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Biomedical subjects

L Aabakken

Publications and source records attributed to L Aabakken.

At least 55 records · Page 3Linked to original sources
PubMed1996

Faecal calprotectin shedding after short-term treatment with non-steroidal anti-inflammatory drugs.

BACKGROUND: Increased faecal calprotectin shedding indicates gastrointestinal mucosal inflammation. METHODS: We studied the effect of short-term treatment with non-steroidal anti-inflammatory drugs (NSAIDs) on faecal calprotectin shedding in two randomized crossover studies, with treatment regimens of indomethacin or naproxen for 14 days in the first study (n = 16) and lornoxicam or naproxen for 7 days in the second study (n = 18). RESULTS: The method's reproducibility and stability were satisfactory. Indomethacin and naproxen increased the faecal calprotectin significantly from a base line of 4.7 mg/l to 9.0 mg/l and 8.0 mg/l, respectively. Lornoxicam failed to increase the faecal calprotectin. Shedding after 7 days of naproxen treatment was positively correlated to gastroduodenal mucosal inflammation assessed by endoscopy. CONCLUSIONS: Although seemingly influenced by concurrent upper airway infections, the study indicates that the calprotectin test may be useful for monitoring the inflammatory response to NSAID treatment, even in short-term setting.

Adult↗
PubMed1996

The X-ray contrast medium iodixanol detects increased colonic permeability equally well as 51Cr-labeled ethylenediaminetetraacetic acid in experimental colitis of rats.

BACKGROUND: Non-ionic, water-soluble radiographic contrast media have been suggested as intestinal permeability probes. We studied the permeability of the isosmolar contrast medium iodixanol and 51Cr-labeled ethylenediaminetetraacetic acid (EDTA) from the non-perforated colon after induction of colonic inflammation. METHODS: Colonic inflammation and ulcerations were induced by luminal colonic instillation of trinitrobenzenesulfonic acid, dissolved in 40% ethanol. Controls received saline. Fourteen days later iodixanol, 320 mg I/ml, and 51Cr-EDTA were given as an enema. Urine was collected for the subsequent 6 h and subjected to high-performance liquid chromatography and gamma activity counting. RESULTS: Urinary recovery of iodixanol and 51Cr-EDTA increased gradually with severity of the colonic inflammation. The correlation between iodixanol and 51Cr-EDTA recovery was strong (corr.coeff = 0.97). CONCLUSIONS: Iodixanol shows as good properties as 51Cr-EDTA when used as intestinal permeability probe in the inflamed and ulcerated rat colon. Use of the radiopaque properties of iodixanol enable intestinal probe exposure registration by film or fluoroscopy.

Animals↗
PubMed1995

[Time utilization in the preparation of medical records].

The time available for preparing a medical record may be of importance for the resulting quality. We studied the records of 166 patients admitted to a medical department during a fortnight. 24 doctors registered the time spent on history taking, clinical examination and emergency treatment, paper work and other patient-associated tasks. The doctors received a mean of seven patients each, spending a mean of 53 (range 20-120) minutes in all. The mean time spent on clinical examination was 27 minutes, on paper work 18 minutes and on other tasks 11 minutes. Time of the day or age of the patient did not influence the time spent on the tasks. Only rarely (7%) did the doctor experience shortage of time.

Age Factors↗
PubMed1995

[The medical record--content, interpretation and quality. Study of 100 medical records from a department of internal medicine].

An evaluation of the primary medical records of 100 patients admitted to a medical department showed that several elements in the journal often had been left out. Therefore all doctors working in the department were asked for their opinion of the necessity for each of the elements in a journal. A comparison of these doctors' opinions with our registrations indicated that the actual "shortening" of the journals was probably a result of choice rather than mere chance. Despite a considerable amount of work trying to establish relevant criteria, we did not succeed in developing a reliable method for measuring the quality of the medical record. The journals recorded at night were significantly shorter than those recorded during the day. A follow-up note (or discharge of the patient within one day), was found in 80% of the journals. Quality standards of the medical record are lacking and should be developed.

