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Biomedical subjects

M Dahl

Publications and source records attributed to M Dahl.

At least 109 records · Page 6Linked to original sources

Blood pressure in children, adolescents and young adults.

The question of whether blood pressure is one of the main risk factors for cardiovascular diseases in childhood has been evaluated in a Study of Cardiovascular Risk in Young Finns. In the second follow-up study, carried out in 1986, blood pressure was successfully measured in 2500 individuals aged nine to 24 years using a random zero sphygmomanometer. The mean systolic blood pressure in girls rose from 102 mmHg (95th percentile 119 mmHg) at age nine to 116 mmHg (138 mmHg) at age 24 and that in boys from 102 mmHg (95th percentile 121 mmHg) to 128 mmHg (148 mmHg). Diastolic blood pressure was more often measurable using Korotkoff's 5th than the 4th phase. The values observed were similar to those reported by the Second Task Force on Blood Pressure Control in Children, but owing to differences in the methods used to measure blood pressure it cannot be reliably concluded that the blood pressures were similar in the two series. Even in childhood blood pressure measurement is important, and since it changes with the physical size of the child, observations should be compared with normal values such as those reported here. No data are yet available to suggest that children with blood pressure values in the high normal range would benefit from interventions. Thus normal blood pressure value curves should be applied with caution when assessing children.

Adolescent↗

Serum insulin and other cardiovascular risk indicators in children, adolescents and young adults.

We wanted to determine the levels of fasting serum insulin during growth, the tracking of serum insulin, and the correlation of serum insulin with other coronary heart disease risk indicators in children and young adults. In 1986 2433 subjects, aged nine to 24 were studied, and insulin data were available from the same population in 1980 and 1983. Serum insulin levels showed a peak during puberty in both sexes and the decline in insulin continued after the age of 21. Tracking of serum insulin was only moderate, especially in females and young boys. Serum insulin correlated positively with body mass index, concentrations of serum triglycerides, and blood pressure, and inversely with the concentration of high density lipoprotein cholesterol. High triglycerides, high systolic blood pressure, and low level of high density lipoprotein cholesterol clustered among subjects within the highest insulin quartile. Our results suggest that the insulin resistance phenomenon, caused mainly by obesity and leading to unfavourable levels of other coronary heart disease risk indicators, is already developing in children and young adults. This suggests that preventing obesity in early life is important.

Adolescent↗

[Rehabilitation after stroke].

Our hospital's stroke rehabilitation programme has been evaluated through a retrospective study of the record of 183 males (mean age 60 +/- 11 years) and 94 females (mean age 59 +/- 14 years) admitted in 1982/83. 87% of the patients had motoric impairments on admission; 45% had apraxia, 17% neglect, 38% aphasia and 57% other cognitive impairments. Most patients had both motoric and cognitive problems. 79% were able to ambulate freely at discharge as opposed to 55% on admission. 88% were independent in ADL when discharged; 67% on admission. The average length of stay (LOS) was shorter (p less than 0.005) for the males (57 +/- 32 days) than for the females (68 +/- 40 days). LOS was not significantly influenced by the patients' age. 81% of the patients were discharged to their homes. Significantly fewer patients with cognitive impairments were able to return to their homes after rehabilitation than in the case of those without such problems. The presence of aphasia did not significantly affect the rehabilitation outcome. It is concluded that the major obstacles for successful rehabilitation (i.e. back to the patient's home) are the cognitive impairments.

Activities of Daily Living↗

The b alleles of U. maydis, whose combinations program pathogenic development, code for polypeptides containing a homeodomain-related motif.

U. maydis is a fungal pathogen of corn with two forms: one is yeast-like and nonpathogenic; the other is filamentous and pathogenic. The b locus, with 25 different alleles, regulates this dimorphism: any combination of two different alleles triggers pathogenic development, whereas the presence of identical alleles results in the yeast-like form. We have cloned four b alleles (b1, b2, b3, and b4) and show that the b locus contains a single open reading frame (ORF) of 410 amino acids with a variable N-terminal region and a highly conserved C-terminal region (60% and 93% identity, respectively). Mutational analysis confirms that this ORF is responsible for b activity. The b polypeptides appear to be DNA binding proteins because they contain a motif related to the homeodomain in their constant region. We propose that combinatorial interactions between b polypeptides generate regulatory proteins that determine the developmental program of the fungus.

Alleles↗

A second time-study of the anaesthetist's intraoperative period.

