[Education in gynecologic and obstetric ultrasound diagnostics].
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Denmark↗
Biomedical subjects
T Larsen
Publications and source records attributed to T Larsen.
[Unskilled ultrasound scanning in gynecology and obstetrics can lead to serious risks].
Four cases of ectopic pregnancy were incorrectly diagnosed by ultrasound examination as intrauterine pregnancies. The clinicians involved were biased by the misinterpretation and did not react to the clinical symptoms of ectopic pregnancy. One patient died because of intraperitoneal haemorrhage and some of the other patients were in serious danger. In a fifth case, a midwife examined a pregnant woman with a gestational age of 31 weeks and suspected twin pregnancy. A senior registrar with limited training in ultrasound methods performed an examination and found one foetus. After this examination, the patient was examined clinically on six occasions by midwives and obstetricians but none of these questioned the ultrasound diagnosis. Unfortunately, a twin pregnancy was present. This became apparent when the first twin was delivered and the second twin was in a transverse lie and delivery by Caesarean section was required. The second twin has since developed spastic palsy. These case reports illustrate that young doctors require improved training in ultrasonic diagnostic methods. In addition, clinicians should not rely too much on the results of ultrasound examinations but should also employ their clinical judgement.
Adult↗
Nutrient digestibilities in ingredients fed alone or in combinations.
Digestibility coefficients (DC) of protein, dry matter, energy, starch, and dietary fibre in individual feedstuffs were used to predict the DC in feed mixtures. Digestibility studies with growing rats involved six feed sources: soya-bean meal, barley, rapeseed meal, peas, wheat bran and wheat, given individually and in various combinations, i.e. fourteen diets in total. True digestibility of protein (TD) and apparent digestibility of starch could be predicted in feed mixtures from their respective DC values for the individual ingredients, except in the diet composed of peas + barley. Dry matter (DM) and insoluble dietary fibre digestibilities in the mixtures could also be calculated from their individual DC values. Energy digestibility could be predicted in all mixtures except for barley + wheat and peas + wheat. Although the discrepancies were significant, the differences were not great. The digestibility of soluble dietary fibre in the mixtures could be predicted as for the individual ingredients in all but three diets: rapeseed meal + barley, peas + barley and peas + wheat. The results confirm that DC values for TD, DM, energy, starch and dietary fibre in mixtures can be calculated with high precision from DC determined from individual ingredients. Caution should be taken though when mixtures contain a high amount of dietary fibre, especially of the soluble type.
Animal Feed↗
Daily food intake and digestibility in rats.
The present work with growing rats was undertaken to study the effect of daily food intake (DFI) on true protein digestibility (TD), and apparent digestibility of dry matter (DM), energy (DE), starch, soluble dietary fibre (SDF) and insoluble dietary fibre (IDF). The design involved two different dietary combinations, barley + rapeseed meal (diet 1) and oats + wheat bran (diet 2). A slight but significantly negative relationship was seen between DFI and TD on diet 1 while no such relationship was found on diet 2. Although significant, DFI influenced DM digestibility of both diets only slightly. A similar situation could also be seen for the effect of DFI on DE. The digestibility of starch was significantly affected by DFI on both diets even though the lowest values were as high as 0.994. SDF digestibility (fermentability) was not influenced by DFI when the rats were given diet 1, while there was a significant negative effect of DFI on digestibility of SDF when diet 2 was given. The digestibility (fermentability) of IDF was not affected by DFI on either of the two diets. The results confirm the existence of a weak negative relationship between DFI and digestibility of a range of nutrients although the effect seems to be only marginal and of no importance under practical feeding conditions.
Animals↗
A comparison of aspiration, antazoline sclerotherapy and surgery in the treatment of hydrocele.
Of 98 hydroceles (mean volume 125 ml) in a consecutive series of 92 patients, treated initially by aspiration, 14% (mean volume 70 ml) were cured. The 76 recurring hydroceles (mean volume 146 ml) were then randomised to either antazoline sclerotherapy on an out-patient basis or surgery. Cure rates were 89 and 100%, respectively, at follow-up 6 months later. Operated patients were admitted for a mean duration of 2.5 days. The results indicated that aspiration alone was inadequate, and sclerotherapy is advocated as the first choice of treatment for hydrocele.
Adult↗
Paroxetine and imipramine treatment of depressive patients in a controlled multicentre study with plasma amino acid measurements.
