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Biomedical subjects

M Jacobsen

Publications and source records attributed to M Jacobsen.

At least 19 recordsLinked to original sources

[Adnexial torsion caused by ovarian hyperstimulation syndrome].

A case of adnexal torsion of an enlarged ovary during early pregnancy after gonadotropin therapy is presented. Adnexal torsion is a rare but serious complication to ovarian hyperstimulation. The diagnosis is difficult, but the combination of ovarian enlargement, abdominal pain, nausea, progressive leukocytosis and anaemia may indicate torsion of the adnex. Prompt diagnosis is important. Simple unwinding of the twisted adnex by a laparoscopic technique has been successful in most cases.

Adnexal Diseases

Chromosome aberrations in Norwegian reindeer following the Chernobyl accident.

Chromosome analyses were carried out on peripheral blood lymphocytes of semi-domestic reindeer in Norway which had been exposed to varying amounts of radiocesium emanating from the Chernobyl accident. The sampling was done in the period 1987-1990. The material included 192 reindeer, originating from four herds in central Norway, an area considerably affected by fallout from the Chernobyl accident, and from three herds in northern Norway which was unaffected by fallout from the accident. Significant heterogeneity in the distribution of chromosome aberrations between herds was observed. The pattern of chromosome aberration frequencies between herds was not related to the variation in radiocesium exposure from the Chernobyl accident. Other factors than the Chernobyl accident appear therefore to be of importance for the distribution of aberration frequencies found among present herds. Within the most contaminated area the reindeer born in 1986 showed significantly more chromosome aberrations than those born both before and after 1986. This could suggest that the Chernobyl accident fallout created an effect particularly among calves, during the immediate post-accident period in the most exposed areas.

Animals

[Behçet's syndrome: an unusual cause of genital erosion].

A case of incomplete mucocutaneous Behçet's disease is presented. In spite of weekly to monthly attacks of genital pain for fifteen years, this diagnostic entity had been ignored. We wish to emphasize that Behçet's disease may be the cause of otherwise unexplained genital erosions. A set of clinical criteria according to an international study group serves to establish the diagnosis. Treatment is controversial. This case has been successfully treated with systemic tetracycline for more than six months.

Adult

The international labour office classification: use and misuse.

The main characteristics of the International Labour Office (ILO) International Classification of Radiographs of the Pneumoconioses (1980) are reviewed. Applications to epidemiological, research, and clinical problems are outlined. The need for multiple readings, reading protocols and appropriate administrative arrangements is emphasized. Possible improvements to the Classification are discussed. The basic descriptive features of the scheme are distinguished from supplementary interpretative facilities; it is suggested that misuse of the Classification occurs primarily when these two functions are confused.

Humans

Partial hydatidiform mole with subsequent trophoblastic tumor; a case report.

A case of partial hydatidiform mole revealed by genetic marker analysis one maternal and two paternal chromosome complements. Levels of serum human chorionic gonadotropin were persistently elevated during follow-up. Avillous curettage specimens prior to chemotherapy were morphologically suspicious for gestational choriocarcinoma. It is still uncertain whether the risk for gestational choriocarcinoma preceded by partial mole exceeds the risk related to non-molar abortions. Careful follow-up with serial serum human chorionic gonadotropin levels is required to detect persistent disease.

Adult

Chromosome aberrations in Norwegian reindeer calves exposed to fallout from the Chernobyl accident.

Chromosome aberrations were analysed in 1222 peripheral blood lymphocytes from 24 reindeer, Rangifer tarandus L., calves from central Norway, where considerable fallout from Chernobyl accident had occurred, and in 1532 lymphocytes from 26 calves from three different districts in Northern Norway which were not affected by fallout from the accident. Three dicentrics, two rings, and three translocations were detected in calves from the exposed area, while no dicentrics, nor rings and only one translocation were detected in the control calves. The frequency of chromatid-type aberrations and chromosome deletions did not significantly differ between the two groups. Although the present study is based on a limited number of observations, the radioactive burden in the exposed reindeer, and the differing character of the chromosome aberrations in the two groups, might indicate that certain genetic effects have occurred as a result of the Chernobyl accident in Norwegian reindeer in the most contaminated areas.

