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Biomedical subjects

B Lund

Publications and source records attributed to B Lund.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Bone loss during low dose glucocorticoid treatment in patients with polymyalgia rheumatica. A double-blind, prospective comparison between prednisolone and deflazacort].

The aim of the study was to compare the long term effects of low dosage prednisolone or deflazacort treatment on bone mass in patients with polymyalgia rheumatica. The subjects were 30 patients with newly diagnosed polymyalgia rheumatica, who were allocated to treatment with prednisolone or deflazacort. Bone Mineral Content (BMC) was measured in the lumbar spine (L-BMC) and distal forearm (A-BMC) before treatment and three, six and 12 months after the start of treatment. After three months the decrease in L-BMC was significantly greater in the deflazacort group than in the prednisolone group (p < 0.05), but at six and 12 months there was not a significant difference between the two groups. There was a significant loss of BMC in all patients after 12 months: a 6.4% loss in L-BMC and a 1.8% loss in A-BMC. In conclusion, this low dose study failed to reveal any calcium sparing property of deflazacort compared with prednisolone.

Aged↗
PubMed1997

[Outbreak of methicillin resistant Staphylococcus aureus in a central hospital].

Until 1994, methicillin resistant Staphylococcus aureus (MRSA) were isolated from less than 60 patients annually in Denmark. We describe an outbreak of MRSA involving eight patients within a timespan of six weeks. Bacteriophage-typing and DNA typing using pulsed field gel electrophoresis revealed that three different strains of MRSA were involved in the outbreak. This emphasizes the importance of typing MRSA in order to clear up the spread in an outbreak. Of the eight patients four died, and in one case MRSA was thought to be the major cause of death. The expenses of the extra hygienic measures i.e. isolation of patients, medication and bacteriological surveillance were estimated to approximately DKK 80.000 pr. patient. Patients, who have been admitted to or worked at a hospital outside Scandinavia within the last six months, are potentially colonized with MRSA. Specific guidelines for hospital hygiene are necessary to prevent the spread of such strains.

Adult↗
PubMed1997

Phase II trial of high-dose cisplatin plus ifosfamide as first-line followed by carboplatin as second-line treatment in epithelial ovarian carcinoma.

BACKGROUND: In a previous study of combined platinum and ifosfamide we found a pathologic complete response rate of 42%. The present study was to test whether the high response rate could be reproduced or even improved by combining high-dose cis-platinum and increased dose of ifosfamide. METHODS: Forty-two previously untreated ovarian cancer patients were included in the study. Cisplatin 50 mg/m2 and ifosfamide 2000 mg/m2 together with mesna 1200 mg/m2 were given daily, Day 1-3 every 4 weeks for six cycles, followed by second-look laparotomy. In the event of residual disease carboplatin was given every 4 weeks for a further six cycles. RESULTS: The pathologic complete response rate was 20% (8 of 41). Five of 26 patients achieved a further response on carboplatin. Hematologic and nonhematologic toxicity caused dose reduction in more than 90 and 50% of the patients, respectively. CONCLUSION: The results of this high-dose regimen equals those obtained with conventional, far less toxic, regimens. Only patients with potentially platinum-sensitive tumors achieved further response when crossed over to the analogue, which may indicate that prolonged treatment is better than increased dose. A randomized trial is still needed to assess the importance of dose intensity in ovarian cancer.

Adult↗
PubMed1997

Roentgen stereophotogrammetric analysis using computer-based image-analysis.

The two-dimensional position of markers in radiographs for Roentgen Stereophotogrammetric Analysis (RSA) is usually determined using a measuring table. The purpose of this study was to evaluate the reproducibility and the accuracy of a new RSA system using digitized radiographs and image-processing algorithms to determine the marker position in the radiographs. Four double-RSA examinations of a phantom and 18 RSA examinations from six patients included in different RSA-studies of knee prostheses were used to test the reproducibility and the accuracy of the system. The radiographs were scanned at 600 dpi resolution and 256 gray levels. The center of each of the tantalum-markers in the radiographs was calculated by the computer program from the contour of the marker with the use of an edge-detection software algorithm after the marker was identified on a PC monitor. The study showed that computer-based image analysis can be used in RSA-examinations. The advantages of using image-processing software in RSA are that the marker positions are determined in an objective manner, and that there is no need for a systematic manual identification of all the markers on the radiograph before the actual measurement.

