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Biomedical subjects

F Madsen

Publications and source records attributed to F Madsen.

At least 91 records · Page 5Linked to original sources
PubMed1987

High dose grass pollen tablets used for hyposensitization in hay fever patients. A one-year double blind placebo-controlled study.

Previous, placebo-controlled clinical trials with oral hyposensitization in grass pollinosis have been disappointing. Since the results possibly could be explained by too low doses of ingested allergens, the present study was initiated to evaluate the effect of high doses of allergens. Forty-two adults with symptoms in the grass pollen season and with grass pollen sensitivity demonstrated by skin prick test and conjunctival provocation test were included. Enterosoluble tablets were administered daily for 1 year. Twenty-two patients, who completed the study, received placebo and 17 mixed grass pollen allergens from rye grass, timothy grass, cultivated rye and velvet grass. Evaluated either by self-assessment or by symptom and medicine score before and after treatment, the group receiving pollens did not improve clinically compared the controls. During the study, conjunctival sensitivity decreased equally in the two groups, and changes in specific IgE, allergen-induced histamine release from blood cells and skin prick test were insignificant and with no difference between groups. Five patients, who received pollen allergens, had episodes of urticaria or angioedema, and a further three patients on the same treatment had slight gastrointestinal side effects. In conclusion, enterosoluble grass pollen allergens in contrast to birch pollens did not have any therapeutic effect, even in doses more than 4,000 times higher than those used for subcutaneous hypersensitization. The reason may be degradation of allergens before the immune system is reached.

Adolescent↗
PubMed1987

House dust mite asthma. Correlation between allergen sensitivity in various organs.

Fifty asthmatics, candidates for hyposensitization with the house dust mite Dermatophagoides pteronyssinus (Dp), went through a series of allergy tests to evaluate the sensitivity of different organs to Dp. All patients were exposed to bronchial challenge with histamine and bronchial, nasal and conjunctival challenge with Dp, skin prick test (SPT) with Dp, analyses for Dp-specific histamine release from blood cells (HR) and for anti-Dp-IgE in serum (RAST). Results from 40 patients reacting positively in all tests were further analysed. Sensitivity to Dp in the various organs did not parallel, but a fair correlation was demonstrated between pulmonary allergen sensitivity and HR (r = 0.65, P less than 0.001), and between pulmonary sensitivity to allergen and to histamine (r = 0.47, P less than 0.001). Combined variations in HR and in (unspecific) bronchial sensitivity to histamine explained 53% of the variation in bronchial sensitivity to the allergen. This parameter showed less correlation to RAST and SPT (r = 0.31 and r = 0.35, P greater than 0.05). The results indicate that bronchial allergen challenge cannot be replaced by similar challenge of other organs, since the sensitivity of the mucosa in different organs of the same patient seems unrelated. Diagnosis should therefore be based on challenge of the organ with dominating clinical importance. In our selected group of patients, however, it was indicated that a substitution of the result of bronchial allergen challenge by measurement of unspecific bronchial reactivity, together with information on the general allergen sensitivity on a cellular level, might be possible. The unpleasant symptoms of the immediate and late bronchial reactions to allergen challenge could thereby be avoided.

Allergens↗
PubMed1987

Fixed ventilation during tidal volume breathing bronchial challenge may improve repeatability.

Tidal breathing during bronchial challenge shows both between- and within-subject variation. A challenge protocol permitting controlled ventilation was designed in order to improve repeatability of the method. Twenty-five patients were challenged twice with an interval of 2 h. The 2 min ventilation was kept constant at each concentration administered. During the 2 min inhalation of aerosol all expired air (VE) was led through a dry gas meter and respiratory frequency was counted concomitantly. The patients were instructed to achieve the same 2 min ventilation at each dosage. All patients accomplished the two challenges without problems. A PC20 was determined by interpolation on the log dose-response curve. Repeatability was improved compared to what has been found in previous studies on adults, although statistically non-significant when compared to one study. The 95% confidence interval for PC20 based on a single determination was rather narrow, being the observed value +/- 0.58 two-fold concentration differences.

Adult↗
PubMed1987

Reproducibility of challenge tests at different times.

