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K L Schmidt

Publications and source records attributed to K L Schmidt.

At least 19 recordsLinked to original sources
PubMed2005

Association of 1.25 vitamin D3 deficiency, disease activity and low bone mass in ankylosing spondylitis.

Vertebral fractures due to osteoporosis are a common but frequently unrecognized complication in established ankylosing spondylitis (AS). It is known that inflammatory activity in rheumatic diseases (i.e., proinflammatory cytokines) itself plays a possible role in the pathophysiology of bone loss. The aim of this study was to analyze whether inflammatory activity and an alteration of the vitamin D metabolism play a substantial role in the loss of bone mass in AS. In this cross-sectional study, 58 patients with established AS and an age- and sex-matched control group were examined. The vitamin D status was investigated, as was, in parallel, the relationship to disease activity (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), markers of bone metabolism (parathyroid hormone [PTH], 1.25 vitamin D3, 25 vitamin D3), calcium, bone alkaline phosphatase (bone-AP), urine cross-links, and plasma tumor necrosis factor alpha (TNFalpha). Bone mineral density was measured by quantitative computed tomography (QCT) of the lumbar spine. Osteoporosis was diagnosed in early as well as in progressive stages of AS (23/58=39.6%). Furthermore, serum levels of 1.25 vitamin D3 and PTH were negatively correlated with disease activity and TNFalpha. The excretion of cross-links showed a positive correlation with disease activity and TNFalpha, and 1.25 vitamin D3 and PTH were positively correlated with bone-AP. TNFalpha also positively correlated with disease activity. AS patients with osteoporosis showed significantly increased CRP, ESR, cross-links and PTH and a significantly decreased 1.25 D3. Osteoporosis is frequent in AS and high disease activity is associated with an alteration in vitamin D metabolites and increased levels of bone resorption in active AS. Our findings propose a close association of BMD, bone metabolism and inflammatory activity, possibly related to vitamin D inflammation interactions.

Adolescent↗
PubMed2005

Balneotherapy in rheumatic diseases--an overview of novel and known aspects.

Balneotherapeutic applications to treat rheumatic diseases have a long-term tradition and are based on established scientific principles, and the majority of rheumatic diseases most frequently include balneotherapy. However, as other therapeutic strategies, balneological interventions require scientific proof of their effect and efficacy. Notably, recent studies providing evidence of the thermic and chemical effects on the immune system and cytokine milieu have enforced the revival of the traditional balneological interventions. This review provides an overview of the known as well as the novel aspects of balneotherapy and their clinical relevance in the treatment of rheumatic diseases.

Balneology↗
PubMed2004

A new approach to studying angiogenesis in rheumatoid arthritis by means of power Doppler ultrasonography and measurement of serum vascular endothelial growth factor.

OBJECTIVE: To evaluate angiogenesis as an essential component of pannus formation and cartilage destruction in rheumatoid arthritis (RA) using power Doppler ultrasonography (PDUS) and serum vascular endothelial growth factor (VEGF) measurement. METHODS: Twenty-one RA patients with a painful and swollen wrist and 12 healthy controls were examined with ultrasound. By means of standard scans, vascularity near and inside the joint capsule was visualized with PDUS. Two trained investigators performed sonography. Representative video clips were stored and read by two independent investigators, under blinded conditions, with regard to the microvascular Doppler flow being either inside or outside the joint capsule and with respect to a qualitative estimate of the intensity of blood flow, according to a grading from 1 to 3. Serum levels of VEGF were measured with a standard quantitative sandwich ELISA. RESULTS: The power Doppler mode identified increased synovial microvascular blood flow inside the joint capsule in 17 of 21 RA patients (81%) vs one of the healthy controls. We found large variation in serum VEGF levels in RA patients and in healthy controls. The degree of synovial vascularity determined by PDUS showed no correlation with the immediate serum VEGF level in the same patient. CONCLUSION: The high correlation between intra-articular microvascular power Doppler flow and clinical synovitis in RA patients (P<0.0001) indicates that PDUS may be helpful in studying the role of synovial blood vessels in rheumatoid inflammation.

Adult↗
PubMed2004

Neutrophil CD177 (NB1 gp, HNA-2a) expression is increased in severe bacterial infections and polycythaemia vera.

The NB1 glycoprotein (CD177, HNA-2a antigen) is exclusively expressed on human neutrophils. As the clinical significance of CD177 expression is unknown, we investigated its expression in healthy individuals before and after stimulation with granulocyte colony-stimulating factor (G-CSF), in patients with rheumatoid arthritis, viral hepatitis, severe bacterial infections and polycythaemia vera. Expression was quantitatively determined by flow cytometry and by real time polymerase chain reaction. Only G-CSF-stimulated individuals and patients with severe bacterial infections and polycythaemia showed a significantly (P < 0.001) increased CD177 expression compared with healthy individuals, indicating that neutrophil CD177 expression can increase significantly in certain clinical conditions.