Arthrography↗
PubMed1997

A double-blind, randomized trial to compare meloxicam 15 mg with diclofenac 100 mg in the treatment of osteoarthritis of the knee.

Meloxicam is a new nonsteroidal anti-inflammatory drug (NSAID), which, in animal tests, displays a high potency for anti-inflammatory and analgesic action. The aim of this study was to investigate the efficacy and tolerability of 15 mg meloxicam in comparison with 100 mg slow-release diclofenac in patients with osteoarthritis of the knee. Two hundred and fifty-eight patients were included in the intent-to-treat analysis; these were randomized into two groups to receive either 15 mg meloxicam (N = 128) or 100 mg diclofenac (N = 130) for a period of 6 weeks. The results with respect to efficacy showed a trend in favor of meloxicam regarding pain on movement, global efficacy and paracetamol consumption, although these differences did not reach statistical significance. The most frequently-occurring adverse events in both groups were of a gastrointestinal (GI) nature. However, there was a higher incidence (26 vs 16%) of GI adverse events in the diclofenac group compared with the meloxicam group. Both drugs were well tolerated when assessed by the patients on a visual analog scale (VAS). Thus, 15 mg meloxicam is an effective and well-tolerated therapy for osteoarthritis and compares favorably with diclofenac 100 mg, a well-established treatment for this indication.

Aged↗
PubMed1997

Loss of bone mineral of the hip assessed by DEXA following tibial shaft fractures.

We measured prospectively early changes (0-6 months) in bone mineral of the hip, the lumbar spine, and the tibia following tibial shaft fractures (n = 12), and in a cross-sectional study we evaluated the maximal amount of bone loss possible at the hip and tibia following long-term (average 3 years) impaired limb function as a consequence of complicated tibial shaft fractures [delayed union or nonunion (n = 7), chronic osteomyelitis (n = 5), decreased limb length (n = 1), or bone defect (n = 1)]. Bone mineral measurements were performed by dual energy X-ray absorptiometry. Following tibial shaft fractures, a significant decrease in bone mineral density (BMD) was seen at the hip reaching 7% [confidence limits (CL): -10.2%; -3.5%] and 14% (CL: -19.6; -7.8%) after 6 months for the femoral neck and greater trochanter, respectively. In the proximal tibia, bone mineral content (BMC) decreased and was 19% (CL: -27.4%; -9.9%) below the initial value after 6 months. BMD of the lumbar spine remained unchanged. In the cross-sectional study, BMC in the tibia of the injured legs was 43% (CL: -53.2%; -31.9%) below the value in the healthy contralateral legs, and BMD in the femoral neck and greater trochanter, respectively, was 22% (CL: -27.4%; -17.6%) and 24% (CL: -36.3%; -12.1%) below the values in the healthy contralateral legs. With respect to the expected age-related decay of bone mineral after peak bone mass, the loss of bone mineral of the hip and tibia associated with tibial shaft fractures may be considered of clinical importance with increased risk of sustaining a fragility fracture of the lower extremity later in life; and the complicated fractures may even represent a present risk of fracture.

Absorptiometry, Photon↗
PubMed1997

The role of second-look laparotomy in the long-term survival in ovarian cancer.

BACKGROUND: To elucidate the role of second-look laparotomy in the management of ovarian cancer patients, were retrospectively reviewed our experience with this procedure in epithelial ovarian cancer patients. PATIENTS AND METHODS: The hospital records of 617 patients with advanced ovarian cancer were reviewed. The 308 patients who underwent second-look laparotomy were followed from four to 18 years with a median follow-up of 12 years after start of primary chemotherapy. RESULTS: Patients who achieved pathological complete response (PCR), microscopic partial response (PPR mic.), macroscopic partial response (PPR mac.), stable disease (PSD), and progressive disease (PPD) at second-look laparotomy had a median survival time of 149, 39.5, 24, 14, and eight months, respectively. Secondary surgical cytoreduction could be performed only in 101 patients with macroscopic persistent disease. The group of all patients with secondary tumor debulking had no survival advantage compared with the group of patients with PPR mac., PSD, and PPD, unable to have secondary cytoreduction. Patients left with no tumor after second-look laparotomy did not survive as long as patients who achieved PCR and PPR mic. at second-look laparotomy. Factors prolonging survival after second-look laparotomy included younger age, good pre-treatment performance status, smaller primary residual tumor size, longer interval between start of chemotherapy and second-look laparotomy, and the pathologically proven CR or PR mic. CONCLUSION: Second-look laparotomy appears to have a minor role in the routine management of ovarian cancer patients, especially in the context of the limited effectiveness of second-line therapy. This procedure should be limited to clinical treatment protocols to determine effectiveness of new agents.

