Certification of oncology nurses.
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Biomedical subjects
Publications and source records attributed to B Nielsen.
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During the period 1976-1984, intracranial meningomata (ICM) were diagnosed in 69 women and 22 men aged 24-83 years. Epileptic manifestations of up to ten years duration and focal neurological signs were thrice as frequent as signs of increased intracranial pressure. Radical removal of the intracranial meningioma was performed in 67 cases, partial resection in 15, biopsy of the tumour in one patient and a shunt-operation was performed in one patient. In one of the patients, the tumour was malignant. Three patients were submitted to irradiation. The neurological condition underwent temporary deterioration and 1/6 and permanent deterioration in a further 1/6. Eleven of the patients had postoperative complications (haematomata and infections) and there were two deaths during the immediate postoperative period. After an average follow-up period of 7 1/2 years, 27 further patients had died. In 3/5 of the survivors, the social conditions and the working ability were unchanged as compared with the preoperative status and these conditions were poorer in the remaining survivors. Recurrence of the intracranial meningeomata had occurred in four patients.
Investigations concerning penicillin allergy (PA) from abroad suggest that considerable overdiagnosing occurs. The absence of standardized commercially available preparations for skin testing and the time necessary for thorough testing are also contributory causes. Fifty patients with suspected PA were investigated with a programme consisting, in serial order, of RAST for IgE to penicillin V and G, a cutaneous test with a commercially available test preparation (Penkit), first with a prick followed by intracutaneous testing and finally with oral provocation. If a positive reaction occurred, the test was discontinued. Six patients (12%) had positive RAST or cutaneous reactions, (1 positive to RAST, 2 to prick and three not until the intracutaneous test), while no patients with negative RAST and cutaneous tests reacted to oral provocation. No generalized allergic reactions occurred during testing. It did not prove possible to predict which patients would react positively on the basis of the case histories. This investigation thus demonstrates that PA is also considerably overdiagnosed in Denmark and that a programme of investigation such as this is suitable for testing for PA and, finally, that the programme of investigation can scarcely be simplified.
All patients attending the psychiatric emergency clinic at Odense University Hospital in the period 2.9-6.10.1985 were interviewed by a psychiatric nurse and physician in order to determine disease pattern and social circumstances. The present investigation deals with sex distribution of alcoholics in the data collected. In the period, 141 patients with alcoholic problems were registered; of these 97 were men and 44 women. It was found that more female alcoholics than male were married/cohabiting. Unemployment was very high for both groups; almost 80 per cent being unemployed. A great number of the women had interpersonal conflicts, but apart from that the sex difference for amount of psychosocial strain was not significant. Drug abuse and affective reactions were significantly more frequent in women. More women than men were found to suffer from character neuroses, and more men than women were deviants, but this may be a reflection of a diagnostic tradition. It must be concluded that more similarities than differences were found between male and female alcoholics attending the psychiatric emergency department.
The frequency of psychosocial strain was systematically registered concerning 330 consecutive patients in the psychiatric emergency unit in Odense. Psychosocial strain was found in 211 patients (63.9%). In all, 551 stressful events were reported, which corresponds 2.5 per patient. Distribution of psychosocial strain by age, sex and civil status revealed no statistically significant correlation at the level of p less than 0.05, but there was a tendency towards greater strain among young persons, women and married/cohabiant patients. All those seeking education had psychosocial strain, while there were significantly fewer patients with psychosocial strain among early retirees and old age pensioners. The investigation showed that there were significantly fewer schizophrenic patients with psychosocial strain, and significantly more patients with strain were found among those with affective reactions and attempted suicides compared with the other patient categories. The most frequently occurring form of strain in all diagnosis groups was interpersonal conflict with a close person. In most cases the strain was not the result of an external catastrophe, and often the patient may himself have contributed in causing the psychosocial strain. This opens the possibility for socialpsychiatric intervention.