Adult↗
PubMed2003

[Cervical myelopathy induced by calcium pyrophosphate tophus in primary chondrocalcinosis].

A 78 year old female patient with cervical myelopathy induced by a calcium pyrophosphate dihydrate tophus around the dens axis with clinical signs of a cervical tumor is presented. After operation of the tumor, the diagnosis of a generalized CPPD disease was established retrospectively, where by patient had complained of joint pain already for many years. This known complication of a primary chondrocalcinosis should be a reason for a careful investigation of the cervical spine in CPPD disease, because neurological disturbances might increase the joint destruction in the manner of "Charcot joints".

Aged↗
PubMed2001

Current aspects of colchicine therapy -- classical indications and new therapeutic uses.

Colchicine has been traditionally used for the treatment of gout. At present there is no generally accepted alternative to colchicine for the treatment of acute attacks or for the prevention of further attacks. The complex actions of this substance, which are mainly attributable to its stabilising action on the cytoskeleton and cell membranes, and its special pattern of distribution form the basis for the results presented here regarding the prophylactic or therapeutic actions of colchicine in a whole range of other diseases. This is all the more significant in that in several instances it concerns diseases that have so far been unsatisfactorily controlled by other treatments. Because of its astonishing absence of side effects, some authors consider that low dose colchicine may be considered as an alternative to previous therapies or even a means of first choice. It is therefore incorrect to think that medical research has shown little interest in this long-known potential and has not sought to confirm promising options by means of controlled studies. Fibrotic and inflammatory systemic diseases and those in which leucocytic chemotaxis play a role seem to be particularly predestined for this.

Adult↗
PubMed2001

[Legal abortion. An analysis of factors which can affect frequency of complications].

INTRODUCTION: Due to a rather high complication rate, we decided to analyze data from women, who were readmitted to hospital with complications to legal abortion. MATERIAL: 760 legal abortions performed in 1993-1994 were retrospectively reviewed for complications. RESULTS: We found 66 complications (8.7% (95% confidence limits (6.7-10.7)), that resulted in readmission to hospital. The distribution of complications was as follows: retention 41 (62% (50-74)), infection 12 (18% (9-27)), bleeding and pain 11 (17% (8-26)) and perforation two (3% (0-7)). There was a slight correlation between a stronger midline echo on ultrasound measurement of the uterine cavity and finding placental tissue on histological examination of the material obtained from reevacuation. The time interval between legal abortion and reevacuation was nine days. Retroflexio uteri was not correlated with reevacuation. CONCLUSIONS: We found a statistically increased risk of complications following legal abortion relative to the figures reported by the national health authority, but not significantly higher than that found in other reports. Moreover, a conservative attitude to retention can reduce the number of reevacuatio uteri after legal abortion.

Abortion, Induced↗
PubMed2001

[Surgeons' experience of complication frequency--registration validity for legal abortion].

INTRODUCTION: The aim was to investigate the degree to which experience influenced the complication rate (cr) in legal abortion. We also compared our cr with that registered by the National Health Service for the same group of patients. MATERIAL: 760 legal abortions from 1993 to 1994 were reviewed retrospectively. RESULTS: We found an overall cr of 8.7% (95% confidence limit: 6.7-10.7). The cr was the same for all groups of doctors, from the youngest to the most senior and experienced surgeons. The experience in months of the younger surgeons was noted for each intervention, and we found that they did not improve their results over time or by practice. In the same study, we found that the National Health Service had received, registered, and published statistical data from the hospitals, which were not entirely accurate. CONCLUSION: The complication rate was not associated with the experience of the surgeon.

Abortion, Induced↗
PubMed2001

Human facial expressions as adaptations: Evolutionary questions in facial expression research.

The importance of the face in social interaction and social intelligence is widely recognized in anthropology. Yet the adaptive functions of human facial expression remain largely unknown. An evolutionary model of human facial expression as behavioral adaptation can be constructed, given the current knowledge of the phenotypic variation, ecological contexts, and fitness consequences of facial behavior. Studies of facial expression are available, but results are not typically framed in an evolutionary perspective. This review identifies the relevant physical phenomena of facial expression and integrates the study of this behavior with the anthropological study of communication and sociality in general. Anthropological issues with relevance to the evolutionary study of facial expression include: facial expressions as coordinated, stereotyped behavioral phenotypes, the unique contexts and functions of different facial expressions, the relationship of facial expression to speech, the value of facial expressions as signals, and the relationship of facial expression to social intelligence in humans and in nonhuman primates. Human smiling is used as an example of adaptation, and testable hypotheses concerning the human smile, as well as other expressions, are proposed.