In a 12-week double-blind study with 36 patients with major depressive episode (DSM-III), paroxetine (Seroxat, Aropax) showed significantly quicker onset of efficacy on the Melancholia Scale, and better tolerance than imipramine. Plasma concentration analyses showed no clear concentration-efficacy correlation in either treatment group. During long-term treatment paroxetine seemed to be superior to imipramine in preventing relapse; both treatments were well tolerated. A significant correlation between baseline plasma tryptophan: large neutral amino acids ratio and final Hamilton Rating Scale for Depression (HRSD) score and a trend towards an inverse correlation between this ratio and percentage reduction in HRSD score were seen in the paroxetine group but not in the imipramine group. In line with previous studies, these results support the hypothesis that paroxetine is an effective and well tolerated antidepressant.
Amino Acids↗
Occurrence of doxycycline resistant bacteria in the oral cavity after local administration of doxycycline in patients with periodontal disease.
Topical antimicrobial treatment is appearing as a means of therapy in patients with advanced periodontal disease. The purpose of the present study was to examine the occurrence of doxycycline resistant bacteria in subgingival plaque and oral cavity after local administration of doxycycline. Five patients with advanced marginal periodontitis were scaled, and one approximal pocket in each patient was additionally treated with locally delivered doxycycline. Microbiological samples were obtained from the test site, a contralateral control site and tongue and tonsils before treatment and 3, 13, 26 and 52 weeks after treatment. The occurrence and morphological distribution of doxycycline resistant bacteria was determined after anaerobic cultivation on enriched tryptic soy agar with and without doxycycline incorporated. At the test site and on tongue and tonsils the percentage of doxycycline resistant bacteria increased from less than 1% before treatment to 22% and 35%, respectively, immediately after treatment, but decreased again at week 13. At the control site no increase was observed. Gram-positive cocci constituted the majority of doxycycline resistant bacteria at all 3 sampling sites (73-94%). The morphological distribution of resistant bacteria was not affected by the doxycycline therapy. Thus, local doxycycline therapy resulted only in a transient increase in resistance in the oral microflora.
Administration, Topical↗
[Use of antibiotics for the treatment of marginal periodontitis].
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Anti-Bacterial Agents↗
US-guided fine needle biopsy of solid renal masses--comparison of histology and cytology.
We report on 134 fine needle biopsies in 127 patients with an ultrasound finding suggesting renal malignancy. Biopsy was performed guided by dynamic ultrasound using an 0.6 mm aspiration needle for cytology and an 0.8 mm Surecut needle for histology. The retrieval rate for cytology was 97.8% compared to 79.1% for histology. Sensitivity for cytology and histology was 89.4% and 70.6%, respectively. The specificity of cytology was 85.4% giving a predictive value of a positive result of 91.6%. Specificity and positive predictive value for histology were both 100%. We conclude that fine needle aspiration biopsy from renal masses in our hands carries too high a false positive rate to be clinically safe. We recommend that fine needle histological biopsy replaces the aspiration biopsy in case of renal masses.
Biopsy, Needle↗
Normal fetal growth evaluated by longitudinal ultrasound examinations.
Fetal weight estimation was evaluated using the equations of Warsof, Shepard and Hadlock in 192 patients, less than 3 days before delivery. Warsof's and Hadlock's equations resulted in significantly better weight estimates compared to Shepard's equation. No systematic error was found below 2500 g by use of Warsof's equation, whereas Shepard's and Hadlocks's equations resulted in significant over-estimation in the low weight group. In a study of 5 fetuses, of 27-38 weeks gestational age, the intra-observer variation was calculated to 4.6%, whereas the coefficient of variation among observer means was 2.9%. The mixed intra- and inter-observer coefficient of variation was 6.5%. Thirty-five low-risk, uncomplicated pregnancies with reliable last menstrual dates were investigated longitudinally with ultrasound measurements of fetal weight. Population growth curves of fetal weight, fetal femur length, abdominal circumference and biparietal diameter were constructed by weighted polynomial regression. After 27 weeks of gestational age the weight growth curve showed only insignificant non-linearity. Compared to a Danish growth curve based on birth weights, significant higher mean weight was found, especially before 31 weeks of gestational age. The 10th and 90th percentiles for the individual percentage deviation change was +/- 4.4% per 28 days.
