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Biomedical subjects

N Milman

Publications and source records attributed to N Milman.

At least 73 records · Page 4Linked to original sources
PubMed1996

Prevalence and prognostic significance of proteinuria in patients with lung cancer.

The purpose of the present study was to ascertain the prevalence and prognostic significance of proteinuria in patients with lung cancer. Results of urinary dipstick testing were retrospectively reviewed in 1026 consecutive out-patients with histologically proven primary lung cancer and 475 consecutive out-patients with benign pulmonary disorders. Postoperative urinary dipstick test results were recorded in 243 surgically resected patients. Proteinuria was significantly more frequent in patients with lung cancer than in controls (30.1% vs 8.8%, p < 0.0001). The presence of proteinuria was significantly correlated with advanced disease stage (p < 0.0001). The frequency of proteinuria was significantly higher in patients with small cell carcinoma than in patients with other histologic types (p < 0.01). In the surgically resected patients, preoperative and postresection proteinuria occurred in 25.5% and 10.7% respectively (p < 0.0001). Patients with malignancies and proteinuria had significantly poorer survival than patients with normal urinary protein excretion (p < 0.0001). In a multivariate analysis including TNM stage, histologic type, sex, and age, proteinuria continued to be a significant predictor of reduced survival time. Our results suggest a high prevalence of increased urinary protein excretion in patients with primary lung cancer. Proteinuria may also be an independent predictor of poor survival.

Adult↗
PubMed1995

[Iron status markers in pregnant women. No clinically significant connection between the values during the second trimester, later in pregnancy and after delivery].

The aim of this randomized, double blind, placebo controlled parallel study was to evaluate whether iron status markers in pregnant women, measured early in the second trimester, could be used to predict levels later in pregnancy, and post partum. One hundred and twenty healthy pregnant women between 14 and 18 weeks of gestation were included. Sixty-three women were allocated to treatment with tablets containing 66 mg ferrous iron (as fumarate) daily, and 57 women to treatment with placebo. Haemoglobin, serum transferrin saturation, and serum ferritin were measured every fourth week during gestation, prior to delivery, one week and eight weeks post partum. Correlation matrices during pregnancy and post partum were calculated for each iron status marker, both in iron and placebo treated women. Haemoglobin, transferrin saturation and serum ferritin values at inclusion displayed steadily declining correlation coefficients with values obtained later in pregnancy. There were no clinically relevant correlations to values obtained eight weeks or less prior to delivery, or post partum. Serum ferritin values at inclusion could not be used to predict values later in pregnancy or post partum. Haemoglobin, transferrin saturation and serum ferritin values measured in the beginning of the second trimester appear unsuitable as guidelines for an individual iron prophylaxis during the remaining period of pregnancy.

Biomarkers↗
PubMed1995

[Percutaneous transthoracic needle aspiration biopsy. Diagnostic yield after negative fiberoptic bronchoscopy in patients with peripheral pulmonary infiltrations].

The diagnostic potential of secondary transthoracic needle biopsy (TNB) following negative fiberoptic bronchoscopy in patients with peripheral circumscribed pulmonary lesions was evaluated in a retrospective study. The records from 224 patients who had TNB performed over a five-year period were reviewed. Of these, 103 patients met the criteria for inclusion in this series. The overall diagnostic yield of TNB in malignancy was 73.8% (54 of 73 patients). TNB allowed cytological classification of the tumour type in 72.2% (39 of 54 patients). Five of the 54 patients (9.3%) presented with small cell anaplastic bronchogenic carcinoma, diagnosed by TNB, and were treated with chemotherapy. Of the 49 patients with a negative TNB, 27 went on to diagnostic surgical procedures; 19 had malignancy, three benign tumour, two infection, and three sequelae after pulmonary infarction. The remaining 22 patients with undiagnosed lesions were followed long term, five showed progression of the pulmonary lesion suggesting malignancy. TNB appeared unsuitable in the diagnosis of benign lesions. Unspecific inflammation was not considered evidence of benignity, and therefore a definitive benign diagnosis was not made by TNB in this series. There were no serious complications to TNB. In 18.1% of the procedures a pneumothorax developed, indicating a chest tube in 8.6% of the procedures. TNB is a suitable diagnostic procedure with a high diagnostic yield in patients with peripheral, malignant pulmonary lesions.

