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Biomedical subjects

A Bremmelgaard

Publications and source records attributed to A Bremmelgaard.

At least 37 records · Page 2Linked to original sources
PubMed1991

[4-year experiences with computer-assisted registration of postoperative wound infections and identification of risk factors].

A continuous record of postoperative surgical infections was carried out by electronic data processing of 9,181 orthopaedic and general operations. The overall infection rate was 5.7%, ranging from 2.0% (clean wounds) to 22.1% (dirty wounds). The corresponding deep infection rates were 1.7%, 0.4% and 5.4%, respectively. Employing a multiple logistic regression analysis, ten risk factors were evaluated. Factors found to be significant for both departments were: wound contamination, duration of operation and age. In addition, in the department of orthopaedic surgery: date of operation and surgeon, and in the department of general surgery: planning of operation, length of preoperative stay and anatomic groups. Sex had no influence on postoperative infection. Significant factors altered during the four years. Postoperative stay was, on an average, 13.9 days longer in infected patients.

Denmark↗
PubMed1991

New operative technique to reduce surgeons' risk of HIV infection.

The surgical team is potentially at risk of acquiring human immunodeficiency virus (HIV) from the patient. Assuming that the probability of an accidental injury during surgery is 0.01 (P2), the prevalence of HIV is 0.01 (P3) and the seroconversion rate is 0.01 (P1), we have estimated the risk (actuarial model) for a surgeon as 0.2% per year, and 5.82% for 30 years of surgery. In view of this we have made changes in surgical technique to reduce the risk to the surgical team from splash or injury. The surgeon must handle tissue with instruments only and minimize the use of fingers. Whenever possible, sharp instruments should be replaced by a blunt type. The surgical nurse loads needles to the needle carrier using forceps. Sharp instruments are placed in a neutral zone on the nurse's stand so that the surgeon and the nurse never touch the same sharp instrument at the same time. Movements should be controlled, and instrument handling accompanied by eye contact. We consider that these changes will reduce the risk of accidental injuries and thereby the transmission of HIV during operations to a greater degree than knowledge of the patient's HIV status.

Asepsis↗
PubMed1991

Interference by cryoglobulins with white blood cell measurements on Coulter Counter.

By using the Coulter Counter S-Plus IV erroneous measurements of leukocytes, platelets and red cells were experienced in blood from two patients with cryoglobulinaemia. Leukocyte levels were estimated too high owing to contamination of the leukocyte counting chamber by unlysed erythrocytes. One of the patients had leukopenia, but the Coulter Counter reported white blood cell counts within normal limits. Rewarming of the sample to 37 degrees C eliminated the problem.

Aged↗
PubMed1991

Susceptibility testing of anaerobic bacteria. Regression lines for six antibiotics determined with and without prediffusion.

The relationship between susceptibility testing by an agar dilution test and a tablet diffusion test was studied for 60 anaerobic bacteria (20 B. fragilis, 20 anaerobic cocci, 20 Clostridium species). For cefoxitin, no prediffusion and prediffusion times of one h, three h, 12 h, 24 h and 48 h were examined. For metronidazole, erythromycin, clindamycin, penicillin and imipenem, only 24 h prediffusion and no prediffusion were studied. Measurements were made after incubation for 24 h and 48 h. Prediffusion improved the correlation for all antibiotics tested, and 24 h prediffusion gave the best results. The slope of the regression line increased and the influence of the individual growth parameters on zone size was reduced. Prediction of susceptibility based on three zone breakpoints to estimate MIC was also better with 24 h prediffusion. However, the variation about the regression line for many of the antibiotics was still extremely high. Measurements after 24 h and 48 h incubation times showed almost identical regression equations, except for erythromycin, where the regression lines differed.

Anti-Bacterial Agents↗
PubMed1990

[Models for calculating risks as a tool in screening for cardiovascular diseases].

