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Biomedical subjects

A Holen

Publications and source records attributed to A Holen.

At least 19 recordsLinked to original sources
PubMed2000

High-dose methotrexate in childhood all.

An event-free survival is currently achieved in 70-80% of children diagnosed with acute lymphocytic leukemia (ALL). A decline in the long-term sequalae from therapy is a challenge at present. Due to the high incidence of central nervous system (CNS) relapse in ALL patients, cranial irradiation was introduced as a prophylactic measure in the beginning of the 1970s. Cranial irradiation, however, may cause secondary malignancies in the CNS. In recent years neurotoxicities have been demonstrated to follow cranial irradiation in a large proportion of ALL patients. Because of these deleterious effects, most ALL protocols are limited to the combination intrathecal and intravenous methotrexate as the standard for CNS prophylaxis. In the 1970s, an intermediate dose was administered, while from the 1980s a high dose of methotrexate was combined with intrathecal methotrexate. The regular methotrexate dose of later years has been in the range of 5-8 g/m2. The intravenous methotrexate dose has actually varied from 2 to 33.6 g/m2. The highest dose, 33.6 g/m2, has been without intrathecal instillation. In a study from Norway, high-dose methotrexate (6-8 g/m2) was used, and only two (2.2%) of 89 ALL cases showed CNS relapse, both of reversible kind. In the United Kingdom, a randomized controlled study was started in 1990. Results published so far are based on a segment of cases characterized by standard risk and white blood cell count below 50 x 10(9); a 4% reduction in CNS relapse was found for high-dose methotrexate in comparison to those treated only with long-term intrathecal methotrexate. The use of methotrexate unalterably warrants some precautions. Rescue therapy with folinic acid is usually started 36 h after initiating the methotrexate infusion. Steps are also taken to secure adequate intake of fluids and alkalinization of the urine. Provided irradiation is avoided, neurotoxicities rarely occur. For regular high-dose methotrexate adverse effects mostly involve mucositis and myelosuppresion.

Antimetabolites, Antineoplastic↗
PubMed2000

Stress reactivity to and recovery from a standardised exercise bout: a study of 31 runners practising relaxation techniques.

OBJECTIVE: To compare the efficacy in runners of two relaxation techniques with regard to exercise reactivity and recovery after exercise. METHODS: Thirty one adult male runners were studied prospectively for six months in three groups practising either meditation (n = 11) or autogenic training (n = 11) or serving as controls (n = 10). Before and after the six months relaxation intervention, indicators of reactivity to exercise and metabolism after exercise (blood lactate concentration, heart rate (HR), and oxygen consumption (VO2)), were tested immediately after and 10 minutes after exercise. Resting HR was also assessed weekly at home during the trial. State anxiety was measured before and after the intervention. RESULTS: After the relaxation training, blood lactate concentration after exercise was significantly (p<0.01) decreased in the meditation group compared with the control group. No difference was observed in lactate responses between the autogenic training group and the control group. There were no significant differences among the groups with regard to HR, VO2, or levels of anxiety. CONCLUSION: Meditation training may reduce the lactate response to a standardised exercise bout.

Adult↗
PubMed1999

[Adults treated as children for acute lymphocytic leukemia--methotrexate, late effects and quality of life].

From 1975 to 1980, 153 Norwegian children were diagnosed with acute lymphocytic leukaemia. In 1995, all 98 survivors were studied and compared to matched family controls. 132 children were treated with the national protocol. Of these, 93 (70.5%) were survivors at the time of the study. The remaining five survivors were treated with different treatment schemes. The national protocol included methotrexate infusions combined with intrathecal methotrexate as prophylactics against neuroleukaemia, instead of the irradiation. Neither doxorubicin nor cyclophosphamide were included. In this study, a questionnaire was used that covered demographic data, quality of life, and medical information the response rates were 96% (94 persons) for survivors and 92% (90 persons) for family controls. Information was also obtained for the remaining four survivors. No significant differences were found between survivors and controls with regard to quality of life and demographics, with one exception, Somatisation on the GHQ-28. Hospital records of all patients were checked for possible late effects. One case of serious sequela (hemiparesis during therapy) was found, probably related to methotrexate therapy. Seven other serious, possible sequelae were recorded, but probably not related to methotrexate. There were no cases of secondary malignant neoplasm.

