Biomedical subjects

K N Hansen

Publications and source records attributed to K N Hansen.

At least 19 recordsLinked to original sources

PubMed1995

[Subcutaneous fat necrosis with hypercalcemia].

A case of subcutaneous fat necrosis (SFN) is presented. The infant developed late onset hypercalcaemia of severe degree. Calcitonin failed to normalize the hypercalcaemia. Glucocorticoids and withdrawal of dietary calcium and vitamin D are the treatment of choice. Like hypercalcaemia in association with other granulomatous diseases, SFN is possibly secondary to locally produced 1,25-dihydroxy-cholecalciferol. Our results were not able to confirm this theory. Infants with SFN should have calcium levels monitored closely for months.

Fat Necrosis↗

PubMed1995

Determinants of emergency department procedure- and condition-specific universal (barrier) precaution requirements for optimal provider protection.

STUDY OBJECTIVE: To determine potential blood and body fluid (B/BF) contacts with specific body areas associated with procedures commonly performed in the emergency department and to thereby delineate appropriate procedure-specific precautions. DESIGN: Prospective, observational study assessing procedure-related B/BF contacts by use of stratified, blocked sampling of shifts. PARTICIPANTS: ED patients in an inner-city tertiary care university hospital. RESULTS: Of 2,529 procedures performed in 1,025 patients, 1,621 (64%) were associated with barrier-protected or unprotected B/BF contact; 92% involved blood or bloody BF. Chest tube placement, lumbar puncture, and examination of the bleeding patient all resulted in B/BF contact with the facial area. All of the 18 procedure categories observed, with the exception of i.m. injection, resulted in B/BF contact with hands. Many procedures resulted in contact with the body or feet. Procedure type, provider, length of time, number of procedures per patient, and successful completion were each independently associated with B/BF contact. Number of attempts, adverse conditions, and triage acuteness were not associated with increased likelihood of contact. CONCLUSION: Virtually all ED procedures require gloves. Barrier protection for the body may be appropriate for all but the simplest procedures. Protection for the face seems appropriate, especially in invasive procedures such as lumbar puncture or physical examination of the bleeding patient. This study, along with other published data, has aided development of detailed guidelines for appropriate barrier precautions to be taken for common ED procedures.

Adolescent↗

PubMed1995

Fever in geriatric emergency patients: clinical features associated with serious illness.

STUDY OBJECTIVE: To determine the clinical significance of fever in geriatric emergency department patients. DESIGN: Case series with follow-up. SETTING: Urban, university-affiliated community hospital. PARTICIPANTS: Consecutive patients over the age of 65 years who presented to the ED during a 12-month period with an oral temperature of 100.0 degrees F (37.8 degrees C) or higher. RESULTS: We considered the following features indicators of serious illness: positive blood culture(s), related death within 1 month of ED visit, need for surgery or other invasive procedure, hospitalization for 4 or more days, IV antibiotics for 3 or more days, and repeat ED visit within 72 hours for related condition. Four hundred eighty-nine patients were eligible for study. Of the 470 patients with complete follow-up data, 357 (76.0%) had indicators of serious illness. Clinical features found to be independently associated with serious illness included oral temperature of 103 degrees F (39.4 degrees C) or more, respiration rate of 30 or more, leukocytosis of 11.0 x 10(9)/L or more, presence of an infiltrate, and pulse of 120 or more. At least one indicator of serious illness was present in 63 of 128 patients (49.6%) with none of these independently predictive clinical features. The most common final diagnoses were pneumonia (24.0%), urinary-tract infection (21.7%), and sepsis (12.8%). CONCLUSION: Fever among geriatric ED patients frequently marks the presence of serious illness. All such patients should be strongly considered for hospital admission, particularly when certain clinical features are present. The absence of abnormal findings does not reliably rule out the possibility of serious illness.

Aged↗

PubMed1995

In vivo diagnosis of Hallervorden-Spatz disease.

The authors present the MRI findings of two children with insidious walking difficulties, signs of corticospinal tract involvement, and signs and symptoms of extrapyramidal dysfunction such as rigidity and generalized dystonia, the latter with predominance of oromandibular involvement. In one child, MRI revealed prominent hypo-intensity in the globus pallidus and in the substantia nigra on T2-weighted spin echo images, consistent with iron deposition and thus with previous post-mortem findings of Hallervorden-Spatz disease. In the other case, the hypo-intensity was restricted to the globus pallidus, in which a small area of hyperintensity in its internal segment was demonstrated--the so called 'eye-of-the-tiger' sign. The authors propose that a combination of previously mentioned neurological signs with these specific MRI findings is highly suggestive of an in vivo diagnosis of the late infantile type of HSD.

Fatal Outcome↗

PubMed1995

HIV testing.

