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Biomedical subjects

J Kjeldsen

Publications and source records attributed to J Kjeldsen.

At least 37 records · Page 2Linked to original sources
PubMed1995

Interpretation of serial measurements of international normalized ratio for prothrombin times in monitoring oral anticoagulant therapy.

Despite careful monitoring of oral anticoagulant treatment (OAT), some international normalized ratio (INR) for prothrombin time values will fall outside the therapeutic range. Considerable changes in serial INR results from OAT patients may be caused by random fluctuation alone, and, for statistical reasons, a fraction of the INR values will fall outside therapeutic range and interfere with dose adjustments. On the basis of therapeutic intervals and statistical evaluation of reference changes, we suggest and discuss an alternative method for interpretation of serial INR measurements. Retrospective evaluation of serial measurements of INR from OAT patients revealed an "overshooting" phenomenon. When a dose was adjusted on the basis of insignificant change in INR value, the subsequent INR value generally fell in the opposite direction. If a further change of dose was initiated because of the new INR value, a similar course in the opposite direction was observed. This "ping-pong" effect renders patients in a fluctuating state of anticoagulation and may introduce increased risk of complications. The suggested method provides an objective criterion for dose adjustments in OAT, which should reduce patients' risk.

Anticoagulants↗
PubMed1993

Treatment of ulcerative colitis with high doses of oral prednisolone. The rate of remission, the need for surgery, and the effect of prolonging the treatment.

Treatment of acute attacks of ulcerative colitis in 89 patients with doses of prednisolone above or equal to 40 mg resulted in an overall remission in 67%. Remission rate and colectomy rate were 47% and 42%, respectively, when the disease was severe, 80% and 13% when moderate, and 84% and 3% when mild. The need for surgery was 28% in pancolitis, 11% in left-sided colitis, and 5% in proctitis. After subsequent treatment episodes colectomy was performed in 35% of patients with pancolitis, in 37% with left-sided colitis, and in 5% with proctitis. The median total duration of therapy in patients who went into clinical remission was 4 months, and the median dose just above 3 g prednisolone. Patients who stayed in remission during the follow-up received a significantly higher start dose and total dose of prednisolone in the treatment episode than patients who had a relapse. In 25 patients treatment with doses equal to or above 75 mg of prednisolone was continued beyond 10 days, and 11 patients experienced remission whereas 14 patients had surgery performed. Orally administered corticosteroids produce results comparable to those obtained after the previously suggested intravenous regimen.

Administration, Oral↗
PubMed1991

[Cesarean section. Changes in frequency and indications in the county of South Jutland during a 10-year period].

During recent years, the frequency of Caesarean section has changed everywhere. Changes during a ten-year period in the Department of Gynaecology in Sønderborg Hospital were registered and involve mainly the groups of imminant foetal death, previous Caesarean section, foeto-pelvic disproportion and placental insufficiency. Alterations in the obstetric services in the County of South Jutland and improved neonatal service have played an important part in development of the frequency of Caesarean section of Sønderborg Hospital.

Cesarean Section↗
PubMed1990

[Defence mechanisms of the gastroduodenal mucosa. The significance of epithelial and subepithelial factors for the development of acute and chronic ulceration].

Extra-epithelial, epithelial and sub-epithelial defence mechanisms protect the gastroduodenal mucosa against acid and pepsin. The epithelial mechanisms include epidermal growth factor, surface active phospholipids on the luminal membrane of the epithelial cells, sulfhydryl compounds and rapid epithelial restitution after damage. The sub-epithelial mechanisms include mucosal blood flow supplying the mucosa with bicarbonate needed for neutralization of the acid which penetrates the epithelium and the protective effect of the process of acid secretion. Prostaglandins, which partially protect the gastroduodenal mucosa against damaging agents, stimulate several of the abovementioned defensive factors but the precise mechanism of the action of prostaglandins is still unknown. The results of several experiments support the idea of the defensive factors being of importance in the development of acute and chronic gastroduodenal ulceration. At present, the therapeutic possibilities seem to be restricted and nothing indicates that stimulation of the defensive factors, only, is more effective in the treatment of peptic ulcer than inhibition of aggressive factors as acid and pepsin.

Duodenal Ulcer↗
PubMed1990

Duodenal disappearance rate of acid during inhibition of mucosal bicarbonate secretion.