In connection with screening for risk factors for ischaemic heart disease in Bispebjerg Hospital, we have assessed three different models for calculation of the risk, employed on our own material. A total of 462 persons participated in the screening and 275 of these were under the age of 65 years. Out of these 275, 92 had plasma cholesterol values over or equal to 7.0 mmol/l and or smoked over 20 gram tobacco daily. On comparison between three models for calculation of the risk: one American, one British and one Swedish, moderate agreement was observed: the correlation coefficients varied between 0.75 and 0.89. The reason for this may be that the models for calculation of the risk are constructed on the basis of statistics already described from epidemiological investigations in which coincidence is demonstrated between selected observable factors and ischaemic heart disease. It is thus possible that the factors which we measure and possibly attempt to influence are not pathogenetic. We consider, therefore, that risk scoring should be employed with caution. As causal connection between ischaemic heart disease and cholesterol and smoking, respectively, have been demonstrated with reasonable certainty, we consider that it is reasonable to screen and intervene for these factors alone.

Adult↗
PubMed1990

[Disseminated intravascular coagulation and pneumococcal septicemia after splenectomy].

Two cases of fulminant pneumococcal septicaemia are reported. These occurred 18 and 25 years after splenectomy. These patients had not received pneumococcal vaccination. Disseminated intravascular coagulation developed early and was of decisive significance for the course of the illness with lethal issue. The characteristic clinical picture in pneumococcal speticaemia in asplenic patients may be misinterpreted initially as influenza and meticulous observation is therefore necessary and antibiotic treatment according to current guidelines should be initiated as early possible in febrile episodes.

Adult↗
PubMed1990

Metabolic changes during treatment with two different progestogens.

Two triphasic oral contraceptives containing the same amount of ethinyl estradiol in combination with gestodene or levonorgestrel were compared with respect to contraceptive effect, on lipid metabolism and coagulation. Serum concentrations of gestodene, levonorgestrel, ovarian and pituitary hormones, and sex hormone-binding globulin were measured. Thirty-five randomized into two groups receiving either of the preparations. Before treatment and in the third and sixth cycles, blood sample were drawn in the morning while subjects were still in bed to obtain basal conditions. The contraceptive effect and cycle control were good with both preparations, and there were only a few minor side effects. Sex hormone-binding globulin was elevated twofold in the levonorgestrel group and threefold in the gestodene group. The gestodene concentration in serum varied more than the levonorgestrel concentration, but with correction for variations in sex hormone-binding globulin binding, less variability in gestodene and levonorgestrel concentrations were seen. High-density lipoprotein2 cholesterol decreased in the levonorgestrel group but was unchanged in the gestodene group, whereas apolipoprotein A1 increased in the gestodene group but not in the levonorgestrel group. Antithrombin III decreased in the gestodene group but was unchanged in levonorgestrel-treated women. Factor VII increased in both groups but more in the gestodene group. We conclude that gestodene has a positive influence on lipid metabolism, probably because of its lower androgenicity, and a slightly negative influence on coagulation. The latter, however, probably has no clinical relevance.

Adult↗
PubMed1989

[AIDS/HIV: risk for surgeons--new surgical routines].

The surgical team is at risk of transmission of human immunodefiency virus (HIV) from the patient, which could progress to AIDS and death. In our hospital, we have estimated a probability of 0.20% per year, and 5.82% for 30 years in surgery. In view of this we have designed new procedures for surgical handicraft to reduce the risk from splash or injury to the surgical team. The surgeon must handle tissue with instruments only and minimize the use of fingers. Sharp instruments should, if possible be replaced by blunt types. The nurse loads needles to the needle carrier using a forceps. Sharp instruments are placed in a neutral zone on the nurse's stand so that the surgeon and nurse never touch the same sharp instrument at the same time. Movements must be controlled and accompanied by eye contact. The measures to prevent injury would hardly affect the individual skill of the surgeon or prolong operation time. We consider that the new routines suggested prevent transmission of HIV during surgical procedures better than by knowing the HIV status, of the patients.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Lipid metabolism and coagulation of two contraceptives: correlation to serum concentrations of levonorgestrel and gestodene.

