[Midazolam and lorazepam as premedication. A randomized double-blind study]. / Midazolam og lorazepam som praemedicinering. En randomiseret dobbeltblind undersøgelse.

Oral administration of midazolam and lorazepam as premedication was compared in a double-blind randomized clinical trial. Eighty patients scheduled for minor gynaecological surgery in general anaesthesia and 80 patients scheduled for hip arthroplasty in spinal anaesthesia were included. Assessments were: 1. patients subjective evaluation of the premedication, 2. sedation scale, 3. recovery of cognitive function assessed by Simple Paper-and-Pencil test and Postbox test, 4. amnesic effects. In the general anaesthesia group midazolam caused less postoperative sedation, less postoperative amnesia and cognitive function returned more rapidly. In the spinal anaesthesia group cognitive function returned more rapidly after midazolam. Midazolam should be preferred for premedication if rapid recovery is desired.

The response to local anaesthetics (EMLA-cream) as a clinical test to diagnose between hypermobility and Ehlers Danlos type III syndrome.

To make a differential diagnosis of Ehlers Danlos (EDS) Type III syndrome and Hypermobile patients has been difficult. In genetic advising and prognosis of the EDS patients there are need for new tools to separate them from hypermobile patients. Topical analgesics (EMLA cream) was applied to seven EDS patients, ten hypermobile patients, and to fifteen controls. The analgesic efficacy of cutaneous analgesia was evaluated by sensory and pain thresholds to brief argon laser stimuli, and the depth of the cutaneous analgesia was measured by sensory and pain threshold depth to controlled needle insertions. Controls and hypermobiles did not differ in their response to cutaneous analgesia. The thresholds to cutaneous laser stimulation and the depth of analgesia increased significantly less in the Ehlers Danlos patients compared to the other two groups. In clinical practice a needle insertion test can easily be applied to investigate if patients are responders or non-responders to local analgesics.

Reduced strength of skin in Ehlers Danlos syndrome, type III.

The biochemical properties, ratio collagen type I/type III and the pattern of reducible collagen crosslinks were studied in skin biopsy samples from 10 patients with Ehlers Danlos syndrome type III (ED III) and 10 age- and sex-matched controls. The ED III patients had marked reductions in skin strength and stiffness (42% and 22%, respectively). The ultimate extensibility of the skin, however, was not different from that of the controls. Consequently, a certain load applied to the skin of these patients results in greater deformation than in that of the controls, due to reduced stiffness. The bursting limit is no different from that of the controls. Thus the skin in the ED III patients is not hyperextensible, it merely has reduced strength and stiffness. The reduction in strength could not be explained by differences in skin thickness or collagen content. Skin thickness, collagen content and ratio collagen type I/type III were the same as in the controls, as also was the pattern of reducible collagen crosslinks. These alterations in the mechanical properties of the skin of patients with ED III may be attributable to the molecular structure of the mature collagen or the arrangement of the collagen fibres.

Catamenial pneumothorax.

Recurrent spontaneous pneumothorax associated with the menstrual bleeding--catamenial pneumothorax--is a rare condition. Only 56 cases have so far been described. Two cases are hereby presented, and the different ways of treatment are mentioned. The basic cause of the condition remains unknown.