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Biomedical subjects

T Krarup

Publications and source records attributed to T Krarup.

At least 55 records · Page 3Linked to original sources
PubMed1990

A phase III trial of zoladex and flutamide versus orchiectomy in the treatment of patients with advanced carcinoma of the prostate.

In a multicenter Phase III trial 264 patients with advanced prostatic cancer were randomized to either bilateral orchiectomy or treatment with zoladex supplemented by flutamide. Presently, median follow-up time is 30 months. A small difference in objective response was recorded in favor of the combination therapy, whereas no statistically significant difference was found in subjective response to therapy, time to progression, and overall survival. Adverse effects were more commonly encountered in the pharmacologically treated patients. It is concluded that the combination of zoladex plus flutamide is not clinically superior to orchiectomy in the treatment of patients with advanced carcinoma of the prostate.

Aged↗
PubMed1990

Complete androgen blockade as primary treatment for advanced metastatic cancer of the prostate.

The results of a series of non-randomized studies suggest that complete androgen blockade, i.e. medical or surgical castration in association with an antiandrogen, is superior to castration alone as regard survival potential. This report presents 11 untreated patients (Stage T2-4, Nx, M1), who were treated with complete androgen blockade, orchiectomy and a pure antiandrogen (Flutamide 250 mg three times a day). The rate of subjective response was 100% and the median time to progression was 12 months. The objective response rate was 82% and the rates of partial remission at one and two years were 45% and 18%, respectively. The survival rates after one and two years were 91% and 53%, respectively, a result which is consistent with that of other studies on the survival of patients with metastatic cancer of the prostate treated with either diethylstilboestrol, orchiectomy or LH-releasing hormones. The results of this study do not support the hypothesis that androgen blockade improves the survival of patients with advanced metastatic cancer of the prostate.

Aged↗
PubMed1990

Inhibition of gastric acid secretion by jejunal glucose and its relation to osmolality and glucose load.

Intrajejunal infusion of hypertonic glucose and hypertonic saline inhibits pentagastrin-stimulated gastric acid secretion in man. This effect is generally ascribed to the hyperosmolality of the solutions. Five volunteers were given 50 g glucose in osmolar concentrations of 2700 mosmol/l and 900 mosmol/l, and five were given 25 g glucose in osmolar concentrations of 2700 mosmol/l and 300 mosmol/l. Control studies with intrajejunal infusion of physiologic saline were performed in all subjects. Median inhibition of gastric acid secretion was 91% after 50 g glucose and 47% after 25 g glucose and was unrelated to the osmolar concentration. These findings suggest that the acid-inhibitory effect of intrajejunally administered glucose is related to the glucose load and not to the osmolar concentration. Plasma responses of intact neurotensin, immunoreactivity, NH2-terminal neurotensin immunoreactivity, enteroglucagon, and gastric inhibitory polypeptide were all related to the amount of glucose given. Glucagon and somatostatin, both of which are potent inhibitors of gastric secretion, were not released by intrajejunally administered glucose.

Adult↗
PubMed1989

[Urologic examination and treatment of patients with acute injuries of the spinal medulla].

During a period of one year, nine patients with traumatic lesions of the spinal medulla were examined and treated urologically. The patients were followed-up for 24-36 months and follow-up will continue. All of the patients were treated primarily with sterile intermittent catheterization by the nursing staff. Exceptions from this were patients in whom indwelling catheters were necessary on account of complicating conditions. During the acute phase, the patients were examined by a urologist and bladder function investigations with cystometry + electromyographic registration from the pelvic floor were undertaken. When patients had recovered from the spinal shock phase, emptying of the bladder supplemented by alpha-adrenergic blocking preparations and clean intermittent catheterization were instituted in the patients with supra-sacral lesions. Patients with infra-sacral bladder paresis were trained in miction on abdominal pressure supplemented by clean intermittent catheterization. No complications from this treatment have occurred and renal function has remained stable. Only one patient has an indwelling catheter and it has not proved possible to persuade the patient to accept removal.

Acute Disease↗
PubMed1989

[Vermiform appendix used as a segment of the ureter].

