Biomedical subjects
Publications and source records attributed to B Nielsen.
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The purpose of this study has been to describe the course over ten years and prognosis for a cohort of patients who had been admitted to a psychiatric department following a suicide attempt. The cohort consisted of 207 patients who had been admitted in the period 1.10.1980-20.4.1981 to a department of psychiatry following a suicide attempt. At the index attempt 99 patients were randomly selected and interviewed. Information on the remainder was obtained from psychiatric case histories, casualty records and discharge reports. Ten years after the index attempt information concerning death, date and cause was collected. Of the 207 patients involved, 52 (25.1%) were dead. Twenty-five (12.1%) had committed suicide, the remainder had died of natural, accidental or unknown causes. Relative to the general population the death rate from suicide and other causes was extremely high. Predictors of suicidal outcome were substance abuse and dangerous index attempt. At least one of these two predictors was present for 72% of those who committed suicide and for 43% of those who did not commit suicide. Aging and previous suicide attempts were the only significant predictors of other causes of death.
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During the autumn and winter of 1993-94 four cases of legionellosis were diagnosed in a Department of Nephrology. Three of the patients were kidney transplanted patients. Two of the patients died. The diagnosis was based on positive culture in two patients and by positive urinary antigen test in the other two patients. Serology was negative for all four patients. Legionella pneumophila was initially found in the cold and hot shower water, in ice-water from the ice machine, from the hot water tank and in the cold water inlet to the building. The isolate from patient no. one and isolates of serogroup 5 from the ice machine and the shower water had identical REA profiles, different from the profiles of the isolate from patient no. four. We concluded that at least one of the four patients was likely to have been infected from the water in the department, either by inhalation of contaminated aerosols from the shower or by aspiration of contaminated ice-water. Precautions were taken to reduce the number of Legionella in the shower- and ice-water. In addition, restrictions in the use of showers and ice-water from the ice machine were introduced.
Treatment of diabetic rats with octreotide can inhibit early diabetic renal hypertrophy. Octreotide administration for 6 months from the day of diabetes induction inhibits renal hypertrophy and diminishes increase in urinary albumin excretion. To investigate the effect of octreotide on manifest diabetic renal changes, octreotide treatment was given for 3 weeks after an untreated diabetic period of 3 or 6 months. In addition, following 6 months of diabetes, a group of diabetic rats was treated with insulin for 3 weeks. Renal and glomerular hypertrophy, and increased urinary albumin excretion were observed in diabetic rats compared to non-diabetic control rats from 3 months and throughout the study period. Octreotide treatment did not affect body weight, food intake, blood glucose or serum fructosamine levels. We observed no effect of octreotide treatment on renal and glomerular hypertrophy or urinary albumin excretion compared to placebo-treated diabetic rats. Insulin treatment for 3 weeks after 6 months of untreated diabetes normalized blood glucose and serum fructosamine levels, and furthermore renal hypertrophy was significantly diminished compared to the placebo-treated diabetic rats. However, insulin treatment had no effect on glomerular hypertrophy or urinary albumin excretion. In conclusion, octreotide treatment for 3 weeks following an untreated diabetic period of 3 or 6 months is unable to reduce the increased renal and glomerular volume or urinary albumin excretion. However, insulin treatment for 3 weeks with induction of euglycaemia diminishes the renal hypertrophy but has no effect on glomerular volume or urinary albumin excretion.
A highly enriched denitrifying mixed culture transformed o-xylene co-metabolically along with toluene by methyl group oxidation. o-Methyl benzaldehyde and o-methyl benzoic acid accumulated transiently as metabolic products of o-xylene transformation. Transformation of o-methyl benzyl alcohol and o-methyl benzaldehyde occurred independently of toluene degradation and resulted in the formation of a compound coeluting with o-methyl benzoic acid on a gas chromatograph. The co-metabolic relationship between toluene and o-xylene could be attributed to a mechanism linked to the initial oxidation of the methyl group.
