Psychosocial stress and severe prematurity.
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Biomedical subjects
Publications and source records attributed to F Jensen.
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Eight patients were examined. Seven had verified rhinorrhoea and six had had one or more episodes of pneumococcal meningitis. In four of the patients a fistula could not be visualized by computed tomography. All eight patients had injections of iodine-123-labelled albumin by lumbar puncture. Tomoscintigraphy (SPET) was performed 3, 6 and 8-9 h after injection. After 6-8 h we were able to demonstrate a fistula in seven of the patients with verified rhinorrhoea and the findings were confirmed by a subsequent operation. In one of the patients we were not able to visualize any leak of cerebrospinal fluid into the nasal cavity. This patient was not operated upon and we were not able to verify the findings in this patient. The operated patients all did well after the operation with no relapse of meningitis. In conclusion, SPECT-cisternography after intralumbar injection of iodine-123-labelled albumin is a valuable diagnostic tool for the detection of small fistulae in patients with rhinorrhea.
Infection around the tonsillar region does not always mean the presence of a peritonsillar abscess although the condition of peritonsillitis without abscess formation may clinically present similarly. It is, however, of therapeutic importance to distinguish between the two conditions. Treatment for abscess is surgical: aspiration, incision and drainage or immediate tonsillectomy. In contrast, phlegmonous peritonsillitis only requires antibiotics. In order to evaluate the diagnostic implications of preoperative ultrasonography in patients referred for treatment of peritonsillar abscess, 27 consecutive patients were subjected to bilateral ultrasound examination to visualize the tonsillar region. The transducer used was placed just below the mandibular angle, pointing posteriorly and cranially. The results of this study showed that it was possible to verify the presence of an abscess in approximately 90% of the cases. We suggest that this examination be performed whenever the normal clinical examination is insufficient due to trismus, lack of patient cooperation, etc.
One hundred six patients with small cell lung cancer (SCLC) were prospectively evaluated with regard to the prognostic impact of abdominal CT-scan in the pretreatment staging when compared to ultrasonography of the abdomen. Staging based on abdominal ultrasonography (US) plus bilateral bone marrow examinations gave as a result that 47 patients had extensive disease (ED) (44%). Seventeen patients with proven ED at time of referral were not included in this study. Abdominal CT-scan was performed in 76 of the 106 patients. Thirty patients of these 76 patients (39%) were classified as having ED after staging including US, but abdominal metastases were disclosed in another ten patients at the subsequent CT-scan. Liver metastases seen in two patients at ultrasonography were overlooked on the CT-scans. Median survival of the 36 patients classified as having limited disease (LD) after both procedures was 458 days, which was significantly better compared to 330 days for the ten patients with stage migration from LD to ED based on CT-scan, (p less than 0.05) and compared to 242 days in the 30 patients with ED demonstrated by both US and CT-scans (p less than 0.05). The prognostic impact of the CT-scan was further investigated in a multivariate analysis (Cox). Stage disease, performance status, LDH and alkaline phosphatase were significant prognostic factors in a proportional hazards model based on the original 106 patients. Patients in the best prognostic group were characterized by LD, good performance status (0-1) and normal LDH and alkaline phosphatase serum values. This group consisted of 22 patients (21%).(ABSTRACT TRUNCATED AT 250 WORDS)
OBJECTIVE: To study the influence of previous or present hepatitis B virus (HBV) infection on HIV disease progression. DESIGN: A prospective study of HIV-positive individuals from HIV diagnosis to diagnosis of AIDS or to the end of the follow-up period on 1 January 1991. Mean follow-up time was 62 months. SETTING: The study population was recruited from a primary health-care clinic for homosexual men and followed by linkage to the National AIDS Registry. PATIENTS, PARTICIPANTS: Of 876 individuals who were tested for HIV, 80 were HIV-positive and included for study. Two individuals were lost to follow-up. MAIN OUTCOME MEASURES: Differences in progression rates to AIDS according to HBV status at study entry. RESULTS: The adjusted relative risk of progression to AIDS for the 48 subjects who were HBV-antibody-positive at study entry was 3.6 [95% confidence interval (CI), 1.3-10.1]. A high frequency of receptive anal intercourse was also associated with more rapid HIV disease progression; adjusted relative risk 2.6 (95% CI, 1.1-5.9). CONCLUSIONS: Our results suggest that presence of HBV antibodies is associated with more rapid HIV-disease progression.
