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Biomedical subjects

A Naalsund

Publications and source records attributed to A Naalsund.

At least 19 recordsLinked to original sources
PubMed2001

[Acute respiratory failure caused by myotonic dystrophy].

BACKGROUND: Respiratory insufficiency is not always caused by pulmonary diseases or diseases involving the pulmonary vasculature. MATERIAL AND METHOD: We present a case history of a 29-year-old patient with acute respiratory insufficiency following a gynaecological operation. RESULTS: Ventilation/perfusion scintigraphy and spiral-CT of thorax excluded pulmonary embolism. Chest X-ray demonstrated elevated diaphragm and slight right-sided atelectatic changes. Spirometry revealed a restrictive ventilatory capacity, which explained the patient's hypoxaemia. Phrenic nerve conduction studies were normal on both sides. Electromyography showed severe myotonic discharges in all examined muscles including intercostal musculature and the diaphragm. INTERPRETATION: Myotonic dystrophy was the cause of respiratory failure in this patient. The case demonstrates that respiratory failure may be caused by neuromuscular diseases, hence the importance of adequate neurophysiological investigation in such patients.

Acute Disease↗
PubMed1997

[Bronchial resections].

In the period 1982-96, 18 bronchial resections were performed. Simple resection was carried out in eight patients, and in ten lung tissue was also removed; six upper lobes and three middle lobes were involved, and in one patient bilobectomy was necessary. The histologic diagnosis was carcinoid in 15 cases (83%), mucoepidermoid carcinoma in two, and in one case neurofibroma. Two patients had postoperative complications, but both recovered completely. All patients were followed up regularly by bronchoscopy. One patient had carcinoid with liver and bone metastases at the time of operation in 1989, but is still alive. Another died from metastases, the rest were in good condition at the most recent follow up. Bronchial resection is a safe procedure which should be preferred to standard pneumonectomy, in order to save as much lung tissue as possible. The frequency of bronchial resections for carcinoids (compared with standard pneumonectomy) was 60%.

Adolescent↗
PubMed1996

[Embolization of congenital pulmonary arteriovenous malformations].

Patients with arteriovenous pulmonary malformations are at risk of developing secondary brain disease such as transient ischemic attacks, strokes or abscesses. Lethal haemothorax and haemoptysis also occur. 12 of 14 malformations in five patients were treated using a total of eight procedures. One patient experienced a transient unilateral hemiparesis, otherwise no complications occurred. None of the 43 deployed occlusion coils was lost through the fistulas. Complete occlusion was achieved in all lesions where coils could be placed in a stable position. One patient suffered a minor recurrence. The use of interlocking detachable coils (IDC) which can be retracted or repositioned prior to full deployment is recommended.

Adult↗
PubMed1996

Deaths from active tuberculosis: can we rely on notification and mortality figures?

SETTING: Notification rates and mortality are the main indicators in the epidemiology of tuberculosis. While errors in case notification are known to be considerable, the quality of the data on deaths is largely unknown. OBJECTIVE: To validate the quality of data on deaths from active tuberculosis. DESIGN: We compared deaths from active tuberculosis in Statistics Norway with the National Tuberculosis Register (NTR) and cases found by autopsy in two Norwegian counties in 1977-1989. We also assessed the diagnostic classification and inclusion criteria for tuberculosis. RESULTS: 110 patients were entered into the study. We excluded 30 of 106 patients in Statistics Norway, primarily because of inactive tuberculosis (16) or minimal lesions (7). We found an additional 20 patients in the NTR and 14 more from autopsy reports. These missing cases were registered in Statistics Norway with a different diagnosis (28), inactive tuberculosis (4) or not found (2). Nineteen of them were diagnosed with tuberculosis by autopsy and five by cultures reported after death. We altered the diagnostic classification of underlying cause in 14% and found tuberculosis to be the underlying cause in 65 patients. CONCLUSION: The mortality rate from active tuberculosis in Statistics Norway was fairly correct, but one-third were under-reported and one-third over-reported. The mortality rate includes only half of all the deaths from active tuberculosis. All the cases in which active tuberculosis is mentioned on the death certificate are a clearer indication of tuberculosis deaths.

