Insulin action, training, and aging.
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Adipose Tissue↗
Biomedical subjects
C M Jensen
Publications and source records attributed to C M Jensen.
Successful immediate weight-bearing of internal fixated ankle fractures in a general population.
Several studies on operated ankle fractures have shown that immediate weight-bearing is recommendable. Consequently, we changed our postoperative standard regimen, from 3 weeks of non-weight-bearing followed by 3 weeks of weight-bearing, to full immediate weight-bearing in all 6 weeks. A below-knee walking cast was applied immediately after surgery. Between December 1995 and September 1996, we studied 62 patients (median age, 55 years; range 21-92 years; M/F, 24/38), with ankle fractures who attended our emergency department and were subsequently admitted for open reduction and internal fixation. We excluded patients with distal tibia fracture and patients under 18 years of age. Overall, our elderly population did not have complication rates higher than those reported in similar studies on younger patients. In 1 patient, we observed radiographic widening of the ankle joint, of about 3 mm, 6 weeks postoperatively. No patients required reoperation. Our study indicates that full immediate weight-bearing after open reduction and internal fixation is recommendable, even in an elderly population.
Adult↗
Absence of pharmacokinetic drug interaction of levetiracetam with phenytoin in patients with epilepsy determined by new technique.
Levetiracetam has recently been approved as an adjunctive medication for partial seizures and frequently will be added to phenytoin. The objective of this study was to determine the presence or absence of a pharmacokinetic drug interaction of levetiracetam with phenytoin. A stable isotope tracer technique using deuterium-labeled (D10) phenytoin and high-performance liquid chromatography with ultraviolet detection (rather than mass spectrometric detection) was employed. Tracer doses of D10-phenytoin were administered i.v. before and 12 weeks after adding levetiracetam to the regimen of 6 subjects on phenytoin monotherapy for epilepsy. Blood was collected for 96 hours after each infusion. The following pharmacokinetic parameters were determined for phenytoin: Cmax, Cmin, Cavo, AUC, CL, t 1/2, VD, and free (nonprotein bound) fraction. The ratio and the 90% confidence interval of the ratio of log-transformed mean values for phenytoin pharmacokinetic parameters before (denominator) and after (numerator) adding levetiracetam all fell within the range of 0.85 to 1.17 (two one-sided test). The authors conclude that the addition of levetiracetam did not bring about clinically important changes in phenytoin pharmacokinetic parameters and that it is not necessary to change the phenytoin dosing rate when levetiracetam is added to phenytoin.
Adult↗
Quality of reinfused drainage blood after total knee arthroplasty.
Reinfusion of postoperative wound drainage blood has become an attractive alternative in primary total knee and hip arthroplasty. Quality of the drainage blood was studied with respect to content of extracellular bioactive substances and coagulation split products. Using the HandyVac ATS autotransfusion system, drainage blood was collected and reinfused within 6 hours postoperatively from 10 patients undergoing primary total knee arthroplasty. Blood samples were collected from the patients immediately after and 1 hour after opening of the tourniquet and after reinfusion of drainage blood. Samples were also collected from the drainage blood immediately before and at the end of reinfusion. The leukocyte-derived and platelet-derived bioactive substances histamine, eosinophil cationic protein (ECP), eosinophil protein X (EPX), myeloperoxidase (MPO), plasminogen activator inhibitor type 1 (PAI-1), and activated complement factor C3(C3a) and various coagulation factors and split products were analyzed in patient and drainage blood samples. None of the patients received additional predonated autologous blood or allogeneic blood components during the study period. Within 6 hours postoperatively, 250 to 1,000 mL drainage blood was collected and reinfused. Histamine, ECP, EPX, MPO, PAI-1, and C3a content was significantly increased in drainage blood immediately before and at the end of reinfusion. Reinfusion did not change the concentration of these substances in samples from the patients. Coagulation factors and various split products showed that drainage blood was defibrinated. Reinfusion of drainage blood did not change the coagulative capacity of the patients. Drainage blood appears to be defibrinated and contains various extracellular leukocyte-derived and platelet-derived bioactive substances. Reinfusion does not change the coagulative capacity or the concentration of bioactive substances of patients.
Arthroplasty, Replacement, Knee↗
[Infectious arthritis in a patient with rheumatoid arthritis].
Patients with rheumatoid arthritis are at greater risk of developing joint infections than any other group of patients. Diagnosis is often delayed because of the difficulties in distinguishing between a flare-up and a septic affection of the joint. A case of septic arthritis with multiple joint involvement and lethal outcome despite extensive antibiotic treatment and successive surgical procedures is presented. The patient developed osteomyelitis and multiple organ failure. In order to reduce morbidity and mortality from septic arthritis, early joint puncture and subsequent antibiotic treatment is essential.
