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K Viskum

Publications and source records attributed to K Viskum.

At least 37 records · Page 2Linked to original sources
PubMed1999

A randomized clinical trial of alpha(1)-antitrypsin augmentation therapy.

We have investigated whether restoration of the balance between neutrophil elastase and its inhibitor, alpha(1)-antitrypsin, can prevent the progression of pulmonary emphysema in patients with alpha(1)-antitrypsin deficiency. Twenty-six Danish and 30 Dutch ex-smokers with alpha(1)-antitrypsin deficiency of PI*ZZ phenotype and moderate emphysema (FEV(1) between 30% and 80% of predicted) participated in a double-blind trial of alpha(1)-antitrypsin augmentation therapy. The patients were randomized to either alpha(1)-antitrypsin (250 mg/kg) or albumin (625 mg/kg) infusions at 4-wk intervals for at least 3 yr. Self-administered spirometry performed every morning and evening at home showed no significant difference in decline of FEV(1) between treatment and placebo. Each year, the degree of emphysema was quantified by the 15th percentile point of the lung density histogram derived from computed tomography (CT). The loss of lung tissue measured by CT (mean +/- SEM) was 2.6 +/- 0.41 g/L/yr for placebo as compared with 1.5 +/- 0.41 g/L/yr for alpha(1)-antitrypsin infusion (p = 0.07). Power analysis showed that this protective effect would be significant in a similar trial with 130 patients. This is in contrast to calculations based on annual decline of FEV(1) showing that 550 patients would be needed to show a 50% reduction of annual decline. We conclude that lung density measurements by CT may facilitate future randomized clinical trials of investigational drugs for a disease in which little progress in therapy has been made in the past 30 yr.

Double-Blind Method↗
PubMed1998

[Therapeutic strategies for patients with tuberculosis].

OBJECTIVES: To determine the effectiveness of strategies used to promote adherence to anti-tuberculosis treatment. SEARCH STRATEGY: MEDLINE 1966-1996 (August), Cochrane Collaboration Trials Registers (October 1996), LILACS 1982-1996 (September); reference lists in articles on adherence, contact with experts in the fields of TB and adherence research. SELECTION CRITERIA: Randomised or pseudo-randomised controlled trials of interventions to promote compliance with curative or preventive chemotherapy for TB, with at least one measure of adherence. DATA COLLECTION AND ANALYSIS: Data on study methods, participants, interventions and outcomes were collected for each study and methodological quality was assessed. Estimates of effect were assessed for categorical outcomes using the Peto odds ratio, with 95% confidence intervals. MAIN RESULTS: Strategies found to be of benefit were reminder cards sent to defaulters, assistance of patients by lay health workers, monetary incentives offered to patients, and increased supervision of TB clinic staff. It is not possible to determine from current trials whether health education by itself leads to better adherence to treatment. Even though directly-observed therapy (DOT) is widely advocated as the most cost-effective means of ensuring completion of TB treatment, no completed trials could be found which confirm or refute this view. CONCLUSIONS: RCT evidence exists that certain strategies improve adherence to anti-tuberculous therapy, and these should be adopted into clinical practice depending on their appropriateness to practice circumstances. Further innovations should be tested to find solutions that will be useful in low income countries. Randomised trials evaluating the independent effects of directly-observed therapy (DOT) are awaited.

Antitubercular Agents↗
PubMed1998

[Multiresistant tuberculosis in Denmark 1993-1996].

Infections with multiresistant tubercle bacilli have also become a problem in the rich part of the world. The reasons are lack of compliance in patients with life style problems and ineffectiveness of the health system due to lack of fundings. During a four year period, 1993-1996 ten patients were seen in Denmark with tuberculosis due to multiresistant Mycobacterium tuberculosis. Nine were infected abroad, one developed MDR-TB during treatment in Denmark. It is possible to cure these patients, but it is expensive and takes a long time. In the future more cases created within Denmark are likely to be seen due to lack of funding for the tuberculosis programme and, depending on immigration, further cases created abroad are expected.

Adult↗
PubMed1998

[Diagnostic procedure in patients with suspected lung cancer. Results of combined evaluation by thoracic surgery and pulmonary medicine specialists].

