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Biomedical subjects

N Milman

Publications and source records attributed to N Milman.

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

Iron status in Danes updated 1994. I: prevalence of iron deficiency and iron overload in 1332 men aged 40-70 years. Influence Of blood donation, alcohol intake, and iron supplementation.

Iron status, S-ferritin, and hemoglobin (Hb) were assessed in a population survey in 1994 (DAN-MONICA 10) comprising 1332 Caucasian Danish men equally distributed in age cohorts of 40, 50, 60 and 70 years. Blood donors (n=186) had lower S-ferritin, median 76 microg/l, than nondonors, median 169 microg/l (p<0.0001). S-ferritin in donors was inversely correlated with the number of phlebotomies (r(s)=-0.57, p<0.0001). S-ferritin in nondonors (n=1146) was similar in men 40-60 years of age, median 176 microg/l, and subsequently decreased at 70 years of age to a median of 146 microg/l (p=0.01). In the entire series, the prevalence of small iron stores (S-ferritin 16-32 microg/l) was 2.7%, that of depleted iron stores (S-ferritin <16 microg/l) 0.45%, and that of iron deficiency anemia (S-ferritin <13 microg/l and Hb <129 g/l) 0.15%. Among nondonors, the prevalence of iron overload (S-ferritin >300 microg/l) was 20%. S-ferritin in nondonors correlated with body mass index (r(s)=0.19, p=0.0001) and with alcohol intake (r(s)=0.26, p=0.0001). In the entire series, 28% of the subjects took supplemental iron (median 14 mg ferrous iron daily). Iron supplements had no influence on iron status. Nondonors (n=170) treated with acetylsalicylic acid had lower S-ferritin, median 136 microg/l, than nontreated, median 169 microg/l (p<0.001) and those treated with H(2)-receptor antagonists (n=30) had lower S-ferritin, median 142 microg/l, than nontreated, median 171 microg/l (p<0.04). Compared with the DAN-MONICA 1 iron status survey of Danish men in 1984, the prevalences of iron depletion and iron deficiency anemia are unchanged whereas the prevalence of iron overload has increased significantly. In Denmark, iron fortification of flour was abolished in 1987. This apparently had no negative effect on iron status in men.

Adult↗
PubMed1999

Relationship between serum ferritin and risk factors for ischaemic heart disease in 2235 Danes aged 30-60 years.

OBJECTIVES: The aim was to examine the relationships between serum ferritin and risk factors for ischaemic heart disease (physical activity, body mass index, tobacco smoking, alcohol consumption, serum total cholesterol, serum triglycerides, serum high-density lipoprotein (HDL) cholesterol, systolic and diastolic blood pressures). DESIGN: Epidemiological population survey performed at the Copenhagen County Centre for Prevention of Disease in 1982-84. SUBJECTS: The participants were selected at random from the census register and comprised 2235 healthy Caucasian Danes, all non-blood-donors (1044 men and 1191 women), in cohorts of 30, 40, 50 and 60 years of age. The participants gave a detailed medical history and had a clinical examination including blood samples. MAIN OUTCOME MEASURES: In both men and women, all risk factors displayed a significant increase with age. In men aged 40-60 years, significant positive associations were found between serum ferritin and the following risk factors: body mass index, alcohol intake, serum triglycerides, and systolic and diastolic blood pressures. There was a significant negative association between serum ferritin and tobacco smoking. There was no association between serum ferritin and physical activity, serum total cholesterol or serum HDL cholesterol. In women aged 40-60 years, significant positive associations were found between serum ferritin and the following risk factors: body mass index, alcohol intake and serum triglycerides. There was no association between serum ferritin and physical activity, tobacco smoking, serum total cholesterol, serum HDL cholesterol or blood pressure. CONCLUSIONS: Associations were found between serum ferritin and some risk factors for ischaemic heart disease in men and women. The clinical significance of these findings remains to be clarified. One may hypothesize that the 'missing link' between serum ferritin and ischaemic heart disease in men is the relationship between serum ferritin, serum triglycerides and blood pressure.