Accidents

DNA flow cytometry in uterine endometrial carcinoma.

The DNA content was investigated by means of flow cytometry in frozen tumor specimens from 33 patients with uterine endometrial carcinoma. The association was tested between ploidy and S-phase fraction on one hand and clinico-pathological parameters on the other. Aneuploidy appeared in 15 (45%) of the patients, and the average S-phase fraction was 0.18 (0.04-0.34). There was a highly significant correlation between DNA-Index (DI) and histologic differentiation (p = 0.01) and a less significant correlation between DI and estrogen receptor content (p = 0.04). DNA ploidy measured by flow cytometry is a highly reproducible parameter that in addition to routine histopathological examination may provide useful information. Further studies are needed to establish the prognostic importance of the flow cytometric parameters.

Carcinoma

Focal changes of the spleen in one case of Gaucher disease--assessed by ultrasonography, CT, MRI and angiography.

Focal lesions of the spleen in one case of Gaucher disease are demonstrated by ultrasonography, CT, MRI and angiography. The sonographic and angiographic features differ from the findings presented in previous reports. The Gaucher manifestations in the spleen as demonstrated by CT, do not seem to have been reported previously. An earlier report on the MR findings in the liver and spleen in this disease did not disclose any focal abnormalities. In this case, ultrasonography and MRI revealed a targetlike configuration of the focal lesions. An attempt is made to analyze the more complex patterns disclosed by MRI against the background of the manifestations by the other imaging modalities and previous reports.

Angiography

The prognostic and therapeutic value of second-look laparotomy in advanced ovarian cancer.

Of 267 patients with ovarian cancer FIGO stages III and IV, 157 underwent second-look laparotomy after combination chemotherapy consisting of cis-platinum and cyclophosphamide with and without doxorubicin. At second-look operation 45% had macroscopic tumour, 15% microscopic tumour, and 40% complete pathological response. Survival 3 years after second look was: complete pathological response 74%; microscopic disease 24%; visible tumour less than 1 cm 28%; visible tumour greater than 1 cm 17%; negative cytology 59%; and positive cytology 18%. Of the patients with macroscopic tumour, 29% had all visible tumour removed at second look. Three-year survival for these patients was about 45%.

Antineoplastic Combined Chemotherapy Protocols

Irregularly shaped small shadows on chest radiographs, dust exposure, and lung function in coalworkers' pneumoconiosis.

The predominant shapes of small opacities on the chest radiographs of 895 British coalminers have been studied. The aims were to determine whether irregular (as distinct from rounded) small opacities can be identified reproducibly, whether their occurrence is related to dust exposure, and whether they are associated with excess prevalence of respiratory symptoms or impairments of lung function. Six of the doctors responsible for regular radiological surveys of all British coalminers each classified all 895 radiographs twice and independently, using the International Labour Organisation's 1980 classification system. The majority view was that 39 films showed predominantly irregular small opacities, 131 showed predominantly small rounded opacities, and 587 showed no small opacities. Readers' opinions varied about the presence and shapes of shadows on the other 138 films. In general, consistency between readers (and within readers on repeated viewings) was satisfactory. The occurrence and profusion of irregular shadows were related significantly both to the men's ages and additionally to their cumulative exposure to respirable coalmine dust as determined from 15 years' dust monitoring close to where the miners had worked. For any given level of exposure, the average level of profusion of the small irregular opacities was less than the corresponding profusion of small rounded opacities. The prevalence rates of chronic cough and phlegm, and of breathlessness, were higher in those with small irregular opacities than in those with no small opacities (category 0/0), but the differences were not statistically significant after adjustment for other factors including smoking habits. The presence of irregular (but not rounded) small shadows was associated with an impairment in respiratory function averaging about 190 ml deficits in both FEV1 and FVC. These deficits were not explicable in terms of the men's ages, body sizes, and smoking habits and they were in addition to the lung function losses attributable to the miners' dust exposure as such. It is concluded that the presence and profusion of small irregular opacities should be taken into consideration when assessing the severity of coalworkers' simple pneumoconiosis.

Age Factors

Clinically important respiratory effects of dust exposure and smoking in British coal miners.