Evaluation Studies as Topic↗
PubMed1995

Hands-on endoscopy training: an evaluation of the SADE endoscopy course. Scandinavian Association of Digestive Endoscopy.

The Scandinavian Association of Digestive Endoscopy course in advanced practical endoscopy has been arranged on a regular basis since 1980, representing a joint Scandinavian effort to offer hands-on endoscopy training with expert supervision at major endoscopy centers. The course has been aimed at gastroenterologists with previous endoscopic experience, focusing on special techniques, practical hints and expert solutions in special cases. Three days of practical training throughout Scandinavia are completed with two days of review lectures, case reports and special techniques. An inquiry among previous course participants indicates that the course has indeed been of practical value for their daily work, and that personal training as well as watching "experts at work" were useful for their ensuing endoscopic practice. The course model does, however, require close co-operation with the endoscopy units hosting the practical part of the course.

Curriculum↗
PubMed1994

[Use of acetylsalicylic acid and other antiphlogistics in hematemesis/melena].

The use of acetylsalicylic acid and other non-steroidal, anti-inflammatory drugs was studied prospectively in 207 patients admitted for suspected upper gastrointestinal bleeding. In addition to detailed drug history, plasma samples for drug analyses were obtained from the majority of the patients. 64 of the patients admitted recent intake of ulcerogenic drugs, and the plasma samples revealed another 11 users. Acetylsalicylic acid was the most prevalent substance, but all available non-steroidal, anti-inflammatory drugs were represented in the material. Gastroduodenal ulcers were found in 94 (44%) of the patients; two thirds of the users and one third of the non-users. Gastric ulcer was slightly more prevalent than duodenal ulcer in both groups. Six patients with drug-associated bleeding had previously had a verified drug-associated ulcer. Only 12 users and 16 non-users denied dyspeptic complaints before admission. The users were older, they generally had a lower Hgb on admission than non-users had, and a slightly higher transfusion requirement, but these factors did not result in significant differences as to clinical outcome. The drug analyses of plasma samples showed a discrepancy to the anamnestic data in 25% of the patients and may be a useful addition to drug history in these studies.

Adolescent↗
PubMed1994

[Metabolic acidosis--a diagnostic challenge].

Metabolic acidosis can be caused by a variety of pathological conditions, but intoxication with ethylene glycol or methanol should be suspected in cases of a combined increase of osmolal and anion gaps. The determination of the gaps is based on readily available laboratory tests, and the results is known soon after the blood sample is taken. This procedure is of particular interest for hospitals where specific analyses for methanol and ethylene glycol are not available, since calculation of the gap can give an early indication of what treatment to use. Therefore, the gaps should be calculated as a routine in patients with metabolic acidosis of unknown origin. The authors describe the principles for calculating and using the gaps, and report three cases which illustrate their usefulness in practice.

Acidosis↗
PubMed1994

Osmolal and anion gaps in patients admitted to an emergency medical department.

1. Osmolal and anion gaps are helpful in the diagnosis and evaluation of intoxications with methanol and ethylene glycol. Reported reference values for osmolal gap and anion gap are -1 (+/- 6) mosm kg-1 H2O and 16 (+/- 2) mmol l-1, respectively. However, we have repeatedly found unexplained increased gaps in patients admitted to our department, and the relevance of the established reference values has been questioned. 2. Osmolal and anion gaps were determined in an unselected population of patients consecutively admitted to an emergency medical department. In the case of unexplained gaps, the blood samples were analysed with respect to the presence of alcohols and organic acids. 3. We included all accessible patients admitted during 14 days. Appropriate blood samples were obtained in 177 patients (88 male, 89 female), with a mean age of 65 years (range 17-94). 4. The mean and (standard deviation) for osmolal and anion gaps in our material were 5.2 mosm kg-1 H2O (7.0) and 12.9 mmol/l (4.2). Neither methanol nor ethylene-glycol was detected in serum from any patients. Small amounts of ethanol were found in 5 patients, and high lactate levels explained in part the most extensively increased anion gaps. However, the calculated analytical standard deviation accounted entirely for the variation in our material, and we suggest that the present reference values be adjusted.

