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Biomedical subjects

J Eriksen

Publications and source records attributed to J Eriksen.

At least 37 records · Page 2Linked to original sources
PubMed2000

Chronic pain in torture survivors.

According to Amnesty International government-sanctioned torture is verified in one third of the countries in the world. The physical and psychological sequelae are numerous. This study focuses on pain diagnosis, characterising pain types as nociceptive, visceral or neuropathic. Torture victims from the Middle East, treated at the Rehabilitation and Research Centre for Torture Victims (RCT) in Copenhagen, participated in the study. The patients were referred to a pain specialist for evaluation of unsolved pain problems. Eighteen male torture victims were examined. Twelve patients experienced pain at more than three locations. Nociceptive and neuropathic pain were demonstrated in all patients. Specific neuropathic pain conditions were related to the following four types of physical torture: Palestinian hanging, falanga, beating and kicking of the head, and positional torture. When treating torture victims, it is important to know about torture methods, to think differently than normal on etiological and pathogenetic factors and always consider the presence of neuropathic pain.

Adult↗
PubMed2000

[Methadone as an analgesic].

Methadone is a synthetic opioid agonist which has been available for more than 40 years. Although its main use has been in the maintenance therapy of opioid addicts, it has a number of unique characteristics including excellent analgesic effect, a high bioavailability, no known active metabolites, long duration of action during long-term treatment, high potency, and low cost. However, its use is limited by the complexity of the pharmacokinetics, with a risk of drug accumulation with toxic effects. Recent findings suggest that standard equianalgesic tables are unreliable, because methadone is much more potent when used for long-term treatment. Therefore methadone should be titrated carefully and increases in dosage should be performed every third or fourth day.

Analgesics, Opioid↗
PubMed2000

Treatment outcome of chronic non-malignant pain patients managed in a danish multidisciplinary pain centre compared to general practice: a randomised controlled trial.

This randomised controlled study investigated the effect of outpatient multidisciplinary pain centre treatment (MPT) compared with treatment by a general practitioner after initial supervision by a pain specialist (GP-group) and with a group of patients waiting for 6 months before treatment was initiated (WL-group). One-hundred-and-eighty-nine chronic non-malignant pain patients were studied. At referral, and after 3 and 6 months patients filled in questionnaires evaluating pain intensity, health related quality of life (HRQL) and use of analgesics. HRQL was evaluated using the Medical Outcome Study-Short Form (SF-36), the Hospital Anxiety and Depression scale (HAD) and the Psychological General Well-being Scale (PGWB). After 6 months patients allocated to MPT (n=63) reported statistically significant reduction in pain intensity (VAS-score, P<0.001), improvement in psychological well-being (PGWB, P<0.001), quality of sleep (P<0.05) and physical functioning (SF-36-Phycical Functioning, P<0.05). No improvements were seen in the GP-group (n=63). In the WL-group (n=63) a statistically significant deterioration was observed in PGWB-scores, HAD-scores and in 6 of 8 SF-36-subscores (P </= 0.05). A reduction in use of opioids administered on demand was obtained in the group receiving MPT (P<0.001). In the MPT- and GP-groups a decrease in the use of short acting opioids was observed (P<0.01). No change in use of analgesics was seen in the WL-group. The study showed that (i) in the MPT-group there was a significant reduction in pain intensity and improvement of HRQL compared to the WL-group, and (ii) the mere establishment of a pain diagnosis and a pain management plan by a pain specialist was not sufficient to enable the referring GP to manage severely chronic pain patients.

Adult↗
PubMed2000

Eradication of Helicobacter pylori compared with long-term acid suppression in duodenal ulcer disease. A randomized trial with 2-year follow-up. The Danish Ulcer Study Group.

BACKGROUND: Trials evaluating long-term management of duodenal ulcer disease have mainly been focused on recurrence of ulcers, disregarding effects on dyspeptic and reflux symptoms. Profound acid inhibition with a proton pump inhibitor is the gold standard therapy in acid-related diseases. We aimed to compare the symptomatic effects of eradication therapy with those of long-term omeprazole treatment in a design with periods both with and without acid inhibition. METHODS: Patients with active duodenal ulcer were randomized either to omeprazole, 20 mg twice daily until healing, followed by omeprazole, 20 mg/ day for 1 year, or to eradication therapy (metronidazole, amoxicillin, and omeprazole for 2 weeks) followed by placebo for 1 year. All patients were followed up passively for an additional year. Clinical controls were performed every 2 months the 1st year (maintenance phase) and every 6 months during the passive follow-up phase. The study was multicentric and double-blind. The primary end-point was discontinuation of treatment, irrespective of reason. RESULTS: Two hundred and seventy-six patients were randomized (139 in the eradication treatment group). In the maintenance phase there were no differences in the reporting of dyspeptic symptoms or in premature withdrawal. In the passive follow-up phase only five patients in the eradication therapy group discontinued owing to relapse of dyspeptic symptoms or ulcer, compared with 51 patients initially randomized to long-term omeprazole. There were no differences in reflux symptoms or in the development of reflux oesophagitis. CONCLUSIONS: Eradication therapy and long-term omeprazole are equally effective in controlling dyspeptic symptoms and reflux in duodenal ulcer patients with healed ulcers. One-quarter of the duodenal ulcer patients who start eradication therapy continue to be symptomatic or fail therapy for other reasons over a 2-year period. Eradication therapy does not increase the risk of reflux in ulcer patients.

