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Biomedical subjects

R Hansen

Publications and source records attributed to R Hansen.

At least 91 records · Page 5Linked to original sources
PubMed1991

Screening for psychosocial dysfunction in pediatric dermatology practice.

The Pediatric Symptom Checklist, a brief psychosocial screening questionnaire, was used in a multi-center study of pediatric dermatology clinics (n = 377). Overall rates of positive screening indicated that approximately 13% of patients screened positive, a rate similar to findings in primary care pediatric settings. Examining the sample in greater detail demonstrated that children whose dermatologic disorder is perceived to have a greater impact on their appearance are at higher risk for psychosocial dysfunction.

Child↗
PubMed1991

Pharmacokinetics, safety, and ability to diminish leukotriene synthesis by zileuton, an inhibitor of 5-lipoxygenase.

Zileuton is a potent and specific inhibitor of 5-lipoxygenase, the first dedicated enzyme in the metabolism of arachidonic acid to the leukotrienes. The leukotrienes have been implicated in numerous pathological conditions. Zileuton was given to normal human volunteers in single doses of 200 mg to 800 mg. Results of these studies indicated that zileuton was well absorbed orally with an elimination half-life of approximately 2.5 hours. Leukotriene B4 production by ex vivo calcium ionophone stimulated whole blood was inhibited by up to 80% of baseline and correlated with plasma concentrations. Zileuton did not significantly inhibit cyclooxygenase as demonstrated by thromboxane B2 levels. There were no safety concerns that would preclude development.

Adolescent↗
PubMed1991

Antigenic analysis of four species of the genus Ehrlichia by use of protein immunoblot.

The antigenic profile of Ehrlichia canis, E risticii, E sennetsu, and E equi was investigated by the use of protein (western) immunoblot technique. Results of analysis of serum from acutely and chronically infected animals indicated that the 4 Ehrlichia species share a unique 25-kD polypeptide in addition to other peptides. Immune sera from dogs inoculated with E canis recognized a wide range of E canis polypeptide antigens, as determined by western blot analysis. A larger number of E sennetsu polypeptides were detected when homologous antiserum and antiserum to E equi were used. The latter antiserum did not recognize antigens of E canis or E risticii. Antisera to E canis, E risticii, and E sennetsu detected E equi antigens. Data indicate that a 25-kD protein is a common antigen among the species of the genus Ehrlichia and that the ascending order of abundance of immunodominant determinants in the 4 species of Ehrlichia studied would be: E risticii----E equi----E sennetsu----E canis. Implications of these findings for diagnosis of ehrlichial infections and prophylaxis are evident.

Animals↗
PubMed1991

Immunogenicity and protective efficacy of affinity-purified Plasmodium falciparum exoantigens in Aotus nancymai monkeys.

Soluble Plasmodium falciparum polypeptides, affinity-purified from culture supernatant fluids using sequential immunoadsorptions employing both monoclonal and polyclonal antibodies, induced protective immunity against experimental falciparum malaria in Peruvian Aotus nancymai monkeys. Susceptible monkeys were vaccinated with polypeptides affinity-purified from supernatant fluids of P. falciparum Indochina I/CDC cultures. Eighteen animals (6 immunized with purified antigens plus adjuvants, 6 injected with only the adjuvant preparation, and 6 untreated) were challenged with whole blood containing monkey-adapted virulent organisms of the Indochina I/CDC strain. Selected hematologic, serologic and parasitologic profiles served as potential indicators of protection. This immunogen, when fortified with an aluminum hydroxide/Quil-A saponin adjuvant combination, elicited good antibody responses to major P. falciparum antigens. Protection in vaccinated animals was evidenced by a significantly limited reduction in hematocrit and hemoglobin levels and a relatively moderate course of infection after homologous needle-challenge with Aotus monkey-adapted P. falciparum parasites.

Animals↗
PubMed1990

[Social medical cooperation after discharge from the hospital].

This article accounts for how general practitioners and a group of neuromedical patients experience cooperation with hospital, social workers and the social authorities after discharge from hospital and their own wishes on this subject. The investigation reveals that communication is not optimal and that it should be intensified. The frequency of contact between the general practitioner and the patients is considerable and half of the patients desire follow-up treatment by the general practitioners. The majority of the general practitioners are willing to undertake follow-up treatment. The majority of the patients want their own general practitioner to be involved in solution of the social problems and the majority of the general practitioners want to be told by the social worker attached to the department about the problems which neuromedical patients may encounter on discharge from hospital. Less than half of the letters of discharge are sent to the patient's general practitioner within two weeks of discharge. By and large, the content of the letters of discharge is satisfactory with the exception about the information given to the patients. Although the patient clientele has serious social problems, cooperation between the general practitioner and the social authorities is defective. The general practitioners emphasize lack of special knowledge and defective understanding of the problems which neuromedical patients experience and defective interest in suggestions made by general practitioners to persons in the social administration. More than one third of the general practitioners would prefer cooperation with the social worker from the department during the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Denmark↗
PubMed1990

[Patients' evaluation of their own discharge].