The current status of cervical cancer treatment in Denmark is discussed. Diagnostic aspects and problems of classification are presented briefly supplemented with a comment on new prognostic parameters based on a semiquantitative score system and flow cytometry. Surgery is the treatment of election for the early stages whereas radiotherapy is the treatment of choice in advanced stages. Chemotherapy should only be employed in the framework of clinical trials. It is concluded that centralised treatment should be maintained.
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To determine the best noninvasive means of evaluating response in patients with advanced ovarian carcinoma, 50 abdominal ultrasound (US) and computed tomography (CT) scans were performed in clinically disease-free ovarian cancer patients. The scans were correlated with the results obtained at a subsequent second- or third-look laparotomy. CT and US were not complementary, and only metastases larger than 2 cm were detected. The overall positive predictive value of nonconcordant scans was 57% compared with 100% for concordant CT and US (95% confidence limits: 18.4-90.1 and 29.2-100%, respectively). The corresponding negative predictive values were 45 and 47% (30.2-59.9 and 30.4-61.2%, respectively), if undetected microscopic disease was classified as a false-negative result. The negative predictive value of US and CT increased only to 60% in both cases, if undetected microscopic disease was registered as a true-negative result. Compared with the pelvic examination CT and US added positive information for 4 of 22 (18%) patients with macroscopic residual disease. In this study neither CT nor US was sensitive enough to preclude second-look laparotomy.
An important prerequisite in CT and also ultrasonic scanning in order to recognize pathological space-occupying processes in the liver is that these processes can stand out in the pictures with "another colour" than the surrounding liver tissue. CT and ultrasonic scanning are based on very different physical principles and, therefore, different tissue parameters are registered. It is to be anticipated that the contrast conditions between the liver tissue and tumour tissue in the individual patient are not identical in the two imaging processes. The case histories presented illustrate the fact that liver metastases which merge with the liver parenchyma with one of the methods and are, therefore, not recognized, can sometimes be recognized with the other method.
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In a pilot study of 6 patients with subarachnoid hemorrhage caused by a ruptured intracranial (grade IV (Hunt and Hess) aneurysm the hemodynamics and plasma-nimodipine concentrations have been observed during a 3-week period of treatment. We found that 3 patients developed reversible hypotension during the nimodipine treatment and that the hypotension tendency could be related to the plasma-nimodipine level and not to a more or less severe sensitivity to nimodipine. Repeated measurements of blood pressure, plasma-nimodipine and regional cerebral blood flow (rCBF) are necessary for the purpose of obtaining the optimum treatment and for evaluating the effect of treatment.
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Liver evaluation of 131 patients with small-cell lung cancer (SCLC) was performed both by peritoneoscopy (PS) with liver biopsy and by ultrasonography (US) with fine-needle aspiration. A total of 33 patients (25%) had liver involvement, 82% detected by US and 76% detected by PS. The difference was due to 27 incomplete investigations by PS and two incomplete investigations by US. In 104 patients in whom both investigations were "successful," PS confirmed 86% and US confirmed 79% of the patients with liver metastases. In each of the investigations, 7% (PS) and 14% (US) of patients had false-negative conclusions as compared with histologic evidence obtained by the other method. US found six patients with extrahepatic intraabdominal disease, while PS found none. S-lactic dehydrogenase (s-LDH), SGOT, and s-alkaline phosphatase were found to be too unspecific to indicate liver metastases unless all three tests were normal or abnormal. It is recommended that US should be used as the initial procedure when staging patients with SCLC, and that PS can be considered complementary in patients with negative US.
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An aggressive visceral form of Kaposi's sarcoma (KS) has been reported in immunosuppressed populations, most notably in patients with acquired immunodeficiency syndrome (AIDS). This presentation contrasts from the indolent skin lesions on the extremities of older males and is distinct enough in the young adult American population to have been included in the working definition of AIDS. The authors describe a case of primary lymphadenopathic KS in an immunocompetent heterosexual 23-year-old man with no epidemiologic, immunologic, or serologic evidence of AIDS. This report emphasizes that a diagnosis of KS in a young American male is not synonymous with the diagnosis of AIDS.