Asplenic patients' knowledge of prophylactic measures against severe infections.
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Adolescent↗
Biomedical subjects
J B Hansen
Publications and source records attributed to J B Hansen.
Highly purified eicosapentaenoic acid and docosahexaenoic acid in humans have similar triacylglycerol-lowering effects but divergent effects on serum fatty acids.
To compare the effects of highly purified ethyl ester concentrates of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on serum lipids, apolipoproteins, and serum phospholipid fatty acids in humans, we conducted a double-blind, placebo-controlled, parallel design intervention study. Healthy nonsmoking men (n = 234) aged 36-56 y were randomly assigned to dietary supplementation with 3.8 g EPA/d, 3.6 g DHA/d, or 4.0 g corn oil/d (placebo) for 7 wk. Serum triacylglycerols decreased 26% (P < 0.0001) in the DHA group and 21% (P = 0.0001) in the EPA group compared with the corn oil group. Although not significant, net decreases in serum triacylglycerols were consistently greater in the DHA group across all quartiles of baseline triacylglycerol concentrations. Serum high-density-lipoprotein cholesterol increased 0.06 mmol/L (P = 0.0002) in the DHA group. In the EPA group, serum total cholesterol decreased 0.15 mmol/L (P = 0.02) and apolipoprotein A-I decreased 0.04 g/L (P = 0.0003). In the DHA group, serum phospholipid DHA increased by 69% and EPA increased by 29%, indicating retroconversion of DHA to EPA. In the EPA group, serum phospholipid EPA increased by 297% whereas DHA decreased by 15%, suggesting that EPA is not elongated to DHA in humans. The serum phospholipid ratio of n-3 to n-6 fatty acids increased in both groups, whereas the relative changes in n-6 fatty acids suggested possible alterations in liver desaturation activity in the DHA group. We conclude that both DHA and EPA decrease serum triacylglycerols, but have differential effects on lipoprotein and fatty acid metabolism in humans.
Adult↗
Experimental pain in the stomach: a model based on electrical stimulation guided by gastroscopy.
BACKGROUND: Abdominal pain is often variable in intensity and difficult to characterise due to its referred pain pattern. Clinical pain is furthermore confounded by various emotional and cognitive factors. AIMS: To develop and apply an experimental model to induce localised gastric pain. SUBJECTS: Twelve healthy male volunteers. METHODS: Stimulating electrodes were mounted on a biopsy forceps and electric stimuli were delivered during gastroscopy. Single, five repeated, and continuous stimuli were given at four locations in the stomach. Pain detection thresholds and pain intensities were assessed together with localisation of the referred pain area. RESULTS: Pain detection thresholds were higher in the prepyloric region compared with those obtained at the lesser and greater curvature. Increasing stimulus intensity resulted in augmented pain perception and repeated stimuli elicited pain at a lower stimulus intensity than single stimuli. Continuous stimuli evoked constant (33%), increasing (33%), or decreasing (33%) pain. The localisation of referred pain varied considerably in the subjects. CONCLUSIONS: The model seems relevant to study basic pain mechanisms elicited by localised stimuli in the stomach. The experimental data support the premise that a gastric focus should always be suspected in patients referred with different kinds of abdominal pain.
Abdominal Pain↗
Prophylaxis against pneumococcal infection after splenectomy: a challenge for hospitals and primary care.