A man aged 67 with a single kidney was admitted on account of haematuria and raised serum creatinine. Investigation revealed a poorly differentiated invasive transitional cell tumour at the middle of the right ureter. After resection of the tumour, a space of 10 cm remained between the two ends of the ureter. During the operation, it had become apparent that the usual methods of reconstruction could not be employed and, therefore, the vermiform appendix was employed as an intermediate segment of the ureter. The appendicular graft functioned satisfactorily until recurrence of the cancer occurred and the patient died one year later. This method may be employed in selected cases where Boariflap, uretero-trans-ureterostomy or autotransplantation of the kidney cannot be employed.

Aged↗
PubMed1989

Does internal urethrotomy prevent urethral stricture after transurethral prostatectomy. Early and late results.

In a randomized study of 200 consecutive patients undergoing transurethral prostatectomy (TURP), the combination of internal urethrotomy and TURP (the trial group) was compared with TURP alone (the control group) with regard to the development of urethral strictures postoperatively. Three months after resection, 14% in the trial group and 21% in the control group had developed a urethral stricture. The difference was not statistically significant. At a late follow-up (median 54 months postoperatively) 5 more patients in the trial group and 8 in the control group had developed strictures. The diagnostic specificity and sensitivity of uroflowmetry in diagnosing urethral strictures was 62 and 96%, respectively. The diagnostic specificity and sensitivity of retrograde urethrography was 58 and 98%, respectively. We conclude that urethrotomy before TURP cannot prevent the formation of postoperative urethral strictures.

Adult↗
PubMed1988

Gastric inhibitory polypeptide in newly diagnosed ketotic type I (insulin-dependent) diabetics.

Plasma concentrations of 5,000 daltons (5 kDa) immunoreactive gastric inhibitory polypeptide (IR-GIP) were measured before and up to 16 hours after the start of low-dose insulin treatment in newly diagnosed ketotic type I (insulin-dependent) diabetics. Nine patients were non-fasting. Before insulin treatment mean IR-GIP was 31 +/- 6 pmol/l (range 9-65 pmol/l). Four patients had IR-GIP concentrations in the normal fasting range (10-25 pmol/l), and nine patients had concentrations below 35 pmol/l. The remaining patients had IR-GIP concentrations in the normal postprandial range. A meal eaten after the start of insulin treatment caused an increase in IR-GIP in all patients. All patients had beta-cell function as estimated by plasma C-peptide. Individual changes in C-peptide were significantly correlated to changes in blood glucose both after the meal (r = 0.80, p less than 0.01) and during insulin treatment (r = 0.85 +/- 0.04). No correlation could be found between IR-GIP and blood glucose, C-peptide or insulin concentrations. Newly diagnosed ketotic type I diabetics have IR-GIP concentrations within the normal postprandial level. Hypoinsulinaemia, hyperglycaemia, and hyperketonaemia do not by themselves increase 5 kDa IR-GIP markedly above normal fasting levels.

Adolescent↗
PubMed1988

Incidence of ureteral obstruction after aortic grafting: a prospective analysis.

In this prospective analysis of the incidence of ureteral obstruction after aortic bifurcation grafting, 120 patients were entered into the study: 19 were subsequently excluded for cause, and 101 patients were studied by isotope renography. The renographic findings were indicative for subsequent intravenous pyelography, which was performed in 26 patients. In two cases supplementary retrograde pyelograms were done. Two patients (2%) had ureteral obstruction related to the vascular prosthesis, and in one of these patients the process was bilateral. The lesions were asymptomatic in both patients.

Adult↗
PubMed1987

Effect of porcine gastric inhibitory polypeptide on beta-cell function in type I and type II diabetes mellitus.