A unique data set of 3,380 British coal miners has been reanalyzed with major focus on nonpneumoconiotic respiratory conditions. The aim was to assess the independent contribution of smoking and exposure to respirable dust to clinically significant measures of respiratory dysfunction. Exposure to coal-mine dust was monitored over a 10-yr period. Medical surveys provided estimates of prior dust exposure and recorded respiratory symptoms. Each man's FEV1 was compared with the level predicted for his age and height by an internally derived prediction equation for FEV1. Four respiratory indices were considered at the end of the 10-yr period: FEV1 less than 80%, chronic bronchitis, chronic bronchitis with FEV1 less than 80%, and FEV1 less than 65%. Results were uniformly incorporated into logistic regression equations for each condition. The equations include coefficients for age, dust, and when indicated, an interaction term for age and dust. Dust-related increases in prevalence of each of the 4 conditions were statistically significant and were similar for smokers and nonsmokers at the mean age (47 yr). There was no evidence that smoking potentiates the effect of exposure to dust. Estimates of prevalences at the mean age of all 4 measures of respiratory dysfunction were greater in smokers. At intermediate and high dust exposure the prevalence of the 4 conditions in nonsmokers approached the prevalence in smokers at hypothetically zero dust exposure. Both smoking and dust exposure can cause clinically important respiratory dysfunction and their separate contributions to obstructive airway disease in coal miners appear to be additive.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Respiratory infections in coal miners exposed to nitrogen oxides.

Coal miners working underground may be exposed chronically to low levels of nitric oxide and nitrogen dioxide from diesel engine emissions and from the use of explosives for blasting. The aims of this study were to establish whether long-term exposures to low concentrations of these gases at nine British coal mines had been associated with increased susceptibility to respiratory infections and, if so, to estimate the relative risks for different levels of exposure. The nine mines concerned had been involved, since 1954, in a prospective epidemiological study of coal miners' health. Median levels of nitrogen oxides in 4,933 pairs of full-shift samples, taken at the mines during the years 1976 through 1982 were 0.2 ppm nitric oxide and 0.03 ppm nitrogen dioxide; 10 percent of the concentrations exceeded 1.1 ppm nitric oxide and 0.08 ppm nitrogen dioxide. Multiple regression estimates of concentrations associated with different underground locations, types of work, and mining conditions at each mine were combined with detailed records of miners' attendance at work at similar locations in earlier years. These retrospective estimates of individuals' underground exposures to nitrogen oxides referred to between five- and 16-year periods of exposure. Also available for study were records of the men's exposures to respirable mine dusts and information from five-yearly medical surveys about their smoking habits, respiratory symptoms, and questionnaire-elicited reports of sickness absences attributed, among other things, to respiratory infections. The reliability of the latter reports was examined in a sample of 471 of the men by comparing the answers to the questionnaire with physicians' diagnoses on certified sickness absence records. Miners' references to bronchitis, influenza, or colds as the cause of prolonged sickness absence during the three years preceding the surveys did, in general, reflect real spells of absence from work, lasting at least seven days, that had been diagnosed by doctors as due to respiratory infections. But only about 20 percent of the men whose colliery records indicated that there had been such an absence acknowledged them in the survey as due to a "chest illness". Most of the under-reporting was of absence certified as due to influenza, colds, or "upper respiratory tract infection", and this under-reporting was not related to the men's ages or smoking habits. The main analyses referred to 5,408 reports of colds, influenza, or bronchitis at a total of 40,071 interviews involving nearly 20,000 miners.(ABSTRACT TRUNCATED AT 400 WORDS)

Absenteeism

Exposure to respirable coalmine dust and incidence of progressive massive fibrosis.

