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Biomedical subjects

E Iversen

Publications and source records attributed to E Iversen.

At least 19 recordsLinked to original sources

Reduced infarct size in nonreperfused myocardial infarction by combined infusion of isosorbide dinitrate and streptokinase.

The value of thrombolytic therapy in myocardial infarction is well established, while any beneficial effect of adjunct therapy is more uncertain. In a double-blind, randomized, parallel-group study the effect of combined intravenous infusions of streptokinase and isosorbide dinitrate (ISDN) on enzyme-estimated infarct size was investigated. One hundred consecutive patients with strong clinical and electrocardiographic suspicion of myocardial infarction, admitted to the coronary care unit within 8 hours after the onset of symptoms, were given a streptokinase infusion of 1.5 million units for 1 hour and a titrated dose of ISDN or placebo for 48 hours. From isoenzyme B of creatine kinase (CK-B) values measured every 4 hours, the infarct size was calculated and the possible presence of reperfusion was evaluated. The infarct size in patients receiving ISDN infusion was reduced (p = 0.04, one-sided test) compared with placebo. By subdividing the patients according to whether or not reperfusion had occurred, the infarct size appeared to be similar following ISDN and placebo in patients with reperfusion (419 versus 369 U/L), whereas the infarct size in patients not reperfused was markedly reduced after treatment with ISDN (223 versus 1320 U/L, p = 0.003). In conclusion, the present study demonstrates that the infarct size may be reduced by other means than reperfusion and it supports the use of combined infusion of thrombolytic agents and nitrates in patients with suspected myocardial infarction.

Adult

Prognosis in postoperative discitis. A retrospective study of 111 cases.

111 cases of postoperative discitis during 1968-1986 were analyzed retrospectively. The diagnosis was confirmed by lumbar tomography. Low back pain appeared at an average of 16 days postoperatively. Laboratory findings were of minor value in the diagnosis since elevated ESR, white blood cell count, and body temperature were inconstant findings. Compared with a matched control group, there was a higher incidence of chronic low back pain and vocational handicap in the discitis patients. There was no difference in the consumption of analgetics, the subjective evaluation of the final outcome, spinal mobility or neurologic findings.

Adult

[Permanent hair loss after Kerion Celsi].

Kerion celsi is a deep dermatophytic infection of the scalp. The diagnosis is based on the characteristic clinical picture and is verified by examination for the fungus. Treatment consists of griseofulvin in a dosage of 10 mg/kg/day. The present article is a retrospective investigation of 18 patients with kerion celsi who had been treated in the Department of Dermatology in Marselisborg Hospital during the period 1978-1989. Sixteen out of the 18 patients were children. Twelve of the children were boys. A questionnaire investigation revealed that only five out of 18 patients had normal hair growth. We found a connection between the degree of severity of the alopecia and the age of the patient and the extent of the primary affection, respectively, so that low patient age and large primary affection result in a poorer prognosis. On the other hand, we have not found any connection between the latent period from the first appearance of symptoms and relevant treatment and the alopecia. Nor is there any evidence that treatment with systemic steroid is of significance for the prognosis.

Adult

A comparison of aspiration, antazoline sclerotherapy and surgery in the treatment of hydrocele.

Of 98 hydroceles (mean volume 125 ml) in a consecutive series of 92 patients, treated initially by aspiration, 14% (mean volume 70 ml) were cured. The 76 recurring hydroceles (mean volume 146 ml) were then randomised to either antazoline sclerotherapy on an out-patient basis or surgery. Cure rates were 89 and 100%, respectively, at follow-up 6 months later. Operated patients were admitted for a mean duration of 2.5 days. The results indicated that aspiration alone was inadequate, and sclerotherapy is advocated as the first choice of treatment for hydrocele.

Adult

Pharmacokinetics of thyrotrophin-releasing hormone in patients in different thyroid states.

In view of recent reports suggesting that thyroid hormone control of TRH degradation occurs outside the central nervous system in animals, the effect of thyroid status on serum and tissue degradation of TRH in man was investigated. In six patients with hyperthyroidism and six patients with hypothyroidism, constant TRH infusions were carried out for determination of plasma clearance rate (PCR) and half-life of disappearance (t1/2) of TRH, with simultaneous determination of half-life of disappearance in serum in vitro (t1/2p). Using a kinetic model, this enabled the calculation of the half-life of disappearance in the extravascular tissue compartment (t1/2t). All patients were reinvestigated after they had become euthyroid. PCR, t1/2 and t1/2p were 22.1 +/- 3.4 ml/kg per min, 6.8 +/- 1.1 min and 17.3 +/- 6.7 min (means +/- S.D.) respectively in the euthyroid patients. The t1/2p was slightly but significantly prolonged during hyperthyroidism. The t1/2 was 5.6 min in the hyperthyroid patients compared with 9.4 min in the hypothyroid patients. The calculated t1/2t was 6.5 min in the euthyroid patients. In the patients with untreated hyperthyroidism, t1/2t was significantly reduced (22.7 +/- 10.7%; mean +/- S.D.), while it was considerably prolonged (41.1 +/- 24.6%) in patients with untreated hypothyroidism. The percentage reduction or prolongation of t1/2t was negatively correlated with the logarithm of the serum concentrations of thyroxine (r = 0.92) and tri-iodothyronine (r = 0.91) in the untreated patients. Thus, thyroid hormones induce alterations in the pharmacokinetics of TRH. This may partly be due to induction by thyroid hormones of membrane-bound pyroglutamyl aminopeptidase.

Adolescent

Direct diabetogenic effect of diltiazem?

In the reported case history, a normotensive and non-diabetic patient with ischaemic heart disease was treated twice with diltiazem. On both occasions diabetes mellitus developed within a few days; at first this was fully reversible, but on the last occasion it was irreversible.