Adult↗
PubMed1999

A longitudinal study of serum ferritin in 319 adolescent Danish boys and girls examined in 1986 and 1992.

This study examined trends in iron status in adolescents. Serum ferritin was measured in 1986 and 1992 in 319 Danes (161 males) stratified into 5 groups: I. median age 9 yr in 1986 vs. 15 yr in 1992; II. 11 vs. 17 yr; III. 13 vs. 19 yr; IV. 15 vs. 21 yr; V. 17 vs. 23 yr. Males in group I demonstrated no change in ferritin or estimated iron stores in mg/kg; groups II-V displayed an increase in iron status parameters. All groups showed an increase in estimated total iron stores. Changes in iron status parameters were inversely correlated with height velocity in group III, and positively correlated with height velocity in group V. Females in age groups I and II demonstrated a fall in ferritin and estimated iron stores in mg/kg in association with menarche; values were unchanged in groups III and IV, and increased in group V. All groups showed an increase in estimated total iron stores. Changes in iron status parameters were inversely correlated with height velocity in groups I and II. In conclusion, ferritin levels in adolescents display great variation during growth spurt and at menarche. Changes in ferritin showed no consistent association with growth velocity. In both genders, estimated total iron stores increased with age.

Adolescent↗
PubMed1999

Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation.

BACKGROUND: Iron supplementation in pregnancy is a controversial issue. The aim of this review was to summarize the results of relevant papers on this subject. METHODS: Placebo-controlled studies on iron treatment in pregnancy were identified from the Cochrane database. RESULTS: Among fertile women, 20% have iron reserves of >500 mg, which is the required minimum during pregnancy; 40% have iron stores of 100-500 mg, and 40% have virtually no iron stores. The demand for absorbed iron increases from 0.8 mg/day in early pregnancy to 7.5 mg/day in late pregnancy. Dietary iron intake in fertile women is median 9 mg/day, i.e. the majority of women have an intake below the estimated allowance of 12 18 mg/day. Iron absorption increases in pregnancy, but not enough to prevent iron deficiency anemia in 20%, of women not taking supplementary iron. Iron-treated pregnant women have greater iron reserves, higher hemoglobin levels, and a lower prevalence of iron deficiency anemia than placebo-treated women both in pregnancy as well as postpartum. Furthermore, children born to iron-treated mothers have higher serum ferritin levels than those born to placebo-treated mothers. An iron supplement of 65 mg/day from 20 weeks of gestation is adequate to prevent iron deficiency anemia. CONCLUSIONS: In order to avoid iron deficiency in pregnancy, prophylactic iron supplement should be considered. Iron supplements may be administered on a general or selective basis. The selective approach implies screening with serum ferritin in early pregnancy, in order to identify women who can manage without prophylactic iron.

Adult↗
PubMed1998

[The prognostic value of thrombocytosis in patients with primary lung cancer].

The prognostic information provided by platelet counts was studied in 1115 patients with primary lung cancer and in 550 control patients with benign lung disorders. Patient records were retrospectively reviewed regarding histological tumour type, TNM stage, thromboembolic episodes and survival. The prevalence of thrombocytosis (platelet count > 400 x 10(9)/l) in patients with lung cancer was 32.1% vs. 6.4% in controls (p < 0.0001). Platelet counts increased with TNM stage (p < 0.0001). Patients with thrombocytosis had a shorter survival than patients with normal platelet count (p < 0.0001). Thrombocytosis was a predictor of short survival also when adjusted for tumour type, sex, age, and TNM stage (p < 0.001). The platelet count and the frequency of thrombocytosis declined after tumour resection (p < 0.0001). Thrombocytosis was not associated with thromboembolism. In conclusion, thrombocytosis is a clinically significant prognostic indicator regarding survival in patients with primary lung cancer.

Adult↗
PubMed1998

[The correlation between serum ferritin, alcohol consumption and social status in a population of 2235 Danes].