Body Weight↗
Comparison of urinary human follicle-stimulating hormone and human menopausal gonadotropin for ovarian stimulation in polycystic ovarian syndrome.
A randomized, double-blind, crossover study was carried out to compare purified urinary follicle-stimulating hormone (FSH) and human menopausal gonadotropin (hMG) for ovarian stimulation in polycystic ovarian syndrome (PCOS). Twelve patients were stimulated with FSH and hMG in three alternate cycles. FSH, luteinizing hormone (LH), estradiol, dihydroepiandrosterone sulphate, free and total testosterone, delta 5-androstenedione, sex hormone binding globulin, and ovarian volume were monitored during the stimulation. There was no difference between the dose of FSH and hMG necessary to induce preovulatory follicles in the individual patients. The mean increase of ovarian volume during stimulation with FSH and hMG was 120% and 129% respectively (no significant difference). Two patients became pregnant in the first cycle. Two other patients had delayed bleeding and positive serum-human chorionic gonadotropin. No significant difference was found in the endocrine changes during the two different stimulation methods. The LH/FSH ratio was normalized after a few days of treatment regardless of the type of stimulation. The size of the material does not permit a comparison of the efficacy of the two treatment schedules. Our clinical and ultrasonic observations do not support the theory that treatment of infertility in PCOS with FSH is more safe than with hMG.
Estradiol↗
In vitro release of doxycycline from bioabsorbable materials and acrylic strips.
Treatment of marginal periodontitis may include use of local antibiotics. In the present in vitro study the bioabsorbable materials Surgicel, Tissell, and CollaCote and acrylic strips were examined for release of doxycycline into liquids and residual antibacterial activity of the materials. Pieces of material were incubated in 1 ml of water or human serum which was exchanged every day for 9 days. The concentration of doxycycline in the liquids was measured spectrophotometrically while the residual antibacterial activity of the materials was determined microbiologically. Surgicel constantly showed very high concentrations and level of residual activity. The acrylic strip and CollaCote decreased to low levels of both concentration and residual activity in a few days. Tissell was intermediate with a continuous decrease in concentration but rather high level of residual activity throughout the study. In serum the acrylic strip was partly dissolved and Surgicel was totally dissolved after 2 days. Left undisturbed in serum Surgicel was not dissolved for 2 weeks. These results indicate that Surgicel and Tissel may be capable of prolonged release of doxycycline in vivo.
Actinobacillus↗
Lack of ability to synthesize tissue factor by endothelial cells in intact human saphenous veins.
It is well established that cultured endothelial cells are induced to generate tissue factor activity when incubated with either endotoxin or thrombin. In this study a perfusion system was used on 3-4 cm long human saphenous veins. The veins were perfused with thrombin (2.5 U/ml), endotoxin (30 ng/ml) or just medium for 3 h at 37 degrees C. After the perfusion, the veins were treated with collagenase, and EC were collected and subjected to tissue factor activity measurements. Some perfused veins were examined for tissue factor activity on the vessel wall by allowing factor VII and factor X to interact with the lumen of the intact vessels, followed by quantitation of generated factor Xa in a chromogenic assay. No formation of tissue factor activity could be found after perfusion in either collagenase-dissolved endothelial cells or in the coupled chromogenic assay for tissue factor activity performed in the lumen of the vessel. Our data strongly suggest that endothelial cells in intact endothelium may behave quite differently from isolated endothelial cells stimulated in cell cultures.
Adult↗
Protein quality and digestible energy of selected foods determined in balance trials with rats.
Chemical analyses and balance trials with rats of 17 foods showed marked differences in protein quality. According to an in vitro procedure true protein digestibility was high (around 90%). The same was also the case for the in vivo values with the exception of two legumes, beans and chick peas, which were digested to a markedly lower degree when compared to the in vitro values. The assumed reason for this is discussed. Due to extensive differences in the amino acid composition of the 17 samples BV varied considerably with the lowest value (45.5) of rice-wheat gluten breakfast cereal. Energy digestibility was generally high. Amino acid digestibility determined in vivo followed the pattern of the corresponding protein digestibility, although marked differences occurred from one amino acid to another in the same food.
Amino Acids, Essential↗
Longitudinal cleavage of the penis, a rare catheter complication seen in paraplegic patients.