Adaptation, Biological↗
PubMed2001

Progesterone supplementation during early gestation after in vitro fertilization has no effect on the delivery rate.

OBJECTIVE: To compare the delivery rate with IVF or ICSI in women who did and did not receive progesterone supplementation in the first 3 weeks after a positive hCG test result. DESIGN: Retrospective study. SETTING: Fertility Clinic, Rigshospitalet University Hospital, Copenhagen, Denmark. PATIENT(S): 200 pregnant women who did not receive progesterone (intervention group) and 200 pregnant women who received progesterone for 3 weeks after a positive hCG result. INTERVENTION(S): In the study group, vaginal progesterone therapy was withdrawn on the day of positive hCG result. In the control group, treatment with progesterone, 600 mg/d, was continued for 3 weeks after a positive hCG result. Both groups received 600 mg of progesterone starting on the day of embryo replacement until testing positive for pregnancy 14 days after embryo transfer. MAIN OUTCOME MEASURES: Delivery rate. RESULT(S): The number of deliveries was 126 in the study group and 128 in the control group. CONCLUSION(S): The delivery rate was the same in pregnant women who received and those who did not receive progesterone for 3 weeks after a positive hCG result. Progesterone supplementation for more than 2 weeks after embryo transfer may therefore yield no benefit in terms of pregnancy.

Adult↗
PubMed2001

A nonischemic electrocardiogram does not always predict a small myocardial infarction: results with acute myocardial perfusion imaging.

BACKGROUND: A nonischemic electrocardiogram (ECG) in association with myocardial infarction (MI) indicates a small MI in some but not all cases. Myocardial perfusion imaging using technetium-99m sestamibi offers the ability to better characterize these "electrically silent" infarctions. METHODS: Patients considered low risk for myocardial infarction with a normal or nonischemic ECG (no significant ST elevation, ST depression, ischemic T-wave inversion, or left bundle branch block) underwent early emergency department perfusion imaging, followed by serial myocardial marker sampling. Risk area (defect size) was quantitated by use of a 50% threshold from multiple short-axis slices. RESULTS: A total of 87 patients with nonischemic ECGs had myocardial infarction (mean peak creatine kinase [CK] 710 +/- 720 U/L, range 111-3196 U/L). Peak CKs were lower in the 7 patients with negative perfusion imaging (420 +/- 290 U/L vs 730 +/- 740 U/L, P =.06). Mean risk area was 18% +/- 11% of the left ventricle (range 0%-62%) and was not significantly different among the different infarct-related arteries. Patients with normal ECGs had a similar risk area compared with other patients (16% +/- 12% vs 19 +/- 12%, P =.25). Coronary angiography was performed in 81 patients, with significant stenoses in 74 (91%) (37 one-vessel, 19 two-vessel, 18 three-vessel), with the infarct related artery most commonly the left circumflex (n = 32 [38%]). CONCLUSIONS: The ischemic risk area in patients with a nonischemic ECG was comparable to patients with inferior ST-elevation myocardial infarction found in previous studies. A nonischemic ECG does not predict a small ischemic risk area.

Coronary Angiography↗
PubMed2000

[Refugee and immigrant children referred to a department of pediatric psychiatry during the years 1991-1994].

The purpose of this study was to describe a group of 42 refugee- and immigrant children up to 14 years old compared to Danish controls in order to identify groups at risk and describe course, examination, treatment and contact. The investigation was based on case records. The only statistically significant results were higher frequencies of referral than expected regarding children from Lebanon and Somalia. However, the data indicate differences between the foreign and Danish groups as to greater problems of speech and language and less behavioural and emotional problems among the foreigners. No foreign children were offered foster homes. The attitudes of the parents towards referral, examination and treatment are more negative in the foreign group. The need for more research is emphasized.

Adolescent↗
PubMed2000

[A high rheumatoid factor titer caused by vaccination?].

A forty year old healthy adult man was admitted to our outpatient department because of a highly elevated rheumatoid factor. Since the person was planning an extended stay in Africa, we performed an extensive history, clinical and laboratory examination to rule out oligosymptomatic inflammatory diseases. We further analyzed if the person presented genetic risk factors to develop rheumatic diseases in the future or if the presence of the rheumatoid factor could be a reaction to multiple immunizations. Possible explanations for an elevated rheumatoid factor including the genetic risk factors are discussed.