Coronary Disease

Turnover of thyrotropin-releasing hormone in patients with chronic renal failure and chronic alcoholic liver disease.

Homogenates of liver and kidney tissues are efficient in degrading TRH, but the liver contains only membrane-bound pyroglutamyl aminopeptidase, active in degrading TRH at the extracellular side of cell membranes. In the present study the effect of liver and kidney failure on the degradation of infused TRH was investigated in man. In 7 uremic patients (group I) and 7 patients with chronic alcoholic liver disease (group II) plasma clearance rate, half-time of disappearance (t1/2) and half time of disappearance of TRH in serum in vitro (t1/2p) was determined. The plasma clearance rate, t1/2 and t1/2p were, respectively, 19.8 +/- 6.2 ml.kg-1.min-1, 6.6 +/- 1.5 min and 16.4 +/- 6.2 min in group I versus 28.2 +/- 4.8 ml.kg-1.min-1, 9.3 +/- 2.6 min and 25.3 +/- 15 min (mean +/- SD) in group II. The volume of distribution of TRH was 19.3% of the body weight in group I and 36.5% in group II. The calculated half-time in the extravascular tissue compartment (t1/2) was 5.4 +/- 1.4 min in group I and 9.2 +/- 2.7 min in group II patients (mean +/- SD). TRH metabolism in the uremic patients was almost identical to that previously reported in normal subjects. In the patients with chronic liver disease plasma clearance rate was significantly greater than in normal subjects, indicating an increased TRH-degrading enzyme activity in the tissue compartment. However, owing to the very large expansion of this compartment, the t1/2 and t1/2t were significantly prolonged. Hence, half-time determination of TRH is no reliable indicator of overall TRH degradation in patients with liver disease.

Adult

Postoperative discitis. Radiology of progress and healing.

The roentgenologic course of postoperative discitis is described in 111 patients examined with laminar tomography. The earliest lesion was blurring of the end plate or minor destructions, leading to cavitation of the vertebral body. Mean time from operation to the first clinical symptoms was 3 weeks. Mean time from operation to first radiologic lesions was 2 months, from operation to maximal lesions 4 months, and to the first radiologic sign of healing 5.5 months. A follow-up study was carried out and the radiologic findings were compared to those of a matched control group. A significantly higher incidence of decrease in disc height, intercorporal fusion and major osteophytes was found in the discitis group. The usefulness of laminar tomography, CT, MRI and isotope studies in the diagnosis of discitis is discussed. It is concluded that laminar tomography is a good alternative, when MRI is not available.

Adult

The effect of hemiplegia on bone mass and soft tissue body composition.

The content of bone mineral (BMC), lean tissue, and fat tissue were measured by single and dual photon absorptiometry in both the paretic and the non-paretic limbs of 15 patients, hemiplegic due to cerebrovascular accident 23-38 weeks earlier. Compared with the non-paretic arm, the paretic arm had approximately 10% lower (P less than 0.01) BMC. This difference was largest at the measuring site with the highest ratio of trabecular to compact bone. The paretic leg had a 4% (P less than 0.001) lower BMC than the non-paretic leg. For both the arms and the legs, the lean content was lower (P less than 0.05) and the fat content higher (P less than 0.01) in the paretic than in the non-paretic. This was relatively more pronounced in the arms than in the legs. We conclude that partial immobilization, owing to paresis after a cerebrovascular accident, results in characteristic changes in the affected limbs, with a marked decrease in the content of bone and lean tissue and a pronounced increase in fatty tissue.

Adipose Tissue

Short pulses of low dose thyrotropin-releasing hormone do not affect thyroid hormone secretion from perfused dog thyroid lobes.

Small amounts of TRH are present in the thyroid, and TRH has been shown in several studies to have a moderate direct inhibitory effect on TSH-stimulated thyroid hormone secretion. In a recent publication, however, data were presented to demonstrate that very low doses of TRH given in short pulses induce immediate increases in T4 secretion from the thyroid. This type of secretion had never been observed previously. We have tried to reproduce these results employing perfused dog thyroid lobes in which small and rapid variations in the release of hormones from the follicular cells are easily detected. TRH was infused in concentrations ranging from 1.7 X 10(-11) to 1.7 X 10(-8) M for 10-min periods. There was no effect on thyroid secretion of T4 and T3, nor did the infusion of 1.7 X 10(-9) M TRH for 160 min alter the T4 secretion induced by 4 microU/ml TSH.

Animals

Intra- and extravascular turnover of thyrotrophin-releasing hormone in normal man.

In 14 normal subjects constant TRH infusions for determination of plasma clearance rate (PCR) and half-life of disappearance (t 1/2) of TRH were carried out with simultaneous determination of half-life of disappearance of TRH in serum in vitro (t 1/2p). PCR, t 1/2 and t 1/2p were 1532 +/- 423 ml/min, 6.6 +/- 1.5 min and 16.8 +/- 9.4 min respectively (mean +/- S.D.) and displayed only minor fluctuations when determined repeatedly in the same subjects (coefficients of variation within individuals were 15.1, 10.6 and 7.5% respectively). Simultaneous determination of PCR, t 1/2 and t 1/2p enabled calculation of the half-life of disappearance of TRH in the extravascular tissue compartment (t 1/2t). Values of t 1/2t (6.3 +/- 1.4 min) correlated to t 1/2p (r = 0.95). Activities of TRH-degrading enzymes in tissues and in serum were independent of sex, phase of female menstrual cycle, time of day and of the concentrations of TRH used. The methods employed for this investigation offer the possibility of examining the degradation of TRH and TRH analogues both in the serum and in the extravascular compartment during various conditions.

Adult