Laser depilation using a free-running long pulse ruby laser.
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Adolescent↗
Biomedical subjects
H Lybecker
Publications and source records attributed to H Lybecker.
Evaluation of the free-running ruby laser for hair removal. A retrospective study.
The free-running ruby laser has recently been introduced for removal of unwanted hair growth. It is assumed that the mode of action of ruby laser depilation is that of selective photothermolysis of the melanin-rich structures. The present data reflects our results of ruby treatment of 133 patients attending a dermatological laser clinic for hair removal. When success of the laser treatment was defined as greater than 50% hair removal, 59.0% of patients reported successful results after 90 or more days after last treatment. With success defined as greater than 25% hair removal at 90 days, successful treatment was obtained in 75.0%. Also, the patients evaluated the overall result of their treatments. The percentage of patients who were either "very satisfied" or "satisfied" after 90 days was 64.2%. Only a few side-effects were observed. In general, pain was no clinical problem. No significant scarring was observed. A temporary hypopigmentation was experienced by approximately 10%, but only one patient still had hypopigmentation 90 days after treatment. Due to variability of hair density as well as anagen and telogen phase durations in different anatomical locations, firm conclusions regarding the long-term effect still cannot be drawn.
Adolescent↗
A random trial comparing recovery after midazolam-alfentanil anesthesia with and without reversal with flumazenil, and standardized neurolept anesthesia for major gynecologic surgery.
STUDY OBJECTIVE: To compare the recovery characteristics of total intravenous anesthesia (TIVA) using midazolam-alfentanil, with or without reversal with flumazenil to a standardized neurolept anesthesia with nitrous oxide (N2O). DESIGN: Randomized, double-blinded clinical study. SETTING: University medical center. PATIENTS: 80 ASA physical status I and II women scheduled for major elective gynecologic surgery. INTERVENTIONS: Patients were anesthetized with one of three different anesthetic techniques. Patients in the TIVA group with reversal received midazolam-alfentanil reversed with flumazenil (Group 1), the TIVA group without reversal received midazolam-alfentanil reversed with placebo (Group 2), and patients in the neurolept group received anesthesia using thiopental sodium, droperidol, fentanyl, and N2O (Group 3). MEASUREMENTS AND MAIN RESULTS: Recovery was assessed by an observer blinded to the treatment allocation, using a Modified Steward Recovery Score and judgment of orientation and comprehension, collaboration and degree of sedation for the first 4 hours after extubation. Arterial blood gases were measured 30 minutes after extubation. A questionnaire regarding the degree of perioperative amnesia was presented to the patients 4 and 24 hours after surgery. The recovery scores were better in the TIVA group with reversal than in the other two groups from 0 to 30 minutes postoperatively. No difference between the groups could be found thereafter, although after 30 minutes some resedation occurred in the TIVA group with reversal. The median injected amount of flumazenil in Group 1 was 0.5 mg. Respiratory depression (breathing frequency below 10 breaths/min) was reversed with naloxone in one patient in the TIVA group with reversal, five patients in the TIVA group without reversal, and no patient in the neurolept group (p < 0.001). On blood gas analysis, there was no evidence of hypoxemia or carbon dioxide retention. No difference was seen between the groups regarding consumption of analgesics, degree of amnesia, or patient rating of the quality of anesthesia. One patient in Group 2, however, recorded awareness at skin incision when questioned 4 hours after the operation, but could not recall this 20 hours later. CONCLUSIONS: TIVA with midazolam and alfentanil can be used for major gynecologic surgery. Recovery in the neurolept group was equal to recovery in the TIVA group without reversal, and flumazenil improves the recovery after midazolam anesthesia. Overall, in comparison with the neurolept technique no major advantage could be demonstrated using TIVA with midazolam-alfentanil.
Adult↗
The effect of epidural blood patch on hearing loss in patients with severe postdural puncture headache.
