Biomedical subjects
Publications and source records attributed to K Jensen.
Amyloid tumors of the gastrointestinal tract are exceedingly rare. Two cases are presented, one in the stomach of a patient who appeared to have systemic amyloidosis and one in the colon which appears to be isolated. The treatment was surgical excision. Extensive diagnostic work-up is required to evaluate the many various possible causes of amyloidosis.
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Eighty cases of Potter sequence due to a renal or urologic abnormality were studied retrospectively. The abnormal renal findings were bilateral renal agenesis in 21.25%; cystic dysplasia in 47.5%; obstructive uropathy in 25%; and others in 5.25%. Fifteen patients had multiple congenital anomalies; of these three had aneuploidy, four had autosomal recessive syndromes, and eight were of unknown cause. Results of chromosome analysis in 41 patients and 21 sets of parents were abnormal in three patients, one of whom had a balanced translocation carrier parent; two additional patients and three parents had apparently balanced translocations. There was one recurrence within the study (the first child had bilateral renal agenesis and the second cystic dysplasia). The ultrasound prenatal diagnosis of the renal abnormality was made in eight cases between 18 and 34 weeks. Family histories were suggestive of an autosomal dominant gene disorder with incomplete penetrance in four of 45 families with nonsyndromic bilateral renal agenesis and cystic dysplasia. The evaluation of patients with the Potter sequence should include an examination for nonrenal defects, autopsy, chromosome analysis, and renal ultrasound or urologic evaluation of parents. Ultrasonographic prenatal monitoring of subsequent pregnancies in such families is strongly warranted because of a definite but unknown degree of recurrence risk.
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The peripheral sympathetic vasomotor nerve function was investigated in 18 male chronic alcoholics admitted for intellectual impairment or polyneuropathy. By means of the local 133Xenon washout technique, the sympathetic veno-arteriolar axon-reflex was studied. This normally is responsible for a 50% decrease in tissue blood flow, when the ankle is lowered 40 cm below heart level in the supine individual. The patients with moderate to severe polyneuropathy, taken as a group, did not differ significantly from the group of patients with no or only mild polyneuropathy, although a lesser response was seen (18% and 48% decrease respectively). However, in three patients with moderate neuropathy, and in one patient with no signs of neuropathy, this veno-arteriolar reflex was absent, indicating dysfunction of the peripheral sympathetic adrenergic nerve fibres. The three patients also showed a lesser degree of arteriolar constriction during 45 degrees passive head-up tilt, although none developed symptoms of orthostatic hypotension. Anhidrosis of the feet was found in only three patients. This study lends support to the view that individual differences in the susceptibility to the deleterious effect of alcohol comprise not only the peripheral sensory and motor nerve fibres, but also the thin pseudomotor and vasomotor nerves.
The influence of human plasma, serum, purified fibrinogen, and fibronectin on Staphylococcus aureus intraperitoneal infection in non-immune mice was studied. Mouse mortality was used as a measure of staphylococcal virulence. Both human plasma and serum were shown to enhance the virulence of S.aureus strain E 2371 and strain E 2476 when added to the bacteria before challenge. This effect of serum was unaffected by storage for 24 h at 37 degrees C or complement-inactivation for 1 h at 56 degrees C. Purified fibrinogen and fibronectin did not influence the S. aureus virulence. It is suggested that the effects of plasma and serum described here might play a role in the establishment of S.aureus infections in humans.
Human serum and plasma have been demonstrated to enhance mortality in Staphylococcus aureus intraperitoneal infection in mice. Two different mechanisms seem to be involved. The effect of serum could be removed by adsorption to S. aureus protein A coupled to Sepharose 4 B and could be reconstituted by the addition of human IgG to IgG-depleted serum. Plasma diluted 1/10 in combination with purified fibrinogen also enhanced mouse mortality. Both effects could be demonstrated, when a coagulase-free variant of S. aureus was used. The results of viable counts of S. aureus in blood and peritoneum of the mice indicate that the enhancing effect of IgG alone and the enhancing effect of fibrinogen in combination with diluted plasma have different mechanisms.