Acid-Base Equilibrium↗
PubMed1993

Pepsinogen A and C serum levels in relation to acute NSAID-associated mucosal lesions in healthy volunteers.

Serum pepsinogen has been suggested as a risk marker for the development of gastrointestinal side effects of non-steroidal anti-inflammatory drugs (NSAIDs). The relation between serum levels of pepsinogen A (PGA) and pepsinogen C (PGC) and endoscopic findings in association with short-term NSAID use was investigated in two double-blind, crossover studies in healthy volunteers. Thirty-two male subjects with a median age of 23 years were given naproxen, oxindanac, or piroxicam for 2 weeks. Upper endoscopy was performed by the same investigator before and after each treatment period, scoring mucosal injection and erosive and hemorrhagic lesions separately on 150-mm visual analogue scales. Blood samples for pepsinogen analyses were drawn before each endoscopy. PGA and PGC were analyzed by means of solid-phase radioimmunoassays. Significant amounts of gastroduodenal mucosal lesions were found in all treatment periods, whereas neither PGA nor PGC changed during treatment. Moreover, the initial levels of serum pepsinogen also failed to predict the subsequent development of gastroduodenal lesions. The risk of a type-II error was small in this study, and our results therefore do not support the use of PGA or PGC as a risk marker in this context.

Adult↗
PubMed1993

[Handbook for rotation candidates--Norwegian experiences].

Clinical handbooks and procedure descriptions have been suggested as a way to improve the practical part of the medical education in Norway, but experience with books of this type is scarce, and the applicability of the model has been questioned. This paper reports a questionnaire survey among Norwegian medical students who have had hands-on experience with such a book throughout their student practice. The book apparently has been used, and no serious criticism has been put forward. It is an obvious sine qua non that such a book is used with proper care, and that the cooperation with senior doctors on duty is maintained.

Clinical Competence↗
PubMed1992

[Decision to withdraw cardiopulmonary resuscitation at Norwegian hospitals].

We present a survey on the use of do-not-resuscitate orders in Norwegian hospitals based on mailed questionnaires. 559 doctors, at least one from every somatic hospital in Norway responded. Do-not-resuscitate orders were issued by 92% of these doctors. There were large differences, however, as to who made the decision, who was involved in the decision-making, the consequences of a do-not-resuscitate order, and how the orders were documented. Formal rules for do-not-resuscitate orders are needed.

Cardiopulmonary Resuscitation↗
PubMed1992

[Use of the R-concept in a medical department].

Do-not-resuscitate orders issued in a medical department were studied by retrospective evaluation of 195 consecutive deaths in the department in 1991. No attempt at resuscitation was recorded in 171 patients. In these cases, do-not-resuscitate orders were documented in 67 only. For more than half of the orders, no reason was given in the medical record, and partial orders not to resuscitate were found in five patients only, none of whom were resuscitated. No difference was found in use of do-not-resuscitate orders between intensive-care units and regular wards, between patients above and patients below 80 years of age, or between patients with and patients without cancer. We suggest extended use of do-not-resuscitate orders in our department, and better documentation of the orders. Written guidelines have been established for this purpose.

Adult↗
PubMed1992

[Mucosal lesions associated with antiphlogistics--treatment and prevention].

Gastrointestinal side effects associated with nonsteroidal, anti-inflammatory drugs are well known, but recent data suggest that the small and large bowel are target organs in addition to the gastroduodenal mucosa, although the clinical significance of changes in permeability and of mucosal inflammation is unknown. Inhibition of prostaglandin synthesis remains the major pathogenetic hypothesis for the entire gastrointestinal tract, but additional mechanisms are probably involved. Ulcers that occur during non-steroidal anti-inflammatory drug therapy can be treated in the same way as other peptic ulcers, but the duration of treatment should be extended if the non-steroidal anti-inflammatory drug cannot be withdrawn. Prophylactic therapy with H2-antagonists or prostaglandin analogues may be justified in selected high risk individuals.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

[Development and use of a database for gastroenterologic endoscopy].