Adolescent↗
PubMed1999

The relation of continuing attachment to adjustment in conjugal bereavement.

The role of continuing attachment in adjustment to conjugal loss was examined. At 6 months postloss, 70 midlife bereaved participants were interviewed to assess different forms of continuing attachment. They also engaged in a monologue role-play with their deceased spouse, providing a behavioral measure of grief-related distress. In addition, they completed general and grief-specific symptom inventories at 6 months and again at 14 and 25 months postloss. The results indicated that use of the deceased's possessions to gain comfort was positively correlated with concurrent distress in the role-play and predictive to less of a decrease in grief-specific symptoms over time in a growth curve analysis. In contrast, attachment through fond memories was related to less distress in the role-play. The results, therefore, suggest that whether continuing attachment is adaptive or not depends on its form.

Adult↗
PubMed1998

[Group learning in medical education].

The implementation of group learning in medical education puts special demands on the participants, but also offers pedagogical benefits, which may be conductive to the efficient learning of facts, skills and attitudes. The group makes it possible to verify or modify the learned material, which is an important part of preparing for a career as a doctor. Students develop a dependence on others when solving problems in groups, whereas as clinicians they are often alone when confronted with problems demanding quick decisions. In this article we discuss some of the pedagogical principles involved in group learning and make suggestions on how to apply them to learning based on problem solving and other forms of group learning in the medical curriculum.

Curriculum↗
PubMed1997

Diagnostic criteria for complicated grief disorder.

OBJECTIVE: Some prolonged and turbulent grief reactions include symptoms that differ from the DSM-IV criteria for major depressive disorder. The authors investigated a new diagnosis that would include these symptoms. METHOD: They developed observer-based definitions of 30 symptoms noted clinically in previous longitudinal interviews of bereaved persons and then designed a plan to investigate whether any combination of these would serve as criteria for a possible new diagnosis of complicated grief disorder. Using a structured diagnostic interview, they assessed 70 subjects whose spouses had died. Latent class model analyses and signal detection procedures were used to calibrate the data against global clinical ratings and self-report measures of grief-specific distress. RESULTS: Complicated grief disorder was found to be characterized by a smaller set of the assessed symptoms. Subjects elected by an algorithm for these symptoms patterns did not significantly overlap with subjects who received a diagnosis of major depressive disorder. CONCLUSIONS: A new diagnosis of complicated grief disorder may be indicated. Its criteria would include the current experience (more than a year after a loss) of intense intrusive thoughts, pangs of severe emotion, distressing yearnings, feeling excessively alone and empty, excessively avoiding tasks reminiscent of the deceased, unusual sleep disturbances, and maladaptive levels of loss of interest in personal activities.

Adjustment Disorders↗
PubMed1997

Fifteen years with clinical guidelines in the treatment of hypertension--still discrepancies between intentions and practice.

OBJECTIVE: To assess physicians' current adherence to the Norwegian clinical guidelines for the treatment of hypertension. DESIGN: Descriptive, retrospective registration of information from patient records of one specified year. In addition, mailed questionnaire to examine the representativeness of the participating doctors. SETTING: General practice in Sør- and Nord-Trøndelag counties in Norway, 380,000 inhabitants. PATIENTS: In one year 2468 patients were registered with the diagnosis of hypertension in the records of 56 general practitioners. The patients were 57% women and 43% men; 41% were 70 years or older. MAIN OUTCOME MEASURES: Levels of blood pressure in accordance with the recommendations of the Norwegian clinical guidelines for hypertension. Fractions of patients with a measured blood pressure and serum cholesterol in one year. RESULTS: At least one blood pressure was recorded in 95% of the hypertensive patients during the specified year. The systolic blood pressure was 140 mmHg or less in 25% and 160 mmHg or less in 65%, while the diastolic blood pressure was 90 mmHg or less in 61%. According to the Norwegian clinical guidelines for systolic blood pressure, 29% of the women and 21% of the men were above recommended levels for treatment. With respect to the diastolic blood pressure, the figures were 38% for women and 40% for men. Patients under 60 years of age were often not treated according to the recommendations. Serum cholesterol was not recorded during the specified year in 68% of the total group, nor in 55% of patients aged 65 years or younger. CONCLUSION: There are still major discrepancies between current practice and the intentions laid down in the Norwegian clinical guidelines. A discussion of alternative methods for implementation and for evaluation of the efficacy of clinical guidelines is needed.