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Natural killer cell (NK) activity in peripheral blood (PB) was followed longitudinally for up to 2 yr after initiation of low-dose IFN-alpha-2b therapy in nine hairy cell leukemia (HCL) patients. A whole blood NK (WB-NK) assay was employed in order to measure the NK activity per unit blood. The pretreatment WB-NK activity was consistently low, indicating that the patients' total NK activity in PB is decreased. Striking differences in WB-NK activity were observed between splenectomized and non-splenectomized patients, whereas no consistent patterns were found when using the conventional NK assay. Thus the WB-NK activity of splenectomized patients showed an immediate increase after initiation of treatment, while the activity in non-splenectomized patients decreased and remained low during the first 3-6 months. Subsequently, after reduction in spleen size, the WB-NK activity began to increase. In splenectomized patients, a second rise in WB-NK was observed after 3-6 months of therapy, coinciding with the normalisation of the peripheral blood counts. In both groups of patients incubation with IFN in vitro induced a rise in NK activity before start of treatment, which was abrogated promptly after initiation of therapy, indicating a maximal in vivo boosting of the NK cells. These differences observed indicate that the response of splenectomized and non-splenectomized HCL patients to IFN treatment should be evaluated separately.
The enantiomers of alpha-amino-4-bromo-3-hydroxy-5-isoxazolepropionic acid (4-bromohomoibotenic acid, Br-HIBO, 1) a selective and potent agonist at one class of the central (S)-glutamic acid receptors, were prepared with an enantiomeric excess higher than 98.8% via stereoselective enzymic hydrolysis of (RS)-alpha-(acetylamino)-4-bromo-3-methoxy-5-isoxazolepropionic acid (4) using immobilized aminoacylase. The absolute configuration of the enantiomers of Br-HIBO was established by X-ray crystallographic analysis, which confirmed the expected preference of the enzyme for the S form of the substrate 4. (S)- and (RS)-Br-HIBO were potent neuroexcitants on cat spinal neurones in vivo, while (R)-Br-HIBO was a very weak excitant. Correspondingly, the S enantiomer of Br-HIBO (IC50 = 0.34 microM) was considerably more potent than the R form (IC50 = 32 microM) as an inhibitor of [3H]-(RS)-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid ([ 3H]AMPA) binding to rat brain synaptic membranes in vitro. In contrast, (S)- and (R)-Br-HIBO were approximately equipotent (IC50 values of 0.22 and 0.15 microM, respectively) as inhibitors of [3H]-(S)-glutamic acid binding in the presence of CaCl2. The enantiomers of Br-HIBO showed no significant affinity for those binding sites on rat brain membranes which are labeled by [3H]kainic acid or [3H]-(R)-aspartic acid.
In a retrospective study, all cases of anaphylactic shock (AS) occurring in a hospital catchment area during a 13-year period were analysed. Twenty cases were found, giving an incidence of 3.2 cases per 100,000 inhabitants per year, and one patient died. The precipitating agents were penicillin (7 cases), aspirin (3), food (2), and bee or wasp sting (8). The drugs had all been given orally. Penicillin-related AS was much commoner than its incidence reported by the Danish national health authorities. In three cases, previous anaphylactic reactions had occurred to the agent in question. We concluded that AS rarely occurs outside hospital, but that oral penicillin is a more important cause than was previously thought. Many recurring episodes of AS should be preventable, since hypersensitivity tests for both penicillin and hymenoptera venoms are available, and hyposensitization with respect to the latter is feasible.
Body composition was measured in 29 healthy adults (12 men and 17 women) by three different methods: Dual photon (153Gd) absorptiometry (DPA), body density measurements (BD) and measurements of total body potassium (TBK). Correlation and regression analysis with the body fat percentage (Fat%) measured by the three different methods gave r values between 0.83 and 0.90 and SEEs between 4.0 and 6.0 (Fat%). We conclude that DPA provides a new method of measuring body composition with precision and accuracy errors in the same range as the more established methods.