With no commercially available endoscopy database manager available, a standalone system for gastroenterological endoscopy departments has been developed since 1985 through joint efforts of gastroenterologists and dedicated programmers. The present system was implemented for daily use January 1989 and, to date, approximately 19,000 examinations have been recorded. Nurses and office assistants carry out administrative work, but the physician enters the endoscopic data, partly as free text, partly as structured data via automated menus and a mouse. In addition to the immediate printout of the result, valuable data are stored in the computer for administrative and research purposes. Mean data entering time for the physician was four minutes 17 seconds, and altogether eight minutes 40 seconds was spent on the computer system for each patient served.

Database Management Systems↗
PubMed1992

Review article: non-steroidal, anti-inflammatory drugs--the extending scope of gastrointestinal side effects.

The gastrointestinal side effects of non-steroidal, anti-inflammatory drugs extend beyond the duodenal bulb, and comprise a variety of lesions in all parts of the gut. Gastroduodenal ulceration is quantitatively dominant, although a major part of these lesions probably go unnoticed and heal spontaneously. Adaptation has been demonstrated for acetylsalicylic acid, and may be of importance for other substances as well. Non-steroidal anti-inflammatory drugs (NSAIDs) may induce relapse of inflammatory bowel disease. Permeability changes and mucosal inflammation are found in the small and large bowel in the majority of subjects taking NSAIDs, although the clinical significance is still not clear. Ulceration and perforation do, however, occur in this part of the gut as well. Treatment of NSAID-associated ulceration is similar to traditional ulcer treatment, possibly with extended treatment duration if the NSAID is continued. Prophylaxis is of some value, but is not required for every patient receiving an NSAID.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

Changes in the gastrointestinal mucosa after long-distance running.

Two groups of long-distance runners were investigated for the effect of marathon running on the gastrointestinal mucosa. In one group gastric erosions with bleeding were found in five of nine subjects, mostly localized to the corpus region. The relative gastric blood flow measured by endoscopic laser Doppler flowmetry was slightly decreased in the cardia region (from 7.0 to 5.8; p less than 0.05) but unchanged in the other parts of the stomach, including the erosive lesions. In another group (n = 8) all the subjects showed a substantial increase in the urinary excretion of 51Cr-labeled ethylenediaminetetraacetic acid after oral intake, which indicates an increase in the intestinal permeability. There is reason to suggest that long-distance running affects the integrity of the gastric and the intestinal mucosa.

Adult↗
PubMed1992

Gastroduodenal lesions associated with two different piroxicam formulations. An endoscopic comparison.

This endoscopic study was performed to compare the gastroduodenal endoscopic findings after short-term treatment with plain and enteric-coated piroxicam tablets. Sixteen healthy male volunteers (mean age, 22 years; range, 19-27 years) were included in a double-blind, randomized study in which 20 mg piroxicam was given once daily for 2 weeks as plain tablets or enteric-coated tablets in a crossover fashion. The washout period was 5 weeks, and endoscopy was performed before each treatment period to ensure base-line conditions. Endoscopic evaluation of the stomach and duodenum was performed, with separate registration of the duodenum distally to the duodenal bulb. Visual analogue scales of 150 mm were used for grading the mucosal lesions, with separate registration of mucosal injection and erosive and haemorrhagic lesions. A 5-point scale (Lanza scale) was also used, to compare the two scoring systems. A significantly lower lesion score was found with the enteric-coated formulation for all endoscopic variables in both scoring regions. The sum of visual analogue scale scores in the stomach/duodenal bulb after treatment was 121 mm and 74 mm, respectively (p < 0.01), and in the middle and distal duodenum the corresponding figures were 54 mm and 23 mm (p < 0.01). The fixed-point scoring gave identical conclusions, as did the separate scoring by a different investigator evaluating the same endoscopies. Subjective symptoms were similar for the two formulations, and no carryover effects were detected. We conclude that enteric coating of piroxicam tablets may offer a means of protecting the gastroduodenal mucosa in short-term treatment of healthy subjects.

Adult↗