The effect of highly purified natural porcine GIP on C-peptide release was examined in six type I (insulin-dependent) diabetics (IDD) with residual beta-cell function, six type II non-insulin-dependent) diabetics (NIDD), and six normal subjects. All subjects were normal weight. From -120 minutes to 180 minutes glucose or insulin was infused IV to achieve a constant plasma glucose level of 8 mmol/L. On two separate days GIP (2 pmol/kg/min) or isotonic NaCl at random were infused from 0 to 30 minutes. After 10 minutes of GIP infusion plasma IR-GIP concentrations were in the physiologic postprandial range. At 30 minutes a further increase in IR-GIP to supraphysiologic levels occurred. In all subjects plasma, C-peptide increased more after 10 minutes of GIP infusion (IDD, 0.48 +/- 0.05; NIDD, 0.79 +/- 0.11; normal subjects, 2.27 +/- 0.29 nmol/L) than on the corresponding day with NaCl infusion (IDD, 0.35 +/- 0.03; NIDD, 0.62 +/- 0.08; normal subjects, 1.22 +/- 0.13 nmol/L, P less than .05 for all). The responses of the diabetics were significantly lower than that of the normal subjects (P less than .001 for both groups). No further increase in C-peptide occurred during the remaining 20 minutes of the GIP infusion in the diabetic subjects (IDD, 0.49 +/- 0.05; NIDD, 0.83 +/- 0.10 nmol/L). In the presence of a plasma glucose concentration of 8 mmol/L, physiologic concentrations of porcine GIP caused an immediate but impaired beta-cell response in IDD and NIDD patients.

Adult↗
PubMed1987

Painful bladder disease: clinical and pathoanatomical differences in 115 patients.

The diagnostic criteria for interstitial cystitis considered as a subgroup of painful bladder disease (that is sensory bladder disease and chronic abacterial cystitis) are not well established. Some urologists rely on symptoms, while others rely on cystoscopic appearance or pathological findings. Among 115 patients with painful bladder disease we compared symptoms, and cystoscopic and urodynamic findings in those with and without detrusor mastocytosis (28 or more mast cells per mm.2) and attempted to elucidate possible differences between the groups. We chose the pathological anatomical criterion of detrusor mastocytosis to be diagnostic for interstitial cystitis. A total of 43 patients had detrusor mastocytosis and other pathological anatomical signs of interstitial cystitis, and 72 had no mastocytosis but the pathological diagnoses of chronic unspecific cystitis, fibrosis of the bladder, detrusor myopathy, intestinal metaplasia and normal findings. When the 2 groups of patients were compared we found no differences in regard to symptoms (pain, dysuria, frequency, nocturia and urgency), frequency of allergy and hysterectomy, duration of symptoms, petechial bleeding during cystoscopy with bladder distension and cystometric findings. The patients with mastocytosis differed from those without mastocytosis in that they were older, and had a higher frequency of hematuria, a higher frequency of a red, scarred and richly vascularized bladder at cystoscopy before distension, and a smaller cystoscopic bladder capacity. We conclude that by dividing patients with painful bladder into 2 groups according to the mast cell counts in the detrusor, certain differences in the clinical findings in the groups can be ruled out. However, in individual patients one cannot note with certainty to which pathological anatomical group the patient belongs, since great overlapping between the groups exists. Whether only patients with detrusor mastocytosis have interstitial cystitis depends on definitions and still remains an open question.

Adult↗
PubMed1987

A prospective double-blind clinically controlled multicenter trial of sodium pentosanpolysulfate in the treatment of interstitial cystitis and related painful bladder disease.

Painful bladder disease, sensory bladder disease, chronic abacterial cystitis and interstitial cystitis are ill-defined conditions of unknown etiology and pathogenesis, and, therefore, they are without any rational therapy. Pathogenetic theories concerning defects in the epithelium and/or mucous surface coat (including glycosaminoglycans) of the bladder, and theories concerning immunological disturbances predominate. Sodium pentosanpolysulfate (Elmiron) acts by substituting a defective glycosaminoglycan layer and inhibits complement reactions in inflammatory processes. We compared sodium pentosanpolysulfate versus placebo in a prospective double-blind, clinically controlled multicenter trial of 115 patients with painful bladder disease. Two protocols were used. Protocol A included 43 patients with clinically and pathologically anatomically verified interstitial cystitis (28 or more mast cells per mm.2), and protocol B included 72 patients with a painful bladder and unspecific histological findings. The patients were randomized to receive either sodium pentosanpolysulfate (200 mg. twice daily) or placebo capsules for 4 months. Before and after the trial the patients were evaluated with symptom grading, urodynamics and cystoscopy with distension and deep bladder biopsies. The results showed no difference between the pre-trial and post-trial values in the sodium pentosanpolysulfate and placebo groups in both protocols in regard to symptoms, urodynamic parameters, cystoscopic appearance and mast cell counts. A significant increase in the cystoscopically determined bladder capacity in the sodium pentosanpolysulfate group in protocol A was found. We conclude that no statistically or clinically significant effect of sodium pentosanpolysulfate was found compared to placebo in patients with painful bladder disease.