Two cases of total necrosis of the penile urethra and overlying ventral structures are described in paraplegic male patients treated with indwelling urethral catheters. The lesions were apparently caused by an inexpedient pull on the catheter causing ischaemic necrosis of the urethral wall.
Adult↗
Effect of scavengers of active oxygen species and pretreatment with acetyl-salicylic acid on the injury to cultured endothelial cells by thrombin-stimulated platelets.
Thrombin-stimulated human platelets adhere to and injure cultured human endothelial cells. We hypothesize that generation of active oxygen species by the stimulated platelets are involved in the injury. To confirm this, catalase [final concentration (8.25 micrograms/ml)], superoxide dismutase (SOD) (10 micrograms/ml), of D-mannitol (9 mg/ml) were added to the cell culture medium before the experiments. Platelet suspension (200,000/microliters) and thrombin (4 U/ml) were added and the culture dishes shaken for 15 min at room temperature. In separate experiments the endothelial cells were pretreated with acetylsalicylic acid (0.05, 0.1, or 0.5 mM) to test whether the arachidonic acid metabolism of the endothelial cells is involved in the injury process. In preliminary experiments we were able to confirm that platelets, when stimulated by thrombin, produce chemiluminescence which was suppressed by mannitol but not by catalase or SOD. The degree of injury to cultured endothelial cells by thrombin-stimulated platelets, as measured by release of 51Cr from prelabeled endothelial cells, was reduced significantly with the presence of mannitol, but only moderately when catalase or SOD had been added. Morphometric quantification based on scanning electron micrographs of the endothelial cells after exposure to thrombin-stimulated platelets in the presence of catalase or mannitol showed a reduced number of injured cells. Pretreatment of the endothelial cells with acetylsalicylic acid did not cause any significant change in the degree of endothelial cell injury as measured by the 51Cr release. It is concluded that active oxygen species, in particular hydroxyl radicals, may be generated during thrombin stimulation of platelets and cause injury to the endothelial cells.
Aspirin↗
Fetal abdominal circumference rather than fetal femur length/abdominal circumference ratio predicts fetal malnutrition in high risk pregnancies.
The aim of this study was to compare the ability of abdominal circumference (AC) and fetal femur length/abdominal circumference ratio (FFL/AC) measured by ultrasound within a period of 2 weeks before birth to predict low birth weight percentile and neonatal signs related to fetal malnutrition. From longitudinal ultrasound measurements in 35 normal pregnancies reference data of AC and FFL was obtained. FFL/AC ratio was constant from 21 weeks until term (mean 20.9, SD 1.2) (figure 1). In 350 risk pregnancies AC standard deviation score (AC-SDS) correlated far better than FFL/AC ratio with the deviation of birth weight from normal (figure 3). Furthermore AC-SDS correlated better with ponderal index (PI) and skinfold thickness (ST) than did FFL/AC ratio. Using cut-off levels on AC-SDS and FFL/AC ratio, which selected about 30% of the population, the sensitivity of AC-SDS in predicting the infant being LGA was 81.8% versus 42.9% using FFL/AC ratio (table II). The prediction of the infant being SGA was not improved when the change in AC-SDS or FFL/AC over the last 6-8 weeks of pregnancy was considered. We conclude that AC-SDS correlates well with birth weight deviation and predicts the infant being SGA with a precision equal to the best results reported in the literature, and that FFL/AC ratio is unreliable even when GA is not known because of a high false positive rate.
Abdomen↗
Closure of the abdominal fascia after clean and clean-contaminated laparotomy.
This prospective, randomized study compares continuous absorbable suture (Dexon), continuous nonabsorbable suture (Surgilon) and interrupted absorbable suture (Dexon) for fascial closure of clean and clean-contaminated laparotomy wounds. Three months postoperatively, the overall frequencies were for wound dehiscence 0% (0/238), wound infection 5.5% (13/238), hernia formation 0.4% (1/238) and sinus formation 0% (0/238). After a median period of 41 months (range 14-59 months) a physical examination was performed in 93.7% (224/238) of the patients and the observed overall frequency of hernia was 3.1% (7/224). No difference was detected in incidence of wound complications when comparing the three groups. We conclude that layered closure of a laparotomy wound is safe whether using nonabsorbable or absorbable sutures and whether applying a continuous or interrupted technique in the fascial closure of clean and clean-contaminated wounds.
Abdominal Muscles↗