STUDY OBJECTIVE: To determine the immediate effect of epidural blood patch (EBP) on the hearing loss that can accompany postdural puncture headache (PDPH). DESIGN: Prospective open study. SETTING: Anesthetic and otolaryngologic departments at a university hospital. SUBJECTS: 16 patients who developed severe PDPH following either myelography or spinal anesthesia. INTERVENTIONS: Epidural injection of 15 ml of autologous blood. MEASUREMENTS AND MAIN RESULTS: Audiometry at 250, 500, 1,000, 2,000, 4,000, and 8,000 Hz before and one hour after the epidural blood patch was performed. Hearing was significantly improved in 12 of the 16 patients studied. The improvement was at least 10 dB at two or more consecutive frequencies, or 5 dB at four or more consecutive frequencies. CONCLUSION: Epidural blood patch improves hearing within one hour in the majority of patients with severe PDPH.
Adult↗
Postdural puncture headache (PDPH): onset, duration, severity, and associated symptoms. An analysis of 75 consecutive patients with PDPH.
Among 873 consecutive patients who had undergone a total of 1021 spinal anaesthesias involving puncture of the lumbar dura, 75 (7.35%) complained of Postdural Puncture Headache (PDPH). The severity of each patient's PDPH was categorized, on a scale from mild to severe, on the basis of the onset, duration, severity of the headaches, and the degree to which they were accompanied by auditory and vestibular symptoms. In the patients who developed PDPH, 65% developed symptoms within 24 hours of the lumbar punctures and 92% developed symptoms within 48 hours. For the patients who recovered spontaneously the mean duration of the PDPHs was 5 days, with a range of 1-12 dyas. PDPH was characterized by headaches that were influenced by the patient's posture and the severity of PDPH was categorized as follows: Mild PDPH resulted in a slight restriction of their physical activity. These patients were not confined to bed and had no associated symptoms. Moderate PDPH forced the patient to stay in bed for part of the day, and resulted in restricted physical activity. Associated symptoms were not necessarily present. Severe PDPH. Patients were bedridden for the entire day and made no attempt to raise their head or to stand. Associated symptoms were always present. Forty-five of the PDPH patients (60%) recovered spontaneously. Of these, 8 patients (11%) were categorized as mild cases of PDPH, 14 (19%) as moderate, and 23 (30%) patients as severe cases of PDPH. Thirty of the PDPH patients (40%) were treated with an autologous epidural blood patch (AEBP). Of these, 27 patients (36%) were classified as severe and 3 patients (4%) as moderate PDPH.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Repetitive hearing loss following dural puncture treated with autologous epidural blood patch.
A case of repetitive hearing loss following an otherwise uncomplicated diagnostic dural puncture is presented. The patient developed severe postdural puncture headache (PDPH) and three episodes of pronounced vestibulocochlear disturbances within five weeks after only one dural puncture. On all three occasions the headache and the associated symptoms were treated with an autologous epidural blood patch (AEBP) resulting in the immediate disappearance of all the subjective complaints of postdural puncture headache and the normalization of an audiological test within minutes.
Adult↗
[Bronchodilating inhalation anesthetics in bronchial asthma and status asthmaticus].
On the basis of a review of the literature, a survey is presented concerning the use of halogenated inhalational anaesthetics (halothane, enflurane, isoflurane) in anaesthesia of asthmatic patients and in intensive care units in the treatment of status asthmaticus refractory to maximal standard therapy. Particular emphasis is placed on the bronchospasmolytic, cardiovascular and organotoxic effect of the anaesthetics. It is concluded that halogenated inhalational anaesthetics are established as bronchospasmolytics, and that their use in bronchospastic disease should be individualized to the patient and his other specific disease process.
Anesthesia, Inhalation↗
[Severe bronchospasm in a 1-year old child treated with halothane].
A case of severe bronchospasm in a one-year old mechanically ventilated girl which in spite of maximal conventional bronchodilatory treatment only responded to halothane inhalation is presented. The benefits and limitations of this therapy are discussed.
Administration, Inhalation↗
[Rational hemotherapy. Indications, complications and practical performance].