Autopsy↗
PubMed1996

When to suspect and how to diagnose pulmonary lymphangioleiomyomatosis.

The objective of this study was to present clinical and radiological data of eight women with histologically proven lymphangioleiomyomatosis (LAM) diagnosed between 1984 and 1994, and to suggest a diagnostic strategy when LAM is suspected. A review of case reports, including results of biopsies, lung function and radiological procedures was undertaken. The mean age of the women at start of symptoms was 36 years, and the mean age at time of diagnosis 42 years. The most frequent presenting complaint was dyspnea, either in conjunction with pneumothorax (3), chylothorax (2) or on exertion (2). All patients had airflow limitation and markedly reduced gas transfer. Five patients had 16 episodes of pneumothorax. In seven patients multiple cysts were observed on the surface of the lung during thoracotomy while computerized tomography (CT) scans revealed numerous cysts evenly distributed throughout the lung parenchyma. The procedures that confirmed the diagnosis included transbronchial lung biopsy (4), open lung biopsy (2), thoracoscopy (1), thoracotomy (3) and autopsy (1). Three specimens had to be revised before the histological diagnosis was confirmed. It was concluded that the important clues to a diagnosis of LAM are recurrent episodes of pneumothoraces in fertile women, progressive air-flow limitation, markedly reduced gas transfer and characteristic findings on thoracic CT scans. A specific request to the pathologist to stain lung tissue specimens for smooth muscle cells is mandatory.

Adult↗
PubMed1995

[An answer to an inquiry on diffuse panbronchiolitis. Now it has found its way here!].

Diffuse panbronchiolitis (DPB) is a disease characterised by chronic inflammation in the region of respiratory bronchioles. The condition has mainly been observed in Japanese patients, though isolated cases have been reported from other countries. In a review published in Läkartidningen (37/94), the question was raised of why this disease had not been seen in Scandinavia, and whether this might be the result of missed diagnosis. The diagnostic criteria were listed, and the question was posed of whether (Scandinavian) physicians existed who had encountered patients with chronic sinusitis, persistent cough and inexplicable nodular changes in lung x-rays. As a direct result of this enquiry, the present article reports what may well be the first Scandinavian patient to fulfil all the diagnostic criteria of DPB. The patient responded with improved lung function and normalised blood gases to a combined treatment regimen comprising immunosuppression (cyclophosphamide and prednisolone) and nebulised antibiotics (gentamicin).

Adult↗
PubMed1995

Adverse reaction to food: assessment by double-blind placebo-controlled food challenge and clinical, psychosomatic and immunologic analysis.

Double-blind placebo-controlled food challenge (DBPCFC) with food items applied in capsules was performed in a prospective study of 17 selected patients and 34 age- and sex-matched healthy controls in the interdisciplinary clinical setting. Protein immunoblotting showed no differences in antigenicity between foods in the capsules and the corresponding fresh foods. All patients reacted to one or more food substances during DBPCFC, with a doubtful reaction to placebo in 2 patients. Agreement between diet history and provocation was seen in 53 of 85 individual food challenges, 36 being positive with both examinations. In 22 (38%) of the 58 positive provocations, the reactions were not expected from the patients' histories. No reaction to food or placebo occurred in the control group. Related to diet history, sensitivity and specificity of provocation were 62 and 63%, respectively, with a positive predictive value of 78%. Allergy, previous gastroenterologic and infectious diseases among first-degree relatives, immunologic abnormalities and elevation of total IgE were significantly more common for the patients than controls. A positive skin prick test correlated well with diet history, but both prick test and food antibodies correlated poorly with DBPCFC. Assessment by the General Health Questionnaire showed a significant difference towards the controls. After 3-4 months of follow-up on an individually based diet, 11 of 15 patients reported general improvement of their condition. DBPCFC may be a valuable diagnostic test in addition to dietary history as a basis for elimination diet on food-intolerant patients. The effect of the elimination diet on the symptoms may also suggest a therapeutic effect or provocation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Deaths from pulmonary tuberculosis in a low-incidence country.

