This thesis has dealt with the role of endosonography in the diagnosis of sarcoidosis. The main conclusion is that endosonography with aspiration of mediastinal lymph nodes has superior... Show moreThis thesis has dealt with the role of endosonography in the diagnosis of sarcoidosis. The main conclusion is that endosonography with aspiration of mediastinal lymph nodes has superior diagnostic yield in comparison to conventional bronchoscopy with taking of peripheral (TBLB) and endobronchial (EBB) tissue (80% vs 53%). Guidelines advising to perform bronchoscopy (including TBLB and EBB) as a first choice procedure to detect granulomas should be revised. In case EUS or EBUS are not available, bronchoscopy may reach comparable sensitivity but only if cTBNA, TBLB and EBB are all performed. This will increase procedure time and likely also complications because of the number of needle and forceps samples. Secondly, we assessed morbidity and mortality rates of EBUS and EUS for pulmonary indications and found that both techniques are very safe. Fatalities have been described but are very rare with a mortality rate of 0.04% and mostly occurred in patients of fragile health. Serious adverse events happen occasionally (0.15%) and are mostly of infectious origin in patients undergoing needle aspiration of cysts, sarcoid of necrotic lymph nodes. Show less
Epidural analgesia provided superior analgesia to remifentanil PCA. Women randomised to epidural analgesia with a request for pain relief are more satisfied with their analgesia than women... Show more Epidural analgesia provided superior analgesia to remifentanil PCA. Women randomised to epidural analgesia with a request for pain relief are more satisfied with their analgesia than women randomised to remifentanil PCA. Costs of epidural analgesia and remifentanil PCA are not significantly different. From an economic perspective, there is no preferential pain treatment in labouring women. Epidural analgesia is associated with a greater incidence of fever and significantly higher temperature overall. Patient controlled remifentanil has an effect on maternal SpO2 with significantly lower mean SpO2 during the labour period. This shows that respiratory complications are a serious problem associated with remifentanil and that continuous monitoring by trained personnel is obligatory. Persistent postpartum pain affects many women. Of surveyed women, 6.1% complained of significant pain related to delivery. Since this was a retrospective follow up study this results might be explained by the study design and these findings have to be evaluated by further research. Show less
Electroconvulsive therapy (ECT) is the transcutaneous application of small electrical stimuli to the brain to produce generalized seizure for the treatment of selected psychiatric disorders, mostly... Show moreElectroconvulsive therapy (ECT) is the transcutaneous application of small electrical stimuli to the brain to produce generalized seizure for the treatment of selected psychiatric disorders, mostly treatment resistant depression, acute mania, and schizophrenic syndromes. Safety of ECT increases the efficacy of therapy and provides fulfillment of a series of required treatments resulting in longer treatment effect of ECT. During the last few decades, researchers have been attempting to improve the effectiveness of ECT, to learn how and why it works, and to understand its risks and adverse side effects. As a result, the safety and efficacy of ECT has been improved and its indications have been relatively defined to increase the efficiency of outcome of therapy. While there has been considerable improvement in safety features, further investigation have been done to promote both the safety and efficacy of the treatment. Such efforts could increase our knowledge on the biological mechanisms involved in effectiveness of ECT that might result in discovery of new treatments. In this dissertation, we investigate how preprocedural medications could improve the safety and efficacy of ECT and further investigated the potential role of pharmacogenetics in the efficacy of ECT and procedural side effects such as cognitive disorders. Show less