Adult↗
PubMed1995

[Preclinical hereditary hemochromatosis--is there an indication for preventive screening?].

A 54 year-old previously healthy woman was admitted with staphylococcus aureus septicaemia. The patient had been treated with oral iron supplementation for two years due to fatigue. In the evaluation of postinfectious anaemia, serum transferrin saturation and serum ferritin were found persistently elevated with values of 74% and 950 micrograms/1, respectively. Hereditary haemochromatosis was suspected even though there was no history of liver disease or diabetes mellitus in the family. A bone marrow biopsy showed a normal content of haemosiderin iron. The liver biopsy revealed haemosiderosis, mainly located to the periportal hepatocytes, and fibrosis in the portal tracts. The HLA-type was A3, B7, B37. Over a period of ten months, a total of 3.9 g of iron was removed by venesection while S-ferritin declined to 31 micrograms/l. A sister to the proband had an identical HLA type, but normal iron status markers, either indicating heterozygosity or homozygosity with lack of penetrance. In preclinical hereditary haemochromatosis, early diagnosis and treatment is essential in order to prevent organ damage and to improve prognosis. Prophylactic screening is recommended. The identification of one homozygous subject in a Danish year-cohort of 60.000 persons costs approximately 40.000 Danish kroner (7.000 US+).

Denmark↗
PubMed1995

Iron status in young Danish men and women: a population survey comprising 548 individuals.

Iron status was assessed by measurement of serum (S-) ferritin and hemoglobin (Hb) in 548 randomly selected healthy Danes (264 men, 284 women) with a median age of 25 years (range 16-31). S-ferritin values in men displayed a gradual increase with age, and at all ages, men had higher values than women. Iron deficiency (i.e., S-ferritin < 16 micrograms/l) was observed in 0.8%; none had iron deficiency anemia (i.e., S-ferritin < 16 micrograms/l and Hb < 129 g/l). Daily iron supplementation was used by 15.5%. The frequency of iron deficiency was 0% in supplement users vs 0.9% in nonusers. The frequency of preclinical hereditary hemochromatosis was 0.38%. There was a slight insignificant increase in S-ferritin values of women with age. Iron deficiency was observed in 14.7% of 16- to 19-year-olds, in 9.2% of 20- to 24-year-olds, and in 8.6% of 25- to 31-year-old women (p < 0.01), and iron deficiency anemia (i.e., S-ferritin < 16 micrograms/l and Hb < 121 g/l) in 14.7%, 3.4%, and 3.7%, respectively (p < 0.01). Daily iron supplementation was used by 21.5%. The frequency of iron deficiency in users was 4.9% vs. 10.8% in nonusers, and the frequency of iron deficiency anemia 1.6% in users vs. 5.8% in nonusers. The results indicate a satisfactory iron status in young men. There is a high frequency of iron deficiency in young women, suggesting that preventive measures should be considered in this risk group.

Adolescent↗
PubMed1995

Iron status markers during pregnancy. No relationship between levels at the beginning of the second trimester, prior to delivery and post partum.

