PubMed Health⌕ Search

Biomedical subjects

J Schou

Publications and source records attributed to J Schou.

At least 55 records · Page 3Linked to original sources
PubMed1994

Prostatic enlargement, symptomatology and pressure/flow evaluation: interrelations in patients with symptomatic BPH.

INTRODUCTION: Benign prostatic hyperplasia (BPH) is the most common pathologic condition to afflict the aging male. Many patients with symptomatic BPH undergo prostatectomy without rigorous evaluation. Three concepts should be considered before any treatment of a patient with symptomatic BPH; Prostatic enlargement, symptomatology and bladder outflow obstruction. PATIENTS AND METHODS: The study comprised 188 consecutive patients with symptomatic BPH, all eligible after pressure/flow examination. One-hundred-seventy-four of the patients answered the DAN-PSS questionnaire, 140 of the patients had their prostate size measured by transrectal ultrasonography. One-hundred-fifty-three patients were able to perform a free flow measurement upon arrival. Uroflowmetry, symptomatology and prostate size were matched with the results of pressure/flow examination. RESULTS: Neither uroflowmetry, symptomatology nor prostate size correlated well with bladder outlet obstruction. The positive predictive value for infravesical obstruction was 88% if a maximum flow rate under 10 ml/s was used. Symptomatology could not be used to differentiate between patients with bladder outlet obstruction and patients without obstruction. The positive predictive value for infravesical obstruction was 76% if a prostate volume over 40 ml was chosen. DISCUSSION: The purpose of diagnostic evaluation in patients with BPH, is to identify precisely the pathophysiology underlying the patients condition, so that rational therapy can be selected. CONCLUSION: The disease entity of BPH is characterized by the interaction of prostate enlargement, the subjective symptom complex of prostatism, and urodynamic infravesical obstruction. Since it is impossible to interpolate from one to another of these conditions, a comprehensive evaluation of a patient with symptomatic BPH should include an assessment of all of these conditions.

Adult↗
PubMed1993

Drug related hospital admissions. Results from an intervention program.

As part of a high-intensity monitoring study of drug events as the cause of admission to departments of internal medicine, the effect of an educational intervention programme was studied. Two departments were included, one specialising in geriatrics and one that received patients by non-selected referral. The series consisted of 607 consecutive admissions studied before and 703 after the intervention. The drug events considered were adverse drug reactions and dose-related therapeutic failures, mainly due to non-compliance. A modest, statistically non-significant decrease in drug related hospital admissions (DRH) was seen, from 14% before to 13% after the intervention period. However, DRHs classified as definitely avoidable showed the significant decrease of 83%. There was no apparent relationship between the topics selected for the intervention programme and changes in the pattern of DRHs. No relationship between alterations in sales data and hospital admissions caused by a given drug could be demonstrated. A blinded external evaluation of case abstracts did not disclose any significant shift in the investigators' assessments. The intervention may have had an non-specific effect on avoidable DRHs.

Denmark↗
PubMed1993

Memokath: a second generation of intraprostatic spirals.

Memokath (Engineers & Doctors A/S, Hornbaek, Denmark) is a new intraprostatic spiral composed of titanium nickel alloy with shape memory effect. We describe the use of this spiral in 30 consecutive patients with prostatic outflow obstruction. Their median age was 79 years and all were either in a high risk group for surgery or had refused surgery. The spiral was inserted under sterile conditions via a delivery catheter under ultrasonic guidance. When flushed with hot water (45 degrees C or above) one section of the spiral expands in the prostatic apex and maintains the spiral in position. When cooled with cold water (10 degrees C or below) the spiral becomes supersoft, making removal easy. With a follow-up of 0.2 to 9 months (median 3) we report a success rate of 83%. Five patients discontinued treatment, 3 because of urinary retention, 1 because of progressive obstructive symptoms and 1 following persistent urinary incontinence. No migration of the spiral was observed. Encrustations have appeared and seem to be a persistent problem. Most patients were satisfied with the procedure, which provided a quick, safe and effective method of relieving infravesical prostatic obstruction. Follow-up is short and late complications have yet to be assessed.

Aged↗
PubMed1993

The value of a new symptom score (DAN-PSS) in diagnosing uro-dynamic infravesical obstruction in BPH.