The effects of two triphasic oral contraceptives containing the same amount of ethinylestradiol (EE) in combination with levonorgestrel (LNG) or gestodene (GES), respectively, on lipid metabolism and coagulation were studied. Serum concentrations of GES and LNG were determined at the same time. Thirty-three healthy women were randomized into two groups receiving either of the preparations. Before treatment and in the 3rd and the 6th cycle, blood samples were drawn in the morning while subjects were still in bed to obtain basal conditions. HDL2-cholesterol decreased in the LNG group but was unchanged in the GES group, whereas apolipoprotein A1 increased in the GES but not in the LNG group. Antithrombin III decreased in the GES group but was unchanged in the LNG-treated women. Factor VII increased in both groups, but more in the GES group. It is concluded that GES has a positive influence on lipid metabolism, and has a slightly negative influence on coagulation but the latter is more likely to be without clinical relevance. The positive influence of GES compared to LNG on lipids is probably due to its lower androgenicity and not to differences in bioavailability.

Adult↗
PubMed1989

Computer-aided surveillance of surgical infections and identification of risk factors.

A continuous record of postoperative surgical infections was carried out by electronic data processing (EDP) of 4340 orthopaedic and general operations. The overall infection rate was 6.3%, ranging from 2.3% (clean wounds) to 27.1% (dirty wounds). The corresponding deep infection rates were 1.6%, 0.4% and 4.6%. Employing a multiple logistic regression analysis, 10 risk factors were evaluated. Factors found to be significant were: wound contamination, department, duration of operation, date of operation and age, and in addition for the department of general surgery: surgeon, planning of operation, length of preoperative stay and anatomic groups. A statistical model for identification of risk patients is described. Postoperative stay was on average 20.5 days longer in infected patients. We find that EDP-recording may result in an annual cost reduction of at least 175,000 pounds for our hospital.

Denmark↗
PubMed1989

Susceptibility testing of Danish isolates of Capnocytophaga and CDC group DF-2 bacteria.

Twelve Capnocytophaga and seven DF-2 strains were tested for their susceptibility to 14 antimicrobial agents using an agar dilution and an agar diffusion method. Twenty-three other antibiotics were evaluated using the diffusion test only. All strains were fully susceptible to penicillin, ampicillin, cefuroxime, cefotaxime, erythromycin, clindamycin, chloramphenicol, doxycycline, rifamycin and ofloxacin using both methods. Clindamycin, rifamycin and cefotaxime were most active. Using agar dilution some strains were susceptible to gentamicin, but agar diffusion showed total resistance. One Capnocytophaga strain was susceptible and another moderately susceptible to metronidazole, other strains were resistant. The agar diffusion test showed that both Capnocytophaga and DF-2 were resistant to most other aminoglycosides, to fosfomycin, polymyxin and trimethoprim. All strains of both taxa were fully susceptible to piperacillin, cefoxitin, imipenem and fusidic acid and showed different susceptibilities to the other agents. Susceptibility testing by means of agar diffusion using an enriched chocolate agar and 5% CO2 atmosphere could be used to test Capnocytophaga and DF-2 strains and gives sufficient accuracy for routine use, when revised inhibition zone breakpoints are employed.

Animals↗
PubMed1988

Adjusted-dose intravenous heparin treatment evaluation of an automated and a non automated schedule.

An automated schedule for adjusted continuous intravenous heparin treatment was tested under physician supervision in 19 patients and the results were compared to those obtained in 27 patients treated prior to automation. Both schedules used plasma activated partial thrombo-plastin time (P-APTT) for adjustment of heparin infusion and aimed at the same therapeutic interval for P-APTT (1.5-2 times the value in normal pooled plasma). The quality of treatment was assessed on the basis of clinical information and its ability to keep the P-APTT within or close to the therapeutic interval. The automated schedule reduced the involvement of the physician by 73% without changing the quality of treatment or increasing the consumption of other resources such as the number of P-APTT analyses. Both schedules were able to keep the P-APTT of the patients within the therapeutic interval for about 40% of the treatment time.

Adolescent↗
PubMed1988

Determination of susceptibility of anaerobic bacteria to beta-lactam antibiotics by a tablet diffusion test.