OBJECTIVE: To evaluate prophylaxis against pneumococcal infection after splenectomy. DESIGN: Retrospective analysis. SETTING: District hospital, Denmark. SUBJECTS: 555 Patients who underwent splenectomy between 1 January 1984 and 31 December 1993. INTERVENTIONS: Splenectomy, pneumococcal vaccination. MAIN OUTCOME MEASURES: Pneumococcal vaccination rates and the time of vaccination related to different indications for splenectomy. Extent of information in hospital records about measures for prophylaxis against pneumococcal infection. Recording of splenectomy and vaccination in discharge letters. RESULTS: The total vaccination rate was 62% (344/555), but vaccination rates from 47% to 91% in five different groups of indications were observed. Patients undergoing splenectomy during cancer surgery or because of inadvertent intraoperative trauma to the spleen were particularly at risk of not being vaccinated. Vaccination rates increased from 59% to 70% during the period studied. Of the 235 patients alive on 1 April 1995, 87% (205) had been vaccinated. Only 23% of the patients were vaccinated at the appropriate time. Splenectomy had not been recorded in 10%, and vaccination status was mentioned in 35% of the discharge letters. Only 6% of the hospital records and 2% of the discharge letters mentioned one or more precautions to consider for asplenic patients. CONCLUSIONS: The pneumococcal vaccination rates of patients after splenectomy were not satisfactory. Most of patients were vaccinated at an inappropriate time in relation to the splenectomy. The discharge letters often lacked information about the patients' vaccination status. More effort is needed to reach an acceptable level of prophylaxis against pneumococcal infection after splenectomy.
Adolescent↗
Laparoscopic versus open appendectomy: prospective randomized trial.
A prospective randomized trial comparing laparoscopic appendectomy with open appendectomy in patients with a diagnosis of acute appendicitis was conducted between October 1992 and April 1994. Of the 158 patients randomized, 7 patients were excluded because of protocol violations (conversion to laparotomy in 4, appendix not removed in 3). The 151 patients randomized to either a laparoscopic (n = 79) or an open appendectomy (n = 72) showed no difference in sex, age, American Society of Anesthesiology (ASA) rating, or previous abdominal surgery. The histologic classification of normal, catarrhal, inflamed, suppurative, and gangrenous appendicitis was not different between the two groups. Conversion from laparoscopic to open appendectomy was necessary in seven patients (9%) who had advanced forms of appendiceal inflammation. When compared to open appendectomy the laparoscopic group had a longer median operating time (63 minutes versus 40 minutes), fewer wound infections (2% versus 11%), less requirement for narcotic analgesia, and an earlier return to normal activity (median 7 days versus 14 days). There was no difference in morbidity, and both groups had a median time to discharge of 3 days. Laparoscopic appendectomy is as safe as open appendectomy; and despite the longer operating time, the advantages such as fewer wound infections and earlier return to normal activity make it a worthwhile alternative for patients with a clinical diagnosis of acute appendicitis.
Adolescent↗
Synthesis and 5HT modulating activity of stereoisomers of 3-phenoxymethyl-4-phenylpiperidines.
A series of pairs of enantiomers of substituted 3-phenoxymethyl-4-phenylpiperidines has been prepared from arecoline or alpha-methylstyrene by a combination of stereospecific reactions and optical resolutions. The ability of the compounds to modulate serotonin (5HT) neurotransmission in vitro was determined. Several derivatives, among which is the antidepressant paroxetine, are very potent inhibitors of 5HT reuptake. These compounds exhibit a pronounced steric requirement for inhibition of 5HT reuptake and binding to 5HT2A and 5HT2C receptors.
Animals↗
Depletion of intravascular pools of tissue factor pathway inhibitor (TFPI) during repeated or continuous intravenous infusion of heparin in man.