INTRODUCTION: A new type of questionnaire for BPH, the DAN-PSS symptom score system, was used in an attempt to predict infravesical obstruction determined by pressure-flow study. PATIENTS AND METHODS: In 50 consecutive patients a reliable questionnaire and a pressure-flow was obtained. RESULTS: Almost none of the unobstructed patients had a total obstructed index (TOI) of more than 6, whereas this was the case in half of the obstructed patients. This difference was statistically significant. DISCUSSION: This study indicates, that if the total obstructed index (TOI) is more than 6, the patient most likely have an infravesical obstruction. With this limit the DAN-PSS-score system can predict infravesical obstruction with a sensitivity of 42% and a specificity of 89%. CONCLUSION: With the new concept of combining quantity with quality in a symptom score system, a strong correlation between symptoms and objective findings has been found.

Aged↗
PubMed1993

[The urodynamic examination in prostatism].

In a prospective study comprising 29 patients the authors analyzed comprehensively subjective complaints of prostatism using the score of prostatic symptoms (PSS) with the objective urodynamic finding (uroflowmetry, cystometry, pressure flow measurement) in men with benign prostatic hyperplasia. The Boyarsky and Madsen-Iversen PSS did not correlate with the infravesical obstruction assessed by the pressure flow measurements. An obstruction was detected in 23 patients (79.3%), incl. a marginal one in 6 patients (20.7%), the diagnostic sensitivity of free uroflowmetry being 90.9%. Cystometry did not reveal a significant difference between the group with and without an obstruction, instability of the detrusor was found in 12 patients (41.4%) with a significant difference of the maximal cystometric capacity, as compared with the group of patients with a stable detrusor.

Humans↗
PubMed1992

[The effect of etomidate on the upper airway reflexes].

Clinical observations during anaesthesia and intubation of emergency patients are presented showing a differentiated impact of etomidate (Hypnomidate) on upper airway reflexes: a blockade of pharyngeal reflexes with sustained but possibly delayed laryngeal reflexes and a certain protection against laryngospasm and vomiting. In addition etomidate enables, preferably in combination, difficult intubation with sustained spontaneous breathing due to its low respiratory depressant effect. These features were confirmed in a small foreshortened clinical study using thiopentone (Trapanal) or etomidate without muscle relaxants, whereby the difference in high risk patients became obvious. The impact of anaesthetics on airway reflexes is generally concealed by muscular relaxants, and observations on this matter are difficult to make subject to quantifiable parameters and controlled studies; accordingly such observations are scarcely found in newer anaesthetic literature. In the development of new techniques for intubation and anaesthesia without muscle relaxation, these methodical problems deserve attention.

Etomidate↗
PubMed1992

[Pneumothorax and cardiac arrest as complications of postoperative nasopharyngeal administration of oxygen].

An unusual but life-threatening complication to nasopharyngeal oxygen administration is described. Following an unsuccessful attempt to advance nasogastric tube during anesthesia for cholecystectomy, the same nostril was used for an oxygen catheter at the end of operation. Within a few minutes after the oxygen supply had been opened following extubation, the patient developed submucous pharyngeal and mediastinal emphysema with subsequent bilateral pneumothorax and cardiac arrest. The patient was reintubated, received close-chest cardiac compressions for a brief period, and the pneumothoraces were drained. She recovered completely within a few hours and was extubated uneventfully the following day. With the increasing--and justified--use of oxygen postoperatively in and during transport to the recovery room, this complication is likely to occur more often. In this case, the anesthetist's previous experience of this complication and consequent rapid therapeutic intervention was probably responsible for the favorable outcome.

Aged↗
PubMed1991

Evoked potentials in urology: a method to make an exact diagnosis?

Due to the complex innervation of the lower urinary tract, many neurological diseases will lead to disturbances in the function of the lower urinary tract. The usual urodynamic procedures leave a group of patients where definitive diagnosis is impossible. Fifty-three patients were evaluated with evoked potentials of the bulbocavernosus reflex at the Urological Laboratory, Herlev Hospital. In 5 cases (2 with operative sequelae after prolapsed intervertebral discs, 1 with tethered cord syndrome and 2 with early multiple sclerosis) the examination gave a definitive diagnosis. The cases are reported.

Adult↗
PubMed1990

The elasticity and the tensile strength of tunica albuginea of the corpora cavernosa.