This second time-study of the anaesthetist's intraoperative period was conducted at The Ohio State University Hospitals. The study involved a total of 30 anaesthetic procedures. The activities of the anaesthetists were videotaped and analysed independently by three reviewers. Unlike our previous study, the present study was performed at a time when automatic noninvasive arterial pressure monitors, automatic ventilators and patient breathing circuit disconnect alarms were in use. The greatest amount of intraoperative time of the anaesthetist (59.1%) was spent monitoring the patient directly (44.8%) or indirectly (14.3%) via patient monitors. This represented an increase from our previous study attributable to the increased use of technology in the operating room. The anaesthetist still spent about 10-12% of his/her time completing patient records.

Anesthesia↗

[Arthroscopy and arthroscopic surgery of the temporomandibular joint].

Diagnostic arthroscopy and arthroscopic surgery of the TMJ has during the recent years been introduced in the treatment of internal derangements, preauricular pain and osteoarthrosis of the TMJ. In closed lock cases and in cases with preauricular pain a satisfactory result of treatment has been described in 80-90% of cases, where there was lacking effect of conservative treatment with splints and physiotherapy. The refinement in the technique has made it possible to use rotating instruments, cauterisation and to perform suturing through the arthroscopic cannula and in this way reduce the need for open joint surgery. Due to the technique only few complications have been reported. In the Department of Oral and Maxillofacial Surgery in the University Hospital of Aarhus arthroscopy of the TMJ was introduced 1 1/2 year ago and 22 patients with the clinical diagnosis closed lock or preauricular pain or a combination of these has been treated during this period. The results are satisfactory in most cases and are comparable with previously published results.

Arthroscopy↗

High Doppler-derived cardiac output in the cerebral arteriovenous fistula measured by pulsed Doppler ultrasound.

Cerebral arteriovenous fistula may cause a significant increase in cardiac output. So far, the right ventricular output measurement with conventional cardiac output methods has been difficult in newborn infants because of the shunts through the foramen ovale and patent ductus arteriosus. This difficulty can be avoided by measuring left ventricular output with the pulsed Doppler ultrasound method. In our case, the patient was a newborn infant with large patent ductus arteriosus and an arteriovenous malformation of the great cerebral vein of Galen. The malformation was found by noticing a loud murmur from the infant's head. The diagnosis was later confirmed by ultrasound scanning and a computer tomography. Left ventricular output was enormous with values from 740 to 830 ml/min/kg, when the normal value for the newborn infant at this age is 260 ml/min/kg. Because of constant cardiac failure, the malformation was operated on. The infant died of cardiac failure during this operation. An enormous left ventricle output in an infant with arteriovenous fistula and patent ductus arteriosus predisposes to cardiac failure. The Doppler ultrasound method in newborn infants seems to be a useful tool to determine cardiac function.

Blood Flow Velocity↗

Blood pressure and excretion of sodium, potassium, calcium and magnesium in 8- and 9-year old boys from 19 European centres.

We have measured systolic and diastolic blood pressure and excretions of sodium, potassium, calcium and magnesium in groups of about 50 8- and 9-year-old boys from 19 European centres using standardized methods for the measurement of blood pressure and collection of urine, and by carrying out all analyses in one laboratory. Weight, height, pulse rate and environmental temperature were also studied. Mean systolic blood pressure ranged from 91 to 105 mm Hg and diastolic blood pressure from 51 to 66 mm Hg. Mean 24-h excretion of sodium was between 91 and 146 mmol/d, that of potassium between 29 and 60 mmol/d, that of calcium between 1.5 and 2.6 mmol/d and that of magnesium between 2.7 and 4.2 mmol/d. Mean sodium excretion tended to be lower and potassium excretion tended to be higher in the boys from the north-western parts of Europe. Relations between either systolic or diastolic blood pressure and electrolyte excretions were generally weak or absent. Most remarkable is that only the association between mean diastolic blood pressure and 24-h magnesium excretion (partial regression coefficient (b +/- s.e., -5.04 +/- 2.08 mm Hg/mmol/d) was statistically significant after adjusting for differences in creatinine excretion and environmental temperature. Mean systolic blood pressure was not significantly related with any of the variables measured. The partial regression coefficient (b +/- s.e.) for diastolic blood pressure on weight was 0.186 +/- 0.062 mm Hg/kg, on height 0.165 +/- 0.056 mm Hg/cm, on pulse rate 0.364 +/- 0.100 mm Hg/beats per min and on outside temperature -0.25 +/- 0.07 mm Hg/degrees C.

Blood Pressure↗

Recommendation for collection of skin puncture blood from children, with special reference to production of reference values.

Reliable reference values need to be collected under standardized conditions. In order to enable comparison of values observed on patients with reference values, it is also desirable to use the same standardized conditions on patients. The present recommendation was produced as a joint effort of representatives of the clinical chemists and paediatricians of Scandinavia and describes the following details. Preparation of the child before specimen collection (food intake, time of day, physical activity, posture, environment), preparation of skin puncture site (warming, disinfection, ointment), instruments for blood collection (lancet, blood collection vessel), site of puncture (plantar surface of foot, finger, ear lobe), collection of emerging blood and handling and storage of the specimen.

