[Basal vital functions in patients admitted as emergencies to a department of acute internal medicine].
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Biomedical subjects
Publications and source records attributed to E Andersen.
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Radiographs of 100 randomly chosen femoral neck fractures were assessed by eight observers using Garden's classification. The radiographs were classified identically by all eight in only 22 cases. Another 45 cases were classified by some observers as undisplaced fractures (Stages 1 and 2) and by others as displaced fractures (Stages 3 and 4). Between the different observers the number of displaced fractures varied from 63 to 89. These results show that observers had a relatively poor ability to delineate the various stages of Garden's classification.
This paper describes the variation in use of soup kitchens throughout the month using data from the New York State Nutritional Surveillance Program. Excluding November, December, and May, when holiday meals created a different pattern of use, number of meals served in soup kitchens generally increased toward the end of the month, averaging 43 per cent higher for Upstate and 14 per cent higher for New York City in the last week as compared to the first week of the month. The overall increase throughout the month and difference in the magnitude of increase between Upstate and New York City corresponds to the timing of income maintenance benefits distribution. Distribution of most public assistance benefits occurs at the beginning of each month in Upstate, whereas it is staggered in New York City throughout the month.
In a phase I trial 4-demethoxydaunorubicin (4-dm DNR) was administered as oral capsules once a week to 51 adults with advanced mainly gastrointestinal solid tumors. No fatal toxicity was observed at doses up to 25.0 mg/m2. Dose-limiting granulocytopenia and non-hematologic toxicity developed at dosages greater than or equal to 22.5 mg/m2. No response to the therapy was observed. The plasma concentrations of 4-dm DNR were measured in 4 of the patients.
Five hundred and fifty consecutive patients with newly diagnosed B-CLL have been registered and classified in a Danish multicenter study. The study includes a protocol for primary treatment of patients in stage B or C (at diagnosis or after demonstrated progression), below 76 years of age, and without complicating serious disease. Until now 144 such patients have been randomized to either prednisolone (PRD) plus chlorambucil (CLB) 5 days every 4 weeks or monthly intensive CHOP treatment. Twenty-nine percent of the treated patients achieved CR on PRD + CLB versus 63% on CHOP (p less than 0.005). No response was found in 29% versus 18%, respectively (NS). A significant difference in survival between patients achieving CR, PR and NR was also demonstrated, whereas to date no difference in survival could be demonstrated between the two regimens. The toxicity was limited, and only 2 treatment-related deaths occurred in approximately 700 CHOP treatment series.
In the period 1984-1987, 500 consecutive, newly diagnosed patients with chronic lymphocytic leukaemia (CLL) have been registered in the still open Danish CLL2-study. As part of patient work-up, the immunological phenotype was established in all patients by immunofluorescence microscopy, and in 458 patients also by flow cytometry, with a panel of polyclonal and monoclonal antibodies. The majority of cases exhibited a CD5-pos, SmIgMD-pos phenotype with faint SmIg-fluorescence, and there is as yet no significant difference in survival between SmIgD-pos and SmIgD-neg cases. Seventy cases were FMC7-pos, a marker associated with a higher B-cell differentiation, and this was significantly correlated with stronger SmIg fluorescence intensity and splenomegaly (Rai stage II). The survival of the FMC7-pos patients was not significantly different from that of the FMC7-neg. Thus, in this preliminary phenotype analysis of the first 500 patients in the CLL2 study, no important prognostic subgroups were detected, although this might be due to the still short observation time (median observation time 532 days).
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The toxicities of oral Ftorafur (1 g/m2/day 1-21) and intravenous 5-fluorouracil (5-FU) (500 mg/m2/day 1-5) were compared in a prospective randomized study in patients with colorectal cancer. The treatment courses were repeated every 6th week. Leucopenia was more common after 5-FU. Leucocyte nadir in connection with first treatment cycle was on average seen on day 15 in patients receiving 5-FU and on day 28 in patients receiving Ftorafur. Significantly more patients on 5-FU developed stomatitis. There was no difference in the number of patients with diarrhea or nausea/vomiting. Median survival and response rates were not significantly different after the two treatment schedules.
