Biomedical subjects
O V Rasmussen
Publications and source records attributed to O V Rasmussen.
[Patient information prior to sterilization].
The law in Denmark prescribes that the patient and the general practitioner to whom the patient directs his or her request for sterilization are obliged to confirm by their signatures that the patient has received information about sterilization, its risk and consequences. We asked 97 men and 96 women, if they had received this information prior to their sterilization. They were also asked about their knowledge about sterilization. 54% of the women and 35% of the men indicated that they had not received information. Only few of these wished further information by the hospital doctor. Knowledge about sterilization was good. It is concluded that the information to the patient prior to sterilization is far from optimal. The patients' signature confirming verbal information is not a sufficient safeguard. We recommend, among other things, that the patient should receive written information and that both the general practitioner and the hospital responsible for the operation should ensure that optimal information is received by the patient.
Medical appraisal of allegations of torture and the involvement of doctors in torture.
Today, torture is used in more than 90 countries. In most of these countries, the authorities try to conceal the use of torture. Therefore torture methods which do not leave marks are more often selected. Consequently, appraisal of statements of torture is mostly based on interviews with ex-prisoners. The statement of torture is compared with the description of symptoms in the period following imprisonment and with the result of the clinical examination, which is often normal. In the evaluation of the validity of a statement reservations often have to be made for minor disagreements between the single elements of the examination, for example because of impaired concentration during the examination and loss of consciousness during the torture. Furthermore, the statement may be incomplete because of psychological inhibitions and imperfect interpretation. Assessment of allegations of medical involvement in torture is also based on information given by the ex-detainee. The presumed doctor's examination technique and the treatment carried out and prescribed by him, are compared with the context in which he acted. Only very rarely do torture victims have marks from e.g. injections or suturing which can be related to medical treatment in torture centres. The critical evaluation of data collected during in-depth interviews with torture victims is the core of documentation of torture and medical involvement in torture. The national medical associations share the responsibility of ensuring that their country's doctors comply with the ethical rules and do not in any way participate in or omit to report torture.
Secondary surgery in patients with malignant germ cell tumors.
A total of 102 men treated for germ cell tumor with chemotherapy containing cisplatin was referred for a secondary operation with signs of tumor in the retroperitoneum or chest. Of the patients 85 underwent laparotomy, 14 underwent thoracotomy and 3 had both operations. Residual tumors were completely resected in 66 patients and incompletely resected in 30, while no tumor was found in 6. The resected specimen was malignant in 18 patients, of whom 11 had complete removal of all malignant tissue. All patients with malignancy in the resected specimen received further chemotherapy. Long-term disease-free status was obtained in 75% of those patients who had a complete resection, compared with 14% in the group with incomplete resection. There was no evidence of malignant disease at operation in 78 patients but 5 of them later died of the disease. Malignant tissue was present in the residual tumor in only 1 of 15 patients whose primary tumor was seminoma alone. Resection was attempted in 14 patients despite abnormal tumor markers preoperatively. Only 5 of these patients achieved a disease-free status and 2 of them died later of malignant disease. Over-all 79 of the 102 patients are without evidence of disease (medium postoperative observation 23 1/2 months). We conclude that a secondary operation constitutes an important part of the treatment of patients with germ cell cancer.
The involvement of medical doctors in torture: the state of the art.
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Gallbladder torsion. Case report.
Gallbladder torsion is a rare surgical emergency occurring primarily in elderly women. The anatomical background is a variation in the attachment of the gallbladder to the inferior margin of the liver. Increasing life span will probably lead to an increasing number of cases, and gallbladder torsion must be kept in mind in patients with sudden onset of pain in the upper right quadrant, nausea, vomiting, and a palpable mass. None of the laboratory routines or non-invasive examinations enables one to make the right preoperative diagnosis. Treatment is cholecystectomy. Promptly treated, the prognosis is good.
[Vasectomy in specialized surgical practice].
In the county of Roskilde an exception was made from the Danish legislation concerning sterilization that vasectomy should be performed in hospitals only on account of the long waiting list for this intervention. Two surgical specialists were selected to perform the operation in their practices. 88% (176/199) elected to accept the offer. All of these sterilizations were carried out within a period of six months. A questionnaire investigation did not reveal any difference in satisfaction between conduct of the intervention by the practising specialist in surgery or in hospital. Justification of the requirement that this form of sterilization can only be undertaken in hospital is discussed.
[Torsion of the gallbladder].
Torsion of the gall bladder is caused by abnormal placement of the gall bladder and is a surgical emergency. A case with a typical history is reported. Treatment is cholecystectomy. Correctly treated, the mortality is less than 3%.
The medical component in fact-finding missions.
Fact-finding missions (FFMs) are useful instruments in examining allegations of human rights violations. The United Nations Convention against Torture and other Cruel Inhuman or Degrading Treatment and the European Convention for the Prevention of Torture and Inhuman and Degrading Treatment or Punishment include the possibility for FFMs. The role of the medical profession in FFMs is discussed, and it is recommended that doctors should be included in FFMs to document allegations of torture and other human rights abuses.
