Biomedical subjects

M Hedegaard

Publications and source records attributed to M Hedegaard.

45 records · Page 3Linked to original sources

PubMed1992

[Aggressive treatment of acute pulmonary embolism. 132 consecutive patients treated with heparin, streptokinase or embolectomy, 1975-1987].

During 1975-1987, 132 patients were treated for acute pulmonary embolism with heparin (n = 41), streptokinase (n = 52), or embolectomy (n = 39). In 1984, the indications for embolectomy were broadened to include all patients with central emboli, also those who were circulatory stable. The heparin-, streptokinase-, and embolectomy groups differed from each other as regards the degree of circulatory impairment (stable circulation/reversible shock/circulatory collapse: 68/32/0% versus 52/48/0% versus 16/56/28%, p less than 0.0001) and embolic score (20 for complete obstruction; 5.6 +/- 3.4 versus 8.7 +/- 2.8 versus 13.2 +/- 2.4, p less than 0.0001), but were comparable in terms of prognosis (30-day mortality/10-year survival +/- standard error: 7%/61 +/- 9% versus 13%/59 +/- 9% versus 18%/61 +/- 10%). Stable circulation, reversible shock, and circulatory collapse prior to embolectomy resulted in 30-day mortalities of 0%, 9%, and 45% respectively (p less than 0.01). During 1984-1987, no early or late deaths after embolectomy were observed in patients without circulatory collapse (n = 10). In comparable patients (embolic score greater than or equal to 9, symptom duration less than or equal to 7 days, no circulatory collapse), streptokinase treatment (n = 13) and embolectomy (n = 25) resulted in 10-year survival +/- standard error of 46 +/- 16% and 82 +/- 10% respectively (p less than 0.0001) and in an embolic score-reduction (score before minus score after treatment) of 5.7 +/- 2.3 and 10.5 +/- 2.9, respectively (p less than 0.0001). Embolectomy during extracorporeal circulation should be considered the treatment-of-choice in patients with acute central emboli.

Acute Disease↗

PubMed1992

Randomised controlled trial of effect of fish-oil supplementation on pregnancy duration.

The high birthweights and long duration of pregnancy in the Faroe Islands led us to suggest that a high intake of marine-fat-derived n-3 fatty acids might prolong pregnancy by shifting the balance of production of prostaglandins involved in parturition. We have compared the effects on pregnancy duration, birthweight, and birth length of a fish-oil supplement, a control olive-oil supplement, and no supplementation. 533 healthy Danish women in week 30 of pregnancy were randomly assigned in a ratio of 2/1/1 to fish oil (four 1 g Pikasol capsules [containing 2.7 g n-3 fatty acids] per day), olive oil (four 1 g capsules per day), or no supplement. The three groups differed in mean length of gestation (p = 0.006), which was highest in the fish-oil group and lowest in the olive-oil group; the result was similar when the analysis was restricted to women with an estimate of gestation length based on early ultrasound findings (443 women). Pregnancies in the fish-oil group were on average 4.0 (95% confidence interval 1.5-6.4) days longer than those in the olive-oil group; the difference in birthweight was 107 (1-214) g. The effect of supplementation on length of gestation was influenced by intake of fish and of fish oil: the difference between fish-oil and other groups was increased by a low fish intake at baseline. Fish-oil supplementation in the third trimester seems to prolong pregnancy without detrimental effects on the growth of the fetus or on the course of labour.

Adult↗

PubMed1992

Episiotomy and perineal lesions in spontaneous vaginal deliveries.

OBJECTIVE: To evaluate the influence of mediolateral episiotomy on the perineal state after spontaneous, singleton vaginal deliveries with fetus in the occiput anterior position. DESIGN: The study was a population based, observational study. Two approaches were used in the analyses. Initially, we considered the parturients as quasi-randomised to one of three equally sized groups of midwives with different attitudes towards episiotomy. Secondly, we studied the effect of episiotomy on the state of the anal sphincter, controlling for birthweight, parity, and duration of second stage of labour. SUBJECTS: 2188 pregnant women delivering consecutively. MAIN OUTCOME MEASURES: Perineal lacerations and tear of the anal sphincter. RESULTS: Women allocated to the group of midwives with the lowest rate of episiotomy were more likely to have intact perineum after delivery (OR = 1.8 (1.4-2.2)), had a slight tendency towards more perineal lacerations (OR = 1.3 (1.0-1.5)), but no increase risk of having tear of the anal sphincter, compared with the women allocated to the two groups of midwives with higher frequencies of episiotomy. The second approach showed that episiotomy was related to an increased risk of tear of the anal sphincter (OR = 2.3 (1.2-4.6)). However, this relation was not found among the group of parturients delivered by the midwives with the lowest rate of episiotomy (22%). CONCLUSIONS: Our results encourage a conservative approach to the use of mediolateral episiotomy, and in the light of previous findings, it seems reasonable to suggest that episiotomy should ideally be used in about one in five spontaneous vaginal deliveries.

Adult↗

PubMed1991

Placental abruption. A case-control investigation.

The course of pregnancy and labour, neonatal outcome and social circumstances, were compared between 87 women with placental abruption and a control group of 5697 women. First and second trimester haemorrhage, amniocentesis, congenital malformations, maternal smoking and a job involving much standing or walking were associated with placental abruption.