The objective was to examine the relationships between serum ferritin, alcohol consumption and sociodemographic factors (school education, occupational education, occupation, income, marital status, cohabituary status, housing, social class) in a survey performed in Copenhagen County during 1982-1984. The participants, selected at random, comprised 2235 Danish Caucasian individuals, all non-blood-donors (1044 men, 1191 non-pregnant women) in cohorts 30, 40, 50 and 60 years old. In all age groups, men had significantly higher serum ferritin and alcohol consumption than women. In men, there was no relationship between serum ferritin and social class. Significant relationships were observed between ferritin and occupation (unemployed and self-employed men had the highest ferritin and ferritin and income (ferritin increased with income). None of the social variables were associated with the prevalence of small or absent iron stores (serum ferritin < or = 30 micrograms/l) or abundant iron stores (serum ferritin > 300 micrograms/l). Alcohol consumption displayed relationships to occupation and become, but not to social class. In women, none of the social variables showed any relationship to ferritin levels or iron overload. The prevalence of small iron stores was lower and the make of alcohol was higher in women from high social classes. In both men and women, serum ferritin displayed significant positive correlations with alcohol consumption. Likewise, the prevalence of iron overload was closely correlated to alcohol consumption. In conclusion, sociodemographic factors per se had a minor influence on serum ferritin levels and iron status in Danes. The distinct association between alcohol consumption and serum ferritin should be considered in future epidemiological iron status surveys.

Adult↗
PubMed1998

Serum ferritin, hemoglobin, and Helicobacter pylori infection: a seroepidemiologic survey comprising 2794 Danish adults.

BACKGROUND & AIMS: Helicobacter pylori infection was recently associated with iron-deficiency anemia. The aim of this study was to examine the relationship between H. pylori infection, hemoglobin, and iron status using serum ferritin as a marker for total body iron. METHODS: Serum ferritin, hemoglobin, and immunoglobulin G (IgG) antibodies against H. pylori were assessed in 2794 Danish adults who attended a population survey. IgG antibodies were measured with an in-house enzyme-linked immunosorbent assay, serum ferritin with an immunoradiometric assay, and hemoglobin with Coulter-S. RESULTS: The seroprevalence of H. pylori infection did not relate to hemoglobin. Serum ferritin levels were significantly lower in men (114 vs. 120 microg/L; P = 0.01) and in postmenopausal women (63 vs. 77 microg/L; P = 0.02) who were IgG positive than in seronegative individuals. IgG-positive people more often had reduced serum ferritin levels (</=30 microg/L) than seronegative people. This association persisted in multivariate analysis after adjusting for possible confounding factors (odds ratio, 1.4; 95% confidence interval 1.1-1. 8). CONCLUSIONS: Serum ferritin levels are reduced in people with increased IgG antibodies to H. pylori. H. pylori infection affects iron metabolism in humans.

Adult↗
PubMed1998

Elements in autopsy liver tissue samples from Greenlandic Inuit and Danes. I. Sulphur, chlorine, potassium and bromine measured by X-ray fluorescence spectrometry.

The purpose of this study was to measure the content of the elements Sulphur (S), Chlorine (C1), Potassium (K) and Bromine (Br) in normal liver tissue samples from Greenlandic Inuit using X-ray fluorescence spectrometry, and compare the results with those obtained in normal liver tissue samples from Danes. Liver tissue sample were obtained at autopsy from 50 Greenlandic Inuit (27 men, 23 women) with a median age of 61 years (range 20-83) and from 74 Danes (44 men, 30 women) with a median age of 52 years (range 15-87). In Inuit, the content of elements given as median and (5-95 percentile) was: sulphur, 108.07 mmol/kg dry liver (86.78 - 169.44); chlorine, 92.16 mmol/kg dry liver (45.39-128.42); potassium, 181.66 mmol/kg dry liver (146.41-236.35); bromine, 0.0901 mmol/kg dry liver (0.0563-0.1589). In Danes, the corresponding values were: sulphur, 147.58 mmol/kg dry liver (70.41-236.81); chlorine, 96.95 mmol/kg dry liver (54.01-162.52); potassium, 198.40 mmol/kg dry liver (150.68-256.37); bromine, 0.1101 mmol/kg dry liver (0.0701 - 0.4203). None of the elements displayed any significant gender difference, neither in Inuit nor in Danes. Inuit had a lower liver content of sulphur (p < 0.0001), potassium (p < 0.008) and bromine (p < 0.002) as compared with Danes.