OBJECTIVE: To evaluate whether levels of iron status markers (haemoglobin, serum transferrin saturation, serum ferritin) in pregnant women, measured in the beginning of the second trimester, could be used to predict levels later in pregnancy, pre partum and post partum. DESIGN: Randomized, double-blind, placebo-controlled parallel study. SETTING: The Birth Clinic at the Department of Obstetrics, Herning Hospital, Herning, Denmark. SUBJECTS: One hundred and twenty healthy pregnant women between 14 and 18 weeks of gestation. INTERVENTIONS: Sixty-three women were allocated to treatment with tablets containing 66 mg ferrous iron (as fumarate) daily, and 57 women to treatment with placebo. MAIN OUTCOME MEASURES: Haemoglobin, serum transferrin saturation, and serum ferritin were measured every 4th week during gestation, prior to delivery, and 1 and 8 weeks post partum. RESULTS: Correlation matrices during pregnancy and post partum were calculated for each iron status marker separately in iron-treated and placebo-treated women. Haemoglobin, transferrin saturation and serum ferritin values at inclusion displayed steadily declining correlation coefficients with values obtained later in pregnancy. There were no clinically relevant correlations to values obtained 8 weeks or less prior to delivery, and no correlations to values post partum. Serum ferritin values at inclusion could not be used to predict values later in pregnancy or post partum. CONCLUSION: Haemoglobin, transferrin saturation and serum ferritin values measured in the beginning of the second trimester appear to be unsuitable as guidelines for an individual iron prophylaxis in pregnant women.

Adult↗
PubMed1995

A longitudinal study of iron status in healthy Danish infants: effects of early iron status, growth velocity and dietary factors.

In a cohort of term infants (n=91), followed from birth to 12 months, iron intake was examined by 24-h food records, and iron status by blood samples (haemoglobin (Hb)), mean corpuscular volume (MCV), serum values for iron, ferritin and transferrin, and erythrocyte protoporphyrin) at 2, 6 and 9 months. At 9 months of age, 5% had anaemia (Hb<105 g/l), but none had developed iron deficiency according to strict definitions used in this study (serum ferritin < 13 micrograms/l and transferrin saturation < 10%). Infants with high serum ferritin, serum transferrin and erythrocyte protoporphyrin values at one blood sampling also had high values at the following sample (tracking, r=0.45-0.80), suggesting that iron stores at delivery are an important determinant of iron stores during late infancy. Factors related to changes in serum ferritin were investigated by multiple linear regression. From 2 to 6 months, serum ferritin was negatively associated with knee-heel growth velocity (p=0.006) and positively with intake of infant formula (p=0.04). From 6 to 9 months it was negatively associated with intake of bread (p=0.001), and there was a trend for a positive association with intake of meat (p=0.07) and fish (p=0.08) and for a negative association with intake of cow's milk (p=0.07). In conclusion, those with a high growth velocity and a dietary pattern with a high intake of bread and a low intake of meat and fish had lower ferritin values and thereby an increased risk of depleting their iron stores later during infancy.

Anemia, Iron-Deficiency↗
PubMed1995

Hyaluronan and procollagen type III aminoterminal peptide in serum and bronchoalveolar lavage fluid from patients with pulmonary fibrosis.

Previous studies of the collagen synthesis markers hyaluronan (hyaluronic acid) (HA) and procollagen type III aminoterminal peptide (PIIINP) in pulmonary fibrosis have reported elevated levels in bronchoalveolar lavage fluid (BALF) and suggested an association with disease activity. The objective of the present study was to evaluate whether HA and PIIINP in BALF and serum (S) correlated with paraclinical markers of disease activity (chest X-ray profusion score, pulmonary function tests (FEV1, FVC, TLC, DLCO)) in patients with pulmonary fibrosis. The material comprised 27 patients with biopsy-proven pulmonary fibrosis (12 cryptogenic and 15 due to connective tissue diseases) and 24 control subjects with normal lung function. BAL was performed in the right middle lobe with 250 ml saline. HA and PIIINP were measured in the cell-free BALF supernatant and in serum. Patients had higher BALF-HA (mean 86 +/- 17 (SEM) micrograms/l) than controls (39 +/- 2 micrograms/l (p < 0.01)), higher BALF-albumin (124 +/- 24 mg/l) than controls (58 +/- 4 mg/l (p < 0.01)) and higher BALF/S-HA ratio (2.4 +/- 0.6) than controls (1.2 +/- 0.6 (p < 0.05)). There were no significant differences respecting BALF-PIIINP, S-HA, or S-PIIINP. Patients (n = 14) with progressive disease had higher BALF-HA, higher BALF-albumin, higher S-PIIINP, and higher S-immunoglobulins than those with stable disease, but the differences did not reach statistical significance. Smokers (n = 18) had lower BALF-HA, lower S-HA, lower S-PIIINP, lower S-immunoglobulins, and higher lung function tests than non-smokers, but the differences did not reach statistical significance. In patients, significantly positive correlations were found between BALF-HA and BALF-albumin, between BALF-PIIINP and BALF-albumin, and a significantly negative correlation between S-PIIINP and TLC. None of the BALF or serum markers correlated with chest X-ray profusion score or any of the other lung function measurements. It is concluded that disease activity may be associated with elevated HA and PIIINP levels. Smoking may influence the immunological processes in pulmonary fibrosis and may be a confounder in studies of these patients.

