The superiority of rectal thermometry to oral thermometry with regard to accuracy.

Electronic oral thermometry is performed routinely in most medical centres. From the studies available on this subject it seems difficult to find any documentation for this practice. We have conducted clinically controlled studies in which the accuracy of electronic oral thermometry (CRAFTEMP and TERUMO WCT) and that of electronic rectal thermometry (TERUMO WCT) were tested. Rectal glass mercury thermometry was used as a reference method. Two studies were designed. In study 1, 184 patients (72 women, 112 men), median age 70 (18-95) years were investigated. In study 2, 91 patients (41 women, 50 men), median age 59 (18-96) years were investigated. Electronic oral thermometry was found unacceptably inaccurate under daily routine conditions. Electronic rectal thermometry was found to be accurate. Calculations of mean temperature difference between reference measurements and test measurements (mean +/- SD) were found to be: routine oral CRAFTEMP at 0.70 +/- 0.50 degrees C, optimum oral TERUMO WCT at 0.75 +/- 0.74 degrees C, routine rectal TERUMO WCT at 0.08 +/- 0.26 degrees C and optimum rectal TERUMO WCT at 0.02 +/- 0.17. In the screening procedure for fever oral thermometry showed low sensitivity (routine CTAFTEMP 0.47 and optimum TERUMO WCT 0.59) whereas rectal thermometry showed high sensitivity (routine TERUMO WCT 0.74 and optimum TERUMO WCT 0.91). It was concluded that rectal thermometry must be preferred to oral thermometry for daily routine measurements.

[Only rectal temperature measurements are suitable for routine temperature measurement]. / Kun rektale målinger er egnede til rutinemaessig temperaturmåling.

A new rapid electronic thermometer (V.C.T. TERUMO) has been introduced to Danish hospitals. Oral and rectal V.C.T. measurements were compared with rectal measurements with mercury thermometers. In addition, rectal V.C.T. measurements in the wards were compared with rectal measurements with mercury thermometers. A total of 91 patients participated in the investigation. The average differences between the electronic rectal and oral compared with recordings by mercury thermometers were found to be 0.02 degree C and 0.75 degree C, respectively, under optimal conditions for measurement while the corresponding scatters of difference in temperature were 0.17 degree C and 0.74 degree C, respectively. The average difference between rectal temperature measurements with mercury thermometers and rectal V.C.T. measurements carried out during daily routine circumstances was 0.08 degree C while the scatter of the difference in temperature was 0.26 degree C. It is concluded that rectal V.C.T. measurements are just as suitable as rectal measurements with mercury thermometers and employment of rectal V.C.T. thermometer measurements is recommended in the daily hospital routine. Employment of oral and axillary measurements is discussed and not recommended.

[Urologic examination and treatment of patients with acute injuries of the spinal medulla]. / Urologisk undersøgelse og behandling af patienter med akutte medulla spinalis laesioner.

During a period of one year, nine patients with traumatic lesions of the spinal medulla were examined and treated urologically. The patients were followed-up for 24-36 months and follow-up will continue. All of the patients were treated primarily with sterile intermittent catheterization by the nursing staff. Exceptions from this were patients in whom indwelling catheters were necessary on account of complicating conditions. During the acute phase, the patients were examined by a urologist and bladder function investigations with cystometry + electromyographic registration from the pelvic floor were undertaken. When patients had recovered from the spinal shock phase, emptying of the bladder supplemented by alpha-adrenergic blocking preparations and clean intermittent catheterization were instituted in the patients with supra-sacral lesions. Patients with infra-sacral bladder paresis were trained in miction on abdominal pressure supplemented by clean intermittent catheterization. No complications from this treatment have occurred and renal function has remained stable. Only one patient has an indwelling catheter and it has not proved possible to persuade the patient to accept removal.

[Vermiform appendix used as a segment of the ureter]. / Appendix vermiformis som uretersegment.

A man aged 67 with a single kidney was admitted on account of haematuria and raised serum creatinine. Investigation revealed a poorly differentiated invasive transitional cell tumour at the middle of the right ureter. After resection of the tumour, a space of 10 cm remained between the two ends of the ureter. During the operation, it had become apparent that the usual methods of reconstruction could not be employed and, therefore, the vermiform appendix was employed as an intermediate segment of the ureter. The appendicular graft functioned satisfactorily until recurrence of the cancer occurred and the patient died one year later. This method may be employed in selected cases where Boariflap, uretero-trans-ureterostomy or autotransplantation of the kidney cannot be employed.