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Biomedical subjects

K Viskum

Publications and source records attributed to K Viskum.

At least 19 recordsLinked to original sources

[Primary malignant pleural neoplasms. Diagnostic code 163.09].

The code 163.09 indicates a primary malignant pleural neoplasma-malignant mesothelioma. We have reinvestigated 173 patients, who were discharged from a department of pulmonary medicine with this code number during a 8 1/2 year period. A revision during which repeated biopsies, course of the disease and, in some cases, autopsy were considered, revealed that 63 were confirmed as having a malignant mesothelioma, 94 had neoplastic disease secondary to malignancy elsewhere, 13 had benign changes and in three cases the records were missing. Malignant mesothelioma entitles the patient to compensation if he has worked with asbestos. An occupational history was present in 94% of those suffering from mesothelioma and in 71% of the remaining patients. Among patients with mesothelioma a history of asbestos exposure was obtained in 44%, a history of no exposure in 22% and no specific mention of asbestos in 34%. In the group of patients who did not have mesothelioma 14% had known exposure to asbestos, eight none and in 78% no specific information concerning asbestos was available. Twenty-three of the 63 patients with mesothelioma had been notified to the workmens' compensation board. Retrospectively, we found that 12 more patients should have been notified. Eight patients who did not fulfil the criteria for malignant mesothelioma had erroneously been notified to the board for compensation. We find that code 163.09 frequently has been used as a working diagnosis, which could not invariably be substantiated. Although malignant mesothelioma had been suspected, previous history concerning asbestos exposure was often incomplete or absent. A correct occupational history and aggressive bioptical procedures are essential in all cases where malignant mesothelioma is suspected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

[Bronchial asthma treated with long-acting beta 2 agonist. Comparison between formoterol (12 mu/g) inhaled twice daily and salbutamol (200 mu/g) inhaled 4 times daily].

Forty patients with stable asthma and daily need for inhaled beta 2-agonist, were included in a randomized double-blind study. They were treated for six weeks with inhaled beta 2-agonist, either salbutamol, 4 x 200 micrograms daily, of formoterol, 2 x 12 micrograms and 2 x placebo daily. This was preceded by a run-in period, where all patients received terbutalin-inhalation, 4 x 500 micrograms daily. Twenty patients were given formoterol and 18 salbutamol. One patient in the salbutamol-treated group discontinued treatment after three weeks, because of deterioration of asthma. On a diary card, patients recorded peak expiratory flow rate (PEFR) morning and evening before medication, score of asthma symptoms (scale 0-3; 0 = no symptoms, and 3 = severe symptoms) and use of additional doses of beta 2-agonist. Forced expiratory volume in 1 sec. (FEV1), forced vital capacity (FVC) and PEFR were obtained after 0, three and six weeks of treatment. Blinded global assessment of the treatment was performed by both patient and physician at the end of the study. During run-in the two groups of patients were different. The group subsequently treated with salbutamol had a statistical significant (ss) higher morning-PEFR, ss fewer asthma-symptom scores than one during night and ss less need for additional puffs of beta 2-agonist. During treatment, the formoterol-treated group showed an ss increase in morning-PEFR, as compared to run-in. Furthermore this group had ss fewer nocturnal symptom scores than one and ss less need for extra beta 2-agonist during night, than the salbutamol-treated group.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation

[Congenital tuberculosis. 2 case reports].

Two cases of congenital tuberculosis are presented and the literature is reviewed. One child survived without sequelae while the other survived but was severely handicapped. The importance of early diagnosis and treatment of this rare but serious manifestation of tuberculosis is emphasized.

Child, Preschool

Inhaled salmeterol in the treatment of patients with moderate to severe reversible obstructive airways disease--a 3-month comparison of the efficacy and safety of twice-daily salmeterol (100 micrograms) with salmeterol (50 micrograms).

