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Biomedical subjects

D Jacobsen

Publications and source records attributed to D Jacobsen.

At least 19 recordsLinked to original sources
PubMed2006

Clinical vs. laboratory identification of drugs of abuse in patients admitted for acute poisoning.

OBJECTIVE: The extent of drug abuse in patients admitted for self-poisonings is uncertain. The aim of this study was to assess the pattern of drugs of abuse among patients admitted for acute poisoning according to age and gender, and to study the concordance between the clinical assessments by the physicians on duty and the drug analyses. METHODS: Prospective cross sectional study of all patients (n = 405, 52% males, median age 31 years) treated for acute poisoning in our department during one year (2001). The physician on-call classified type of drug of abuse by history and clinical assessment. This was later compared to urine and blood samples analysed for ethanol, benzodiazepines, opiates, cocaine, ecstasy, GHB, amphetamine and cannabis. RESULTS: In 320 admissions (79%), the comparison between clinical diagnosis and laboratory analyses could be performed. A total of 478 drugs were suspected and 621 were found. The main toxic agents found were benzodiazepines (49.7%), ethanol (40.3%), opiates (35.3%), cannabis (23.8%) and amphetamine (21.3%). Ninety-two had used drugs of abuse. The agreement between clinical assessments and laboratory findings was best for GHB and ethanol (kappa = 0.43), and for opiates (k = 0.38). For benzodiazepines and cannabis, the concordance was poor (k = 0.18 and 0.10, respectively). However, the correct clinical evaluation for these substances was 59% and 77%, respectively. CONCLUSIONS: Drugs of abuse were more frequently found than suspected clinically. Benzodiazepines, ethanol and opiates were most common. The agreement between clinical assessment and drug analyses was moderate to low. Physicians seem to underestimate the use of these drugs.

Acute Disease↗
PubMed2005

Methanol outbreak in Norway 2002-2004: epidemiology, clinical features and prognostic signs.

OBJECTIVES: Knowledge on methanol poisoning does mainly come from clinical studies. We therefore report epidemiological, clinical and prognostic features from the large methanol outbreak in Norway in 2002-2004 where the new antidote fomepizole was the primary antidote in use. DESIGN AND SUBJECTS: Combined prospective and retrospective case series study of 51 hospitalized patients who were confirmed poisoned with methanol, of whom nine died. In addition, eight patients died outside hospital. Most patients were admitted in a late stage and because of symptoms. Treatment consisted of alkali, fomepizole (71%) and haemodialysis (73%). RESULTS: The median serum methanol was 25.0 mmol L-1 (80 mg dL-1) (range 3.1-147.0 mmol L-1), median pH was 7.20 (6.50-7.50), and median base deficit 22 mmol L-1 (range 0-31). The most frequent clinical features reported were visual disturbances (55%), dyspnoea (41%), and gastrointestinal symptoms (43%). Twenty-four per cent were comatose on admission, of whom 67% died. There was a trend towards decreasing pCO2 with decreasing pH amongst the patients surviving. The opposite trend was demonstrated in the dying; the difference was highly significant by linear regression analyses (P<0.001). CONCLUSIONS: Methanol poisoning still has a high morbidity and mortality, mainly because of late diagnosis and treatment. Respiratory arrest, coma and severe metabolic acidosis (pH<6.90, base deficit>28 mmol L-1) upon admission were strong predictors of poor outcome. Early admission and ability of respiratory compensation of metabolic acidosis was associated with survival.

Adult↗
PubMed2005

Fomepizole may change indication for hemodialysis in methanol poisoning: prospective study in seven cases.

BACKGROUND: Treatment of methanol poisoning includes administration of buffer, antidote and hemodialysis. The role of hemodialysis using the new antidote fomepizole has not been studied. We studied the kinetics of methanol and formate during hemodialysis, and the possibility for delayed hemodialysis in the methanol poisoned patients without severe metabolic acidosis or visual disturbances. PATIENTS AND METHODS: Prospective case series study on methanol, formate and dialysis kinetics in 7 cases of severe methanol poisoning treated with buffer, fomepizole and hemodialysis (average 7 hours, range 5 - 8). Four patients were dialyzed early after diagnosis was obtained, while three were dialyzed "electively" the next day. RESULTS: The median pH upon admission was 6.9 (range 6.6 - 7.5) and median base deficit 20.4 mmol/l (range 5.1 - 30.0). Their median S-methanol was 76.3 mmol/l (range 15.6 - 140.6) and S-formate 13.6 mmol/l (range 3.3 - 21). The median half-life of methanol during fomepizole treatment before dialysis was 71.2 hours (range 69.3 - 77); compared to 2.5 hours (range 1.7 - 3.3) during procedure. The median half-life of formate during dialysis was 1.7 hours (range 1.5 - 1.9). The median dialysis clearance of methanol was 222 ml/min (range 204 - 232) and for formate 225 ml/min (range 220 - 229) at a blood flow of 250 ml/min. One patient died and 2 were discharged with permanent visual and cerebral sequelae, whereas one died one year later. All three patients, in whom "elective" hemodialysis was performed, were discharged without sequelae. CONCLUSION: The efficacy and side effect profile of fomepizole may change the role of hemodialysis in methanol poisoning. More patients may be stabilized in local hospitals and transferred for "elective" dialysis, if methanol removal is still indicated after correction of metabolic acidosis.