Adult↗
PubMed1998

Serum concentrations of lignocaine and its metabolite monoethylglycinexylidide during fibre-optic bronchoscopy in local anaesthesia.

Fibre-optic bronchoscopy was performed in local anaesthesia using lignocaine. Serum concentrations of lignocaine and its active metabolite monoethylglycinexylidide (MEGX) were measured in 16 patients at regular intervals up to 120 min after administration. Lignocaine was administered as an aerosol in the upper respiratory tract and as a solution in the bronchial tree. The total dose of lignocaine ranged from 243 to 608 mg (2.4-8.0 mg kg-1 body weight). The dose of lignocaine given as an aerosol ranged from 163 to 508 mg (1.6-6.6 mg kg-1) and the dose given as a solution ranged from 60 to 180 mg (0.8-2.5 mg kg-1). The highest median serum lignocaine concentration, 10.5 mumol l-1, was measured 20 min after administration. None of the patients had toxic serum lignocaine levels (> 26 mumol l-1) or adverse effects. The highest median serum MEGX concentration, 1.7 mumol l-1, was measured 120 min after administration. The dose of lignocaine, expressed in mg per kg body weight correlated with serum lignocaine and serum MEGX (rs = 0.47 and rs = 0.39, respectively). Lignocaine is a clinically safe, local anaesthetic agent provided the total dose does not exceed 6-7 mg kg-1 body weight.

Aged↗
PubMed1998

Idiopathic pulmonary haemosiderosis. Epidemiology, pathogenic aspects and diagnosis.

Idiopathic pulmonary haemosiderosis (IPH) is a rare clinical entity characterized by recurrent episodes of diffuse alveolar haemorrhage, often presenting with haemoptysis. Many patients have iron deficiency anaemia due to deposition of haemosiderin iron in the alveoli, and eventually develop moderate pulmonary fibrosis. Typically, intensive search for an aetiology ends up negative. There is no evidence of pulmonary vasculitis or capillaritis. The aetiology is obscure, but may be an immunological or toxic mechanism causing a defect in the basement membrane of the pulmonary capillary. IPH affects both children and adults. During an acute episode, a chest X-ray demonstrates bilateral, alveolar infiltrates. Sputum examination discloses haemosiderin-laden alveolar macrophages. Diagnosis is established by lung biopsy (fiber-optic or thoracoscopic), showing large numbers of haemosiderin-laden macrophages in the alveoli and without evidence of capillaritis or deposition of immunoglobulins. Corticosteroids and/or immunosuppressive drugs may be effective during an acute bleeding episode, and may in some patients improve symptoms and prognosis on the long-term, but the response to treatment displays great interindividual variation.

Adrenal Cortex Hormones↗
PubMed1998

Pulse oximetry at fibre-optic bronchoscopy in local anaesthesia: indication for postbronchoscopy oxygen supplementation?

The requirement for supplementary oxygen (O2) after fibre-optic bronchoscopy (FOB) was evaluated by means of pulse oximetry in 34 patients (19 men) of median age 62 years (range 28-85) who had had a diagnostic FOB. The patients were allocated at random into two groups, each of 17 persons, which were comparable concerning sex, age and the dose of benzodiazepine (diazepam tablets 10 mg 1 h before FOB and midazolam 2-5 mg i.v. during FOB) used for premedication. Patients in group 1 had lower pulmonary function (FEV1, FVC as a percentage of predicted values) than patients in group 2 (P < 0.02). The oxygen saturation of the haemoglobin (SpO2) in the tip of the index finger was recorded continuously for 30 min after the administration of oral diazepam, during FOB and for 120 min after the FOB procedure. All patients received nasal O2 supplement 21 min-1 during FOB. After FOB, O2 was discontinued in group 1, while group 2 continued to receive O2 21 min-1 for 120 min. The incidence of hypoxaemic episodes (SpO2 < or = 90% for a period of a minimum of > or = 12 s) after oral diazepam, before FOB, was similar in the two groups, 35%. After FOB, the incidence of hypoxaemic episodes was 88% in group 1 and 41% in group 2 (P < 0.01). The cumulated duration of hypoxaemia after FOB was a median of 30 s (range 0-7140) in group 1 and a median of 0 s (0-156) in group 2 (P < 0.0001). Impaired lung function (FEV1 < 75% of predicted value) was a risk factor for hypoxaemia. Postbronchoscopy, O2 supplement should be administered to sedated patients with impaired lung function until the patients have fully recovered.