Tissue factor pathway inhibitor (TFPI) is a potent inhibitor of the extrinsic coagulation system. TFPI is increased several-fold in postheparin plasma and thereby thought to contribute significantly to the antithrombotic action of heparin. The present study was conducted to investigate how repeated (n = 8) and continuous (n = 6) administration of heparin affect plasma TFPI and the inhibition of tissue factor (TF)-induced coagulation ex vivo in humans. Free TFPI antigen (TFPI Ag) increased from 19.2 +/- 4.0 ng/ml to 204.7 +/- 31.7 ng/ml after intravenous injection of 5000 IU of unfractionated heparin. Five repeated injections of 5000 IU of heparin at 4 h intervals caused a progressive decrease (-45 +/- 8%, p < 0.0001 for time effect) in heparin-releasable TFPI and a progressive shortening of the clotting time as determined in a dilute prothrombin time assay (dPT) (-8.7 +/- 6.1 s, p < 0.0001). The basal concentration of TFPI Ag in plasma collected immediately before each heparin injection was decreased by 29 +/- 15% (p < 0.0001), whereas the dPT was decreased by 6.9 +/- 3.5 s (p < 0.0001). During a 24 h continuous infusion of heparin TFPI Ag decreased from 161.5 +/- 26.0 ng/ml to 35.6 +/- 4.7 ng/ml (-77.3 +/- 5.1%) (p < 0.0001). The contribution of TFPI to the inhibition of TF-induced coagulation during heparin infusion was estimated to decrease from 60 +/- 15% to 20 +/- 10% (p < 0.0001). The present data indicate partial depletion of intravascular pools of TFPI by repeated and continuous heparin administration and thereby attenuation of its contribution to the antithrombotic action of heparin.
Adult↗
Retention of phagocytic functions in cryopreserved human monocytes.
Phagocytosis and respiratory burst activity were measured by flow cytometry in fresh and cryopreserved human monocytes, after ingestion of Escherichia coli and Staphylococcus aureus. Mononuclear leukocytes, isolated from 15 healthy donors, were divided into two portions, of which one was examined immediately and the other was cryopreserved for 3 weeks. Morphological characteristics and expression of receptors involved in phagocytosis were similar in fresh and cryopreserved monocytes. Furthermore, both internalization of bacteria and respiratory burst activity remained unchanged after cryopreservation. Transmission electron microscopy confirmed actual internalization of bacteria and not merely bacterial attachment to monocytes. Monocytes were demonstrated to retain integral cellular functions during cryopreservation. This may imply that the method has potential for use in basal and clinical trials.
Adult↗
The prognostic value of exercise testing early after myocardial infarction in patients treated with thrombolytics.
Exercise testing early post AMI was evaluated as a predictor of reinfarction in patients treated with thrombolytics. AMI patients exercise-tested prior to discharge were included in the study (n = 178). The patients were followed for 2.9 +/- 0.9 years (mean +/- 1 SD) for the development of new cardiac events defined as cardiac death or reinfarction. Cox regression analysis of clinical and exercise test variables showed that there was significant predictive value of treating heart failure with drugs from two or more therapeutic groups (P < 0.001; hazard ratio 9.4 (3.1-28.2) (estimate and 95% confidence interval)), such as those with a previous history of myocardial infarction (P = 0.001; hazard ratio 4.0 (1.7-9.6)) and of significant ST depression (P = 0.029; hazard ratio 2.5 (1.1-5.7)). Significant ST depression could be substituted by the delta ST/delta HR index (P = 0.042; hazard ratio 2.8 (1.2-6.8)). The exercise test had independent but limited prognostic value in AMI patients treated with thrombolytics. The delta ST/delta HR index did not improve the predictive value of the exercise test.
Aged↗
Effect of cholesterol lowering on intravascular pools of TFPI and its anticoagulant potential in type II hyperlipoproteinemia.
Tissue factor pathway inhibitor (TFPI) inhibits the extrinsic coagulation system. A major pool of TFPI is associated with the vascular endothelium and can be mobilized into the circulation by heparin. In circulating blood, TFPI is mainly associated with LDL (80%), whereas 10% to 20% is carrier free. In this study, heparin administration caused a 2.2-fold and a 7.5-fold increase in TFPI activity and TFPI antigen, respectively, in 25 patients with phenotypes IIa and IIb hyperbetalipoproteinemia. Because the antigen determination of TFPI almost exclusively measures carrier-free TFPI, more than 90% of the heparin-induced increase in TFPI activity was caused by mobilization of carrier-free TFPI from the vascular endothelium. Therapeutic lowering of total cholesterol (a decrease of 31.1 +/- 11.6%, P < .001) by 40 mg/d lovastatin in 17 patients with hyperbetalipoproteinemia was accompanied by a parallel decrease in TFPI activity (of 27.7 +/- 24.2%, P < .001) because of a reduction in LDL-TFPI complexes. However, drug intervention did not affect carrier-free TFPI or the magnitude of the vascular pool of TFPI that could be mobilized into the circulation by heparin. Moreover, this reduction of LDL-TFPI complexes did not reduce the anticoagulant potency of TFPI in plasma or of the vascular endothelial pool. The results of this study may imply that the anticoagulant potency of TFPI is associated with its carrier-free form in plasma or on the endothelium and that downregulation of LDL affects neither the size nor the anticoagulant potency of the endothelial pool of TFPI.