OBJECTIVES: To study the validity of official mortality statistics regarding deaths from pulmonary tuberculosis, and to identify factors contributing to death. DESIGN: A retrospective study. SETTING: Cases were enrolled from the data of the Central Bureau of Statistics from where the official mortality statistics are issued, the National Tuberculosis Register and all Autopsy Registers in the region. SUBJECTS: Case and autopsy reports from all patients who died from active pulmonary tuberculosis in two Norwegian counties between 1977 and 1989. MAIN OUTCOME MEASURES: Patients identified from all three registers with active pulmonary tuberculosis, concomitant diseases/risk-factors, chest X-rays, symptoms, number of patients investigated and treated for tuberculosis, duration from hospital admission until start of treatment and/or death. RESULTS: Ninety-six patients, median age 75 years, died from pulmonary tuberculosis, 51 without treatment. Thirty-four patients had not been registered at the Central Bureau of Statistics. Thirty-nine patients had cough on admission. Weight loss and generalized malaise occurred just as frequently. Forty-two patients had infiltrates on chest X-ray located elsewhere than in the apical region. In 42 patients, no diagnostic tests for tuberculosis were performed. The median length of stay in hospital was 24 days before death in the untreated group, and 21 days before start of treatment in the treated group. CONCLUSION: Reliable figures of patients who died from pulmonary tuberculosis could not be obtained from the official statistics because of under-notification and erroneous codification of diseases. Deaths occurred mainly because the diagnosis was established too late: in half of the patients at autopsy. Eighty-one patients had concomitant diseases known to lower resistance against tuberculosis. Lack of diagnostic suspicion may have been caused by nonspecific symptoms and atypical chest X-ray findings.

Adult↗
PubMed1994

Aluminium potroom asthma: the Norwegian experience.

Work-related asthma in aluminium potroom workers, is reviewed and discussed, mainly on the basis of own investigations. The occurrence of work-related asthma has been shown to be associated with the duration of potroom employment, although the prevalence of asthmatic symptoms is not significantly different from that of the general population. Typical manifestations of occupational asthma are described in potroom workers, and a close relationship between the levels of fluoride exposure and work-related asthmatic symptoms has been observed. The existence of occupational asthma in aluminium potroom workers has been confirmed by characteristic patterns of repeated peak flow measurements, supported by changes in methacholine responsiveness in workers with suspected work-related asthma. However, no immunological test is available to establish the diagnosis. Methacholine challenge appears to be inappropriate for screening aluminium potroom workers in order to detect work-related asthma. Current smoking, but not self-reported allergy, is a risk factor for potroom asthma. A family history of asthma and previous occupational exposure may have some effect on the risk of developing symptoms. The prognosis of potroom asthma seems to depend on early replacement to unexposed work. The pathogenetic mechanisms are unknown, although some studies indirectly imply a hypersensitivity reaction. Future studies involving specific bronchial challenge appear to be necessary to find the causal agent(s) of aluminium potroom asthma.

Aluminum↗
PubMed1992

[Occupational asthma. Occurrence, diagnosis, course and prevention].

Occupational asthma is defined as variable air flow obstruction caused by inhalation of agents at work. The condition is increasingly recognized as a cause of work-related respiratory disease, and in Norway is estimated to account for approximately 20% of the cases of asthma among adults exposed to dust or gases. These figures are likely to increase when more inhalable reactive chemicals are introduced at places of work. A careful and detailed history, immunological tests, serial measurements of peak expiratory flow (PEF) and demonstration of increased non-specific bronchial reactivity are useful tools for diagnosing occupational asthma. Accurate diagnosis is important because of the economic consequences of the label "occupational disease", and because early recognition and relocation to work not involving exposure to such chemicals might improve the prognosis of the disease.

Adult↗
PubMed1992

Allele diversity of the H-ras-1 variable number of tandem repeats in Norwegian lung cancer patients.