A total of 43 pigs, inoculated with Salmonella typhimurium (O:1,4,5,12) and un-inoculated controls were followed weekly by blood and faecal samplings for up to 18 weeks post inoculation (p.i.). Three pigs, inoculated with S. infantis (O:6,7) were followed similarly for 9 weeks. All inoculated pigs, except one, were positive for Salmonella by traditional faecal culture on at least one occasion during the first week of infection, whereafter shedding of bacteria rapidly declined to < 10% of the pigs from week 7. All control pigs remained Salmonella negative by culture of faecal samples. When examined serologically in an indirect ELISA using mixed purified LPS from S. typhimurium and S. choleraesuis (O:6,7), all but one S. typhimurium infected pig and all S. infantis infected pigs produced significantly increased optical densities (OD) in the ELISA as compared to the control groups. The maximum anti-LPS response was observed at day 22, when 86% of the S. typhimurium inoculated pigs had seroconverted, while the frequency of seropositive pigs peaked at days 30 (92%) and 37 p.i. (92%). Large variations were found among pigs concerning time of seroconversion (between 6 and 37 days p.i.), maximum OD-level attained (between 8 and 130% of a reference serum) and persistence of reaction. At the time of necropsy, 18 weeks p.i., 67% of the S. typhimurium inoculated pigs were found seropositive, while 100% of the S. infantis inoculated pigs were found seropositive at necropsy, 9 weeks p.i. Salmonella in internal organs were detected at necropsy in 4/22 of the S. typhimurium inoculated pigs with persistent anti-LPS reaction and all 3 S. infantis inoculated pigs but in none of the antibody-negative pigs. The ELISA is therefore suitable for screening for the presence of infection with S. typhimurium or S. infantis on a herd basis. Its suitability for other serotypes of Salmonella will require further testing.
The urodynamic measurement of micturition, the process of voiding, is combined with the filling cystometrogram to provide a comprehensive evaluation of bladder function. Two voiding studies, uroflowmetry and the voiding pressure test, provide data about the detrusor contraction, urethral sphincter mechanism response, and urinary outflow. With careful interpretation, these data provide insight into the disorders of micturition that cause urinary retention and its complications. This discussion reviews complex urodynamic techniques used to perform and evaluate bladder evacuation.
The pilocarpine iontophoresis test (P-test) is used as a predictor of the capacity to produce sweat. Therefore, we studied the reproducibility of this test in 12 normal subjects on 10 consecutive days. Furthermore, we determined whether the P-test reflects whole-body and regional sweat secretion during exercise in the heat. Finally, we determined whether the P-test stimulates the eccrine sweat glands to maximal sweat secretion. Six growth hormone-deficient (GHD) patients who are known to have decreased sweating, and 11 healthy control subjects were studied. To induce maximal sweat secretion, the patients exercised on a bicycle ergometer at a workload corresponding to 40% of their maximal aerobic power (VO2max). The 11 healthy subjects exercised at a workload of 150 W. All subjects exercised for 60 min in ambient air at 35 degrees C, with 50% relative humidity. The P-test showed a mean day-to-day variation of 20.8% between individual subjects. There was a significant positive correlation between the P-test and regional sweat secretion (r2 = 0.74). The correlation coefficient (r2) was 0.50 for the correlation between the P-test and whole-body sweat secretion, and 0.52 for the correlation between regional sweat secretion and whole-body sweat secretion. We conclude that the pilocarpine iontophoresis test reflects heat- and exercise-induced sweating capacity. However, this test does not induce maximal sweating, and it cannot be used as a single reliable predictor of whole-body sweating, due to considerable day-to-day variation.
Dual-energy X-ray absorptiometry (DXA) measures three of the principal components of the body: fat mass, lean soft-tissue mass (comprising muscle, inner organs, and the body water), and the bone mineral content. The purpose of this study was to test the estimation capacity of DXA when it is applied to patients with end-stage renal failure. Twenty dialysis patients were examined by DXA before and after one hemodialysis session. A highly significant positive correlation between weight measurements performed by conventional scales and DXA was found. A positive correlation between fluid loss during dialysis and reduction in fat-free mass (lean soft-tissue mass plus bone mineral content) was observed by DXA. The estimation of the fat-free mass was independent of the amount of fluid loss. No significant differences in variance between the data obtained before and after the dialysis were observed. We conclude that DXA is a useful tool for estimating the magnitude of body compartments in patients with end-stage renal failure.