A low-dose interferon (IFN)-alpha regimen for the treatment of hairy cell leukemia (HCL) was evaluated by following changes in leukocyte differentiation antigens (LDA), natural killer cell (NK) and 2',5'-oligoadenylate (2-5A) synthetase activities. Due to hairy cells' (HC) weak expression of several antigens positive for T cells, B cells, NK cells and monocytes, the use of a double marker specific for hairy cells was needed to distinguish the different subpopulations. Analysis of LDA in peripheral blood (PB) showed a total normalization of the T cell and monocyte numbers within 90 days, the number of NK cells normalized in 90 to 180 d, whereas normalization of B cell number was seen only after 180 to 360 d of treatment. Mean pretreatment 2-5A synthetase activity was normal or low, but upon treatment the levels rose immediately to higher than normal values and remained high throughout the study. Pretreatment NK activity was low, but normalized after between 90 to 360 d, except in 2 patients with severe splenomegaly. In vitro incubation of peripheral blood mononuclear cells (PBMNC) with IFN-alpha induced activation of the NK and 2-5A synthetase activity in untreated patients, but with treatment these effects were gradually abolished, indicating an increasing effect of IFN-alpha in vivo with time. These results shows that the different PBMNC subpopulations and important immunological functions normalize with treatment. This normalization is, however, not seen until at least after 1 year of treatment, indicating that the treatment schedule should be longer. As no exhaustion to the effect of IFN was seen, as measured by the 2-5A synthetase activity, a continuing beneficial effect of treatment is anticipated. The increasing effect of IFN-alpha after the first signs of clinical effect suggests that the doses used in the present study were higher than necessary.
Quinolone antibiotics, which can be proconvulsant in susceptible patients, were found to inhibit the specific binding of the adenosine receptor ligands L-3H-N6-phenylisopropyladenosine (L-3H-PIA) and 3H-N-ethylcarboxamidoadenosine (3H-NECA) to rat brain synaptic membranes. The inhibitions were concentration dependent, and for both ligands the order of potency was rosoxacin greater than nalidixic acid greater than oxolinic acid greater than or equal to ciprofloxacin greater than norfloxacin greater than enoxacin: IC20 values (concentrations causing a 20% inhibition of specific binding) ranged from 30-35 microM to 1-3 mM. Hill coefficients were approximately 0.5, suggesting that the compounds are probably antagonists at these sites. Most of the compounds did not alter 3H-diazepam binding directly, although rosoxacin showed relatively strong, and enoxacin weak, concentration-dependent inhibition. At 50 microM the compounds enhanced the maximal gamma-aminobutyric acid (GABA) activation of 3H-diazepam binding to varying degrees, without altering the EC50 of activation, whereas at 200 microM they tended to reduce GABA activation. Most noteworthy was the large increase in GABA-stimulated 3H-diazepam binding caused by 50 microM nalidixic acid. The compounds did not alter the Ca2+/Cl- -dependent binding of 3H-glutamate, nor of the binding of the glutamate site-selective ligands 3H-kainate and alpha-3H-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (3H-AMPA); the uptake of the non-metabolized glutamate analogue D-3H-aspartate by cortical homogenates was also unaffected. The CNS side effects of these antibiotics may result, in part, from interaction with sites which mediate the inhibitory neurotransmission of adenosine and, possibly, GABA.
The forearm fat content (FATarm, measured by single photon (125I) absorptiometry) and the 24-h urinary creatinine excretion (24 Ucrea) were determined in 29 healthy adults (12 males and 17 females), whose total body fat percentage was measured by three different methods: (i) Dual photon (153Gd) absorptiometry (DPA); (ii) body density measurements (BD); and (iii) total body potassium determinations (TBP). Lean body mass (by DPA, BD, and TBP) correlated significantly with 24 Ucrea (r = 0.87-0.89, standard error of estimate (SEE) = 5.2-6.3 kg). The total body fat percentage could be predicted from FATarm with SEEs at 3.4-5.8 (r = 0.85-0.88) and from 24 Ucrea + body weight with SEEs at 5.1-7.5 (r = 0.61-0.72). We conclude that the FATarm measurement represents a new tool for simple assessment of body composition on a group basis.
Patients are often labelled "allergic to penicillin" without adequate reason. Since penicillins are frequently the drugs of choice, this label should not be accepted lightly. The allergic reactions to penicillins are of immediate, accelerated, or delayed-type hypersensitivity. The most serious reactions are those of acute- and accelerated-type, which are both IgE mediated. Ideally, patients suspected of being allergic to penicillins should be tested in succession with RAST, skin testing, and per-oral provocation. Patients with serious infections and documented penicillin allergy should undergo desensitisation. Patients with penicillin allergy have a slightly increased risk of reactions to cephalosporins.