This article illustrates how a group of patients assess their own discharge from a neuromedical department. The length of notice about discharge is connected with the patient's experience of orientation and planning. The longer the notice, the greater the satisfaction with the orientation given by the doctor about the disease, the therapeutic possibilities and the prognosis and with the nursing staff as regards intake of medicine. Although the patient clientele has serious social problems, only one fourth had had contact with a social worker in connection with hospitalization. Over one third of the patients found that the first weeks after discharge constituted the most difficult period during the entire course of the disease and this may be connected with the fact that many of them experienced discharge as being badly planned. This shows that discharge is a stressing event in the course of an illness and that it requires more attention than it has hitherto received.

Denmark↗
PubMed1990

[Social intervention at discharge. Cooperation between a hospital department, general practice and the social sector].

The object of this investigation is to illustrate the effect of intensive social assistance at and after discharge from hospital and, if possible, to present some practical proposals. The investigation was controlled: 100 patients domiciled in two communities in the catchment region of the hospital participated in the investigation. The patients were aged 25-75 years and they were discharged from a neuromedical inpatient department. These were subdivided at random into an intervention and a control group. The investigation comprises interviews with the patients, questionnaires to the general practitioners and the social and health authorities. Intervention was undertaken for five months in one of the groups in cooperation with the general practitioner. Although the intervention revealed that there were numerous unsolved problems and that patients with poor ability were left to themselves to a great extent, the intervention did not result in any measurable difference in patient satisfaction as compared with the control group. No readmissions occurred on account of social reasons in the intervention group. A series of planned forms of assistance did not function on discharge. The fact that patients are discharged earlier in the course of the condition than previously is considered to be the cause of a number of the unsolved problems. At the conclusion of the investigation, there were more numerous unsolved problems in the control group than in the intervention group and the need for advice and support, not only for the patients but also for the relatives, which was considerable after discharge, was documented. This need has not fulfilled and proposals are discussed.

Adult↗
PubMed1990

Successful allogeneic transplantation of T-cell-depleted bone marrow from closely HLA-matched unrelated donors.

We describe a four-year experience with bone marrow transplantation involving closely HLA-matched unrelated donors and 55 consecutive patients with hematologic disease who were seven months to 48.6 years old (median, 18 years). An intensive pretransplantation conditioning regimen and graft-versus-host disease (GVHD) prophylaxis with CD3-directed T-cell depletion and cyclosporine were employed. Durable engraftment was achieved in 50 of 53 patients who could be evaluated (94 percent; 95 percent confidence interval, 83 to 98 percent). Acute GVHD of Grade II to IV developed in 46 percent of the patients (confidence interval, 27 to 66 percent). The incidence and severity of acute GVHD were increased in recipients of HLA-mismatched marrow as compared with recipients of phenotypically matched marrow (incidence of 53 percent [confidence interval, 37 to 68 percent] vs. 17 percent [confidence interval, 5 to 45 percent]; P less than 0.05). Extensive chronic GVHD and deaths not due to relapse also tended to be more frequent when HLA-mismatched marrow was used, but not significantly so. With a median follow-up of more than 19 months (range, greater than 9 to greater than 39), the actuarial disease-free survival of transplant recipients with leukemia and a relatively good prognosis (acute leukemia in first remission and chronic myelogenous leukemia in chronic phase) was 48 percent (confidence interval, 24 to 73 percent), and that of recipients with more aggressive leukemia was 32 percent (confidence interval, 18 to 51 percent); the actuarial survival of recipients with non-neoplastic disease was 63 percent (confidence interval, 31 to 86 percent). We conclude that marrow transplantation with closely HLA-matched unrelated donors can be effective treatment for neoplastic and non-neoplastic diseases. Although transplants from phenotypically HLA-matched unrelated donors appear to be most effective, transplants with limited HLA disparity can also be successful in some patients.

Adolescent↗
PubMed1990

[Simpson's atherectomy of the peripheral arteries: early results and follow-up].

Over a seventeen-month period, a percutaneous transluminal removal of stenosing plaque material from leg and pelvic arteries was performed successfully and without complication in 43 patients. A complete atherectomy in the femoropopliteal vessels succeeded in 99% of cases. In the pelvic region, the primary results were much lower (58%). After six months, the angiographically checked restenosis rate was 17% for femoropopliteal vessels and 11% for iliac arteries, and the corresponding Kaplan-Meier cumulative patency rates were 73.8 and 78.7% respectively. Simpson's atherectomy is the only method of its kind that is therapeutically effective and diagnostically significant, since the removed plaque can be used for further tests.