Adult↗
PubMed1997

Safety profile of gemcitabine, a novel anticancer agent, in non-small cell lung cancer.

Gemcitabine is a novel anticancer agent showing activity with relatively mild toxicity across a range of solid tumors including non-small cell lung cancer (NSCLC). In studies using similar doses and schedules, consistent response rates of around 20% were recorded in NSCLC. In an integrated safety study using data from 360 patients with NSCLC, gemcitabine exhibits a mild safety profile for such an active drug. Hematological toxicity is mild and short lasting, and the level of infection associated with this degree of myelosuppression was low. Mild transaminase elevations occurred frequently but were not progressive or dose limiting. There was no evidence of cumulative hepatic or renal toxicity. Nausea and vomiting were mild, rarely dose limiting and generally well controlled with standard antiemetics. Mild flu-like symptoms were experienced in a small proportion of patients and rarely resulted in discontinuation. Where edema or peripheral edema were experienced, there was no evidence of any association with cardiac, hepatic or renal failure. Hair loss was rare and there was no grade 4 alopecia. In conclusion, gemcitabine is a promising new agent in the treatment of NSCLC. Its mild toxicity which is non-overlapping with other cytotoxics has prompted investigation into its use in combination with other chemotherapy regimens.

Adolescent↗
PubMed1997

Paclitaxel (175 mg/m2 over 3 hours) with cisplatin or carboplatin in previously untreated ovarian cancer: an interim analysis.

The side effects of cisplatin (75 mg/m2) in combination with paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) (175 mg/m2 over 3 hours) are expected to be more severe and frequent than those of carboplatin (area under the concentration-time curve of 5) in combination with the same dose of paclitaxel, but the combinations are expected to be equally effective. A disadvantage of the cisplatin-based regimen is that patients need to be admitted to the hospital. The carboplatin regimen can be administered to outpatients. We tested both combinations administered every 3 weeks in a randomized phase III study in patients with previously untreated epithelial ovarian cancer. An interim analysis for toxicity was performed in 145 patients shortly after study closure. We observed a difference in the incidence of nausea, vomiting, and neurotoxicity favoring the women treated with the carboplatin regimen, but this regimen caused more myelotoxicity. Maturation of the study is awaited before survival data can be analyzed and final conclusions can be drawn.

Adult↗
PubMed1996

Late changes in bone mineral density of the proximal tibia following total or partial medial meniscectomy. A randomized study.

The adaptive bone remodeling in the proximal tibia following medial meniscectomy was measured quantitatively by dual photon absorptiometry. Thirty-three patients who had undergone a meniscectomy (randomized to either total [n=19] or partial [n=14] meniscectomy) performed by open joint surgery approximately 12 years earlier were included in the study. Bone mineral density was measured in the previously injured legs and in the healthy contralateral legs in areas located medially and laterally in the cortical bone of the subchondral plates and below in the trabecular bone of the medial and lateral tibial condyles. The distribution of bone mineral within the proximal tibia showed a characteristic and significant pattern. In the trabecular bone of the healthy contralateral knees, bone mineral density was 15% higher in the medial tibial condyles compared with the values laterally; a total or partial meniscectomy increased this difference to 25%. With regard to the cortical bone of the subchondral plates, the bone mineral density in the healthy knees was 24.8-29.4% higher medially than laterally, whereas after total and partial meniscectomy the differences were, respectively, 37.7 and 41.4%. No significant differences in the distribution of bone mineral density, at either cortical or trabecular measuring sites, were found between totally and partially meniscectomized knees.

Absorptiometry, Photon↗
PubMed1996

Inactivation of virus during anaerobic digestion of manure in laboratory scale biogas reactors.