During the last 50 years, the 5-year survival of lung cancer patients has been unchanged at 5%. As the prognosis for patients with operable nonsmall cell lung cancer (NSCLC) is much better, the diagnostic examination of tumour suspicious lesions with secondary judgement of operability in NSCLC is an important subject. This study focuses on the diagnostic process. During the years 1991-1993, 467 consecutive patients with pulmonary tumour suspicious lesions were prospectively followed at the Department of Pulmonary Medicine and the Department of Thoracic Surgery, Bispebjerg Hospital. In 40% of the patients, the diagnostic delay was longer than 30 days. Fiberbronchoscopy and fine needle biopsy were the most important diagnostic tests with an accuracy of approx. 90% for both central and peripheral lesions. Benign lesions comprised 19% of all, while the prevalence of squamous cell carcinoma, adenocarcinoma, small-cell carcinoma and large-cell carcinoma was respectively 21%, 26%, 15% and 18% of the malignant infiltrates. Histological diagnosis was not achieved in 104 patients. Histological diagnosis was achieved in most patients, but the diagnostic process was slow. A faster diagnostic process is to be aimed for and can, hopefully, be achieved by accomplishing diagnostic standards as just proposed by the Danish Lung Cancer Group.

Adenocarcinoma↗
PubMed1998

[Therapeutic and prognostic course in patients with suspected lung cancer. Results of combined thoracic surgery-pulmonary medicine evaluation].

Survival of patients with lung cancer is poor in Denmark and worse than in the other Nordic countries. The study focuses on the treatment, the selection for operation, prognostic factors and the prognosis in lung cancer. During the years 1991-1993, 467 consecutive patients with pulmonary tumour suspicious lesions were prospectively followed at the Departments of Pulmonary Medicine and Thoracic Surgery, Bispebjerg Hospital, Copenhagen. Operation was performed in 83 (33%) of 252 patients with non-small-cell lung cancer. More than 70% of the 169 non-operated patients were judged inoperable on the basis of a clinical examination and a chest x-ray. The initial estimation of operability, done by the chest physician, was able to predict 91% of the inoperable patients. Therapeutic delay (diagnosis-operation) was on average 26 days and 95% were operated within 60 days. Three-year survival for all the operated patients was 36%, while 62% were alive when they were judged radically operated. For stage I tumours, 51% were alive after three years, while all with stage IV tumours were dead. In the operated patients, lung function was positively related to survival (p = 0.013). Females had a better survival than males (p = 0.01 for operated, p = 0.02 for non-operated). Among 43 with small-cell lung cancer, 32 were treated with chemotherapy, and half of these were alive after one year. Preoperative histology in peripheral lesions is of value in preventing unnecessary operations without significant losses. Mediastinoscopy should be performed before operation. Registration of TNM stage and lung function should become standard in order to make comparison from country to country more valid.

Aged↗
PubMed1998

Fibrous pleural tumour producing 171 litres of transudate.

Localized fibrous tumours of the pleura (or localized benign mesothelioma) are rare, and in most cases, asymptomatic. This report describes a 48 yr old female with a right-sided fibrous pleural tumour, which produced 171 L of transudate before a correct diagnosis was reached. The tumour was surgically removed and the transudation stopped immediately.

Female↗
PubMed1997

Artificial pneumothorax by the Veress cannula: efficacy and safety.

In 16 patients with pulmonary fibrosis, an artificial pneumothorax was introduced using the Veress cannula and the Saugman water manometer. Atmospheric air was introduced by fractionated insufflation to a total volume of 800 ml (median). The interpleural space was found on the first attempt, and in all cases, fractionated insufflation of atmospheric air was conducted while the intrapleural pressure was controlled with the water manometer. In one case, the procedure was stopped because of a rise in the pleural pressure after insufflation of only 50 ml air. This was undoubtedly caused by pleural adhesions not visible on chest X-ray. The main concern with air insufflation is air embolism but this was not observed clinically in any of the present cases. The patients in the present study all suffered from pulmonary fibrosis judged by clinical examination, chest X-ray and pulmonary function tests. Despite a diffusion capacity (DCO/VA) with a median value of 48% expected, the procedure was well tolerated. It has previously been shown that artificial pneumothorax preceding thoracoscopy is well tolerated due to hyperventilation, with an increase in respiratory frequency and a fall in arterial CO2 concentration (PaCO2), while pH and arterial O2 concentration (PO2) remain constant. This probably also explains the tolerance of the patients in this material. Insufflation of air as described here should be restricted to senior pulmonologists because it is an infrequent procedure. The present authors found the procedure to be uncomplicated and easy to perform with little discomfort to the patients.

Adult↗
PubMed1997

Risk of malignant neoplasms in patients with pulmonary sarcoidosis.