Amoxicillin↗
PubMed1999

[Diagnosis and treatment of postoperative nerve damage. Chronic neuropathic pain].

Neuropathic pain is caused by lesions in the peripheral and/or central nervous system. Patients with pain due to nerve damage after operations are often misinterpreted and met with suspicion of malingering. Neuropathic pain typically presents with a characteristic set of sensory disorders independent of the cause. The sensory dysfunction may manifest itself as hypo- and/or hyperesthesia to one or more modalities, increased pain to painful stimuli (hyperalgesia) and/or pain to non-painful stimuli (allodynia). Conventional analgesics such as acetaminophen, non-steroidal anti-inflammatory drugs and opioids are often ineffective. Instead, antidepressants and anticonvulsants may be tried. The pain condition is unknown to most physicians. This may result in mistreated patients having undergone several unnecessary and ineffective investigations and treatments.

Aged↗
PubMed1999

Opioid rotation in chronic non-malignant pain patients. A retrospective study.

BACKGROUND: The clinical advantage of opioid rotation is probably due to incomplete cross-tolerance favouring analgesia more than adverse effects. The objectives of opioid rotation in chronic non-malignant patients are 1): rotation between different long-acting opioids (LAO) to improve analgesia and reduce side-effects, and 2): rotation from short-acting opioids (SAO) to LAO to establish stable analgesia in order to minimise withdrawal symptoms, risk of tolerance and addiction. METHODS: A retrospective analysis of 37 rotations between different LAO and 59 rotations from SAO to LAO. RESULTS: The main reason for opioid rotation was insufficient pain relief. Opioid rotations resulted in significantly better pain control in 59% (CI95=49-76%) of the patients rotated between different LAO and 73% (CI95=60-84%) of the patients rotated from SAO to LAO. During rotations symptoms of withdrawal and overdosing were relatively frequent in both groups. No significant dose changes were seen when rotating between different LAO. However, the consequence of rotation from SAO to LAO was a 74% increase in the opioid dose (CI95=30-117%). CONCLUSION: Opioid rotations between different LAO resulted in better pain control and fewer side-effects at dose levels predicted to be equianalgesic. The majority of the patients rotated from SAO to LAO obtained improved analgesia, but the cost was a 74% increase in the opioid dose.

Adult↗
PubMed1998

[Pain epidemiology and health-related quality of life in patients with chronic non-malignant pain].

This paper presents the results of a detailed study of the pain epidemiology and health related quality of life (HRQL) in 150 chronic non-malignant pain patients referred to a Danish multidisciplinary pain centre. Mean pain intensity was 71.6 (SD 18.5) on the VAS scale. HRQL was evaluated using the questionnaires: SF-36, HAD and PGWB. Compared with the normal population (NP) both physical, psychological and social well-being was severely reduced, and 58% were found to have a depressive or anxiety disorder. Sixty-three percent of the patients had neurogenic pain conditions. Of these, only 25% were treated with antidepressants or anticonvulsants. At referral 73% were treated with opioids. Mean opioid consumption was 64 mg of morphine per day. Patients had used the health care system five times more often than the NP (p < 0.001). The study showed that HRQL of chronic non-malignant pain patients is among the lowest observed for any medical condition.

Adult↗
PubMed1998

[Neurosurgical treatment of trigeminal neuralgia. A comparative study of alcohol block, neurectomy and electrocoagulation].

The objective was to assess the present condition of patients previously treated with neurosurgical procedures for trigeminal neuralgia (TN). Between 1976 and 1991, 383 patients were treated for TN at the Department of Neurosurgery, Hvidovre Hospital. The latest surgical intervention performed was radiofrequency coagulation (64%), neurectomy (18%), alcohol block (16%), trigeminal tractotomy (1%), and microvascular decompression (1%). Questionnaires were sent to 316 patients treated neurosurgically for trigeminal neuralgia during the 16 year period. After radiofrequency coagulation, neurectomy and alcohol block, 83, 51 and 42% respectively experienced a pain free postoperative period. At present 49, 17 and 18% were without pain and 33, 21 and 36% had less pain compared with the preoperative state. Sequelae were described in 65, 57 and 49% of the patients. The four most common sequelae were hypaesthesia, paraesthesia, eye complaints, and dysaesthesia. If relevant pharmacotherapy has been tried without benefit, radiofrequency coagulation may still be considered as a treatment of trigeminal neuralgia.