Adult↗
Proatrial natriuretic polypeptide (31-67) in healthy individuals: day-to-day variation and influence of sex and age.
N-terminal parts of proatrial natriuretic polypeptide have been proposed to be sensitive and specific markers of congestive heart failure (CHF). A prerequisite for use of a clinical marker is knowledge of day-to-day variation and dependence on age and sex. Immunoreactive N-terminal proatrial natriuretic polypeptide (31-67) (ir-N-ANP(31-67)) was measured in a clinically relevant population of healthy individuals. A total of 21 females (mean age 52 years, range 42-76) and 26 males (mean age 54 years, range 42-73), without cardiovascular disease, were included in the study. No correlation was found between ir-N-ANP(31-67) and sex. A statistically significant positive linear correlation (ir-N-ANP pmol 1(-1) = 182+ (8.2 x age in years) (p = 0.004) was found between age and ir-N-ANP(31-67). For the youngest subjects (42 years) the expected mean ir-N-ANP(31-67) was 530 pmol 1(-1), and for the oldest subjects (76 years) it was 800 pmol 1(-1). For all the subjects, the median ir-N-ANP(31-67) was found to be 626 pmol 1(-1) (range 300-1151). The day-to-day variation was studied and no significant difference was found in the plasma concentration of two samples taken 2-5 days apart. Of the individual day-to-day variation, 95% would be expected to be in the interval from -244 to 188 pmol 1(-1) (mean +/- 2 x SD). We conclude that ir-N-ANP(31-67) rises with age. The age-dependent rise in ir-N-ANP(31-67) is modest, but should be taken into consideration in order to use ir-N-ANP(31-67) as a diagnostic marker of CHF. The day-to-day variation is found to be rather high and cannot be neglected if N-ANP(31-67) is to be used as a marker of asymptomatic heart failure.
Adult↗
[Shared leadership--responsibility faced everyday. Interview by Kirsten Bjørnsson].
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Anesthesia Department, Hospital↗
[The role of social factors in the place of death of cancer patients in the county of Nordjylland].
The purpose of this study was to evaluate the importance of social factors on whether cancer deaths occurred at home or in hospitals. The study was based on questionnaires to the patient's general practitioner and to the home nursing service. The study included 241 patients with terminal cancer who were all identified by death certificates via the Department of Public Health in the period of the 1st February, 1992 to the 31st April, 1992. The study demonstrated that significantly more patients died in their own homes when a contact to the home nursing service had been established. The same tendency could be observed for patients with relatives being reimbursed for loss of income while providing care in the home. Significantly more patients died at home in municipalities where 24-hour nursing facilities could be offered. No association between age, sex, or whether the patient lived alone or lived cohabitantly were observed. The study suggest that an intensification of the home nursing facilities would give a greater number of terminal cancer patients the option of dying in their own homes. The possibility of relatives being reimbursed for loss of income while providing care in the home has a positive influence on the development of the number of cases home nursing.
Adult↗
[Tilt test--part of examination in syncope].