Aged↗
[Reconstructive joint surgery and rheumatoid arthritis. Status over a developing field].
Rheumatoid arthritis has a prevalence of between 1% and 2%. The majority of patients face the prospect of surgical treatment of joints, that do not respond to medical treatment. With respect to the extensive development in joint surgery during the last decade, today's recommendations for surgical treatment of the individual joints are surveyed.
Arthritis, Rheumatoid↗
Observer variation in the radiographic classification of fractures of the neck of the femur using Garden's system.
By means of Kappa statistics, we calculated the inter- and intra-observer variation in the classification of fractures of the neck of the femur according to Garden's system. Radiographs of 96 consecutive patients were assessed independently by six observers who agreed on classification for only 14 fractures (15%). The level of agreement was poor for the overall classification (Kappa = 0.39). When reducing Garden's system into non-displaced (Stage I and II) and displaced fractures (Stage III and IV) the level of agreement became acceptable (Kappa = 0.68). However, problems remain in distinguishing Stage II and Stage III fractures, and further improvements in the classification system are necessary.
Femoral Neck Fractures↗
Biodegradable pins versus Kirschner wires in hand surgery.
We compared biodegradable pins with standard Kirschner wires in the fixation of fractures, arthrodeses and osteotomies in the hand in a prospective, randomized study. Eleven patients were allocated to the biodegradable pin group and 12 to the Kirschner wire group. Age, gender, operative procedure and postoperative treatment did not differ in the two groups. All patients were evaluated after 6 months. No differences in time to union or complication rates were found, but the number of additional operative procedures in the Kirschner wire group significantly exceeded the number needed in the biodegradable pin group.
Adult↗
Establishing the maximum tolerated dose of lesopitron in patients with generalized anxiety disorder: a bridging study.
Lesopitron, a 5-hydroxytryptamine 1A agonist, is a new potential anxiolytic of the azapirone class. It has greater potency in animal models of anxiety than buspirone, gepirone, or ipsapirone, and it lacks the antidopaminergic effects associated with buspirone. Lesopitron has been tolerated at single doses up to 50 mg and repeated dosages of 45 mg/day in healthy volunteers. Forty-two patients with generalized anxiety disorder (GAD) were enrolled in this double-blind bridging study to determine the safety and tolerability of fixed doses of lesopitron (20, 25, 30, 40, 45, 50, and 60 mg two times a day) over a 6 1/2-day inpatient administration period. Each of the seven panels included six patients (four drug/two placebo). One patient in the 25-mg, two-times-a-day panel voluntarily withdrew because of increased anxiety symptoms. One patient experienced severe orthostatic hypotension at 60 mg two times a day, and moderate to severe adverse events (dizziness, lightheadedness, nausea, headache) occurred in two other patients at this dosage. The most commonly reported adverse events in all the panels were headache, dizziness, and nausea. Lesopitron is rapidly absorbed in patients, having a time to maximum concentration (Tmax) ranging from 0.5 to 1 hour, and its elimination half-life ranged from 1.1 to 5.6 hours. Peak plasma concentrations showed high interindividual variability for lesopitron, but increased linearly with dose for the main metabolite, 5-hydroxylesopitron. We defined the maximum tolerated dose in GAD patients as 50 mg two times a day, twice as high as the highest dose tested in healthy volunteers.
Adolescent↗
Elbow synovectomy in rheumatoid arthritis.
We present the results of a clinical and radiographic follow-up study of patients undergoing elbow synovectomies. Twenty-five elbows in 24 patients with rheumatoid arthritis were followed for a median period of 52 months (range 10-108) after operation. Nineteen (74%) stated they had improvement of pain and function. Two patients reported increased pain. Improvement of motion was noted, but this was not statistically significant. Radiographic classification showed statistically significant progressive changes. Three complications were noted, all without permanent sequels. Moderate elbow destruction can provide a good indication for elbow synovectomy in the treatment of patients suffering from rheumatoid arthritis.
Adult↗
[Synovectomy in rheumatoid arthritis].
Surgical synovectomy in the treatment of rheumatoid arthritis has been performed for more than a 100 years, and yet the definite indication has not been made clear. Synovectomy has a convincing, but mostly time-limited effect on pain and articular hydrops, but the radiological progression continues almost undisturbed. Histological evaluation of the regenerating synovial membrane has now shown a tendency towards reversing to baseline within about a year. The difficulties in evaluating the operation are caused by the lack of comparable randomized studies performed on large populations, treated in a double-blind fashion and examined in cooperation between surgeon and rheumatologist.
Arthritis, Rheumatoid↗
Injury mortality among Iowa farmers, 1980-1988: comparison of PMR and SMR approaches.