A standardized tablet diffusion test and a reference agar dilution test was evaluated for susceptibility testing of anaerobic bacteria to beta-lactam antibiotics. 74 freshly isolated anaerobic bacteria and three control strains (Cl. perfringens ATCC 13124 B. fragilis ATCC 25285, B. thetaiotaomicron ATCC 29741) were tested. The in vitro activities of 7 beta-lactam antibiotics were compared with metronidazole and clindamycin. Most active were metronidazole and clindamycin. Cefoxitin had the best activity of the beta-lactam antibiotics, whereas piperacillin and carbenicillin had good activities. High resistance rates were found for penicillin, ampicillin, cefuroxime and cefotaxime. MIC on control strains fell well within range set by the National Committee for Clinical Laboratory Standards (NCCLS). Correlation between MIC and inhibition zone diameters was generally good. Tablet diffusion can be used to divide anaerobic bacteria into three susceptibility categories. In addition all bacterial strains were tested for production of beta-lactamase by a nitrocefin tube test. Beta-lactamase production by the nitrocefin test indicated reduced sensitivity to beta-lactam antibiotics.

Anti-Bacterial Agents↗
PubMed1987

Susceptibility testing of 7 antibiotics against anaerobic bacteria: comparison of 2 different media and carbon dioxide concentrations.

Anaerobic agar (AA) and Danish Blood agar (DBA) were evaluated by a standardized agar diffusion and agar dilution test in 5% CO2. The activity of seven antibiotics (tetracycline, clindamycin, metronidazole, rifamycin, chloramphenicol, penicillin, erythromycin) was tested against 40 anaerobic bacteria, including 3 control strains (Cl.perfringens ATCC 13124, B.fragilis ATCC 25285, B.thetaiotaomicron ATCC 29741). 70% of the strains were resistant to erythromycin in 10% CO2, only 30% in 5% CO2. No evident CO2-effect could be seen with the other antibiotics. Mean MIC for tetracycline was twice as great on AA than DBA. In spite of that, tablet sensitivity testing with tetracycline on AA proved to be more accurate and completely separated the resistant and susceptible strains. For penicillin, the mean MIC was one dilution step higher on AA. No major differences could be seen with the other antibiotics. AA was superior to DBA in providing growth of anaerobes. Measurement on AA was easier, and it was more precise. Except for tetracycline. MIC on control strains fell well within range set by The National Committee for Clinical Laboratory Standards (NCCLS) on AA. Acceptable correlation coefficients were recorded between agar diffusion and agar dilution. Prediction of susceptibility based on zone diameter measurements was very good on AA. Only one discrepancy that could cause change of susceptibility status occurred on AA, while there were 12 on DBA. On DBA, there was poor correlation between MIC, compared with earlier results on the same agar. The 50% inhibitory concentration (IC50) was also measured, but offered no advantage over MIC.

Anti-Bacterial Agents↗
PubMed1987

The role of vaginal secretory immunoglobulin A, Gardnerella vaginalis, anaerobes, and Chlamydia trachomatis in postabortal pelvic inflammatory disease.

In a prospective study of 129 women undergoing induced first-trimester abortion, 14 (10.9%) contracted postabortal pelvic inflammatory disease (PID). Samples of vaginal secretion for quantitation of secretory immunoglobulin A (sIgA) as well as isolates from cervix/urethra for the culture of anaerobes and aerobes, including Bacteroides fragilis et melaninogenicus and Gardnerella vaginalis, were obtained at the preoperative visit. Two blood samples from each woman with postabortal PID were analysed for antibodies against G. vaginalis. Twenty-five per cent of women with a history of PID developed postabortal PID, and 25% with vaginitis contracted postabortal infection (p less than 0.001 and p less than 0.005). Twenty-five per cent of women harboring C. trachomatis at the time of abortion developed infection. The presence of anaerobes or G. vaginalis was not associated with the frequency of postabortal PID (all p-values greater than 0.1). One woman with postabortal PID produced a culture positive for G. vaginalis and a rise in specific antibody titer. The levels of vaginal sIgA were not significantly associated with a positive history of PID (p greater than 0.6), with postabortal PID (p greater than 0.4) or with the presence of anaerobes or G. vaginalis at the time of abortion (p greater than 0.3). However, significantly elevated levels of sIgA were found in women harboring C. trachomatis (p less than 0.05). Thus, the study could not demonstrate any correlation between vaginal sIgA and PID, but increased sIgA in Chlamydia-positive women. A history of PID and vaginitis entailed a significant risk of contracting postabortal PID.

Abortion, Induced↗