[Practical experience in providing pharmaceutical services in public pharmacies in Denmark]. / Praktické zkusenosti s poskytováním lékárenské péce ve verejných lékárnách v Dánsku.

The paper evaluates practical activities of the public pharmacy in Denmark, which materialize the content of the so-called pharmaceutical care in everyday contacts of the pharmacist and patients. It has been found that the conception of pharmaceutical care is materialized in somewhat different ways in different countries and in different types of establishments (clinical pharmacy--public pharmaceutical service). The Czech pharmaceutical service could link up with the tradition of the 1970s and 1980s when there were efforts to make pharmacist's work more effective, aiming at solving the patient's problems concerning medication. This is a world-wide trend worth joining.

[Complications after surgical treatment of malign thyroid diseases]. / Komplikationer ved kirurgisk behandling af maligne thyreoidealidelser.

Eighty-eight patients with thyroid malignancy seen at the Rigshospital, Copenhagen during the period 1.5.1989-1.5.1994 were retrospectively studied. There were 64 females and 24 males. The average age was 54 years. Seventy-nine patients were operated (six with subtotal and 73 with total thyroidectomy). Thirty-six (46%) had had previous thyroid operations and 12 of these patients had preoperative fine-needle aspiration biopsies performed. The second operation thyroidectomy specimen contained carcinoma in 14 (39%) of the 36 patients. Forty-nine patients (62%) had different types of modified neck dissection performed under the operation and 31 (39%) of the operated patients had lymph-node-metastases. Among the patients who were operated at the department there were no accidental permanent recurrent nerve paralysis. Among the 36 patients who were operated at other departments there were four (11%) accidental recurrent nerve paralysis from the primary operation. Twenty (25%) of the 79 operated patients developed permanent hypoparathyroidism.

[Inguinal funicular block in vasectomy]. / Ingvinalt funikelblok ved vasektomi.

The analgesic efficacy of inguinal funicular block with 10 ml carbocaine 1% as a supplement to local infiltration analgesia of the vas deferens was investigated in patients undergoing vasectomy. Pain/discomfort during vasectomy and on the first and third day postoperatively were investigated using a questionnaire. Fifty-seven male patients scheduled for legal sterilization were randomized and allocated in a double-blinded manner to receive the 10 ml carbocaine 1% in the right or left side and 10 ml isotonic NaCl in the contralateral side, the patient then being his own control. There was significantly less intraoperative pain on the side of the active inguinal funicular block (p < 0.0001), but no significant differences were found at the first and third postoperative day (p = 1.16-1.19). Inguinal funicular block can be recommended as a supplement to the usual use of local infiltration analgesia of the vas deferens.

PIP: Vasectomy is performed routinely under local anesthesia without major complications. The most frequently used method is local infiltration analgesia (LIA) of the vas deferens at the site of the resection. During the period of August 1992 - February 1993, all men who were referred for vasectomy at the Frederikssund Hospital were solicited to participate in the study. The analgesic efficacy of inguinal funicular block (FB) with 10 ml carbocaine 1% as a supplement to LIA of the vas deferens was investigated. Pain and discomfort during vasectomy and on the first and third day postoperatively were investigated using a questionnaire. 57 healthy male patients scheduled for legal sterilization were randomized in a double blind manner to receive 10 ml carbocaine 1% in the right or left side and 10 ml isotonic NaCl in the contralateral side, the patient thereby serving as his own control. Six patients were excluded for inadequate answers to the questionnaire (5) or reoperation for bleeding (1) which could not be related to administration of analgesia. 42 (82%) of 51 patients had pain during the operation; 39 (76%) on the first day after the operation; and 29 (57%) on the third day postoperatively. The therapeutic effect with active FB as a supplement to LIA in the scrotal skin was 73% (p 0.0001). There was significantly less intraoperative pain on the side of the active inguinal funicular block (p 0.0001), but no significant differences were found at the first and third postoperative day (p=1.16-1.19). With active FB on the left side, the localization of pain was exclusively scrotal in 14% (3/12) and both abdominal and scrotal in 86% (18/21). With active FB on the right side, pain distribution was scrotal in 52% (11/21) and abdominal/scrotal in 48% (10/21). Inguinal funicular block can be recommended as a supplement to the routine use of local infiltration analgesia of the vas deferens.

[Withdrawal of antihypertensive treatment]. / Seponering af antihypertensiv behandling.

Research over the years has given considerable evidence that medically induced normalization of the blood pressure in hypertensive patients decreases cardiac and cerebrovascular morbidity. On the other hand, few studies have attempted to evaluate the consequences of a subsequent withdrawal of anti-hypertensive treatment. This paper assesses the research in this field and concludes that approximately 20-25% of patients with mild hypertension remain normotensive during a follow-up period of 1-2 years. Based on this conclusion, the following is recommended: in patients with well treated, mild hypertension, who have been normotensive for a minimum of two years, withdrawal of antihypertensive treatment could be attempted followed by monthly measurements of blood pressure. Concurrent non-pharmacological intervention is recommended. Sequential antihypertensive therapy may thus be an alternative to the currently established strategy of life-long treatment.

[Treatment of isolated systolic hypertension in the elderly by general practitioners]. / Praktiserende laegers behandling af isoleret systolisk hypertension hos aeldre.

By means of a questionnaire investigation, 150 general practitioners selected at random were asked about how they defined isolated systolic hypertension in elderly individuals, whether they employed medicinal treatment of this patients group and what their reasons for this were. The mean values for the highest systolic blood pressure which were considered to be normal were 175, 185 and 200 mmHg for the age groups 60-69 years, 70-79 years and > or = 80 years. Only approximately one fourth of Danish general practitioners consider medicinal treatment of isolated systolic hypertension and only at a much higher systolic blood pressure level than shown by a corresponding investigation among American doctors where 89% employ treatment for isolated systolic hypertension. On the basis of the present strategy in Denmark and the recent results from the first prospective placebo-controlled investigation of the treatment of isolated systolic hypertension, the future therapeutic strategy is discussed.