BACKGROUND: For over 20 years the association between sarcoidosis and malignancy, particularly lymphoma and lung cancer, has been disputed with misclassification being the major concern. The aim of the present study was to analyse the incidence of malignancies in a cohort of patients with sarcoidosis by linkage to a nationwide population based cancer register. METHODS: The cohort comprised 254 patients followed for a median of 25 years until death, emigration, or 31 December 1992, whichever came first. The expected number of cancer cases was calculated using the annual age and sex specific cancer rates from the Danish Cancer Registry. RESULTS: Thirty six cancers were registered, three of which were misclassified as sarcoidosis, leaving 33 cancers compared with 23 expected (standardised incidence ratio (SIR) = 1.4; 95% CI 0.99 to 2.0). Five lung cancers were observed compared with 2.5 expected, yielding an SIR of 2.0 (95% CI 0.7 to 4.7). There was no incidence of lymphoma and only one case of leukaemia. There was a significant excess number of pharyngeal cancers based on two cases (SIR = 15.4; 95% CI 1.7 to 56). CONCLUSIONS: This study does not support the theory of an association between sarcoidosis and malignancy, and the main reason other studies have shown such an association is most likely to have been due to selection bias and misclassification.

Adolescent↗
PubMed1997

Does alpha1-antitrypsin augmentation therapy slow the annual decline in FEV1 in patients with severe hereditary alpha1-antitrypsin deficiency? Wissenschaftliche Arbeitsgemeinschaft zur Therapie von Lungenerkrankungen (WATL) alpha1-AT study group.

Patients with severe hereditary alpha1-antitrypsin deficiency (alpha1-ATD) face a high risk of developing emphysema at a young age. Intravenous augmentation therapy with purified human alpha1-antitrypsin (alpha1-AT) is now available. However, a controlled trial to show its efficacy has never been carried out. The aim of this study was to compare the decline in forced expiratory volume in one second (deltaFEV1) between Danish patients who had never received augmentation therapy and German patients treated with weekly infusion of alpha1-AT. From the files of the Danish alpha1-ATD register, 97 exsmokers, with a PiZ phenotype and for whom results of at least two lung function measurements with an interval of at least 1 yr were available, were identified. From a German group of patients treated with weekly infusions of alpha1-AT, 60 mg x kg(-1) body weight, 198 exsmokers, with biannual lung function measurements were identified. The deltaFEV1 was compared between the two treatment groups by random effects modelling. The deltaFEV1 in the treated group was significantly lower than in the untreated group, with annual declines of 53 mL x yr(-1) (95% confidence interval (95% CI) 48-58 mL x yr(-1)) and 75 mL x yr(-1) (95% CI 63-87 mL x yr(-1)), respectively (p=0.02). The two groups differed with respect to gender and initial FEV1% predicted. Gender did not have any influence on the deltaFEV1. Stratification by initial FEV1% pred showed a significant effect of the treatment only in the group of patients with an initial FEV1% pred of 31-65%, and deltaFEV1 was reduced by 21 mL x yr(-1). This nonrandomized study suggests that weekly infusion of human alpha1-antitrypsin in patients with moderately reduced lung function may slow the annual decline in forced expiratory volume in one second.

Adult↗
PubMed1997

Multidrug-resistant tuberculosis in Denmark 1993-1995.

SETTING: All bacteriologically confirmed new cases of tuberculosis and treatment relapses in Denmark are examined for drug resistance. In the years 1993-1995, nine cases of multidrug-resistant tuberculosis (MDR-TB), all acquired outside Denmark, were identified among 1354 cases of tuberculosis. OBJECTIVE: To examine incidence, treatment and prognosis for patients with tuberculosis due to MDR Mycobacterium tuberculosis. DESIGN: Retrospective evaluation of routine data. RESULTS AND CONCLUSION: Multidrug resistance was present in less than one present of patients with tuberculosis. One patient died from tuberculosis without revision of treatment, and eight patients responded favourably to a regimen of pyrazinamide, streptomycin or amikacin, ofloxacin and cycloserine. In two patients, this regimen was supplemented with para-aminosalicylic acid and thiacetazone respectively. All patients needed prolonged hospitalization and had observed treatment. It is possible to cure such patients, but it is a lengthy and expensive process. It is expected that similar cases will be imported into the country and that they will occur within Denmark in the future.

AIDS-Related Opportunistic Infections↗
PubMed1996

[Diagnostic invasive procedures in the diagnosis of primary lung cancer. Diagnostic value and complications].

The invasive procedures used in the diagnosis of primary lung cancer are reviewed based on the literature. The choice of method should be related to its diagnostic accuracy, complications and cost. The chest x-ray provides the background for the further choice of diagnostic method. In central tumors, bronchoscopy meets the requirements and in peripheral lesions percutaneous transthoracic needle biopsy fulfils the conditions. In some centres, mediastinoscopy is preferred in all cases preoperatively, while others only perform this examination if a CT-scan shows mediastinal lymph nodes larger than 1 cm in diameter. If the latter procedure is followed, 10-30% of the patients will have lymph node metastases. Thoracoscopy is used when a pleural effusion remains undiagnosed after pleuracentesis. A considerable amount of patients will be shown to have pleural neoplastic spread even though cytological examination of the pleural fluid did not demonstrate malignant cells. The complication rates in all methods are low.

