[Preoperative risk assessment of patients with congenital heart disease in non-cardiac surgery].

Over the last decades, remarkable advances in survival in patients with congenital heart disease (CHD) have been reported. Currently, 90% of infants born with CHD can expect to reach adulthood. Moderate and severe CHD is associated with increased perioperative mortality. To ensure optimal management of CHD patients undergoing non-cardiac surgery, preoperative risk assessment is pivotal, along with a multidisciplinary approach and collaboration across hospitals. The objective of this review is to provide a simple model to identify CHD patients at risk prior to non-cardiac surgery.

Impaired physical function, loss of muscle mass and assessment of biomechanical properties in critical ill patients.

Intensive care unit (ICU) admission is associated with muscle weakness and ICU survivors report sustained limitation of physical capacity for years after discharge. Limited information is available on the underlying biomechanical properties responsible for this muscle function impairment. A plausible contributor to the accentuated catabolic drive in ICU patients is a synergistic response to inflammation and inactivity leading to loss of muscle mass. As these entities are predominantly present in the early phase of ICU stay, interventions employed during this time frame may exhibit the greatest potential to counteract loss of muscle mass. Despite the obvious clinical significance of muscle atrophy for the functional impairment observed in ICU survivors, no preventive therapies have been identified as yet. The overall aim of the present dissertation is to characterize aspects of physical function and biomechanical properties in ICU patients and to provide new insights into ICU-induced muscle wasting and the underlying biomechanical mechanisms responsible for the residual impairment of physical function in ICU survivors.

Acceptable long-term outcome in elderly intensive care unit patients.

INTRODUCTION: The number of elderly intensive care unit (ICU) patients is increasing. We therefore assessed the long-term outcome in the elderly following intensive care. MATERIAL AND METHODS: The outcome status for 91 elderly (=75 years) and 659 nonelderly (18-74 years) ICU patients treated in the course of a one year period was obtained. A total of 36 of 37 eligible elderly survivors were interviewed about their health related quality of life (HRQOL), social services and their wish for intensive care. RESULTS: The mortality (54% at follow-up and 64% after one year) was higher in the elderly ICU patients than in non-elderly ICU patients (33% and 37%, respectively, p<0.001) and than in the Danish background population≥75 years (9%, p<0.001). Elderly ICU survivors had significantly lower HRQOL scores in two of four physical domains and a lower physical component summary score than age matched controls (38 (31-46) versus 43 (36-52), p=0.01). However, ICU survivors scored like controls in three of four mental domains and higher than controls in "mental health" (p=0.04). At follow-up, 89% had returned to live in their own home. CONCLUSION: Elderly ICU patients had high long-term mortality rates and survivors had impaired physical function. Nevertheless, their mental function was in line with that of the background population and the majority had returned to their home and wished intensive care again. FUNDING: The study was supported only by Rigshospitalet's Research Council. TRIAL REGISTRATION: Not relevant.

[Compartment syndrome following adder bites]. / Kompartmentsyndrom efter hugormebid.

Bites from the adder, Vipera Berus, can have serious clinical consequences due to systemic effects. Meanwhile, the local swelling calls for attention as well. Two cases of seven- and eleven-year-old boys are reported. The first patient was bitten in the 5th toe, the second in the thumb. Both developed fasciotomy-requiring compartment syndrome of the lower and upper limb, respectively. Recognition of this most seldom complication of an adder bite is vital to save the limb. We recommend that the classical signs and symptoms of compartment syndrome serve as indication for surgery. However, compartment pressure measurement can be helpful in the assessment of children.