Adolescent↗

Early feeding problems in an affluent society. III. Follow-up at two years: natural course, health, behaviour and development.

The aim of this study was to investigate the natural course of later problems and their prevalence in children with early feeding difficulties. Forty-two children with feeding problems without any obvious medical reason during the first year of life were followed up prospectively to the age of two years. Comparisons were made with 42 age- and sex-matched controls. Information was obtained from parental interviews, medical records and assessments of psychomotor development. In 21 (50%) of the children with feeding problems the problems persisted at the age of two years. There were significantly higher frequencies of infections and behavioural problems among the children with early feeding problems than among the controls. No differences in psychomotor development were found. Recurrent infections, behaviour problems and psycho-social problems were significantly correlated with severe persistent feeding problems at the age of two years.

Child Behavior Disorders↗

Early feeding problems in an affluent society. IV. Impact on growth up to two years of age.

A study was undertaken to investigate growth in children with different types of early feeding problems without any obvious medical explanation. Altogether 42 children were studied and followed up to the age of two years. Twenty-five children refused to eat (RTE), nine had colic, seven had vomiting and one child displayed hyperirritability at mealtimes. Comparisons were made with controls matched for sex, age and residential area. Attained weight and length were measured frequently; rates of gain were calculated and the growth variables were transformed to standard deviation scores (SD scores). After the onset of the symptoms the SD scores of attained weight and length decreased significantly in the children with RTE and in those with vomiting (p less than 0.05), and the rate of weight gain was significantly lower in the RTE group than in the control group (p less than 0.001). At two years of age the children with vomiting had recovered and showed a complete catch-up growth, while the RTE group had attained significantly lower SD scores of attained weight (p less than 0.001) and length (p less than 0.001) than the control group. It was found that the risk of growth impairment was greatest in children who refused all food or all food except breast milk.

Body Height↗

Polymorphonuclear neutrophil function and infections following splenectomy in childhood.

22 subjects were controlled 3-23 yr after splenectomy due to childhood trauma (10), idiopathic thrombocytopenic purpura (9) or congenital spherocytosis (3). The control comprised a history of infections, physical examination, routine hematologic values, determinations of serum immunoglobulins, evaluation of complement activities, cultivations from throat and nasopharynx and polymorphonuclear neutrophil (PMN) function tests. 14 patients (63%) had increased susceptibility to recurrent bacterial infections (SBI), most often tonsillitis. All these patients also had abnormal PMN function. The other 8 patients with normal susceptibility to infections showed essentially normal PMN function. There were no differences between these groups with regard to indication for splenectomy, age at splenectomy or the time interval after splenectomy. This abnormal PMN function may explain the raised susceptibility to infections.

Adolescent↗

Early feeding problems in an affluent society. I. Categories and clinical signs.

The aim of this study was to analyse early feeding problems. Fifty infants, between the ages of 3 and 12 months, were reported by the Child Health Centre (CHC) nurse and the parents to have some form of feeding problem, which had been present for at least one month. Data were collected by a visit to the infant's home, from medical records and by interviewing the CHC nurse. Three main problem categories were distinguished: Refusal to eat (28 infants), colic (9 infants) and vomiting (8 infants). The problems had often begun at an early age and had persisted for a long time (mean age at onset 4.3 months, mean duration 4.5 months). Eight of the infants had significant medical disorders, which in seven of them explained the feeding problems. In 23 infants the weight increase had been poor since the commencement of the problems. The CHC nurses considered most of the problems troublesome, difficult to treat and uncommon.

Body Weight↗

Early feeding problems in an affluent society. II. Determinants.

The aim of this investigation was to identify different factors of importance for the occurrence of feeding problems during the first year of life. Forty-two infants, 3-12 months old, with feeding problems without any obvious medical explanation were matched to 42 controls with respect to age, sex and Child Health Centre (CHC) affiliation. Information was obtained by interviewing the parents and from medical records. Four factors emerged as being highly significant, namely "feeding problems presented by the parents during their own infancy" (p less than 0.001), "great anxiety experienced by the mother during the pregnancy" (p less than 0.02), "breast-feeding problems experienced by the mother" (p less than 0.001) and "ill-health in the mother" (p less than 0.001). A special study in which the maternal and paternal grandparents were interviewed, corroborated the parents' information on their own early feeding difficulties. This finding could explain a large proportion of the feeding problems that have no obvious medical origin.

Analysis of Variance↗