Acidosis↗
PubMed2003

Conventional and diffusion-weighted MRI in the evaluation of methanol poisoning.

Cerebral lesions were studied in 2 methanol-poisoned patients using conventional magnetic resonance imaging (MRI). In 1 patient, diffusion-weighted MRI (DWI) was also performed. In this patient, conventional MRI showed symmetrical, bilateral increased signal in the lentiform nuclei, involving predominantly putamina, but also extending into the corona radiata, centrum semiovale and subcortical white matter. DWI showed decreased diffusion, which most probably reflects cytotoxic edema. In the other patient, fluid attenuated-inversion recovery (FLAIR) and T2-weighted images showed hyperintensity in the putamina, characteristic of post-necrotic changes.

Adult↗
PubMed2001

[Two cases of pneumococcal pericarditis].

BACKGROUND: Bacterial pericarditis is often overlooked, partly because symptoms and signs associated with pericarditis are frequently missing, but also because of the rarity of the disease. MATERIAL AND METHODS: Two cases of pneumococcal pericarditis treated at Ullevaal University Hospital are presented. RESULTS: Pneumococcal pericarditis is a rare, but serious complication to infections like pneumonia, pleural empyema, and septicaemia. Patients with an infectious disease who develop signs of elevated central venous pressure, enlarged cardiac silhouette on chest x-ray, or severe hypotension should have an echocardiography performed. If pericardial fluid is present, a diagnostic pericardiocentesis should be considered. INTERPRETATION: Treatment consists of drainage and antibiotics. Pericardiocentesis and subxiphoid catheter drains may be inadequate because of fibrin precipitation resulting in organization of the fluid. In these cases surgical intervention has traditionally been recommended, but intrapericardial fibrinolysis could be an alternative.

Aged↗
PubMed2001

Enhanced semantic priming in thought-disordered schizophrenic patients using a word pronunciation task.

Previous research on semantic priming in schizophrenia has produced contradictory findings. For the present study, it was intended to resolve some of the ambiguities in the literature. Using a semantic priming task with word pronunciation, evidence is provided that thought-disordered schizophrenic (TD) patients exhibit significantly increased semantic priming as compared to healthy and psychiatric controls. Results suggest that enhanced semantic priming is not confined to tasks that require lexical decision. Moreover, results indicate that TD schizophrenic patients suffer from a decay of hierarchical thinking, i.e. TD schizophrenics reveal a tendency to process the less meaningful rather than the dominant aspects of external information. Priming effects for the inferior meaning of homograph words (for example, 'dance' is an inferior, and 'game' is a superior associate of the word 'ball') were significantly greater compared to healthy controls and non-TD schizophrenics. Results were not moderated by sociodemographic background variables, psychomotor slowing and psychopathological symptoms other than thought disorder.

Adult↗
PubMed2001

Neuropsychological correlates of schizophrenic syndromes in patients treated with atypical neuroleptics.

There is widespread evidence that schizophrenic symptomatology is best represented by three syndromes (positive, negative, disorganized). Both the disorganized and negative syndrome have been found to correlate with several neurocognitive dysfunctions. However, previous studies investigated samples predominantly treated with typical neuroleptics, which frequently induce parkinsonian symptoms that are hard to disentangle from primary negative symptoms and may have inflated correlations with neurocognition. A newly developed psychopathological instrument called the Positive and Negative and Disorganized Symptoms Scale (PANADSS) was evaluated in 60 schizophrenic patients. Forty-seven participants treated with atypical neuroleptics performed several neurocognitive tasks.A three-factor solution of schizophrenic symptomatology emerged. Negative symptomatology was associated with diminished creative verbal fluency and digit span backward, whereas disorganization was significantly correlated with impaired Stroop, WCST and Trail-Making Test B performance.Data suggest that disorganization is associated with tasks that demand executive functioning. Previous findings reporting correlations between negative symptomatology and neurocognition may have been confounded by the adverse consequences of typical neuroleptics.