In a prospective, randomized trial, 104 consecutive patients with displaced femoral neck fractures were allocated either to fixation with a sliding screw plate or 4 ASIF cancellous bone screws. The patients were reexamined at fixed intervals to determine the time of union. The 2-year-cumulated rate of union was 64 per cent in the plate group and 84 per cent in the screw group.
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The response of medial thalamic neurons to noxious peripheral stimulation were studied with intracellular recording methods in the cat. Electrical stimulation of the contralateral forepaw produced an EPSP-IPSP sequence followed by rebound excitation in these medial thalamic neurons. Action potentials appeared with the initial EPSP or with the rebound excitation. The mean latency to onset was 15 ms for the EPSP and 33 ms for IPSP. In contrast, electrical stimulation of the PAG or of the pericruciate cerebral cortex produced large IPSPs in the medial thalamic neurons. When PAG or cortex stimulation were paired with noxious stimulation, both the PAG and cortex responses predominated over the noxious response. This shows that the PAG and the cerebral cortex have the capabilities of influencing the responses of the medial thalamus to noxious stimulation. The medial thalamus is part of the relay system which sends information about noxious stimulation to the cerebral cortex where the noxious information reaches conscious awareness, so influencing the message at the level of the medial thalamus would probably alter the conscious perception of pain. The data suggest the existence of an ascending pain modulation system from the midbrain to the thalamus and also suggests a mechanism of cortical control over pain perception.
A modification of the Evans repair using only half of the peroneus brevis tendon was applied in the treatment of 34 patients with chronic functional lateral instability of the ankle. With a median follow-up of 25 months, 32 patients were examined. Functional stability was achieved in all but one patient. This modification of Evans' repair is recommended, as it is technically easy, gives good functional stability, and has the theoretical advantage of saving an important pronator of the foot.
A consecutive series of 28 patients (31 knees) with a symptomatic mediopatellar plica without concomitant lesions excised arthroscopically under local anaesthesia in the outpatient department is described. The results were classified as excellent or good in 26/31 cases after a median follow-up period of 15 months. It is concluded that excising a fibrosed mediopatellar plica large enough to cover the medial femoral condyle during flexion is followed by good results; local anaesthesia is sufficient and economical, and arthroscopic excision under local anaesthesia carries a low morbidity.
A prospective, randomized trial of 104 consecutive patients with displaced fractures of the femoral neck treated with either a sliding screw plate or four AO cancellous bone screws was performed to study the influence of the fixation device and the fixation procedure on the vascularity of the femoral head. The vitality of the femoral head was determined by 99mTc-MDP scintigraphy performed 2-3 months after the operation. Eighty-seven patients (84 per cent) were available for assessment. The two treatment groups were comparable with regard to age, degree of primary displacement and quality of reduction. There were significantly more (P less than 0.01) avascular femoral heads or femoral heads with reduced vascularity in the sliding screw plate group (14/40, 35 per cent) than in the four AO cancellous bone screw group (5/47, 11 per cent).
Whether the perception of vowels takes place in the right or left cerebral hemisphere, or is dependent on bilateral cortical processes, is of importance in our treatment of patients with language deficiencies. To investigate this problem a phonetic test with a series of vowellike stimuli was administered to 68 right-handed adult patients with cerebral lesions, mainly of vascular origin. The results were compared to the results in a control group of 19 speech therapists. Second, a neuroradiologic method was developed in order to visualize the anatomic site of Wernicke's area in the left hemisphere on CT scans. This method formed the basis for an evaluation of the extent and localization of the patients' lesions in Wernicke's area. Of 46 patients with lesions in the left hemisphere, 19 had no perceptual disturbances and 27 had severe perceptual disturbances with lesions predominantly located in Wernicke's area. Twenty-two patients with lesions in the corresponding area in the right hemisphere showed no perceptual disturbances. The results of this investigation appear to indicate that the perception of vowels in right-handed persons is unilaterally located in Wernicke's area in the left hemisphere.
A case of an ameloblastic carcinoma in an unusual situation in the maxilla is presented. The lesion is characterized histologically by areas with features of a typical ameloblastoma and areas with anaplastic transformation. A Caldwell-Luc operation was followed by a recurrence after 3 years. Due to the advanced age and poor general health of the patient an enlarged, but not radical operation was performed. There is no evidence of metastatic tumour.