Three-hundred and fifty patients with moderate to severe reversible obstructive airways disease (forced expiratory volume in 1 s or peak expiratory flow rate < or = 50% predicted, a 15% reversibility to inhaled salbutamol and symptomatic) were recruited into a multi-centre, multinational, double-blind, parallel-group randomized study. Two-hundred and eighty-three patients were randomized to receive 50 micrograms salmeterol twice daily or 100 micrograms salmeterol twice daily administered from a metered-dose inhaler for 3 months. Salbutamol (100 micrograms per metered actuation) was provided for symptomatic relief. Morning and evening peak expiratory flow rate (PEFR), day-time and night-time asthma symptoms and additional bronchodilator usage were recorded by the patient on a daily basis. Lung function and patient/physician assessment of treatment efficacy were recorded at scheduled clinic visits. Safety was determined by monitoring adverse events and standard biochemical, haematological and cardiovascular parameters. Salmeterol 100 micrograms twice daily was consistently superior to salmeterol 50 micrograms twice daily in morning and evening PEFR measurements (mean differences between the treatments: 10-14 l min-1 for morning, 95% CI-0, 22 l min-1, P = 0.047; and 10-15 l min-1 for evening, 95% CI 2, 22 l min-1, P = 0.023). The improvement in PEFR was independent of concurrent steroid usage, with the most marked improvement being seen in the more severe asthmatics requiring concurrent oral corticosteroids (mean differences between the treatments: 27-31 l min-1, 95% CI: 3,55 l m-1, P = 0.027).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation

A seven-year follow-up study of 343 adults with bronchial asthma.

A study of 343 urban adult outpatients with a history of bronchial asthma was initiated in 1981. Asthma was verified by a reversibility in airflow obstruction of at least 0.5 1 in forced expiratory volume (FEV1) (70%). The rest of the 343 patients was included because of diurnal variations of at least 100 l/min in peak expiratory flow (PEF) (22%), or because of a characteristic history of asthma (8%). In 1988, a follow-up study was performed. Two hundred-fourteen patients replied (80%), 100 women and 114 men. Fifty-four did not respond, but were known to be alive. Twenty-one had emigrated; of these, the fate of five was unknown. The mortality rate was significantly raised among the men (Standard mortality rate (SMR) = 1.55). In 19%, the cause of death was pulmonary. Seventeen percent were found dead. In these, no cause of death was obvious, and they may have died from an exacerbation of their pulmonary disease. One hundred and forty-four had non-allergic and 69 allergic asthma verified retrospectively by positive skin prick test in 1988. One was not tested and not classified. Seventy-five percent of the whole group were smokers. An annual decline of approximately 90 ml per year in FEV1 was found in both groups and was only partially explained by smoking and ageing. The remaining observed decline in lung function may be caused by asthma. Reversibility of 0.5 l in FEV1 was only maintained in the allergic group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

[Alternative treatment of lung diseases].

A total of 671 patients attending two outpatient clinics for pulmonary medicine received a questionnaire about possible alternative treatment of the pulmonary disease for which they were receiving treatment. Six hundred and five questionnaires were answered anonymously. Among the 605 patients, 75 (12%) had received alternative treatment. No differences in the frequencies were observed between men and women. Employment of alternative treatment was most frequent in the age groups 20-29 and 50-59 years. Prolonged illness without definite prospects of cure such as chronic bronchitis and asthma resulted in employment of alternative treatment more frequently than briefer illness without possibility of cure (cancer of lung) or with the possibility of cure (tuberculosis, pneumonia). The patients had practically always consulted their general practitioner before the alternative therapist (94%). Half of the patients had improved, half were unchanged and only a few per cent had deteriorated. In the majority of cases, the expenses were moderate but isolated patients had, however, paid more than 10,000 Danish crowns (approximately pounds 1,000) for the alternative treatment.

Adult

Hyaline pleural plaques and asbestos bodies in 198 randomized autopsies.

In 198 randomized autopsies of adults, hyaline pleural plagues were found in 49 men and 17 women; bilateral in 47 cases, unilateral in 19. No correlation between previous pr present pulmonary disease and hyaline plaques was found. Asbestos bodies were found in nine men and five women; nine out of these 14 cases with asbestos bodies also had hyaline pleural plaques.

