukocytes), thus rendering useful parameters within initial assessment. A clinical biochemist was affiliated and analysis the blood samples taken between 10:00–22:00 hours, i.e. the period where 80% of the total patient flow occurs. The aim of the present study was to investigate whether POCT provides faster blood test results than ordinary clinical laboratory equipment (CLE).