Acute Disease↗
PubMed2001

'Hyper-priming' in thought-disordered schizophrenic patients.

BACKGROUND: A number of studies have suggested that indirect semantic priming is enhanced in thought-disordered schizophrenics. However, research on direct semantic priming has produced conflicting results. The aim of the present study was to resolve some of the ambiguities of previous findings. METHODS: For the present study, 44 schizophrenic patients were split according to the presence of associative loosening into a positive thought-disordered (TD) and non-positive thought-disordered (NTD) group. Thirty healthy subjects and 36 psychiatric patients served as controls. RESULTS: Schizophrenics displayed increased indirect semantic priming compared with psychiatric controls. When subtyping the sample, TD-patients exhibited significantly enhanced indirect semantic priming compared with healthy and psychiatric controls as well as NTD-patients. Overall slowing was found to be independent of priming effects. Medication, age and chronicity of the schizophrenic illness did not modulate priming. CONCLUSIONS: In line with Spitzer and Maher it is inferred that disinhibited semantic networks underlie formal thought disorder in schizophrenia. For future research, it would be appropriate to: employ indirect semantic priming rather than direct semantic priming conditions; and, pay more attention to potential moderators of the priming effect, most importantly, the prime display duration and the length of the stimulus onset asynchrony.

Adult↗
PubMed2001

Impact of comorbid depressive symptoms on neuropsychological performance in obsessive-compulsive disorder.

There is indirect evidence from previous research that several executive disturbances in obsessive-compulsive disorder (OCD) are mediated by comorbid depressive symptoms. For the present study, the authors investigated whether OCD patients with elevated Hamilton Rating Scale for Depression (HRSD) scores would exhibit deficits in tasks sensitive to the medial and dorsolateral frontal cortex as well as other executive tasks. The 36 OCD patients were split along the median according to their HRSD scores and compared with matched control subjects. Patients with high HRSD scores performed significantly worse than control subjects and patients with low HRSD scores on the Wisconsin Card Sorting Test, the Trail-Making Test (TMT, Part B), and the TMT difference score. Moreover, patients with high HRSD scores exhibited deficits on a (creative) verbal fluency task. It is suggested that comorbid depressive symptoms may have artificially inflated some executive deficit scores in previous studies.

Adult↗
PubMed2001

The effects of creatine dietary supplementation on anterior compartment pressure in the lower leg during rest and following exercise.

OBJECTIVE: To examine the effects of creatine supplementation on anterior compartment pressure of the lower leg at rest and following exercise. DESIGN: 14 college-age males received creatine or placebo supplementation for 34 days. At baseline, anterior compartment pressure was measured preexercise, immediately postexercise, and 1, 5, and 15 minutes postexercise after a level treadmill run for 20 minutes at 80% of maximal aerobic power. INTERVENTION: Following baseline testing, subjects began a 6-day creatine or placebo loading phase at a dosage of 0.3 g x kg body mass(-1) x d(-1). This was followed by a 28-day maintenance phase at a dosage of 0.03 g x kg body mass(-1) x d(-1). Subjects and investigators were blinded as to treatment administration. Subjects continued to exercise during the supplementation period. After 6 days and 34 days of supplementation. anterior compartment pressure was measured at rest and following exercise. RESULTS: Creatine supplementation for 6 days significantly increased compartment pressure compared with the placebo group at rest (76%), immediately post- (150%), 1 minute post- (125%), 5 minute post- (106%), and 15 minute postexercise (77%). Anterior compartment pressures continued to remain significantly higher for the creatine group compared with the placebo group at rest (72%), immediately post- (125%) and 1 minute postexercise (180%) after 34 days of creatine supplementation. CONCLUSIONS: These data indicate that creatine supplementation abnormally increases anterior compartment pressure in the lower leg at rest and following 20 minutes of level running at 80% of maximal aerobic power.

Adenosine Triphosphate↗
PubMed2000

[Methemoglobinemia--causes, diagnosis and treatment].

BACKGROUND: Methaemoglobinaemia is an infrequent condition. It can be congenital or be induced by several toxic compounds. In methaemoglobin (metHb) the iron in the haem moiety of haemoglobin is oxidized from the ferrous (Fe2+) to the ferric state (Fe3+). This complex is dark brown and unable to transport oxygen. Combined with a leftward shift in the oxyhaemoglobin dissociation curve this leads to decreased tissue oxygenation with subsequent hypoxic features in patients. CASE REPORTS: We report two cases of dapsone-induced methaemoglobinaemia. The blood, mucosa and nail beds adopted a brown-bluish appearance which was used diagnostically. One patient was treated effectively with repeated injections of methylene blue, which reduces methaemoglobin. In the other patient, the methaemoglobin level declined with a T50 of 50 hours. Both patients had few symptoms and made an uneventful recovery. INTERPRETATION: The hypoxia in methaemoglobinaemia may be effectively treated with methylene blue. Repeated injections may be necessary.