Biopsy, Needle↗
PubMed1996

Patient-administered sequential spirometry in healthy volunteers and patients with alpha 1-antitrypsin deficiency.

The launching of cheap, pocket-sized spirometers, with data storage capability, has made patient-administered sequential spirometry (PASS) an attractive method of monitoring ventilatory capacity. At present, little information is available on the quality of PASS, compared to laboratory spirometry. The aim of this study was to investigate whether patients could perform PASS without loss of reliability and reproducibility as compared with traditional laboratory spirometry. Ten healthy volunteers performed spirometry for 1 month and 10 emphysematous patients with alpha 1-antitrypsin deficiency (type PiZ) performed spirometry twice daily for up to 2 yr. To fulfil Good Clinical Practice criteria on full data documentation, a traditional direct recording spirometer, the Vitalograph R-model, was used. A decompression device was used for calibration and a 3.8% annual drift in volume registration was noted. This drift was largest for the first year. After training, all patients were able to perform unsupervised spirometry, producing technically correct forced expiratory curves. Reproducibility of FEV1 and FVC obtained by PASS was found to be as good as for laboratory spirometry. After adjustment for the diurnal variation, the residual variation of FEV1 was 2.5% (range 1.6-4.2%) for healthy volunteers and 5.6% (range 4.2-7.7%) for emphysematous patients. Forced vital capacity showed the same pattern. In conclusion, PASS is possible in highly motivated individuals without loss of reliability and reproducibility when compared to laboratory spirometry.

Adult↗
PubMed1995

[Sarcoidosis. Dependence of life expectancy on lung function, respiratory symptoms, roentgenologic stage and age at diagnosis and significance of extrapulmonary manifestations].

Patients with intrathoracic sarcoidosis have - during prolonged observation (27 years) - the same survival as the general population. A higher mortality from sarcoidosis as well as from diseases not related to sarcoidosis is found among persons who at the time of diagnosis of sarcoidosis had respiratory symptoms and a low FEV1, TLC and Tiffeneau. Our knowledge of the prognosis for extrapulmonary manifestations and their influence on survival is sporadic. Symptoms from heart and CNS have in studies of selected patients been connected with an elevated mortality.

Adolescent↗
PubMed1995

[Long-term prognosis of pulmonary sarcoidosis. 1. Prognostic value of lung function and symptoms].

A follow-up of 254 patients with intrathoracic sarcoidosis has been carried out after a median of 27 years from diagnosis. All patients could be traced. No excess mortality was found (80 deaths observed versus 66 expected). The causes of death were related to sarcoidosis in 41%. X-ray stage was related to survival with a significant excess mortality for stage 3. Early clearing of X-ray changes gave a favourable vital prognosis. Survival was related to lung function, especially forced expiratory volume in 1 second (FEV1) and total lung capacity (TLC). All deaths from sarcoidosis were seen among patients with respiratory symptoms at presentation. For sarcoidosis & sarcoidosis-related deaths (N = 33), presence of one or more of the respiratory symptoms increased the risk significantly. For overall mortality respiratory symptoms were also significant predictors; this was the case even after adjusting for age, sex, x-ray stage and lung function (FEV1 & TLC) at presentation. In conclusion, no excess mortality was observed after a median of 27 years follow-up. Lung function, respiratory symptoms and to some extent X-ray stage at time of diagnosis influenced long-term mortality in patients with intrathoracic sarcoidosis.

Adult↗
PubMed1995

[Long-term prognosis of pulmonary sarcoidosis. 2. Cardiac sarcoidosis and other extrapulmonary manifestations].

Frequency and prognostic importance of extrapulmonary manifestations have been examined in 254 patients with intrathoracic sarcoidosis. A follow-up was carried out after a median of 27 years from diagnosis. All patients could be traced. Extrapulmonary manifestations were found in 119 patients (47%), mostly occurring within the first years after diagnosis of intrathoracic sarcoidosis; skin manifestations were most frequently seen. ECG-abnormalities were found in 35 patients (14%); in 17 cases in the form of sinus tachycardia. No excess mortality was found (80 deaths observed versus 66 expected). The causes of death were related to sarcoidosis in 41%. Only tachycardia was associated with an unfavourable prognosis and this association vanished after adjusting for decreased lung function. None of the other extrapulmonary manifestations were associated with an unfavourable vital prognosis. Erythema nodosum was of no prognostic significance concerning survival. In conclusion, extrapulmonary manifestations are frequent in patients with intrathoracic sarcoidosis but do not influence vital prognosis.

Aged↗