Adult↗
PubMed1998

Microalbuminuria in patients with lung cancer.

In a prospective study of 102 outpatients with histologically proven lung cancer, the prevalence and prognostic significance of microalbuminuria (urinary albumin excretion > 20 micrograms/min) were analysed. 65 consecutive outpatients with benign lung disorders served as controls. An immunoturbidimetric assay, sensitive at low concentrations, was used to quantify the albumin excretion rate in timed overnight urine samples. Patients with malignancies had a significantly higher frequency of microalbuminuria (32.4% compared with controls, 13.8%, P < 0.01) and median urinary albumin excretion rate (13.4 versus controls, 8.9 micrograms/min, P < 0.003). Urinary albumin excretion was significantly higher in lung cancer patients with TNM stage III and IV. Patients with malignancies and microalbuminuria had a significantly lower survival rate than patients with normoalbuminuria (probability of survival 1 and 3 years after diagnosis 66% and 16% versus controls, 22% and 4%, P < 0.00001). In a multivariate model, which adjusted for age, sex, performance status, histological type and TNM stage, microalbuminuria continued to be a significant predictor of survival. In conclusion, an increased prevalence of microalbuminuria has been demonstrated in patients with lung cancer. The presence of microalbuminuria was associated with advanced disease stage and poor survival.

Albuminuria↗
PubMed1998

Dietary and non-dietary factors associated with iron status in a cohort of Danish adults followed for six years.

OBJECTIVE: To examine the association between food intake and serum ferritin over time. DESIGN: Two hundred and thirty-eight individuals, at baseline aged 35, 45, 55 and 65 y, had their food intake assessed by a short food frequency questionnaire and a diet history interview, and serum ferritin measured, first in 1987/88, and again in 1993/94. SETTING: The County of Copenhagen, Denmark. RESULTS: Apart from intake frequencies of alcoholic beverages dietary items were poor predictors of serum ferritin. Besides food intake serum ferritin was associated with blood donation in men, and with menopausal status in women. CONCLUSIONS: For this middle-aged population, information on alcohol intake and blood loss may be used to rank individuals in relation to iron status, whereas information on intake frequency of dietary items may not.

Adult↗
PubMed1998

Sarcoidosis in children. Epidemiology in Danes, clinical features, diagnosis, treatment and prognosis.

This paper reviews current knowledge of childhood sarcoidosis with regard to the epidemiology in Danes, clinical presentation, diagnostic procedures, treatment and prognosis. Sarcoidosis is a granulomatous disease of unknown aetiology, with multiorgan involvement. The diagnosis is confirmed by the demonstration of epitheloid cell granulomas in tissue biopsy specimens. During the period 1980-92, three cases of childhood sarcoidosis were recorded in Copenhagen County, which has a total population of 610,000. The approximate incidence of clinically recognized sarcoidosis in Danish children younger than 15 y of age was 0.22-0.27/100,000 children per year, corresponding to approximately three new cases in Denmark each year. The true incidence is unknown, since the disease is often asymptomatic and resolves without a clinical diagnosis being made. In children younger than 5 y of age, the disease is characterized by involvement of skin, eyes and joints, whereas in older children involvement of lungs, lymph nodes and eyes predominate. The mainstay of treatment consists of oral corticosteroids. The risk/benefit ratio of using long-term corticosteroids needs to be evaluated in each individual patient. Some patients may benefit from additional therapy with methotrexate. The long-term prognosis is not well established, but it seems to be poorer in children younger than 5 y. Older children appear to have as favourable a prognosis as young adults.

Age Factors↗
PubMed1998

Oral and inhaled corticosteroids in the treatment of pulmonary sarcoidosis--a critical reappraisal.