In 50 consecutive patients with Graves' disease treated with PTU, 7 (group 1) developed increasing goitre in spite of unmeasurable TSH. Thyroid variables were compared with those from 10 controls with an ordinary response to PTU (group 2). Serum T4 decreased in group 1 from 246 +/- 47 nmol/l (mean +/- SD) to 40 +/- 9 nmol/l after 6 weeks of PTU treatment and continued to be below the normal range during the next 4 months. In group 2 serum T4 decreased from 190 +/- 35 to 88 +/- 47 nmol/l and stayed in the normal range. Serum T3 was normalized in both groups after 6 weeks but increased to values above the normal range in group 1 after that time. In spite of unmeasurable TSH during the 6 months of treatment in group 1, thyroid volume, determined ultrasonically, increased significantly from 60 +/- 29 to 93 +/- 68 ml (P less than 0.05), but was unaltered in group 2 about 25 ml. Thyroid stimulating antibodies (TSAb) measured by adenylate cyclase activation (normal below 109%) decreased in group 2 from 117 +/- 23 to 90 +/- 17% (P less than 0.01) (6 months of therapy), but increased significantly in group 1, from 201 +/- 47% to a maximum value of 234 +/- 69% (P less than 0.05). TSH binding inhibitory immunoglobulins (TBII) (given as per cent inhibition, normal below 26%) decreased in group 2 from 43 +/- 29 to 29 +/- 27% (P less than 0.05) but were unaltered high in group 1, 66 +/- 25% before therapy and 57 +/- 26% after 6 months of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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The influence of propranolol on blood flow in peripheral tissues was studied in 10 normotensive subjects. Adequacy of beta-blockade was ascertained by an ergometric test. Perfusion of the subcutaneous tissue and skeletal muscle was measured by the local 133Xe-washout technique. The arteriolar dilatation underlying the autoregulatory response to a decrease in arterial perfusion pressurehead was not affected by beta-blockade. Propranolol did not change the magnitude of arteriolar constriction elicited by the local sympathetic veno-arteriolar reflex. Thus, the locally induced increase in the discharge rate along the peripheral sympathetic adrenergic fibres did not lead to measurable change in beta-receptor activity. The present results indicate that local bloodflow regulatory mechanisms are not affected by propranolol. They also indicate that the direct peripheral effects of propranolol are of no clinical importance in normotensive subjects in the supine position, when the general activity in the sympathetic nervous system is low.
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Four previously healthy Danish homosexual men developed Kaposi's sarcoma or opportunistic infections with fever of unknown origin and lymphadenopathy. One patient died of a Pneumocystis carinii pneumonia. Three patients had defective cell-mediated immunity with absent leucocyte interferon production and decreased proliferative response to mitogens and antigens. T lymphocyte helper subsets and natural killer cell activity were reduced. Unstimulated mononuclear cells produced leucocyte migration inhibitor factor. Two patients were sexual partners and three had never been to the USA, where cases of severe acquired immunodeficiency have been reported. Thus, the syndrome must also be suspected in European homosexual men who present with fever of unknown origin, opportunistic infections, or Kaposi's sarcoma.
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During the past year five patients from countries in the Middle East admitted to a burns unit were found to harbour a strain of Staphylococcus aureus with unusual multi-resistance to antibiotics. The admission of the first patient was followed by an outbreak of infection with this strain involving ten patients in the unit. In addition five staff members were found to be nasal carriers of the strain. As a result of this incident, the following four patients admitted to the unit were isolated on admission and the spread of their strans was thus prevented. It is recommended that patients on admission to burns units, or similar departments with patients very susceptible to infection, are isolated until their bacterial floras have been examined.
1. The effect of head-up tilt upon subcutaneous blood flow in the distal arm and leg was studied in 12 patients with complete traumatic spinal cord transection at the cervical level. 2. Blood flow was measured by the local 133Xe washout technique. 3. Leg lowering induced a 47% decrease in blood flow in the distal leg. During head-up tilt (45 degrees) blood flow in the leg decreased by 48%. In the arm remaining at heart level blood flow decreased by 37% during tilt and this vasoconstriction could be prevented by nervous blockade with lignocaine injected subcutaneously 5 cm proximally to the labelled area. Leg blood flow was unaltered by proximal blockade but could be blocked by local infiltration in the labelled area with lignocaine in low doses. 4. Head-up tilt of tetraplegic patients induced vasoconstriction in the subcutaneous tissue of the forearm, which could be prevented by proximal blockade. Thus the vasoconstriction could be due to a spinal sympathetic reflex mechanism. This as well as local mechanisms including the venoarteriolar reflex may play a role in recovery of arterial blood pressure during head-up tilt in the tetraplegic patient.
One hundred and fifty patients treated for an acute migraine attack all received a standard regimen consisting of metoclopramide 10 mg i.m. and--20 min later--paracetamol 1 g orally. Simultaneous trial medication was given. This consisted of placebo, diazepam 5 mg as tablets, or chlormezanone 400 mg as capsules given in a double dummy fashion. A successful treatment result was defined as a decrease of two or three steps on a four-point verbal pain report scale, and no need for further treatment. Patients with severe pain (all three treatment groups together) showed significantly better treatment results (p less than 0.001) than patients with pain of medium severity. In the group with severe pain there was no significant difference between diazepam, chlormezanone or placebo. In the group with pain of medium severity there was a significant (p less than 0.01) effect of chlormezanone, but no significant effect of diazepam. Chlormezanone may possibly be a valuable addition to antiemetic and analgesic therapy of migraine attacks.