Adult↗
PubMed1995

Percutaneous lung biopsy with a fine bore cutting needle (Vacu-Cut): improved results using drill technique.

BACKGROUND: Percutaneous transthoracic needle biopsy is used in the diagnosis of pulmonary and pleural lesions. The standard procedure using the Vacu-Cut cutting type of needle is the "thrust" technique in which the needle is rapidly forced through the lesion. In our experience this technique has a low yield of histological biopsy specimens. The diagnostic yield of a new biopsy technique ("drill" technique) using the Vacu-Cut needle was assessed. METHODS: The series comprised 29 consecutive patients, 23 with localised peripheral pulmonary lesions and six with pleural lesions. The Vacu-Cut 1.2 mm needle was rotated and drilled by hand through the lesion. RESULTS: Biopsy specimens 4-30 mm long were obtained in 20 of the 23 patients with pulmonary lesions; in three patients material was available for cytological examination only. The diagnostic yield in the 18 malignant pulmonary lesions was 89% and in the five non-malignant lesions 80%. Biopsy specimens 10-30 mm long were obtained in all patients with pleural lesions. The diagnostic yield in the four malignant and two non-malignant lesions was 100%. The total diagnostic yield in malignant lesions was 20 of 22 patients and in non-malignant lesions six of seven patients. The diagnostic yield in the entire series was 26 of 29 patients (90%). Pneumothorax occurred in seven of the patients and three needed a chest tube. There was no haemoptysis and no deaths. CONCLUSIONS: The drill technique has a high diagnostic yield in both malignant and non-malignant pulmonary and pleural lesions, and is suggested as the ideal biopsy technique when using the Vacu-Cut needle.

Aged↗
PubMed1995

Diagnostic yield of transthoracic needle aspiration biopsy following negative fiberoptic bronchoscopy in 103 patients with peripheral circumscribed pulmonary lesions.

The diagnostic potential of secondary transthoracic needle biopsy (TNB) following negative fiberoptic bronchoscopy (FOB) in patients with peripheral circumscribed pulmonary lesions was evaluated in a retrospective study. The records from 224 patients who had TNB over a 5-year period were reviewed. Of these, 103 patients met the criteria for inclusion in this series. The overall diagnostic yield of TNB in malignancy was 73.8% (54 of 73 patients). TNB allowed cytologic classification of the tumor type in 72.2% (39 of the 54 patients). Five of the 54 patients (9.3%) presented with small-cell anaplastic bronchogenic carcinoma, diagnosed at TNB, and were referred to chemotherapy. Of the 49 patients with a negative TNB, 27 went on to diagnostic surgical procedures; 19 had malignancy, 3 benign tumor, 2 infection, and 3 sequelae after pulmonary infarction. The remaining 22 undiagnosed patients were followed up over a long period of time, 5 showed progression of the pulmonary lesion suggesting malignancy. TNB appeared unsuitable for the diagnosis of benign lesions. Unspecific inflammation was not considered evidence of benignity, and therefore no definitive benign diagnosis was made by TNB in this series. There were no serious complications to TNB. In 18.1% of the procedures a pneumothorax developed, indicating a chest tube in 8.6% of the procedures. TNB is a suitable diagnostic procedure with a high diagnostic yield in patients with peripheral localized malignant pulmonary lesions.

Adult↗
PubMed1995

Distinction between homozygous and heterozygous subjects with hereditary haemochromatosis using iron status markers and receiver operating characteristic (ROC) analysis.