Adult

The ABO and rhesus blood groups in patients with pulmonary tuberculosis.

During the 3 year period 1970-1972 a total of 554 patients were notified for the first time as having bacillary or abacillary pulmonary tuberculosis in the Municipality of Copenhagen; 99 per cent of these patients were typed according to the ABO and rhesus system. The bacillary patients showed an excess of group O and AB and a deficit of A and B as compared to the general population. The deviations were statistically highly significant for group O and A. The distribution according to the rhesus system did not deviate from the expected pattern. The ABO and rhesus distribution of the abacillary patients did not differ significantly from the expected pattern. During a follow-up period of 2-5 years after the initial diagnosis 104 bacillary patients died; the ABO pattern among the survivors was now closer to the normal; this resulted from a high number of deaths from tuberculosis among patients of group O and a low number among those belonging to group A. More rhesus negative patients died from tuberculosis than rhesus positive. It is concluded that a study of the ABO and rhesus pattern among the tuberculosis patients becomes biased if a break-down by bacteriological findings and history is not made. It is also important that the study covers all patients who contract tuberculosis within a certain period, as the longevity of the patients is apparently to some extent dependent on their blood group.

ABO Blood-Group System

Mind and ulcer.

Among 2,619 patients admitted to a medical department for duodenal ulcer, gastric ulcer and ulcer dyspepsia without ulcer demonstrable by x-ray, admissions to psychiatric departments were investigated. A total of 20.4% of the patients had at some time during their lifetime been admitted, but no significant differences were observed in percentage among the three ulcer groups or the sexes. The incidence of psychoses was close to the expected, whereas neuroses among women and neuroses and psychopathy among men were far in excess of the expected. Among those operated on, the percentage of persons admitted to a psychiatric department was greater than among unoperated patients and their number of admissions per 100 observation years were significantly greater than for unoperated patients, within well-defined observation periods. For patients operated on, only men with duodenal ulcer had significantly more admissions per 100 observation years in the postoperative than in the preoperative period. The course of the disease was more severe for patients with duodenal and gastric ulcer admitted to a psychiatric department than for those not admitted, but the subjective status at the time of the follow-up did not differ between the two groups. Among men, there were a number of heavy drinkers, especially among those operated on.

Adult

Ulcer, attempted suicide and suicide.

Attempted suicide and suicide have been investigated among 2,619 patients suffering from duodenal ulcer, gastric ulcer and ulcer dyspepsia without ulcer demonstrable by x-ray. There was no difference in the percentage of attempted suicides and suicides among the three ulcer groups or between the sexes. Within well-defined periods, there was a statistically significant greater excess of attempted suicides among patients operated on than among unoperated patients. The distribution according to psychiatric diagnosis was very similar to the one observed among persons in general in Copenhagen attempting suicide. The number of patients committing suicide exceeded the expected number significantly, for men as well as for women, but there was no difference between patients operated on and unoperated patients. The psychiatric diagnoses of those committing suicide were predominantly neuroses and psychopathy.

Denmark

Ulcer disease and the law.

Among 1,780 male persons with duodenal ulcer, gastric ulcer and ulcer dyspepsia without ulcer demonstrable by x-ray, 737 (21%) had been convicted of law offences. There were no differences among the three ulcer groups with regard to the frequencies of the different crimes or the percentage of persons in each of the groups. The percentage of persons admitted to a psychiatric department was higher among those convicted than in the material in general. The dominating psychiatric diagnosis among those convicted was psychopathy. Among patients operated on, the percentage of convicted persons was significantly higher than among those not operated on. Among 168 persons convicted for offences committed while under the influence of alcohol, the percentage of heavy drinkers was higher than in the material in general. Only 3.1% of 771 women had been convicted for an offence. The observed frequencies of law breakers among the patients in the three ulcer group did not exceed the frequencies in the general population.

Alcohol Drinking