Abruptio Placentae↗

PubMed1991

Anxiety in voluntary HIV-antibody testing in pregnancy and its implications for preventive strategies.

During a three-month period in 1989, 820 pregnant women attending the antenatal clinic of the Aarhus University Hospital, Denmark, were offered a HIV-antibody test and asked to fill out an anonymous questionnaire about attitudes to HIV-antibody testing; 779 (95.0%) agreed to do so. One hundred and fifty-six women (20.0% of the participants) had been tested on a previous occasion, and 629 (80.7%) accepted the present offer to be tested. The most prevalent reasons to decline testing were indifference to the epidemic (45.3% of those declining), refusal of (further) blood testing (34.7%) and fear of being infected (16.7%). Women who consented to be tested most often expressed fear of being infected (21.8%). Fear of registration worried less than 5% of study group members; only 1% declined to be tested because of such worry. The pattern of worries expressed by the pregnant women is interpreted as one of anxiety and, in part at least, perplexity as concerns how to take rational consequences of public messages about the HIV epidemic. It is suggested that future surveillance be based primarily on voluntary testing and, whenever needed and possible, supplied with anonymous unlinked testing of existing blood samples from groups and persons declining to be tested. Such surveillance strategies should be supported in individual patient contacts and public health educational campaigns underscoring the risk of heterosexual transmission of HIV and the need for repeated HIV-antibody testing of selected groups and individuals.

AIDS Serodiagnosis↗

PubMed1990

[Acceptance of HIV antibody testing among pregnant women].

During the period April 17-July 14, 1989, 820 pregnant women were offered HIV-antibody testing at the antenatal clinic, Aarhus Municipality Hospital. Seven hundred and seventy-nine (95%) agreed to complete a questionnaire concerning, among other things, previous HIV-antibody testing. 20% of the participants had been tested previously, half of them because they were blood donors. More than 3% had been tested because of self-perceived risk behaviour or a risk environment. In three women, the previous test had shown HIV-antibodies to be present, and three further women refused to report the test result. 81% of the women consented to be tested. Acceptance declined during the project period. Those who had not been tested previously consented more frequently than those who had. Students were less willing to consent than others. Nineteen out of 20 women (2.6%), who considered themselves at high risk, accepted the offer to be tested. Thirty-eight (5%) of the 150 women who declined to be tested, would have accepted if their general practitioner had suggested it. None of the women tested at present were found to be HIV-antibody positive. When the project was terminated, a total of 87% of the women had been HIV-antibody tested previously or at present. We suggest routine HIV surveillance of pregnant women by use of voluntary HIV-antibody testing in combination with anonymous testing (AUT technique) in case the women does not want to know the test result.

Acquired Immunodeficiency Syndrome↗

PubMed1990

[Infusion cavernosography and erectile dysfunction].

Infusion cavernosography with the object of quantitating the rate of venous drainage from the penis and localization of possible abnormities in drainage was employed as a routine investigation in examination of erectile dysfunction in 46 patients. "Infusion to obtain erection" (IOE) and "infusion to maintain erection" (IME) were determined. In five patients, IOE was found to be greater than 180 ml/minute which was considered to be diagnostic of venous leakage. Infusion cavernosography could be assessed in 31 patients. Filling of the glans with the radio-opaque medium was found before rigidity was obtained in 27 whereas, in 19 filling of the glans occurred after rigidity was obtained. No localizing fistulae were demonstrated. It is concluded that routine employment of infusion cavernosography in investigation of impotence is unnecessary. Filling of the glans with the radio-opaque medium in infusion cavernosography does not appear to be a sign of a cavernoso-spongious fistula but rather a physiological phenomenon.

Erectile Dysfunction↗

PubMed1987

A critical reappraisal of cystometry in neurogenic bladder diseases.

Repeated cystometry was performed over an eight hour period in 14 patients with detrusor hyperreflexia. Volumes at first contraction, and at bladder capacity and also bladder compliance showed significant differences within individual variances and an increase in standard deviation in relation to increase in mean value. Amplitude of contractions showed equal variances in all patients. After a logarithmic transformation of the measurements the volume at first bladder contraction showed a significant increase (p less than 0.02) from the first to the second investigation performed an hour later. Determination of sample size in clinical trials using the pooled estimate of the standard deviations is discussed.

Adolescent↗

PubMed1987

Diuresis renography and simultaneous renal pelvic pressure in hydronephrosis.

We investigated 23 hydronephrotic kidneys in 10 male and 12 female patients (mean age 32 years) with diuresis renography and simultaneous, continuous renal pelvic pressure measurement to compare isotope washout with pelvic pressure changes. No correlation was found between these 2 parameters. Of the kidneys 14 were investigated further by a standard Whitaker pressure flow study. There was only a poor correlation between diuresis renography and the pressure flow study, and between the pelvic pressures during perfusion and forced diuresis. Impaired renal uptake fraction signifying the degree of obstructive nephropathy did not correlate with the dynamic tests. An Anderson-Hynes pyeloplasty was done in 19 patients. There was no correlation between the presence of organic stenosis or external compression and the outcome of the diagnostic tests. We concluded that the currently used diagnostic procedures for hydronephrosis generally are insufficient to discriminate between significant and nonsignificant obstruction.

Adult↗