Sweat secretion is often disturbed in patients with GH secretory disorders. Hyperhidrosis is a classic feature of acromegaly, and it has recently been shown that GH-deficient patients exhibit decreased sweating capacity after pilocarpine stimulation of the skin. Thus, patients with GH-deficiency may be at risk for developing hyperthermia. To pursue this, we performed a controlled study on sweating and body temperature regulation during exercise in the heat in 16 GH-treated GH-deficient patients with normalized insulin-like growth factor-I and insulin-like growth factor/binding protein-3 serum levels [11 with multiple pituitary deficiency (MPD) and 5 with isolated GH deficiency] and in 10 healthy subjects as controls (CTs). Each subject exercised on a bicycle ergometer for 60 min at a workload corresponding to 45% of their individual maximal oxygen consumption (VO2max), in a room maintained at 35 C. GH serum concentrations increased significantly after approximately 10 min of exercise in the CTs (P < 0.001) but remained low in the patients. Body heat storage was significantly higher in the patients compared with the CTs [89 (SE +/- 10) watts (MPD) vs. 37 (SE +/- 8) watts (CTs), P < 0.001]. Consequently, the core temperatures of the patients increased significantly after exercise compared with those of the CTs [38.3 C (0.10 C) (MPD) and 38.1 C (0.06 C) (isolated GH deficiency) vs. 37.5 C (0.2 C) (CTs) (P < 0.004)]. Skin temperature increased significantly during exercise in the patients but remained unaltered in the CTs. Sweat secretion rates, as determined by the pilocarpine method, were significantly lower in the MPD patients [77 (SE +/- 10) mg/30 min] than in the CTs [115 (SE +/- 7) mg/30 min] (P < 0.005). Total body sweating was lower in the patients than in the CTs, although the difference did not reach statistical significance. Significantly reduced estimated evaporative heat loss was demonstrated in the patients compared with the CTs (P < 0.001). In conclusion, 1) decreased sweating, decreased sensitivity of the sweat gland, and impaired thermoregulation are part of the adult GH-deficiency syndrome, and 2) GH-deficient patients are at risk for developing hyperthermia during physical activity in hot environments.
IGF-I acts as a renotropic factor in early streptozotocin-induced diabetes. Somatostatin analogue (octreotide) treatment initiated at the onset of diabetes prevents kidney IGF-I accumulation and renal growth. Seven days of octreotide treatment initiated after 3, 5, 7 or 9 days of untreated diabetes was investigated. Diabetic renal hypertrophy was followed by renal hyperplasia. Compared with placebo-treated diabetic rats, the earliest octreotide intervention was followed by a greater reduction in renal growth compared with intervention later on (days 3 to 10, 12%; days 5 to 12, 10%; days 7 to 14, 9%; days 9 to 16, 6%; P < 0.05). Octreotide treatment was unable to reduce protein accumulation and kidney DNA increase consistently. No difference in glomerular volume fraction or total glomerular volume was observed between placebo- and octreotide-treated diabetic rats. Octreotide treatment was followed by reduced kidney and serum IGF-I especially following early intervention, while no effect over that of diabetes was observed in the later intervention periods. The results confirm the notion that initial renal IGF-I accumulation is a prerequisite for early diabetic kidney hypertrophy in rats and show that delayed octreotide treatment cannot reverse renal and glomerular growth which is already manifest.
In the 25-year period 1968-92, 3,317 out of 477,420 patients admitted to Frederiksberg Hospital experienced 3,491 episodes of bacteremia. Enterobacteriaceae dominated as causative agents (57%), following by Gram-positive cocci (31%) and anaerobes (7%). Polymicrobial bacteremia was found in 8% of the episodes. The incidence of Enterobacteriaceae bacteremia culminated in the middle (1978-82) of the period (4.7/1,000 admissions) and decreased during the last decade. Gram-positive bacteremia increased throughout the period (from 1.8 to 2.9; p < 0.001), due mainly to increasing incidences of bacteremia caused by non-hemolytic streptococci, Streptococcus pneumoniae and coagulase-negative staphylococci. Bacteroides fragilis accounted for a rising incidence of anaerobic bacteremia (from 0.3 to 0.7; p < 0.05). Clinical data were available for the 2,599 bacteremic episodes in the 20-year period 1968-87. 59% of these were hospital acquired. Of those, 38% were associated with indwelling catheters, mainly bladder catheters (28%) and i.v. lines (7%). The urinary tract dominated as source of bacteremia (46%), followed by the respiratory (11%) and the gastrointestinal tract (9%). Half of the patients had predisposing underlying diseases, most frequently malignancies (20%) and diabetes mellitus (7%). The mortality rate related to bacteremia decreased from 25% to 11% (p < 0.001). More than half (55%) of the fatal cases related to bacteremia occurred within the first 2 days after the first positive blood culture was obtained. Logistic regression analysis defined 7 variables that independently influenced the outcome related to bacteremia: age, source, culture verification of source, shock, body temperature, leukocyte count and empiric antibiotic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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