The purpose of the present study was: 1) to evaluate which of the four iron status markers (serum iron, serum transferrin, serum transferrin saturation, serum ferritin) displayed the highest discriminatory potential in the distinction between homozygous patients with hereditary haemochromatosis and heterozygous relatives, 2) to suggest optimum cut-off values for these iron status markers, and 3) to demonstrate how these cut-off values change if the expected utility from a correct diagnosis is incorporated into the analysis. The patients and relatives were found by a nation-wide epidemiological survey. The study population consisted of 162 patients with clinically overt hereditary haemochromatosis and 84 asymptomatic heterozygous relatives. The statistical evaluation was performed using receiver operating characteristic (ROC) curve analysis. The diagnostic power of the iron markers is expressed as the area under the ROC curve. The optimum cut-off value is at the point where the slope of the ROC curve is equal to one. Changes in the optimum cut-off value at varying expected utility from a correct classification was estimated by changing the scaling of the ROC diagram. Serum iron and serum transferrin had the smallest area under the ROC curve, and were both unsuitable as discriminators. Near complete discrimination was obtained with serum transferrin saturation and serum ferritin concentrations, displaying the largest area under the ROC curve (0.991 and 0.998). The optimum threshold value for transferrin saturation was 61%, and for serum ferritin concentration 800 micrograms/l. The transferrin saturation level reflects the presence of the haemochromatosis allele, whereas the serum ferritin concentration indicates the degree of iron overload.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Hyaluronan and procollagen type III aminoterminal peptide in serum and bronchoalveolar lavage fluid in patients with pulmonary sarcoidosis.

The aim of this study was to evaluate whether markers of collagen synthesis, hyaluronan (HA) and procollagen type III aminoterminal peptide (PIIINP) in bronchoalveolar lavage fluid (BALF) and serum (S) were correlated to paraclinical markers of disease activity (S-ACE, S-IgG S-IgA S-calcium, chest X-ray (CXR) profusion score, pulmonary function tests (FEV1, FVC, TLC, DLCO)) in pulmonary sarcoidosis. The material comprised 48 patients with biopsy proven sarcoidosis (35 male, 13 female, median age 31 years) and 24 controls (16 male, 8 female, median age 60 years). BAL was performed in the right middle lobe with 250 ml saline. Patients had higher BALF-HA, mean 88 +/- 13 (SEM) micrograms/l, than controls, 39 +/- 2 micrograms/l (p < 0.01), higher BALF-albumin, 121 +/- 13 mg/l, than controls 58 +/- 4 mg/l (p < 0.01), and higher BALF/S-HA ratio, 3.35 +/- 0.51, than controls, 1.23 +/- 0.60 (p < 0.01). There were no significant differences for S-HA, BALF-PIIINP, or S-PIIINP. In patients significant correlations were found between BALF-HA, S-HA, and BALF-albumin; between S-HA and S-ACE; between BALF/S-HA and BALF-albumin; between CXR profusion score and S-HA, S-ACE, S-IgG, S-IgA, FEV1, FVC, TLC and DLCO. The results indicate that measurement of S-HA, BALF-HA, and BALF-albumin may be of value in the monitoring of disease in pulmonary sarcoidosis.

Adult↗
PubMed1995

[Diagnosis of pneumonia. Which methods of clinical-microbiological sample taking should be selected?].

The review encompasses a systematic description of the methods available in the clinical setting for diagnostic evaluation of lower respiratory tract infections. Among the tracheo-broncho-alveolar secretions, examination of a representative sputum sample still holds an important role. Introduction of fiberoptic bronchoscopy has improved the diagnostic yield considerably, especially in immunocompromised patients with severe pneumonia. Fiberoptic bronchoscopy in local anaesthesia allows the collection of secretions from the lower respiratory tract through broncho-alveolar lavage (BAL), as well as protected specimen brush and, on certain indications, transbronchial lung biopsy. In severe pneumonia, a specific diagnosis is mandatory in order to design a rational treatment. The diagnosis should be obtained early in the course of the disease, by the use of procedures displaying an appropriate balance between diagnostic yield, incidence of complications and costs. The evaluation of patients with infectious lung disease implies collaboration between pulmonary medicine, infectious medicine, clinical microbiology and pathology.