Aged↗
PubMed1990

Growth parameters and attention to faces at 4 to 6 months of age.

Duration of attention to faces and response decrement were studied in 57 full-term infants between 15.1 and 28.5 weeks of age during a health maintenance clinic visit. Six measures of growth, obtained from the medical record, included weight, length, and head circumference at birth, and weight, length, and head circumference at the time of the clinic visit. Correlation analysis revealed that longer average initial fixation time was associated with male sex, shorter birth length, and larger ponderal index. Multiple regression analysis indicated that together these three variables accounted for 17% of the variance in average initial fixation time (p less than 0.05). Length at the time of the health maintenance visit and male sex also were associated with longer average initial fixation time and, together, accounted for 13% of the variance (p less than 0.05). Response decrement was larger in children with larger head circumference at birth, in girls, and in infants with a larger ponderal index at birth. Together, these three variables accounted for 27% of the variance (p less than 0.001). Results suggest that more efficient processing of visual information may be related to neurophysiological maturity at term, and raises the possibility that neurophysiological maturity may account for a substantial portion of the correlation between attention behavior and later intelligence.

Arousal↗
PubMed1989

Glucose-6-phosphate dehydrogenase. Characteristics revealed by the rat liver enzyme structure.

The primary structure of glucose-6-phosphate dehydrogenase from rat liver has been determined, showing the mature polypeptide to consist of 513 amino acid residues, with an acyl-blocked N-terminus. This structure is homologous to those of both other eutherian and marsupial mammals (human and opossum), thus characterizing a mammalian type enzyme to which the human form, notwithstanding its large number of genetic variants, conforms. The mammalian type differs from the fruit fly enzyme by about 50%. Known mutant forms exhibit further differences, widely distributed along the polypeptide chain. Structural patterns show glucose-6-phosphate dehydrogenases to consist of a few variable regions intermixed with relatively constant segments.

Amino Acid Sequence↗
PubMed1989

Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope.

Neurally mediated hypotension and bradycardia are believed to be common causes of syncope. We used the "upright-tilt test" (duration, less than or equal to 10 minutes) with or without an infusion of exogenous catecholamine (isoproterenol [1 to 5 micrograms per minute], given intravenously) to elicit bradycardia, hypotension, or both in 24 patients with recurrent syncope and in 18 control subjects. A conventional electrophysiologic test performed before the tilt test was positive in 9 of the 24 patients, revealing arrhythmias that may have caused recurrent syncope, but was negative and thus nondiagnostic in 15 patients. The tilt test alone (i.e., without isoproterenol) induced symptomatic bradycardia or hypotension in 1 of the 9 patients with positive electrophysiologic tests (11 percent), 4 of the 15 patients with negative electrophysiologic tests (27 percent), and none of the controls. When the isoproterenol infusion was administered during the tilt test, 9 of the 11 patients with negative electrophysiologic and tilt tests had syncope, marked slowing of the heart rate, and hypotension. In contrast, isoproterenol was associated with tachycardia and only a slight decline in arterial pressure in the 8 remaining patients with positive electrophysiologic tests and the 18 control subjects, and syncope developed in only 1 of the 8 patients with positive electrophysiologic tests and negative tilt tests (13 percent) and 2 of the 18 control subjects (11 percent). We conclude that an isoproterenol infusion administered in conjunction with the upright-tilt test may be useful for identifying susceptibility to neurally mediated recurrent syncope.

Adolescent↗
PubMed1989

Continuous systemic 5-fluorouracil infusion in advanced colorectal cancer: results in 91 patients.

Ninety-one patients with metastatic colorectal cancer were treated with continuous ambulatory 5-fluorouracil (5FU) infusion 250-300 mg/m2/day through a chronic indwelling central venous catheter. Twenty-six of the 91 patients (29%) had received previous bolus 5FU. Fifty-eight of the 91 patients (64%) had two or more sites of disease, and 74 of 91 patients (81%) had liver metastases. Results were complete remission in 5 of 91 (6%), partial remission in 25 of 91 (27%), stable disease in 33 of 91 (36%), and progressive disease in 28 of 91 (31%), for an overall response rate of 30 of 91 (33%); median duration of response was 7 months. Twenty-six of 65 previously untreated patients (40%) experienced objective response. Median survival from initiation of treatment for all patients was 11 months. Forty-one percent of patients experienced no significant toxicity and were able to continue therapy without treatment interruption. Toxicities necessitating treatment interruption included stomatitis in 35 patients (39%), hand-foot syndrome in 33 patients (36%), and diarrhea in 10 patients (11%). No significant myelosuppression or serious catheter-related complications were encountered. We conclude that continuous systemic venous infusion of 5FU produces a higher response rate than traditional bolus 5FU schedules, with apparent enhancement of survival and easily managed toxicity.