Reduction of porcine parvovirus, bovine enterovirus and faecal enterococci were measured in biogas reactors continuously run on manure and manure supplemented with household waste at 35 degrees C and 55 degrees C and in batch test run at 70 degrees C. The aim of the experiments was to study the sanitation effect of anaerobic digestion and to evaluate the use of faecal enterococci as an indicator of sanitation. Parallel studies on the reduction of virus and faecal enterococci were done in physiological saline solution. Heat inactivation was found to be an important factor in thermophilic biogas plants and the overall dominant factor at 70 degrees C. However, other environmental factors with a substantial virucidal and bactericidal effect were involved in inactivation. The death rates for faecal enterococci were generally higher than for porcine parvovirus and lower than for bovine enterovirus. For faecal enterococci, a logarithmic reduction of 4 (corresponding to the recommended minimum guaranteed retention time) was obtained after 300 hours at 35 degrees C and after 1-2 hours at 55 degrees C. In continuously-fed reactors, a high reduction rate was initially seen for the virus tested, followed by a reduction in the rate. For porcine parvovirus, a minimum guaranteed retention time of 11-12 hours is necessary at 55 degrees C in the initial phase (0-4 hours) and 54 hours hereafter (4-48 h). Correspondingly, for bovine enterovirus a MGRT of 23 hours was necessary at 35 degrees C and < 0.5 hours at 55 degrees C. The data indicate that faecal enterococci measurements give a good indication of inactivation of enterovirus and other more heat sensitive virus, especially under thermophilic conditions. Parvovirus is very suitable for comparative investigations on inactivation in the temperature range of 50-80 degrees C, due to the extreme thermal resistance of this virus. However, in stipulating sanitation demands for biogas reactors it seems more reasonable to use less resistant virus, such as a reovirus or picornavirus, which better represents the pathogenic animal virus.

Anaerobiosis↗
PubMed1996

Local recurrences in giant cell tumour of bone. Long-term follow up of 31 cases.

We studied the value of histopathological grading in determining the prognosis of giant cell tumour (osteoclastoma) and the rate of local and distant recurrences in a consecutive series of 31 patients. We found that grading had no prognostic value. Eighteen patients were treated by intralesional curettage and 13 by wide excision. Ten patients (56%), who were all treated by curettage, had local recurrences, but none of the tumours with wide excision recurred (p < 0.05). Five (16%) had local recurrences as well as distant metastases, usually to the lungs. The recurrences developed later than an average of 12 years after primary treatment in 3 patients. Wide excision and life-long follow up should be considered in the management of these tumours.

Adolescent↗
PubMed1996

Phase I pharmacokinetics and limited sampling strategies for the bioreductive alkylating drug EO9. EORTC Early Clinical Trials Group.

EO9 is a synthetic indoloquinone which was designed to undergo redox cycling and formation of alkylating intermediates under bioreductive conditions. As part of a phase I clinical trial, EO9 plasma disposition was evaluated in 20 patients receiving 2.7-15 mg/m2i.v. weekly for 3 weeks. Pharmacokinetic studies were performed with the first and third dose of therapy and nine blood samples were obtained over 30 min postinfusion. Plasma EO9 was detected using HPLC UV and the disposition described by a two-compartment model. Wide variability in EO9 pharmacokinetics was observed. EO9 was rapidly eliminated from plasma with a median systemic clearance of 3.5 l/min/m2 (range 1.2-9.8), apparent volume of distribution of 6.2 l/m2 (1.0-34.9) and t 1/2 beta of 10.1 min (2.2-63.0). Substantial intrapatient variability was observed for all pharmacokinetic parameters. Linear regression and Bayesian methods were developed and validated for estimation of EO9 plasma AUC using up to three samples postinfusion. The use of two or three plasma samples provided precise estimation with acceptable prediction bias. In addition, a Bayesian algorithm offered more robust estimation of AUC and is preferable to linear regression models for future EO9 population pharmacokinetic analysis.

Adult↗
PubMed1996

Re-evaluation of the role of P-wave duration and morphology as predictors of atrial fibrillation and flutter after coronary artery bypass surgery.