Antibodies, Bacterial↗
PubMed1995

Bronchoalveolar lavage in radiologically detected diffuse lung disease. Diagnostic value of total and differential cell count in a series of 130 patients.

During a 7-year period bronchoalveolar lavage (BAL) was performed as a routine diagnostic procedure at fiberoptic bronchoscopy in 172 consecutive patients with diffuse pulmonary lesions. In 42 patients, BAL was technically insufficient or data were incomplete. These patients were excluded. The remaining 130 patients consisted of 78 men and 52 women with a median age of 43 years (range 19-79); 59 were smokers. They were divided into 6 groups: I. sarcoidosis (n = 77); II. cryptogenic fibrosing alveolitis (n = 16); III. secondary fibrosing alveolitis (n = 7); IV. malignancy (n = 7); V. allergic alveolitis (n = 6); VI. miscellaneous (n = 17). Group VI was not included in the statistical evaluation, which involved only the 113 patients in groups I-V. BAL was performed in a segment of the right middle lobe with 150-200 ml isotonic saline. The return fluid (BALF) was filtered through two layers of cotton gauze, and total and differential cell counts were assessed. Median BALF return volume was 67% (range 35-90). Eighty percent of the procedures were performed by the same operator. Total cell count displayed no significant difference amongst the five diagnostic groups (p = 0.06). Differential cell count displayed differences amongst the groups respecting macrophages (p = 0.002), lymphocytes (p = 0.0004), neutrophils (p = 0.0001) and eosinophils (p = 0.04). Patients with sarcoidosis had a higher percentage of lymphocytes, patients with secondary fibrosis a higher percentage of neutrophils, and patients with cryptogenic fibrosis a higher percentage of eosinophils than the other groups. Malignant cells were observed in BALF in 14.3% of patients with malignant lesions. Among the patients with sarcoidosis, 75% had a lymphocyte-dominated BALF (> 10%) compared with 31% of the patients with cryptogenic fibrosis, 14% of the patients with secondary fibrosis, and 43% of the patients with malignancy. Dominance of neutrophils (> 10%) and/or eosinophils (> 5%) in BALF was observed in cryptogenic and secondary fibrosis. In most patients, BAL cannot provide a definite diagnosis, but may support the clinical suspicion of a specific diagnosis. In clinical practice, BAL seems to be of limited value in the diagnostic evaluation of radiologically detected diffuse, non-infectious pulmonary lesions.

Adult↗
PubMed1995

Haemophilus influenzae release histamine and enhance histamine release from human bronchoalveolar cells. Examination of patients with chronic bronchitis and controls.

Haemophilus influenzae (H. influenzae), Streptococcus pneumoniae (S. pneumoniae) and Branhamella catarrhalis (B. catarrhalis) are often found in the lower respiratory tract of patients with chronic bronchitis. Earlier studies have shown that bacteria induce mediator release from human basophils and parenchymal lung mast cells. In this study the capability of bacteria to trigger or potentiate histamine release from superficially located mast cells in the airway epithelium was studied in cell suspensions obtained by bronchoalveolar lavage in patients with chronic bronchitis (CB). In approximately half of the patients H. influenzae and Staphylococcus aureus (S. aureus) were found to trigger histamine release, whereas no response was obtained by S. pneumoniae or B. catarrhalis. The mediator release was caused by a non-IgE-dependent mechanism. At lower concentrations of H. influenzae causing no histamine release the bacterium was found to enhance IgE-mediated histamine release triggered by anti-IgE antibody. The synergy was more pronounced in patients with CB than in controls. Since H. influenzae is found in the lower respiratory tract of the patients but not in normal individuals, the infection here may via histamine release lead to harmful effects on the airways of importance for precipitation and exacerbation of chronic bronchitis.

Adult↗