Approximately three percent of all emergency room contacts are caused by syncopes. Despite thorough neurological and cardiological examination, more than 40% of all cases are never given a clear diagnosis. These might be caused by neurally mediated hypotension and bradycardia. Head-up tilt table test (HUT), done by the Westminster standard, provokes vasovagal syncope (VVS) in patients with recurrent unexplained syncope. VVS is believed to be caused by triggering the Bezold-Jarish reflex. Several treatments have been suggested. None of these treatments have been promising. By HUT the patient can be made aware of prodromic symptoms and be given instructions to prevent syncope. HUT is useful in the investigation of unexplained syncope.
Humans↗
[Tilt-induced vasovagal syncope].
In a patient with recurrent unexplained syncope, a case of tilt-induced vasovagal syncope is presented. In a 60 degrees head-up tilt table test, the patient developed complete AV-block and hypotension with loss of postural tonus. After treatment with a B-receptor blocker the head-up tilt table test was better tolerated. The importance of instructions to recognize prodromic symptoms to prevent syncope is underlined. No obvious benefits of medical therapy have been found.
Adult↗
Basal plasma concentration of tissue plasminogen activator (t-PA) and the adaption to strenuous exercise in familial hypercholesterolaemia (FH).
Epidemiological studies have provided evidence that attenuated fibrinolytic activity and increased antigen levels of plasminogen activator are risk factors for coronary heart disease (CHD). In a comparative study, tissue plasminogen activator (t-PA) antigen and activity concentrations were examined in plasma from familial hypercholesterolaemia (FH) patients without manifest CHD (n = 14) and in age- and sex-matched normolipaemic controls (NLC) at rest and after the same bicycle exercise. The FH patients had higher systolic and diastolic blood pressure than their controls. The plasma level of t-PA antigen was higher in FH patients than in NLC under basal conditions (7.3 +/- 3.1 ng/ml vs 4.8 +/- 2.2 ng/ml, P = 0.022), whereas no difference was found in t-PA activity. Bicycle exercise induced a marked increase in t-PA antigen (P < 0.001 for both groups) which did not differ between groups. A more prominent rise in t-PA activity was observed among the FH patients during the exercise (1.71 +/- 0.99 vs 0.85 +/- 0.89 IU/ml, P = 0.24). Neither the basal level of thrombin-antithrombin III complex (TAT) nor the significant increase (P < 0.001 for both groups) induced by exercise differed between groups. A high t-PA antigen level may precede clinical manifestations of cardiovascular disease in patients with familial hypercholesterolaemia.
Adaptation, Physiological↗
Ballooning platelets in the myelodysplastic syndromes (MDS)
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Blood Platelets↗
Changes in cellular immune function after immune specific guided imagery and relaxation in high and low hypnotizable healthy subjects.
This article presents the results of two investigations, each measuring cellular immune function on 3 investigation days 1 week apart in 15 high and 15 low hypnotizable healthy subjects randomly selected for three groups: (1) a guided imagery group receiving instructions to enhance cellular immune function: (2) a relaxation group which did not receive instructions regarding the immune system, and (3) a control group. Study 1 investigated changes in monocyte chemotaxis (MC) and lymphocyte proliferative response (LPR) to three mitogens, while natural killer cell activity (NKCA) was measured in study 2. The results show similar patterns of brief decreases in LPR and NKCA immediately after intervention on all investigation days in both the imagery and relaxation groups. Increases in MC were found in both intervention groups on day 1. On a follow-up investigation day in study 2, a brief stress task yielded a slight increase in NKCA. In study 2, the control group showed decreases in NKCA similar to those observed in the two intervention groups. In general there were no significant changes in preintervention immune function throughout the investigation period. When comparing the effects in high and low hypnotizable subjects, we found that high hypnotizables showed greater decreases in LPR and NKCA than low hypnotizables. There are several inconsistencies between the results of the limited number of investigations studying the effects of guided imagery and relaxation on immune function. These differences may in part be explained by differences in methodology, time intervals between blood sampling, and subject characteristics such as age, health status and hypnotizability. The inconsistent results make it premature to make inferences about possible benefits of the application of these techniques in the treatment of immune related diseases, and further investigations are needed.
Adolescent↗