Data gathered since 1953 concerning more than 30,000 coalminers while employed at 24 collieries in England, Scotland, and Wales have been used to study the incidence of progressive massive fibrosis (PMF) in working coalminers. Results refer to 52,264 approximately five year intervals when the miners were at risk of an attack of PMF. One objective of the present study was to describe how the five year attack rate of PMF was related to miners' age, colliery, and simple pneumoconiosis category at the start of the periods at risk. The main objective was to estimate the relation between exposure to dust and incidence of PMF and to examine how this relation changes in the presence of coalworkers' simple pneumoconiosis (CWSP). Film readings, in some cases based on clinical assessments only, showed 462 attacks of PMF over the five year risk periods. The men concerned had experienced higher cumulative exposures to dust than their colleagues of similar age at the same collieries, a result found at 65 of the 68 age colliery groups where an attack had occurred. The association was highly significant statistically. Simple pneumoconiosis clearly predisposed to PMF, with five year attack rates of 13.9%, 12.5%, 4.4%, and 0.2% among men with categories 3, 2, 1, and 0 respectively at the start of the risk periods. Once simple pneumoconiosis category 1 or more had been attained, those with higher cumulative exposure to dust were not at greater risk of an attack of PMF than other men with the same CWSP category. Among most miners, those with category 0, however, the risks of an attack of PMF increased clearly with exposure. Risks of an attack were higher among older men irrespective of CWSP category. In addition, there were large colliery specific variations in incidence related to variations in the carbon content of the coal though not fully explained by them. It is concluded that cumulative exposure to respirable dust is the decisive central factor in the development of PMF. Its effect is primarily in causing simple pneumoconiosis category 1 or higher which predisposes to PMF, though the dust related incidence among men with category 0 is not negligible in view of the large numbers at risk. Continuation of the policy to minimise dust concentrations underground therefore seems the only secure strategy to limit, and eventually eliminate, PMF.

Adult

The histomorphology of Kaposi sarcoma in three homosexual men.

Three homosexual men with acquired immunodeficiency syndrome (AIDS) were referred to Hvidovre Hospital, Copenhagen, during 1981. Biopsies from lymph nodes (case 2), skin (case 1 and 3), oral mucosal membrane (case 1) and lung (case 3) revealed Kaposi Sarcoma (KS). Furthermore, KS was found at autopsy in several other organs in case 3. While the tumor morphology of the lymph nodes, the oral mucosal membrane, and the internal organs was identical to that of classical KS, the skin lesions appeared different. Macroscopically, the skin lesions in case 1 and 3 were alike, but microscopically, the lesions in the two cases differed from each other. In both cases small tumor infiltrates were dispersed in the dermis with interjacent preserved dermal tissue. In case 1 the tumor infiltrates were composed of different vascular structures including irregular slits formed by dermal collagen fibres lined with long slim tumor cells. In case 2 the infiltrates were mainly composed of solid collections of pale tumor cells with faintly stained nuclei. The difficulties in establishing a diagnosis of KS on skin biopsies from patients with AIDS are emphasized.

Acquired Immunodeficiency Syndrome

Dust exposure, pneumoconiosis, and mortality of coalminers.

General mortality in approximately 25 000 British coalminers over 22 year periods ending in 1980 was 13% lower on average than in English and Welsh men in the same regions of Britain. There were significant within region variations between collieries, and standardised mortality ratios increased during the later years of the follow up, approaching or slightly exceeding 100 in most of the 20 coalmines studied. Age specific comparisons of 22 year survival rates were made in subgroups. Relative risks of death from all non-violent causes for men with the earliest stage of progressive massive fibrosis (PMF category A), compared with risks in miners with no pneumoconiosis (category O), ranged from 1.2 in those aged 55-64 initially to 3.5 for those aged 25-34. Mortality in miners with higher categories of PMF (B or C) was even more severe. Survival rates in men with category 1 simple pneumoconiosis were about 2% to 3% lower than in miners with radiographs classified as category O, but there was no consistent evidence of an increase in mortality with increasing category of simple pneumoconiosis. Mortality from all non-violent causes increased systematically with increases in estimates of exposure to dust before the start of the follow up. That gradient was attributable primarily to deaths certified as due to pneumoconiosis and those recorded as due to bronchitis and emphysema (p less than 0.001). There was some evidence of a dust related increase in deaths from cancers of the digestive system (p approximately equal to 0.05), but none of an association between exposure to coalmine dust and lung cancer. Lung cancer mortality, assessed over 17 year periods, was about 5.5 times higher in smokers than in life long non-smokers. Smokers with no pneumoconiosis had slightly higher lung cancer death rates than smokers with pneumoconiosis. We conclude that miners exposed to excessive amounts of respirable coalmine dust are at increased risk of premature death, either from progressive massive fibrosis or from chronic bronchitis or emphysema.

Adult