To evaluate the significance of P-wave duration and morphology for the development of post-operative atrial fibrillation/flutter, we investigated 189 consecutive patients scheduled for elective coronary artery bypass surgery. The longest pre-operative total P-wave duration was measured from the standard electrocardiogram at a paper speed of 50 mm.s-1 (mean of two independent observers). By the signal averaging technique we determined the pre-operative total P-wave duration, and root-mean square voltage of the last 10, 20, and 30 ms of the filtered (40-250 Hz) P-wave from a vector composite of three orthogonal leads at noise level 0.2 microV. Forty-two (22%) of the patients developed atrial fibrillation/flutter. Older age (mean +/- SD) 62 +/- 8 vs 56 +/- 8 years (P < 0.000), increasing body weight 83 +/- 11 vs 79 +/- 12 kg (P = 0.05), treatment for hypertension 26 vs 13% (P = 0.04), and a longer P-wave duration in the standard electrocardiogram 129 +/- 12 vs 124 +/- 12 ms (P = 0.01) were associated with development of atrial fibrillation/flutter documented by a 12-lead electrocardiogram. Logistic regression analysis identified independent predictors, estimated adjusted relative risk (95% confidence interval) of atrial fibrillation/flutter: with age > 60 years, the relative risk was 4.46 (2.05-9.73), and body weight > 80 kg, the relative risk was 3.81 (1.71-8.46). Thus, P-wave duration and morphology did not provide significant information on the risk of atrial fibrillation/flutter when controlling for the effects of increasing age and body weight.

Aged↗
PubMed1996

Changes in bone mass during low dose corticosteroid treatment in patients with polymyalgia rheumatica: a double blind, prospective comparison between prednisolone and deflazacort.

OBJECTIVE: To compare the long term effects of low dosage prednisolone or deflazacort treatments on bone mass in patients with polymyalgia rheumatica. METHODS: Thirty patients with polymyalgia rheumatica were allocated on a random double blind basis to receive treatment with prednisolone or deflazacort. Bone mineral content (BMC) was measured in the lumbar spine and in the distal forearm before treatment and three, six, and 12 months after treatment. RESULTS: At three months the decrease in lumbar BMC and bone mineral density (BMD) was significantly greater in the deflazacort group than in the prednisolone group (p < 0.05), but at six and 12 months there was no difference between the two groups. In all patients after one year there was a significant loss of BMC: a 6.4% loss in lumbar BMC and a 1.8% loss in distal forearm BMC. Loss in lumbar BMC after six months was correlated to the cumulative dose of corticosteroid (r = 0.4; p < 0.05) and was significantly greater in the group of patients who had persisting symptoms of polymyalgia at six weeks, three months, or both, after treatment started (p = 0.05). CONCLUSION: This low dose study failed to reveal any calcium sparing properties of deflazacort compared with prednisolone. Possible explanations for this finding are discussed.

Aged↗
PubMed1996

Decreased bone density of the distal femur after uncemented knee arthroplasty. A 1-year follow-up of 29 knees.

We measured the early adaptive bone remodeling of the distal femur prospectively for 1 year after uncemented total knee arthroplasty (TKA) in 29 knees with primary arthrosis. 18 patients were randomized to receive a PCA Modular femoral component (n 9) or a modified version of the same prosthesis (n 9) with an altered location of the porous coating. The other 11 patients (n 11) formed a consecutive series with the Duracon femoral component. In the trabecular bone above the femoral component, bone mineral density (BMD) was measured in 2 regions of interest (ROI) anteriorly to the fixation pegs (ROI 1) and above the pegs (ROI 2), using dual photon absorptiometry (DPA). There were no differences between the Modular component and the modified version regarding the postoperative decrease in BMD. There was a decrease in BMD in both ROI 1 and ROI 2 with all 3 different femoral components, and in both ROIs the highest bone loss rate was observed during the first 3 months after surgery. On average (n 29), a significant bone loss of 44% and 19% in ROI 1 and ROI 2, respectively, was reached at the 1-year follow-up, compared to the initial values. A decrease of this magnitude in BMD in the anterior distal femur 1 year after TKA may be an important determinant of periprosthetic fracture and later failure of the femoral component. In this experimental set-up, a modified femoral component with an altered location of the porous coating did not influence the development of bone loss.

Absorptiometry, Photon↗