Bronchial challenge for determination of bronchial reactivity is widely used in the diagnosis of asthma, the grading of severity, and evaluation of effect of treatment with new antiasthmatic drugs. Allergen challenge is also used for diagnosis of specific IgE-mediated asthma and evaluation of the effect of immunotherapy. A number of factors influence the result of the challenge test including the selection of patients, criteria for carrying out the challenge test, a number of technical factors concerning the challenge, the dosing schedule, pulmonary function tests carried out and analysis of the data. All these factors have to be taken into consideration before reproducible challenge tests can be performed. Detailed description of the equipment and procedures used and inclusion criteria for the patients should be included in all publications concerning challenge tests in order to be able to compare results from different laboratories. Each clinic or laboratory needs to perform reproducibility studies on bronchial challenge testing procedures and equipment used in their clinic.

Aerosols↗
PubMed1987

Fixation of displaced femoral neck fractures. A comparison between sliding screw plate and four cancellous bone screws.

In a prospective, randomized trial, 104 consecutive patients with displaced femoral neck fractures were allocated either to fixation with a sliding screw plate or 4 ASIF cancellous bone screws. The patients were reexamined at fixed intervals to determine the time of union. The 2-year-cumulated rate of union was 64 per cent in the plate group and 84 per cent in the screw group.

Adult↗
PubMed1986

Bambuterol: dose response study of a new terbutaline prodrug in asthma.

The bronchodilator activity and side-effects of treatment for 4 days with either 0.085, 0.170 or 0.34 mg/kg bambuterol b.i.d. (a prodrug of terbutaline) or 0.071 mg/kg terbutaline t.i.d. have been evaluated over 12 h, in a double-blind, randomized crossover trial in 19 asthmatic out-patients. Plasma terbutaline concentrations after bambuterol administration were smoother, with a ratio between the maximum and minimum values of about 1.4 compared to 2.6 for terbutaline. The plasma terbutaline level rose with dose, but by less than the increase in dose. The bronchodilator effect was related to the plasma terbutaline concentration in each treatment group, so bambuterol produced more prolonged bronchodilatation than treatment with terbutaline. Tremor and cardiac side-effects were most pronounced after administration of bambuterol 0.34 mg/kg. No severe side-effects were seen. Bambuterol produced stable plasma levels of terbutaline, indicating that as a prodrug of terbutaline it might possibly be administered once daily with good antiasthmatic effect.

Adult↗
PubMed1986

Avascular femoral head necrosis following fracture fixation.

A prospective, randomized trial of 104 consecutive patients with displaced fractures of the femoral neck treated with either a sliding screw plate or four AO cancellous bone screws was performed to study the influence of the fixation device and the fixation procedure on the vascularity of the femoral head. The vitality of the femoral head was determined by 99mTc-MDP scintigraphy performed 2-3 months after the operation. Eighty-seven patients (84 per cent) were available for assessment. The two treatment groups were comparable with regard to age, degree of primary displacement and quality of reduction. There were significantly more (P less than 0.01) avascular femoral heads or femoral heads with reduced vascularity in the sliding screw plate group (14/40, 35 per cent) than in the four AO cancellous bone screw group (5/47, 11 per cent).

Adult↗
PubMed1986

Reproducibility of standardized bronchial allergen provocation test.

Standardized bronchial allergen provocation was performed twice (with an interval of median 14 days (range 14-44)) in 19 extrinsic, well-defined asthmatic patients to study the reproducibility of the bronchial response. Smoking and medications were strictly withheld prior to the provocation. Ten-fold increasing concentrations of allergen solution 0.9 ml were inhaled by tidal volume breathing for 5 min at 10-min intervals. The actual dose given was expressed by the concentration of the solution used. Forced expiratory volume in the first second (FEV1) was used to determine responses, and the provocation continued until an allergen concentration (allergen PC20) was reached which caused at least 20% decrease of the post-saline FEV1. All provocations were followed by a bronchial reaction within clinically acceptable limits. The reproducibility was high, evaluated by the Spearman rank correlation coefficient Rho = 0.90 (P less than 0.01). It is concluded that bronchial provocation with allergens performed as outlined in this study represents a reproducible test which can be applied in routine allergy diagnostics, and in further investigations concerning specific bronchial reactivity.

Allergens↗
PubMed1986

Bronchial histamine challenge in the diagnosis of asthma. The predictive value of changes in airway resistance determined by the interrupter method.

The predictive value of a bronchial challenge with histamine was determined in a prospective survey on a population with a high prevalence of asthma (0.62). Without knowledge of the bronchial responsiveness 133 patients were classified as asthmatics (83) or non-asthmatics (50) according to variation in peak expiratory flow rate and medical history. Response to challenge was determined by the interrupter method, and the concentration of histamine inducing a 40% increase in resistance to breathing (PC40-Rt) was calculated from the log dose response curve. When defining a positive test as a test giving PC40-Rt-values below 2.00 mg/ml, the predictive value of a positive test was 0.75 and the predictive value of a negative test was 0.72. By decreasing the limit for a positive test to 0.25 mg/ml the corresponding predictive value was increased to 0.91. When further increasing the limit to 4.00 mg/ml the predictive value of a negative test in the diagnosis of asthma was increased to 0.81. The interrupter technique is suitable for diagnostic purposes in the detection and exclusion of bronchial asthma.