[Carcinoma of the urachus].
The urachus is an embryological structure originating from the allantois and situated in Retzius' space. Neoplasms originating from the urachus are very rare. They become clinically manifest late in the course of the disease. Deformation of the apex of the bladder and supravesical calcifications are described as radiological findings but these are of limited diagnostic value and should be supplemented by ultrasonic scanning, computed tomography and possibly by magnetic resonance scanning which will provide information about the extent of the disease. The final diagnosis is based on the macroscopic findings and the macroscopic picture. Three cases representing various aspects of the disease are presented. Treatment consists of en bloc resection in the form of partial cystectomy and excision of the tissue in Retzius' space and the umbilicus. The results are, however, disappointing as the five-year survival rates in the majority of materials do not exceed 10%. Irradiation is of doubtful value and chemotherapy is scarcely of value in the treatment.
Male or female sterilization: a comparative study.
The study compares 709 males and 546 females recruited from a well-defined geographic area and sterilized during a 5-year period at the same hospital. Medical records were reviewed and questionnaires sent out. Widespread satisfaction with the sterilization was found. The sterilized women had experienced contraceptive side effects and failures more often than the men. Only 70% of the laparoscopic sterilizations could be carried out during a 1-day admission, 25% of the women complained about long-term sequelae, and there were 1% failures. The vasectomies were carried out on an outpatient basis, there were few postoperative symptoms, and 0.5% failures were recorded. Female sterilization was at least four times as expensive as vasectomy. It is concluded that vasectomy is generally to be preferred to female sterilization, and that the preoperative guidance should involve both man and wife.
Doctors involved with torture.
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Sequelae to torture. A controlled study of torture victims living in exile.
Twenty-eight Turkish refugees living in Denmark were examined by the authors in the period 1984-85. Fourteen of the persons alleged having been tortured in Turkey during the period 1980-83. The remaining 14 persons reported that they had not been tortured and thus acted as controls. All the testimonies were found valid according to a method previously used by us. The most common forms of violence reported were blows and electrical torture. Blindfolding, solitary confinement and threats were also frequent. At the time of examination the main mental complaints were sleep disturbances with nightmares and impaired memory. Emotional lability and concentration disturbances were also frequent. Physically the torture victims suffered from headache, various cardio-pulmonary and muscular pains, dyspepsia and reading disturbances. All reported that they had been healthy before torture. The clinical examination revealed only a few signs related to torture, although examples of minimal scars, fractured or missing teeth, discrete neurological disorders and mental depression were found. The 14 controls had significantly fewer complaints, and almost no abnormalities were found during the clinical examination. The present study clearly demonstrates the traumatic effects of torture.
Hot air coagulation: an animal study.
Aerothermotherapy with a Leister hot air coagulator was tested in a simulated operation field followed by a prospective double-blind animal pilot study to examine hemostasis and tissue reactions. Two symmetrical incisions were made on the back of 5 rabbits. One of the two wounds was randomised to aerothermotherapy. The temperature rise in the wound was registered by thermistors. No wound complications were observed. Five days postoperatively all wounds were excised for histological examination. A superficial muscular cell necrosis was observed in 3 of the 5 hot-air-coagulated back wounds. Liver resection was performed in 2 of the rabbits. The bleeding from the resection surface was stopped effectively by aerothermotherapy. Combination of the hot air temperature, the distance to the tissue and the application time was crucial for avoiding burns. If these factors are observed, the hot air coagulator may be used as a supplement to conventional methods of hemostasis.
Regret among 547 Danish sterilized women.
To help identify potential regretters of female sterilization, the women sterilized at Frederiksborg County Hospital, Hørsholm, Denmark, from 1978 through 1982 were contacted by questionnaires, and their medical records were reviewed. Ninety-two per cent (547/594) responded. The median observation time was 50 months. Five per cent of the women (n = 28) regretted the sterilization. The risk of regretting the sterilization was significantly increased among women who at sterilization experienced marital disharmony (12.5% regretted), had a child less than one year old (14.7% regretted), had the sterilization performed in connection with another surgical procedure (16.1% regretted), were outside the social groupings (17.0% regretted), or had no paid work (10.0% regretted). No association between number of children at the time of sterilization, prior number of contraceptives used, abortion at sterilization, and later regret was found. Twenty-five per cent of the regretters had had psychiatric problems prior to the sterilization. The regretters were sterilized shortly after their request (median 1 month) compared to 3 months among non-regretters. The main reason for regret of sterilization was the desire for more children, independent of a change in marital status. Sequelae to the sterilization was a common complaint. Refertilization was requested by 1% of the sterilized women. The study suggests that the psychosocial situation should be carefully evaluated in women requesting sterilization. A time lag from request to the sterilization should be mandatory and a thorough pre-sterilization counseling including information about possible sequelae and alternative contraceptives should be given.
[Regret after female sterilization. Review of the literature with a description of groups at risk].
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[Falanga torture. Are the sequelae of falanga torture due to the closed compartment syndrome in the feet and is this a common clinical picture?].
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