Adult↗
PubMed1989

Effects of thoracic paravertebral block with bupivacaine versus combined thoracic epidural block with bupivacaine and morphine on pain and pulmonary function after cholecystectomy.

Twenty patients undergoing elective cholecystectomy via a subcostal incision were randomized in a double-blind study to either thoracic paravertebral blockade with bupivacaine 0.5% (15 ml followed by 5 ml/h) or thoracic epidural blockade with bupivacaine 7 ml 0.5% + morphine 2 mg followed by 5 ml/h + 0.2 mg/h, respectively for 8 h postoperatively. Mean initial spread of sensory analgesia on the right side was the same (Th3,4-Th11 versus Th2,6-Th11), but decreased (P less than 0.05) postoperatively in the paravertebral group. All patients in the epidural group had bilateral blockade, compared with three patients in the paravertebral group. In both groups only minor insignificant changes in blood pressure and pulse rate were seen postoperatively. Pain scores were significantly higher in the paravertebral group, as was the need for systemic morphine (P less than 0.05). Pulmonary function estimated by forced vital capacity, forced expiratory volume and peak expiratory flow rate decreased about 50% postoperatively in both groups. In conclusion, the continuous paravertebral bupivacaine infusion used here was insufficient as the only analgesic after cholecystectomy. In contrast, epidural blockade with combined bupivacaine and low dose morphine produced total pain relief in six of ten patients.

Adult↗
PubMed1988

Nonfunctioning islet cell carcinoma of the pancreas. Complete response to continuous 5-fluorouracil infusion.

An unresectable, intraabdominal recurrence of a nonfunctioning islet cell carcinoma of the pancreas developed in a 56-year-old man 9 years after he achieved complete remission from extensive radiotherapy. Chronic renal failure secondary to radiation nephritis precluded the use of streptozotocin. 5-fluorouracil (5-FU) (300 mg/m2 per day) was given as a continuous, systemic infusion through a chronic indwelling central venous catheter for 1 year's duration. Treatment resulted in the prompt disappearance of all signs and symptoms of cancer, and computed tomography (CT) of the abdomen documented complete response. The patient continues in complete clinical remission 16 months after 5-FU was stopped. Continuous 5-FU infusion may be a potentially efficacious and less toxic alternative to streptozotocin in the treatment of islet cell carcinoma. Further clinical evaluation will be necessary to define its overall role in the management of these patients.

Adenoma, Islet Cell↗
PubMed1988

Phase I-II study of prophylactic hepatic irradiation with local irradiation and systemic chemotherapy for adenocarcinoma of the pancreas.

Although the addition of 5-FU to radiation therapy for locally advanced adenocarcinoma of the pancreas improved short-term survival (GITSG), there were no differences in patterns of failure. Hepatic metastases were equally common in both groups. Therefore, a pilot study of prophylactic hepatic irradiation was developed. Between March 1983 and May 1985, 16 patients were entered in a Phase I/II study of prophylactic hepatic irradiation with local irradiation and systemic chemotherapy for adenocarcinoma of the pancreas at the Medical College of Wisconsin Affiliated Hospitals. Megavoltage radiation (1.8 Gy/fraction) was given to the pancreas with a minimal margin (2 cm) around the tumor, localized by surgical clips or CT scan with a total dose of 61.2 Gy over 7 weeks. Prophylactic hepatic irradiation was added to the fourth week of irradiation to a total dose of 23.4 Gy over 21/2 weeks. 5-Fluorouracil, 500 mg/M2/day was given at Day 1, 2, 3, 29, 30, and 31 of radiotherapy, then a weekly maintenance for 1 year. Fifteen patients were evaluable: One patient refused chemotherapy. The follow-up period was 14 to 50 months (median 26 months). The most common side effect was nausea. Maintenance 5-FU was discontinued in one patient because of GI bleeding. Three-quarters of the patients developed temporary elevations of hepatic enzymes. No severe or life-threatening complications were observed. One, 2-, 3-, and 4-year disease-free survivals are 66.7%, 46.7%, 20% and 13.3%, respectively. Patterns of failure revealed that only two patients had hepatic metastasis as the first site of failure, five patients died of abdominal carcinomatosis, and three patients failed in the pancreas. Two patients died without evidence of cancer. Two patients are alive and well beyond 4 years after the diagnosis. This study confirms that such aggressive combined modality treatment is well tolerated and suggests that the frequency of hepatic metastasis can be reduced.

Adenocarcinoma↗