Employment of allogenic blood products involves the risk of a series of complications in the recipient: transfusion-transmitted disease, immune suppression, immunological transfusion reactions and coagulopathy. Hepatitis C is the most common transfusion-transmitted infection with a post-transfusion incidence of 2-4%. Transfusion-transmitted AIDS plays a quantitatively lesser role but the course of the condition is frequently fatal. The duration of the period during which a HIV-sero-negative individual is potentially infectious is uncertain. After blood transfusion, the immune apparatus is suppressed, probably on account of the leukocyte content of the blood transfusion. These disturbances in immune function increase the risk of infection and possibly the frequency of recurrence of cancer after operative treatment of a series of neoplastic diseases. Coagulopathy after blood transfusion may be related primarily to the number of transfusions and can be counteracted by administration of the relevant coagulation factors. Rational hemotherapy aims at minimizing these transfusion-related complications by restricting the indications for blood transfusion, blood component therapy, peroperative normovolaemic haemodilution, preoperative deposition of autologous blood and/or peroperative collection of blood and re-infusion. Employing rational hemotherapy, it becomes possible to reduce the need for transfusion by 20-90% and hence the morbidity and the mortality connected with blood transfusion.
Blood Substitutes↗
[Prehospital treatment. The Odense ambulance project. A prospective study].
No legislation exists about ambulance services in Denmark. The present Danish prehospital treatment is undertaken by Falcks Redningskorps A/S and the municipal fire services. During a period of 12 months (1.2.1988-31.1.1989) a prospective investigation was carried out in Odense concerning the effect of medical support to the ambulance service, partly in the form of a medically staffed ambulance, partly in the form of an arrangement in which an independent doctor's car (rendez-vous arrangement) was sent together with the nearest ambulance. In addition, the heart ambulance model as recommended by the Danish National Board of Health was also tested. Experience from abroad and recent Danish trial arrangements demonstrate the positive effect of extended professional prehospital treatment. The authors consider, therefore, that an ambulance law is required as this would ensure better and more uniform prehospital treatment in Denmark. Planning of the future prehospital treatment of acute and injured patients including the extent of the training, equipment and treatment must be established on the basis of a healtheconomical assessment of the Danish arrangements.
Ambulances↗
[Ambulance services for patients with acute cardiac conditions in Denmark--current state].
In 1985, the Danish Board of Health published a review of the therapeutic value of heart ambulances. A report is presented here concerning the extent to which prehospital treatment of cardiac arrest recommended by the Board of Health has been intensified after publication of the review. The prehospital treatment of cardiac arrest has been intensified in four counties and in the municipalities of Copenhagen and Frederiksberg whereas it has not been altered in the remaining ten counties. Recent Danish investigations have demonstrated better prognosis both as regards survival and as regards recovery when intensified prehospital treatment of cardiac arrest is employed. Hence legislation steps should be taken to improve pre-hospital treatment of cardiac arrest.
Ambulances↗
[First aid in cases of out-of-hospital heart arrest].
In connection with participation of doctors in the emergency ambulance service in Odense, the number of cases of observed cardiac arrest outside hospital was registered during a period of six months. The object was to assess how often primary treatment for cardiac arrest was instituted by passers-by before arrival of the ambulance. Seventy-four cases of observed cardiac arrest occurred. In 11 of these (15%) primary resuscitation was attempted outside hospital. In only three (4%) cases the primary resuscitation was undertaken by lay persons. Treatment of cardiac arrest before arrival of the ambulance increases survival. It is therefore essential to increase the number of courses in the treatment of cardiac arrest for lay persons, if mortality is to be reduced.
Denmark↗
[Out-of-hospital heart arrest. Prospective study of various types of expanded prehospital treatment in Odense].