Adult↗
PubMed2000

Cross-cultural analysis of eventfulness in the lives of people with schizophrenia.

Eventfulness as a strategy for creating a meaningful life is an important component of the attempts of people with schizophrenia to present a positive self-image. This study of patients with schizophrenia shows that the phenomenon of creating eventfulness through normalcy accounts is relevant cross-culturally, with common themes occurring in the speech of participants from Papua New Guinea and New Zealand. Both patient (n = 23) and nonpatient (n = 27) participants from these two countries were interviewed as part of a larger research project. Conversational speech of participants was analyzed for passages that could be defined as normalcy accounts. A total of 61 such accounts were obtained from the conversational samples. The three most common themes of normalcy accounts (educational achievement and goals, national pride, and travel) were characteristic of the self-presentation of nonpatient subjects as well as patients with schizophrenia. Normalcy themes varied slightly depending on nationality and patient or nonpatient status. The similarity of both normalcy account themes and presentation, however, was remarkably consistent across cultures.

Adult↗
PubMed1999

Comparison of myocardial perfusion imaging and cardiac troponin I in patients admitted to the emergency department with chest pain.

BACKGROUND: Identification of patients with acute coronary syndromes (ACS) among those who present to emergency departments with possible myocardial ischemia is difficult. Myocardial perfusion imaging with 99mTc sestamibi and measurement of serum cardiac troponin I (cTnI) both can identify patients with ACS. METHODS AND RESULTS: Patients considered at low to moderate risk for ACS underwent gated single-photon emission CT sestamibi imaging and serial myocardial marker measurements of creatine kinase-MB, total creatine kinase activity, and cTnI over 8 hours. Positive perfusion imaging was defined as a perfusion defect with associated abnormalities in wall motion or thickening. cTnI >/=2.0 ng/mL was considered abnormal. Among the 620 patients studied, 59 (9%) had myocardial infarction and 81 (13%) had significant coronary disease; of these patients, 58 underwent revascularization. Perfusion imaging was positive in 241 patients (39%), initial cTnI was positive in 37 (6%), and cTnI was >/=2.0 ng/mL in 74 (12%). Sensitivity for detecting myocardial infarction was not significantly different between perfusion imaging (92%) and cTnI (90%), and both were significantly higher than the initial cTnI (39%). Sensitivity for predicting revascularization or significant coronary disease was significantly higher for perfusion imaging than for serial cTnI, although specificity for all end points was significantly lower. Lowering the cutoff value of cTnI to 1.0 ng/mL did not significantly change the results. CONCLUSIONS: Early perfusion imaging and serial cTnI have comparable sensitivities for identifying myocardial infarction. Perfusion imaging identified more patients who underwent revascularization or who had significant coronary disease, but it had lower specificity. The 2 tests can provide complementary information for identifying patients at risk for ACS.

Biomarkers↗
PubMed1999

Myocardial perfusion imaging with technetium-99m sestamibi in patients with cocaine-associated chest pain.

STUDY OBJECTIVE: To describe the characteristics and outcome in patients presenting to the emergency department with chest pain associated with cocaine use, the majority of whom underwent early rest perfusion imaging. METHODS: From January 1994 to June 1996, 218 patients had 241 ED visits for evaluation of symptoms consistent with myocardial ischemia after cocaine use. High-risk patients (N=25) were admitted directly to the CCU for exclusion of myocardial infarction (MI). Moderate- to low-risk patients (N=216) were promptly injected with technetium-99m sestamibi in the ED and underwent gated myocardial perfusion imaging 60 to 90 minutes later. Moderate-risk patients were observed in the CCU, whereas low-risk patients with negative perfusion imaging results were discharged home directly from the ED. RESULTS: A diagnosis of MI was made in 6 patients, 4 of whom had ECG findings consistent with MI. Of the 216 patients who underwent perfusion imaging, 5 had positive study results, including 2 with MI. None of the 38 patients with negative results after perfusion imaging who were admitted to the CCU had a diagnosis of MI. Only 6 of the 67 patients undergoing stress perfusion imaging had reversible perfusion defects. At 30-day follow-up, there were no cardiac events in patients with negative results after rest perfusion imaging. CONCLUSION: Acute MI is infrequent in patients presenting with cocaine-associated chest pain. Positive results after rest perfusion imaging are uncommon, suggesting that myocardial ischemia is infrequently the cause of cocaine-associated chest pain. Early perfusion imaging may offer an effective alternative to routine CCU admission of patients with cocaine-related cardiac symptoms.

Adult↗