We have examined restriction fragment length polymorphisms of the H-ras-1 gene in germ-line DNA from 214 lung cancer patients and 309 unaffected controls. When DNA samples were digested with MspI/HpaII, Southern blot analysis revealed at least 22 different alleles, grouped according to their frequencies as common, intermediate, and rare. The frequency of rare alleles in lung cancer patients (16/428) is significantly different (p = 0.002) from that in the control group (5/618). Individuals with rare alleles were found to be at 4.7-fold greater risk of lung cancer than those with no rare alleles.

Alleles↗
PubMed1991

[Single lung transplantation as treatment of terminal lung diseases].

The article describes the first cases of single lung transplantation in Norway. The indication for surgery was end-stage pulmonary disease (1 sarcoidosis, 2 emphysema) in three severely disabled patients requiring administration of oxygen. The operation necessitated cardiopulmonary bypass in all patients. Primary graft function was excellent. Epidural analgesia, peripheral pulse oxymetry and continuous monitoring of mixed venous oxygen saturation aided early extubation. The initial postoperative course with a four drug immunosuppressive regimen has been encouraging. Rejection is monitored by clinical examination, chest x-ray, serial pulmonary function tests and transbronchial biopsies.

Adult↗
PubMed1991

[Allogeneic bone marrow transplantation in adults. Results after fractionated whole body irradiation and high dosage cyclophosphamide and use of HLA-compatible sibling donors].

We present short and long-term results of allogeneic bone marrow transplantation after hyper-fractionated total body irradiation and high dose cyclophosphamide in ten patients treated for leukaemia during the period 1985-89. Three patients died from complications connected to the transplantation, while seven are living free from leukaemia 18 to 59 months after transplantation (mean 41 months). Two patients need treatment for chronic graft versus host disease. Allogeneic bone marrow transplantation is expensive and risky. Close cooperation between clinicians and laboratory specialists is essential. The treatment increases long term survival and probably cures certain patients with leukaemia. Some of these patients will need treatment for chronic graft versus host disease and other late sequelae.

Adult↗
PubMed1990

[Combined lung and heart surgery].

Patients with concomitant pulmonary carcinoma and serious heart disease represent a therapeutic challenge. With the introduction of combined lung-heart surgery, both conditions may be treated adequately and safely. At Rikshospitalet, combined surgery was performed in four cases during the period 1984-88. In three patients heart surgery and lung resection were performed in one anesthetic session. In the fourth case the heart disease was corrected first and the tumor removed a few weeks later. After 1-4 years follow-up none of the patients has clinical manifestations of either condition. Combined surgery is only applicable if tumor removal is confined to wedge resection or lobectomy.

Aged↗
PubMed1990

Ha-ras-1 alleles in Norwegian lung cancer patients.

We have examined DNA restriction fragment length polymorphisms (RFLP) of the Ha-ras-1 gene in DNA from 118 lung cancer patients and 123 unaffected controls. When DNA samples were digested with MspI/HpaII restriction endonucleases. Southern blot analysis demonstrated 4 common, 4 intermediate and 7 different rare alleles in the combined population after hybridization to the pGDa1 probe. Six of the rare alleles were unique for the lung cancer group and 1 rare allele for the control group. The frequency of rare alleles in lung cancer patients (10/236) was significantly different (P less than 0.01) from the control group (1/246). The lung cancer group also had a significantly lower frequency of the common 2.57 kb fragment than the controls (P less than 0.02). The results thus indicate that Ha-ras genotyping may be of value in lung cancer risk assessment.

Alleles↗
PubMed1989

[Cyclophosphamide-induced pneumonitis].

Cyclophosphamide is an alkylating agent with a wide spectrum of activity against malignant tumours. Because of its pronounced immunosuppressive effect it is also frequently used in organ transplantations and in the treatment of certain autoimmune diseases. The drug has toxic side effects, however, some of which are ascribed to specific metabolites. This report describes a patient who developed cyclophosphamide associated cystitis and pneumonitis while being treated for Wegener's granulomatosis. Early recognition of the condition and discontinuation of therapy is essential for a favourable outcome.

Adult↗