Testing for HIV infection is not generally required for the appropriate treatment of medical emergencies. Current standard HIV tests rely on the detection of antibodies to the HIV virus and are among the most sensitive and specific tests used in medicine. Standard HIV tests can be unreliable for detecting infection in certain patients, such as individuals who have been recently infected and neonates born to mothers with HIV infection. Other methods for detecting HIV infection, such as viral culture, polymerase chain reaction (PCR) amplification of viral DNA or RNA, and detection of viral antigens have limited clinical applications. Testing for HIV infection requires facilities for effective counseling, access to appropriate medical referrals, and the ability to maintain strict patient confidentiality.

AIDS Serodiagnosis↗

PubMed1994

[Pyridoxine dependent seizures].

Pyridoxine dependent seizures is a rare autosomal recessive disorder. Its manifestations are intractable epilepsy leading to death in status epilepticus. Treatment with pyridoxine prevents the seizures and normalizes the EEG. Early diagnosis is important for the intellectual outcome. In Denmark, the disease has occurred in a child of healthy Tamil immigrants, who are first cousins. The child's case story is described and points to awareness of increased occurrence of rare autosomal recessive disorders in immigrants from cultures with traditional consanguinity. We suggest giving a pyridoxine test dosis to all cases of severe epilepsy and status epilepticus in infants younger than 18 months.

Consanguinity↗

PubMed1994

The role of Mycobacteria Other Than Tuberculosis (MOTT) in patients with cystic fibrosis.

The purpose of this study was to estimate the frequency of and evaluate the clinical impact of pulmonary mycobacterial infections among cystic fibrosis (CF) patients. 185 CF patients aged 2.2-38.5 years were screened by sputum samples and by intracutaneous skin tests against tuberculin and sensitins produced from Mycobacterium chelonae subsp. abscessus, M. avium, M. intracellulare and M. scrofulaceum (the MAIS complex). The skin tests towards the sensitins in BCG-vaccinated patients (n = 60) were significantly influenced by the vaccination. 26 of the remaining 125 non-vaccinated patients had > or = 1 positive skin test (95% confidence limits 15-29%). The majority reacted against the MAIS complex. However, the reactions were similar to those of healthy siblings and an age-matched control group. Moreover, the lung function, growth and HbA1c were similar among skin test positive and negative patients. Three patients had repeated positive sputum cultures, the point prevalence being 1.6% (M. intracellulare, n = 2 and M. chelonae subsp. abscessus, n = 1). During the subsequent 4 years, 4 additional patients with M. chelonae subsp. abscessus were identified. Based on clinical observations, 5 of the infected patients were considered asymptomatic, while 2 might have been symptomatic. In 1 patient, M. chelonae subsp. abscessus disappeared spontaneously. Despite intensive treatment with new antibiotics against Mycobacteria Other Than Tuberculosis (MOTT) in 4 patients, the mycobacteria were not eradicated. In conclusion, MOTT infection was rare and the clinical impact difficult to prove. Treatment should focus on clinical improvement in the individual patient suspected of suffering from significant symptomatic infection. Eradication of the bacteria should not be expected.

Adolescent↗

PubMed1992

[Late hemorrhagic disease in newborn infants. Is the current preventive treatment with oral vitamin K adequate?].

During recent years, we have observed two cases of haemorrhage due to vitamin K deficiency which developed late in the neonatal period. One patient was a female infant aged six weeks with severe intracranial bleeding and the other was a female infant aged three weeks with marked haemorrhage from the umbilicus. Both of these infants were entirely breast-fed and had received vitamin K (1 mg fytomenadion) orally at birth. Both infants had unrecognized alfa-1-antitrypsin deficiency with liver involvement. In other European countries, many cases of late haemorrhagic disease of the newborn due to vitamin K deficiency have been registered in infants who had received oral vitamin K prophylaxis. On the basis of these observations and investigations which suggest that oral vitamin K prophylaxis is not so effective as intramuscular administration, it is suggested that the present oral vitamin K prophylaxis should be altered.

Administration, Oral↗

PubMed1991

The potential utility of a rapid CK-MB assay in evaluating emergency department patients with possible myocardial infarction.

STUDY OBJECTIVES: To determine the sensitivity, specificity, and predictive values of a new rapid creatine kinase-MB (R-CK-MB) assay compared with a standard CK-MB (S-CK-MB) assay and to determine its potential use in the evaluation of emergency department patients with possible myocardial infarction. DESIGN: Retrospective patient identification with subsequent testing of excess sera for CK-MB and total CK using an identity-unlinked procedure. SETTING: Large, urban, teaching hospital ED. PARTICIPANTS: All adult patients with excess sera and one of several defined presentations chosen to identify those with possible myocardial ischemia or infarction. Patients with clearly documented noncardiac etiologies of their symptoms or signs were excluded. MAIN RESULTS: The sensitivity, specificity, and positive and negative predictive values of 271 patient specimens for the R-CK-MB assay compared with the S-CK-MB assay were 100%, 96.8%, 75.0%, and 100%, respectively. The R-CK-MB assay was positive for 32 patients (11.8%). Of these, eight (25.0%) were admitted to unmonitored beds, and five (15.6%) were discharged home. All of these 13 patients had initial ECGs without evidence of ischemia or infarction. On follow-up, at least eight of the 13 had evidence of infarction. CONCLUSION: The R-CK-MB assay demonstrated high sensitivity and specificity compared with the S-CK-MB assay. When used for patients in whom a cardiac care unit admission is not considered, the rapid assay may identify some patients with unsuspected myocardial infarction and prevent inadvertent discharge or admission to unmonitored beds.