Adult↗
PubMed1987

Outcome of the glucagon test depends upon the prevailing blood glucose concentration in type I (insulin-dependent) diabetic patients.

The outcome of 97 paired glucagon and meal tests was related to the prevailing fasting blood glucose concentrations on the two test days. At blood glucose concentration less than 7 mmol/l both the C-peptide responses and the maximal (6 min) C-peptide concentrations during the glucagon tests were significantly lower than the corresponding values found during the meal tests. During the glucagon tests, a direct relationship was found between the responsiveness of the pancreatic beta-cells and fasting blood glucose values when these were between 3 and 7 mmol/l. No significant difference was found between the outcome of the two tests when the fasting blood glucose concentration was greater than 7 mmol/l. The results indicate that the outcome of the glucagon test in Type I patients depends upon the prevailing fasting blood glucose concentration and that the predictive value of the glucagon test as to how the beta-cells will respond to a meal during everyday life is low when fasting blood glucose is less than 7 mmol/l.

Adult↗
PubMed1987

Heterogeneity of immunoreactive gastric inhibitory polypeptide in the plasma of newly diagnosed type 1 (insulin-dependent) diabetics.

The aim was to compare the three molecular forms of plasma immunoreactive gastric inhibitory polypeptide (IR-GIP) i.e. void volume (Vo), 8 and 5 kDa IR-GIP, found in type 1 diabetics with those found in normal subjects. Plasma from 6 non-fasting newly diagnosed ketotic type 1 diabetics obtained before and 1 h after a test meal given at start of insulin treatment, and before and 1 h after a test meal given after one and seven days of insulin treatment, respectively, was gel filtered and so was plasma from 6 normal subjects. The immunoreactivity in the effluents was measured with five different antisera. The elution positions of the three peaks were similar in controls and diabetics. With any given antiserum none of the components differed significantly as to amount of immunoreactivity between diabetics and controls, neither after the meals nor in the fasting state. The amount of Vo did not change in response to the meal, whereas the 8 and 5 kDa forms in the diabetics increased similarly to the increase in normals, also during ketosis. The Vo component did not differ significantly between diabetic and normal subjects, but it decreased significantly after start of insulin treatment. In the non-fasting, ketotic state before start of insulin treatment, no IR-GIP form was elevated significantly above normal postprandial levels. We conclude that the molecular forms of IR-GIP are similar in type 1 diabetics and normal subjects, but the molecular forms measured and their relative amounts vary according to which antiserum is used. The present study does not support that lack of insulin and ketosis markedly influence IR-GIP in plasma.

Adult↗
PubMed1987

Transurethral prostatectomy or incision of the prostate in the treatment of prostatism caused by small benign prostates.

In a prospective, randomized study 21 patients with prostatism caused by small prostates (estimated weight less than 20 gram) had a transurethral prostatectomy (TURP), and 17 patients a transurethral incision of the prostate (TUI). In the TUI group operation time and blood loss was significantly less than in the TURP group, while there was no intergroup difference in postoperative fever greater than 38 degrees C, antibiotic treatment, number of days with indwelling catheter or days of hospitalization after surgery. Three patients in the TUI group had repeated surgery. In the TURP group one patient underwent reoperation and one was discharged with a permanent indwelling catheter. Thirty-three patients had a follow-up of 3 months. Both surgical procedures significantly improved symptoms and maximum flow rates, and there was no intergroup difference of the surgical outcome. Forty-five per cent in the TURP group developed retrograde ejaculation versus none in the TUI group. In this preliminary report TUI was as effective as TURP in relieving bladder outlet obstruction caused by small prostates.

Aged↗