During the period 1.2.1988-31.1.1989, a prospective investigation was undertaken of the intensive prehospital treatment in Odense. Comparison was undertaken between a medically staffed ambulance (2 months), a motorized doctor (rendez-vous, model 4 months) and the heart ambulance (recommended by the Danish National Board of Health (6 months]. Out of 28 patients brought in by the medically staffed ambulance, two (7%) were discharged alive. Out of 57 patients brought in the phase with the motorized doctor nine (16%) were discharged alive. Out of 78 patients brought in by heart ambulance one (1%) was discharged alive. The results of this investigation reveal that the prehospital treatment of cardiac arrest in Odense can be improved by participation of a doctor in the treatment, (particularly the rendezvous model). Suggested improvements consist of 1) improved alarm system, 2) intensification of training laymen in treatment of cardiac arrest and 3) increased information to the population.
Ambulances↗
[Intensified prehospital treatment of heart arrest increases the number of survivors with good cerebral function].
Psychological assessment in the form of a test for dementia was carried out in 69 individuals. Thirty of these were survivors of cardiac arrest outside hospital. Seven of these were brought to hospital in ordinary emergency ambulances, 14 in heart ambulances and nine in medically staffed ambulances. In addition, 28 patients with acute myocardial infarction (AMI) and 11 control persons were examined. The result of the investigation demonstrates that the more intensive the prehospital treatment of cardiac arrest, the more patients survive with good cerebral function. In particular, the percentage of cerebral damage was least in cases where a medically staffed ambulance was employed.
Brain Damage, Chronic↗
Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias.
The incidence of postdural puncture headache (PDPH) was investigated prospectively in 873 consecutive patients undergoing a total of 1021 spinal anesthesias, and its association to age, sex, needle size, number of attempted dural punctures, needle bevel direction, duration of postoperative recumbency, and previous PDPH was analyzed. Multivariate analysis showed that age (P less than 0.0001), direction of the bevel of the needle when puncturing the dura mater (P = 0.022), and a history of previous PDPH (P = 0.018) were significant predictors of PDPH. The estimated relation between PDPH, on the one hand, and age and orientation of the bevel, on the other, enables the anesthetist to predict the risk of PDPH and thereby to choose an acceptable age limit for spinal anesthesia.
Adolescent↗
[Acute poisoning with organic phosphates treated at an intensive care unit].
During the period 1.1.1976 to 31.12.1985, 23 patients were treated in an intensive care unit following acute poisoning with organic phosphates. Sixteen of the cases of poisoning were intentional and were part of attempted suicide. Eight were accidental. The severe cases of poisoning were all attempted suicides. Nineteen of the cases of poisoning occurred during the months from April to August during which these sprays are employed. The average age was 41 years ant the sex ratio men: women was 3:0. Respirator treatment was necessary in six patients. Sixteen patients were treated with a bolus injection of atropine and/or continuous infusion and six of these patients received antidote treatment with obidoxim, simultaneously. It is concluded that the majority of cases of poisoning are with suicidal intent and employ preparations which are freely obtainable and that only very few cases of poisoning occur in professional persons in connection with their employment. Treatment of cases of acute poisoning with organic phosphates is both specific and symptomatic. A therapeutic programme is established which aims primarily at ensuring free respiration, prevention of further absorption of poison, specific antidote therapy with atropine and obidoxim and symptomatic therapy.
Adult↗
Transvenous retrieval of intracardiac catheter fragments.
Six cases of catheter embolism are presented, and various techniques of retrieving these foreign bodies from the heart are described. The techniques may be carried out under local anaesthesia. They are rapid, safe and enable the patients to avoid thoracotomy.
Adolescent↗
Pregnancy and cesarean section in a patient with a rate-responsive pacemaker.
The function of a rate-responsive pacemaker was monitored during pregnancy and cesarean section in a woman with complete atrioventricular block. The observations during pregnancy were compared to similar observations obtained in a pregnant normal woman of comparable age, height and weight, and in 12 normal women during elective cesarean section. During pregnancy, the heart rate increased in the normal woman, whereas the pacing rate in the woman with the implanted pacemaker was unchanged. Fetal movement caused an increase in pacing rate in the 37th week of gestation, whereas the heart rate in the normal woman did not respond. During cesarean section the pacing rate was generally within the mean +/- 1 SD for normal women.
Adult↗