Adult↗
PubMed1998

Chronic neuropathic symptoms after exposure to mustard gas: a long-term investigation.

BACKGROUND: Long-term investigations of persons exposed to mustard gas are few and have primarily focused on its carcinogenic properties. To our knowledge neuropathic pain has never been described. OBJECTIVE: We investigated late symptoms in the skin after exposure to sulfur mustard. METHODS: Five patients exposed to mustard gas during battlefield operations in the Middle East and five fishermen accidentally exposed to sulfur mustard by pulling shells leaking the chemical agent aboard their fishing vessels participated in this study. Clinical examination of the patients from the Middle East and telephone interviews with the fishermen were performed. RESULTS: All patients suffered from neuropathic pain or other deafferentation symptoms. CONCLUSION: Persistent damage to the afferent nerve system resulting in chronic neuropathic symptoms is probably a frequent complication in persons exposed to mustard gas.

Accidents, Occupational↗
PubMed1998

P-glycoprotein expression in Ehrlich ascites tumour cells after in vitro and in vivo selection with daunorubicin.

Fluctuation analysis experiments were performed to assess whether selection or induction determines expression of P-glycoprotein and resistance in the murine Ehrlich ascites tumour cell line (EHR2) after exposure to daunorubicin. Thirteen expanded populations of EHR2 cells were exposed to daunorubicin 7.5 x 10(-9) M or 10(-8) M for 2 weeks. Surviving clones were scored and propagated. Only clones exposed to daunorubicin 7.5 x 10(-9) M could be expanded for investigation. Drug resistance was assessed by the tetrazolium dye (MTT) cytotoxicity assay. Western blot was used for determination of P-glycoprotein. Compared with EHR2, the variant cells were 2.5- to 5.2-fold resistant to daunorubicin (mean 3.6-fold). P-glycoprotein was significantly increased in 11 of 25 clones (44%). Analysis of variance supported the hypothesis that spontaneous mutations conferred drug resistance in EHR2 cells exposed to daunorubicin 7.5 x 10(-9) M. At this level (5 log cell killing) of drug exposure, the mutation rate was estimated at 4.1 x 10(-6) per cell generation. In contrast, induction seemed to determine resistance in EHR2 cells in vitro exposed to daunorubicin 10(-8) M. The revertant EHR2/0.8/R was treated in vivo with daunorubicin for 24 h. After treatment, P-glycoprotein increased in EHR2/0.8/R (sevenfold) and the cell line developed resistance to daunorubicin (12-fold), suggesting that in EHR2/0.8/R the mdr1 gene was activated by induction. In conclusion, our study demonstrates that P-glycoprotein expression and daunorubicin resistance are primarily acquired by selection of spontaneously arising mutants. However, under certain conditions the mdr1 gene may be activated by induction.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1997

[Neurogenic pain following Palestinian hanging].

The number of refugees around the world who have fled political or ethnic persecution has increased. An increasing proportion of these refugees are survivors of torture. Many of these suffer physical as well as psychological sequelae to torture. In trying to evaluate the torture claims of the refugees, it is important for the physician to learn about types of torture and to look for symptoms. After positional torture, in which the victims are suspended by their wrists which are tied behind their back (Palestinian hanging), severe lasting nerve, ligament, or tendon damage is seen. In this paper we present two cases of brachial plexus injury. Only sensory nerves were affected causing a neurogenic pain condition including dysaesthesia and neuralgia.

Adult↗
PubMed1997

Effects of maternal ethanol consumption and buspirone treatment on dopamine and norepinephrine reuptake sites and D1 receptors in offspring.