Adolescent↗
PubMed1986

Self-administered prophylactic postoperative positive expiratory pressure in thoracic surgery.

Application of self-administered postoperative prophylactic positive expiratory pressure (S-PEP) treatment in addition to conventional physiotherapy was investigated in 75 patients undergoing thoracotomy. Twenty-nine patients used a face-mask set supplied with an expiratory resistance (S-PEP group) and 27 patients used a face-mask set without resistance (control group). The observation period and postoperative treatment with the face-mask was 3 days. In the S-PEP group 13 patients developed radiographic atelectasis during the 3 postoperative days compared to eight patients in the control group (P greater than 0.05). The postoperative PaO2 in the S-PEP group was 0.36 kPa lower than in the control group (P greater than 0.05). We conclude that application of S-PEP postoperatively after thoracotomy in addition to conventional physiotherapy including early mobilization had no beneficial effect in preventing atelectasis, as evaluated by changes in blood gas tensions and chest roentgenograms.

Adolescent↗
PubMed1986

Comparison of two aerosols containing both fenoterol and ipratropium in a high (Duovent) and low (Berodual) concentration, respectively.

Twenty-one stable asthmatic patients were randomly allocated to be treated with either Duovent (ipratropium bromide 40 micrograms and fenoterol 100 micrograms) and Berodual (ipratropium bromide 20 micrograms and fenoterol 50 micrograms) in a cross-over double-blind design over a 12-week period, each treatment period lasting for 6 weeks. During the study, patients used the test medicine 2 puffs 4 times daily. At the day of inclusion, 6 and 12 weeks after start, a dose-response curve was obtained after inhalation of the test medicine used during the previous 6-week period. Asthma symptoms were recorded in a diary card and morning and evening peak flow was measured. Berodual and Duovent showed a significant bronchodilating effect, the effect of Duovent comparatively more pronounced, but the absolute lung function values after Berodual equalized the effect of Duovent. No difference between peak flow values measured in the morning and evening could be demonstrated. We conclude that no preference between either Duovent or Berodual could be established in the treatment of asthma.

Aerosols↗
PubMed1986

A rapid challenge protocol for determination of non-specific bronchial responsiveness.

A rapid method for determination of non-specific bronchial hyperreactivity was developed. Resistance to breathing was determined by a modified expiratory airway interrupter technique and combined with a dosimeter-controlled nebulizer which made continuous determination of response possible during challenge. The patients inhaled histamine chloride 8 mg/ml at every eighth breath until resistance to breathing (Rt) was increased by 60%. The number of inhalations (NI) or the provocative concentration (PC60-Rt) of histamine increasing Rt by 60% were determined in 68 patients. The new method correlated well to a non-cumulative standard protocol and could be terminated either within 10 min or within 20 inhalations. The results of this new challenge procedure enables us to predict the responsiveness to inhaled histamine precisely enough to separate patients into hyperreactive or normal reactive patients. Furthermore, the repeatability of the new method is comparable or superior to that of standard methods. The 95% confidence interval for the difference between replicates was the observed value +/- 2.4 NI. Thus this new method will be suited for studies of drug modifying effect on bronchial hyperreactivity since individual dose titration is easily performed, and the method could be valuable in epidemiological and occupational surveys as well.

Adolescent↗
PubMed1986

Early mobilizing treatment in lateral ankle sprains. Course and risk factors for chronic painful or function-limiting ankle.

In a prospective study, 150 patients with lesions of lateral ankle ligaments were treated with early mobilization without any fixation of the ankle. After 8 days, 67% were free from pain on ordinary walking and 81% had resumed work. After 1 month 90% were free from pain and 97% had resumed work. Sport was resumed by 70% of athletes after 1 month and 90% after 3 months. At the 1-year follow-up (n = 137), 18% were not fully recovered and experienced pain (14%) or functional instability (7%) or had not resumed sport at their normal level (7%). However, only 8% found the condition inconvenient. Athletes had an increased risk of residual symptoms (p less than 0.01) and residual symptoms occurred in 32% of top athletes after 1 year.

Adolescent↗