Adolescent↗
PubMed2000

Effect of inhibition of sterol delta 14-reductase on accumulation of meiosis-activating sterol and meiotic resumption in cumulus-enclosed mouse oocytes in vitro.

Two sterols of the cholesterol biosynthetic pathway induce resumption of meiosis in mouse oocytes in vitro. The sterols, termed meiosis-activating sterols (MAS), have been isolated from human follicular fluid (FF-MAS, 4,4-dimethyl-5 alpha-cholest-8,14,24-triene-3 beta-ol) and from bull testicular tissue (T-MAS, 4,4-dimethyl-5 alpha-cholest-8,24-diene-3 beta-ol). FF-MAS is the first intermediate in the cholesterol biosynthesis from lanosterol and is converted to T-MAS by sterol delta 14-reductase. An inhibitor of delta 7-reductase and delta 14 reductase, AY9944-A-7, causes cells with a constitutive cholesterol biosynthesis to accumulate FF-MAS and possibly other intermediates between lanosterol and cholesterol. The aim of the present study was to evaluate whether AY9944-A-7 added to cultures of cumulus-oocyte complexes (COC) from mice resulted in accumulation of MAS and meiotic maturation. AY9944-A-7 stimulated dose dependently (5-25 mumol l-1) COC to resume meiosis when cultured for 22 h in alpha minimal essential medium (alpha-MEM) containing 4 mmol hypoxanthine l-1, a natural inhibitor of meiotic maturation. In contrast, naked oocytes were not induced to resume meiosis by AY9944-A-7. When cumulus cells were separated from their oocytes and co-cultured, AY9944-A-7 did not affect resumption of meiosis, indicating that intact oocyte-cumulus cell connections are important for AY9944-A-7 to exert its effect on meiosis. Cultures of COC with 10 mumol AY9944-A-7 l-1 in the presence of [3H]mevalonic acid, a natural precursor for steroid synthesis, resulted in accumulation of labelled FF-MAS, which had an 11-fold greater amount of radioactivity incorporated per COC compared with the control culture without AY9944-A-7. In contrast, incorporation of radioactivity into the cholesterol fraction was reduced 30-fold in extracts from the same oocytes. The present findings demonstrate for the first time that COC can synthesize cholesterol from mevalonate and accumulate FF-MAS in the presence of AY9944-A-7. Furthermore, AY9944-A-7 stimulated meiotic maturation dose dependently, indicating that FF-MAS, and possibly other sterol intermediates of the cholesterol synthesis pathway, play a central role in stimulating mouse oocytes to resume meiosis. The results also indicate that oocytes may not synthesize steroids from mevalonate.

Animals↗
PubMed2000

Multicenter analytical evaluation of an automated immunoassay for total plasma homocysteine.

A fully automated immunoassay for total plasma homocysteine assay was evaluated at four centers. To measure total homocysteine, oxidized forms of homocysteine in serum and plasma were reduced by dithiothreitol and assayed by a competitive fluorescence polarization technique. The assay had within-run precision from 0.9 to 3.0% and total precision from 2.8 to 4.1% for control materials with homocysteine concentrations of approximately 7, 12.5, and 25 micromol/L, a sensitivity of 0.35 micromol/L, good parallelism upon dilution, and analytical recovery ranging from 97.4 to 103.8%. The immunoassay correlated with four different HPLC assays for homocysteine, yielding a slope of 0.98, an intercept of -0.19 micromol/L, and a correlation coefficient of 0.966 for 440 paired samples. The reference range, determined with plasma samples from 609 males and 600 females, yielded a mean of 9.17+/-2.86 micromol/L, with a central 95% range of 4.78-15.43 micromol/L. The immunoassay is a suitable alternative to HPLC and may be useful in screening persons with high risk of coronary artery disease.

Chemistry, Clinical↗
PubMed1998

[Amphetamine poisoning].

We describe five patients with complications following amphetamine overdose. Two of the patients died: one with disseminated intravascular coagulation and circulatory collapse, one with severe rhabdomyolysis and ischemic colitis. Among the other three cases, one developed acute psychosis, hyperthermia and rhabdomyolysis, one developed acute respiratory distress syndrome and one pericarditis. The effects of amphetamine are discussed along with the diagnosis and treatment of patients with such poisoning.

Adolescent↗