Previously, it was shown that in utero ethanol exposure results in decreased serotonin (5-HT) and altered concentrations of 5-HT reuptake sites and 5-HT1A receptors in fetal and/or postnatal rats. Because fetal 5-HT is an essential trophic factor, this laboratory previously investigated the hypotheses that the early ethanol-associated 5-HT deficit contributed to subsequent development abnormalities in the serotonergic system and that the effects of the fetal 5-HT deficit could be prevented by maternal treatment with buspirone, a 5-HT1A receptor agonist. The present report determined the effects of maternal treatment with buspirone on two other neurotransmitter systems in the developing offspring of ethanol-fed dams: dopamine (DA) and norepinephrine reuptake sites and D1 receptors in postnatal day 19 offspring of control and ethanol-fed dams, that received daily injections of saline or 4.5 mg/kg buspirone. These investigations found that in utero ethanol exposure significantly decreased norepinephrine reuptake sites in the dorsomedial hypothalamic nucleus and anteroventral thalamic nucleus. There was also an ethanol effect in the dorsal raphe. D1 receptors were moderately increased (5-10% increase) in the striatum, and DA reuptake sites were unchanged in PN19 ethanol-exposed offspring. No other significant ethanol-related effects were noted. Maternal buspirone treatment did not adversely affect the concentration of DA reuptake sites or D1 receptors in control rats. Thus, whereas buspirone exerts protective effects on the developing 5-HT system of ethanol-exposed rats, it does not appear to damage the development of the DA system. Maternal buspirone produced only one significant abnormality in control offspring; it resulted in significant reduction of norepinephrine reuptake sites in the DR.

Animals↗
PubMed1996

Involvement of interleukin-4 and -10 in inflammatory bowel disease.

The pathogenesis of ulcerative colitis (UC) and Crohn's disease (CD) may be associated with a decreased production of cytokines suppressing macrophage and T-cell functions: interleukins (IL) -4 and IL-10. Serum concentrations of IL-4 and IL-10 were measured using an ELISA technique, and intestinal IL-4 and IL-10 mRNA was detected by a reverse transcriptase polymerase chain reaction (RT-PCR) in 34 patients with inflammatory bowel disease (IBD) (20 with UC and 14 with CD) and compared to 12 control subjects. The superoxide production was measured spectrophotometrically in activated PMNs initially incubated in the presence of IL-4 or IL-10. No differences were found in numbers of cells that might be potential IL-4 or IL-10 producers (T cells, macrophages, B cells, and mast cells) in biopsy specimens using immuno- and histochemistry. IL-4 mRNA was detectable in specimens from 77.8% of the UC patients (P > 0.05) and 0% of the CD patients (P < 0.05), as compared to 81.8 in controls, and was significantly different (P < 0.0001) between UC and CD patients. The IL-10 amplification product was detectable in specimens from 30.0% UC patients (P < 0.003), but not in CD patients (78.6%, P > 0.05) as compared to controls (91.7%). The circulating protein levels of IL-4 were below the detection limit in all groups (detection limit 4 pg/ml), while the median IL-10 concentration was 12.5 pg/ml in UC, 18.1 pg/ml in CD, and 19.5 pg/ml among controls (detection limit 3 pg/ml), which did not differ in any of the three groups (P > 0.05). Finally, the superoxide production was inhibited and delayed by the addition of IL-10 (P < 0.01), whereas IL-4 only delayed this parameter. In conclusion, apart from the well-known suppressive effect on proinflammatory cytokine production, IL-4 delays and IL-10 inhibits superoxide generation. IL-4 mRNA expression is decreased in intestinal tissue from CD patients, while IL-10 mRNA expression is decreased in majority of UC patients, suggesting different immunopathogenesis of the two diseases.

Adult↗
PubMed1996

Neurosurgery for trigeminal neuralgia: comparison of alcohol block, neurectomy, and radiofrequency coagulation.

OBJECTIVES: We wished to assess the present condition of patients previously treated with a neurosurgical procedure or procedures for trigeminal neuralgia (TN) in 383 patients treated between 1976 and 1991, for TN at the Department of Neurosurgery, Hvidovre Hospital. Of these, 67 were lost to follow-up. The latest surgical intervention performed was radiofrequency coagulation (RFC) (64%), neurectomy (18%), alcohol block (16%), trigeminal tractotomy (1%), and microvascular decompression (1%); 72% of patients underwent only one neurosurgical procedure. METHODS: Questionnaires were sent to 316 patients treated neurosurgically for TN during the 16-year period; 288 (91%) patients responded. The follow-up period varied from 1 to 16 years (mean 8 years). Outcome measures were effect of RFC, neurectomy, and alcohol block; present pain conditions; and sequelae. RESULTS: After RFC, neurectomy, and alcohol block, 83, 51, and 42% of patients, respectively, experienced a pain-free postoperative period; 49, 78, and 84% of these patients had recurrence of pain. At present, 49, 17, and 18% are pain-free and 33, 21, and 36% now have less pain than they did preoperatively. Temporary or permanent analgesics for facial pain were required in 41, 72, and 69% of the patients. Sequelae were described by 65, 57, and 49% of the patients. The four most common sequelae were hypoesthesia, paresthesia, eye complaints, and dysesthesia. CONCLUSION: If relevant pharmacotherapy has been tried without benefit, RFC may still be considered as a treatment for TN.

Adult↗