The aim of this study was to determine the tensile strength and the elasticity of the tunica albuginea (TA), and describe morphological structures in the tissue before and after mechanical deformities. Twenty cadavers of men aged between 33 and 83 were examined. Cavernosometry was performed in all specimens. Afterwards in five cadavers the flow rate was increased until a herniation of the TA appeared. A strength about 1500 mm. Hg was found. Similar results were found in four who had an inflatable prosthesis (AMS 700) inserted, and the intraprosthetic pressure increased until a deformity was noted. Slices of TA (thickness 1.3 to 3.3 mm.) from 11 specimens were tested in a tensiometer. The elasticity coefficient was found to be around 10(8) N/m2, and the tensile strength to be 600 to 750 mm. Hg (10(4) to 10(5) N/m2). The difference between the tensile strength achieved in the tensiometer and during saline infusion is possibly caused by the intracavernous framework. Microscopy showed that TA is mainly composed of collagen fibres which are situated in an undulating arrangement, with a few elastic fibres arranged longitudinally which connect the undulating bundles of collagen fibres. When the tissue is overstretched, the elastic fibres are destroyed and the undulating arrangement disappears.

Adult↗
PubMed1990

[The double mask].

While the consequences of occupational exposure to anesthetic gases and volatile agents on morbidity in operating room staff are controversial (survey in Swiss investigations show a distinct correlation with subjective complaints, e.g. tiredness and headache on the day of exposure (Table 1). In Sweden, rigorous control of occupational exposure to anesthetic gases has prompted development of various scavenging systems, among which the double mask (Fig. 1) is the latest and most advanced. During mask anesthesia, escaping anesthetic gases are evacuated at the point of leakage via a thin slot between a flexible silicone inner mask and a rigid plastic outer mask. A small plate in the mask produces turbulence in the otherwise laminar flow of anesthetic gases, thus reducing the speed of gas leakage. A silicone chamber is mounted on the mask and connected to a fan, requiring a flow of 35 m3/h for optimal function. This chamber does, however, also associate the system with two practical problems: the system with its evacuation tube is heavier to hold than conventional masks, and it is associated with increased dead-space that is only partly minimized by a modification of the Y-connector. While the handling is largely a matter of routine and the weight of the system is minimized when the evacuation tube is arranged to draw slightly upward, the increased dead space may reduce the practicality of the double mask in infants.

Gas Scavengers↗
PubMed1989

[Injury patterns on the first icy day of winter--a survey in Copenhagen County].

The injuries on the first icy day of the winter 1986-1987 in Copenhagen County were compared to the injuries on the preceding day. There were 368 and 276 injuries (both days 95 non-surgical) respectively. The significant increment of fractures and emergency hospitalization was mostly due to fractures of the wrist, humerus and femur. Only a few sprains of the ankle were registered. The majority of patients were middle aged and elderly women. The economical and personal consequences are considerable, but impossible to evaluate, as reliable statistics are needed. Intensive snow clearing and recurrent propaganda are recommended.

Accidental Falls↗
PubMed1987

[Therapy of paradoxical reactions to midazolam in regional anesthesia].

Many patients fear being awake in the operating room, and the acceptance of regional anesthesia is often made dependent on the promise of adequate sedation. With the introduction of the short-acting benzodiazepine (bzdp) midazolam, it seemed possible to achieve induction and maintainance of sleep throughout an operative procedure. This substance may, however, occasionally result in a "paradoxical reaction" (PR) characterized by agitated excitement, mental confusion, and uncooperativeness. We have treated this condition successfully with physostigmine, as documented here in two case reports where a possible interaction between promethazine and midazolam may have been responsible for the PR. The symptoms resemble some of those seen in the central anticholinergic syndrome, as further implied by the therapeutic effect of physostigmine, but an etiological difference may exist. A direct anticholinergic effect of bzdp's is described only following excessive doses. An indirect effect may result from the impact on GABA-receptors, which have been identified as structurally related to the bzdp receptors. Physostigmine itself is not bound at the bzdp receptor, but has been shown to block the binding of bzdp's to their receptors and to reverse sedation from midazolam, perhaps through an indirect stimulatory effect. Previous case reports have indicated the effect of physostigmine in reversing PR following various bzdp's. Without treatment, a PR during regional anesthesia frequently makes general anesthesia necessary in order to immobilize the patient sufficiently to make surgery possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