In order to investigate the relation between duodenal mucosal and pancreaticobiliary bicarbonate secretion, we have studied the effect of inhibition of mucosal bicarbonate secretion by indomethacin on the disappearance rate of acid and the concomitant plasma secretin concentrations. 10 healthy subjects were studied twice, with and without indomethacin pretreatment. By means of a double-lumen tube the duodenum was perfused with increasing amounts of acid (0, 3.0, 6.0 and 9.5 mmol/h) and the disappearance rate of acid, pH of duodenal aspirate and plasma secretin were measured. In both experiments nearly all acid, even at the highest acid load, disappeared (pH greater than 6). Inhibition of the duodenal mucosal bicarbonate secretion did not decrease the acid-neutralizing capacity of the human duodenum. In fact, the disappearance rate of acid at the highest acid load was a little greater when mucosal bicarbonate secretion had been inhibited than when not (10.3 +/- 0.5 vs. 9.2 +/- 0.2 mmol/h). The pancreaticobiliary secretion of bicarbonate, as judged by plasma secretin concentrations, increased, however, earlier when mucosal bicarbonate secretion had been inhibited than when not (3.7 vs. 3.0 pmol/l at an acid load of 6.0 mmol/h). This indicates that bicarbonate from the duodenal mucosa normally plays a role in the in lumen neutralization of acid in the human duodenum.

Adult↗
PubMed1990

Morphine inhibits secretion of bicarbonate from the human duodenal mucosa. Possible role of endogenous opioids in the regulation of human duodenal mucosal bicarbonate secretion.

Mucus and bicarbonate secreted from the epithelium are thought to be important for the protection of the duodenal mucosa against acid and pepsin, but so far little is known about the regulation of human duodenal mucosal bicarbonate secretion. After isolating a segment of the proximal human duodenum from gastric and pancreaticobiliary secretion we quantified the secretion of bicarbonate from the human duodenal mucosa. The method was evaluated by measurements of basal and prostaglandin E1 analogue-stimulated bicarbonate secretion. The duodenal mucosal bicarbonate secretion was inhibited 70% after intravenous infusion of morphine in a dose of 73.6 micrograms/kg/h and increased after intravenous administration of naloxone. Thus, the inhibition is most likely mediated by mu-receptors, and the results suggest a role of endogenous opioids in the regulation of the secretion of bicarbonate from the human duodenal mucosa.

Adult↗
PubMed1989

[Defense mechanisms of the gastroduodenal mucosa: the role of mucus and bicarbonate in the development of peptic ulcer].

The existing knowledge of the mucus and bicarbonate production of the gastroduodenal mucosa is reviewed. Mucus and bicarbonate are produced in the surface epithelium of both duodenum and ventricle. The production is regulated by neural stimuli, gastrointestinal hormones and local synthesis of prostaglandins. Several of the factors suspected of being of importance to the development of peptic ulcers also have a negative influence on the production of mucus and bicarbonate. This indicates that mucus and bicarbonate are important in the pathogenesis of peptic ulcer. Two newly registered so-called mucosaprotective anti-ulcer drugs (De-Nol, Succralfat) both exert positive influences on the production of mucus and bicarbonate.

Bicarbonates↗
PubMed1985

Maternal-serum-alphafetoprotein screening for fetal malformations in 28 062 pregnancies. A four-year experience from a low-risk area.

From 1st March, 1980 and up to 29th February 1984 a multicenter serum alpha-fetoprotein (S-AFP) screening project was carried out for the detection of severe fetal malformations. S-AFP was determined by a radio-immunoassay in 28 062 pregnant women between the 16th and 20th week of gestation. Patients with elevated S-AFP values, e.g. above 95 percentile, were examined further with a second S-AFP and by ultrasound scan. 244 amniocenteses (0.9%) were carried out to detect 62 malformations (21 anencephalies, 14 spina bifidas, 2 encephaloceles, 7 omphaloceles, 5 gastroschises, 4 chromosome abnormalities and 9 other malformations). Fifteen of the 16 cases of spina bifida could not be verified by ultrasound scan, whereas all other malformations except chromosome abnormalities were confirmed by ultrasonography. Two cases of spina bifida and one case of skin-covered encephalocele had normal S-AFP concentrations and were therefore not detected. There were no definitive false-positives, e.g. therapeutic abortion of a normal fetus. Our conclusion is that a nationwide S-AFP screening should be recommended.

Abdominal Muscles↗