State and provincial proportional mortality studies in the United States and Canada have found increased ratios of overall injury mortality among farmers, including occupational injuries and other unintentional injuries, such as those from motor vehicle crashes and fires, as well as suicides. In contrast, Scandinavian standardized mortality (morbidity) studies have found no increase in the injury fatality or morbidity ratios of farmers in comparison with the rest of the population. This study reviews the injury mortality of Iowa farmers for the years 1980-1988. Among white male farmers, we found an increased proportional mortality ratio for all injuries of 1.26 (95% confidence interval (CI) 1.21-1.31). In part, this was a result of the increased proportional mortality ratio for at-work injuries of 3.77 (95% CI 3.35-4.24), but there were also elevated proportional mortality ratios for such nonoccupational injuries as suicides, 1.20 (95% CI 1.09-1.32), motor vehicle crashes, 1.23 (95% CI 1.12-1.34), and electrocutions, 1.78 (95% CI 1.08-2.95). For younger farmers aged 20-64 years, we calculated standardized mortality ratios as well. The standardized mortality ratios were generally within 10% of the proportional mortality ratios, which suggests that the differences between North America and Scandinavia are not the result of methodological differences, but are more likely related to differences in environmental exposures and safety practices.
Accidents, Occupational↗
[Quality assurance in amputation of the lower extremities due to vascular insufficiency].
In this retrospective study we reviewed the clinical charts for 82 patients who underwent lower limb amputation at our department during 1990 and 1991. Our results are compared with the literature, and different aspects of the treatment are discussed. Subsequently a model for future quality assurance is presented.
Adult↗
Removal of internal fixation--the effect on patients' complaints: a study of 66 cases of removal of internal fixation after malleolar fractures.
To estimate the effect of removal of internal fixation after treatment of malleolar fractures on postoperatively presented complaints, we retrospectively evaluated 66 patients by their records and by personal questionnaires. Of all the patients, 89.4% had one or more complaints. These were typically soreness over implant and cicatrix, reduced movement of the ankle joint, and strain-related pain. About 75% of these patients reported improvement after removal. The AO mode of fixation, i.e., typically by lateral semitubular plating and transsyndesmotic screw and a medial screw or pins, and the Wiberg-Cedell mode, i.e., typically consisting of lateral single or double cerclage and staple and medial pinning, constituted the principal groupings of the patients. The two groups were comparable. In this series, we found significantly more complaints associated with the AO mode in the postoperative period. We conclude that removal of internal fixation after malleolar fractures is indicated when common types of complaints are presented.
Adolescent↗
Amputations in the treatment of Dupuytren's disease.
23 finger amputations in 19 patients operated on for Dupuytren's disease were reviewed 6 months to 8.5 years after operation (mean 4 years). The distribution of amputations were 17 little fingers and six ring fingers. We found a recurrent lack of extension in nine out of 16 finger amputations distal to the MP joint and painful neuroma or phantom limb pain in five out of seven little finger amputations through or proximal to the MP joint. When amputation in the little finger is necessary, disarticulation of the MP joint may be preferable to amputation at a more distal level. Alternatives to finger amputation should be sought in difficult cases of Dupuytren's disease.
Adult↗
A diagnostic problem in tuberculous dactylitis.
We report a case of tuberculous dactylitis. This rare manifestation of extra-pulmonary tuberculosis must be kept in mind in the diagnosis of a slowly-growing bone tumour. The diagnostic problems and pitfalls are discussed.
Child↗
Early and late synovectomy of the knee in rheumatoid arthritis.
The results after open knee synovectomy in the treatment of rheumatoid arthritis were investigated in a retrospective study including 44 patients with 55 knees. Median observation time was 73 months. Early synovectomy showed significant pain-relief and improvement of knee function, effusion was reduced and range of motion was unchanged. Total knee alloplasty (TKA) was performed in one knee among the patients who underwent early synovectomy, while reoperation with TKA had been performed in 12 out of 28 knees after late synovectomy. It is concluded that early synovectomy is indicated when medical treatment has failed. Late synovectomy must be regarded as a palliative procedure in order to postpone TKA.
Adult↗
Tension-band wiring of olecranon fractures with nonsliding pins. Report of 20 cases.
Twenty consecutive patients with displaced fractures of the olecranon were operated on using the tension-band wiring technique with a nonsliding pin. The patients were followed until clinical and radiographic healing or removal of the implant. Healing was uneventful in 19 patients after a median of 6 weeks. Redislocation occurred in 1 patient with a severely comminuted fracture. The design of the nonsliding pin eliminates outward pin migration, as well as migration into the medullary canal.
Adult↗