Oral corticosteroids are widely used in patients with pulmonary sarcoidosis, but no consensus has yet been reached on their place in the management of the disease. Over the short term, oral corticosteroids can improve respiratory symptoms, chest X-ray, lung function and biochemical markers of disease activity. However, over the long term, there is no conclusive evidence of an effect on the development of irreversible pulmonary damage. In many patients the lung is the only organ displaying clinically significant impairment of function, and prognosis is closely associated with pulmonary status. The localization of the inflammation in the lungs is predominantly "bronchocentric", and the disease is accompanied by a lymphocytic alveolitis. Due to these features, and a low frequency of side effects, it should be evaluated as to whether inhaled corticosteroids may influence the outcome of the disease. Two double-blind, placebo-controlled studies have examined the effect of inhaled budesonide 1.2 to 2.0 mg/day given for 6 to 12 months to patients with pulmonary sarcoidosis stage I, II or III. In one study there was no effect on any of the recorded parameters (symptoms, chest X-ray, lung function, 67Gallium scan, biochemistry). In the other study there was a favourable effect only on inspiratory vital capacity but not on any of the other parameters. The number of patients who had to be switched to oral corticosteroids was similar in the budesonide and placebo groups. Due to spontaneous recovery from the disease, an improvement was seen in symptoms and biochemical measures in both the budesonide and placebo groups. At present it has not been clarified as whether there is a place for inhaled corticosteroids in the treatment of pulmonary sarcoidosis. Until convincing evidence in favour of inhaled corticosteroids has been presented, these drugs should not be recommended as a routine treatment for pulmonary sarcoidosis.

Administration, Inhalation↗
PubMed1998

Chlamydia pneumoniae and possible relationship to asthma. Serum immunoglobulins and histamine release in patients and controls.

Chlamydia pneumoniae (C.pn.) is claimed to be of importance for the development of bronchial asthma in previously healthy individuals. This is a new and speculative theory. Earlier studies have mainly focused on C.pn. and exacerbation of asthma. If this new theory were true, one would expect titres of C.pn.-specific IgG to be higher or more common in patients compared with controls. It would also seem probable that pathobiological mechanisms as found in connection with other microorganisms could be demonstrated, i.e. presence of C.pn.-specific IgE and the capability of C.pn. to induce or enhance histamine release from basophil leukocytes. We therefore examined C.pn.-specific IgE, IgG and IgM in sera from 22 adults with bronchial asthma and 25 healthy controls. IgE was verified by passive sensitization of basophils from umbilical cord blood. The prevalence of IgE was approx. 69% and IgG approx. 23% in both groups. IgG-titres were between 1:16 and 1:64 in both groups. No IgM was found. Further, C.pn. could neither induce nor enhance histamine release from basophil leukocytes of patients or controls. We conclude that patients with bronchial asthma and healthy controls do not differ in relation to 1) C.pn.-specific IgE in sera, 2) the capability of C.pn. to induce or enhance histamine release from basophil leukocytes, since no such effect was found, or 3) previous C.pn. infection judged by the presence of specific IgG antibodies. Our results cannot support the theory that C.pn. is a cause of adult-onset asthma.

Adolescent↗
PubMed1997

[Iron requirements and iron balance during pregnancy. Is iron supplementation needed for pregnant women?].

Among fertile, nonpregnant, Danish women, 33% have absent or reduced iron stores; 22% have serum ferritin values above 70 micrograms/l, i.e., iron reserves of more than 530 mg, corresponding to the net iron losses during a normal pregnancy. During pregnancy, the demands for absorbed iron increase from 0.8 to 7.5 mg/day. Controlled studies show that iron-treated pregnant women have higher serum ferritin levels, i.e., larger iron stores, and higher haemoglobin levels than placebo-treated women. A supplement of 66 mg ferrous iron daily from the beginning of the 2nd trimester prevents iron deficiency anaemia. In Denmark, general iron prophylaxis with 60-70 mg ferrous iron daily from 20 weeks of gestation is recommended by the health authorities.

Anemia, Iron-Deficiency↗