Adult↗
PubMed1995

When avoiding unpleasant emotions might not be such a bad thing: verbal-autonomic response dissociation and midlife conjugal bereavement.

It has been widely assumed that emotional avoidance during bereavement leads to either prolonged grief, delayed grief, or delayed somatic symptoms. To test this view, as well as a contrasting adaptive hypothesis, emotional avoidance was measured 6 months after a conjugal loss as negative verbal-autonomic response dissociation (low self-rated negative emotion coupled with heightened cardiovascular activity) and compared with grief measured at 6 and 14 months. The negative dissociation score evidenced reliability and validity but did not evidence the assumed link to severe grief. Rather, consistent with the adaptive hypothesis, negative dissociation at 6 months was associated with minimal grief symptoms across 14 months. Negative dissociation scores were also linked to initially high levels of somatic symptoms, which dropped to a low level by 14 months. Possible explanations for the initial cost and long-term adaptive quality of emotional avoidance during bereavement, as well as implications and limitations of the findings, are discussed.

Adult↗
PubMed1995

Meditation: a modulator of the immune response to physical stress? A brief report.

OBJECTIVE: To test the hypothesis that stress reducing techniques such as meditation alter immune responses after strenous physical stress. METHODS: The hypothesis was tested by studying six meditating and six non-meditating male runners in a concurrent, controlled design. After a period of six months with meditation for the experimental group, blood samples were taken immediately before and after a maximum oxygen uptake test (VO2max). RESULTS: The increase in CD8+ T cells after VO2max was significantly less in the meditation group than in the control group (P = 0.04). The amount of CD2+ cells doubled after VO2max, mainly because of a rise in the CD8+ fraction. CONCLUSIONS: Meditation may modify the suppressive influence of strenous physical stress on the immune system.

Adult↗
PubMed1993

[Normal and pathological grief--recent views].

The author considers the symptoms of pathological grief related to conjugal loss, and report on recent efforts to develop a structured interview for assessing status of grief. The recommendations of the DSM-III-R to subsume "pathological grief" under "major depression" are challenged. Some implications for therapy are discussed. Similarities and differences between "pathological grief" and "post-traumatic stress disorder" are touched upon. The author also points out the qualitative differences of the stressors in the two conditions. In "post-traumatic stress disorder" the stressor amounts to a threat to life while in "pathological grief" the stressor is the loss of a person with whom the patient has had close ties.

Bereavement↗
PubMed1976

Ten cases of malignant hyperthermia in Norway.

Data are presented on ten cases of anaesthesia-induced malignant hyperthermia in Norway. Seven of the patients died, three recovered. The fatal cases were all boys in the age group 11-20 years. This age and sex distribution suggests that puberty with the increase in androgens is a precipitating factor in malignant hyperthermia. One of the victims who survived was a 4 1/2-year-old pseudohermaphrodite girl with the adrenogenital syndrome. The coincidence of malignant hyperthermia in a patient with such a rare syndrome points to the excessive formation of androgens in patients with this syndrome as a predisposing factor. The indications for surgery were traumatic injuries in five cases, congenital abnormalities in three and appendicitis in two cases. These conditions in themselves may cause an increased sensitivity to suxamethonium. One patient received only hexobarbitone, halothane and suxamethonium. After the last drug jaw rigidity and temperature rise to 41.3 degrees C prompted the anaesthetist to end the anaesthetic. The fact that the patient survived proves that suxamethonium induced jaw rigidity is valuable as a warning. The absence of cardiovascular depression after procaine 3.5 g in one patient is ascribed to the correction of acidosis at the time of infusion of this drug. It is suggested that procaine should be withheld until other measures such as cooling, correction of acidosis and steroid therapy have been tried.

Adolescent↗