Adult↗

PubMed1990

[Hypoglycemia in the neonatal period. The need for blood sugar control].

In order to evaluate the demand of blood glucose measurements (BG) in the neonatal period, a retrospective study of BG in 177 newborn babies was undertaken. Babies with birth weight less than 2,500 grams, gestational age (GA) less than 37 weeks, and/or a low birth weight in relation til gestational age were included in the study. Accordingly, the babies were grouped as appropriate for GA (AGA), small for gestational age (SGA), or large for GA (LGA). Neonatal hypoglycemia (NH), BG less than or equal to 1.4 mmol/l, was found in 33 babies. In 31 babies, NH occurred before 12 hours of age while six babies had recurrent NH. Correlation was seen between total number of clinical symptoms and NH, which was, as anticipated, commonest among preterm SGA-babies. The risk of subsequent NH in early fed low birth weight newborn seems to be very low, if NH has not appeared within the first 12 hours of life. After this time, serial blood glucose measurements only seem justified, if concomitant perinatal disease is present.

Blood Glucose↗

PubMed1990

Rapid estimation of serum myoglobin concentration during rhabdomyolysis with a latex-agglutination test (Rapi-Tex).

A latex-agglutination test (Rapi-Tex) was used for semiquantitative estimation of myoglobin concentration in 89 serum samples obtained from ten patients undergoing lower-limb arterial embolectomy. Each serum sample was tested with Rapi-Tex both undiluted and after 1:50 dilution with saline. The myoglobin concentration was additionally measured with enzyme-immunoassay. In the undiluted samples there were five 'false negative' Rapi-Tex results--two in the myoglobin concentration interval 0-300 micrograms and three in the samples with myoglobin exceeding 25,000 micrograms/l--and four 'false positive' results. None of the diluted samples gave rise to false classification. Using 1:50 diluted serum, the negative predictive value of the Rapi-Tex test for identification of a myoglobin concentration greater than 5,000 micrograms/l was 0.99 (95% confidence limits 0.94-1.00), and the positive predictive value was 1.00 (0.61-1.00). Rapi-tex is concluded to be a useful emergency test for severe hypermyoglobinemia.

Acute Kidney Injury↗

PubMed1989

The effect of carotid sinus massage is independent of posture in patients with heart disease.

The influence of posture on the effect of carotid sinus massage (CSM) in patients with heart disease has not been systematically evaluated. In the present study CSM was performed in 80 patients (mean age 55 +/- 10 (SD) years) suffering from various cardiovascular diseases. Each subject had unilateral right- and left-sided CSM performed in the supine and in the sitting position, while heart rate and systolic blood pressure were monitored. No statistically significant differences in the CSM-induced response in systolic blood pressure or heart rate were found between the two postures. In the supine position the drop in heart rate was significantly greater after right-sided than after left-sided CSM (P less than 0.05). In only one patient (1%) was a significant carotid sinus reflex evoked. The response was cardioinhibitory with asystole for 3700 ms during right-sided, supine CSM. These results imply that posture does not influence the effect of CSM in patients suffering from heart disease.

Aged↗

PubMed1989

Sensitivity to tuberculin and sensitins from atypical mycobacteria (M. chelonae subsp. abscessus, M. avium, M. intracellulare, M. scrofulaceum) in 100 Danish school children.

One hundred non-BCG vaccinated Danish school children aged 7.3-14.9 yrs (median 12.8 yrs) were studied with regard to the size of skin induration 72 hrs following intracutaneous injections of 1 unit of tuberculin PPD and 0.1 microgram of four different sensitins produced from M. chelonae subsp. abscessus. M. avium, M. intracellulare and M. scrofulaceum. Fifteen children showed at least one significant reaction (i.e. skin induration greater than 6 mm). Of these children, 13 had two or more significant reactions. None of the children showed primary reactions to tuberculin; but the tuberculin reaction in one child was significant, whereas five other children had detectable tuberculin reactions, all being due to cross reactions to atypical mycobacteria. In addition to the atypical mycobacteria, the following frequencies of significant reactions were found: M. chelonae subsp. abscessus (6%), M. avium (11%), M. intracellulare (13%), M. scrofulaceum (12%). The reactions to the 5 skin tests were significantly different (p less than 0.001). However, the skin reactions to M. avium, M. intracellulare and M. scrofulaceum (i.e. the MAIS complex) were similar, and they correlated significantly (p less than 0.001). On the other hand, the members of the MAIS complex correlated with neither M. tuberculosis nor with M. chelonae subsp. abscessus, and the reactions to these two atypical mycobacteria were significantly different (p less than 0.01). This seems to indicate extensive cross reactions between the members of the MAIS complex. Consequently, cutaneous testing for this complex in epidemiological surveys only requires a skin test with one of the members.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1988