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Biomedical subjects

J H Pedersen

Publications and source records attributed to J H Pedersen.

At least 19 recordsLinked to original sources
PubMed2002

Impaired postoperative outcome in chronic alcohol abusers after curative resection for lung cancer.

OBJECTIVE: It has been demonstrated that chronic alcohol misusers, who drink at least 60 g of ethanol per day, are suffering increased postoperative morbidity after various non-pulmonary surgical procedures. The aim of this study was to evaluate the association between alcohol consumption and postoperative morbidity and mortality after potential curative resection for lung cancer. METHODS: The records of all patients who underwent curative resection for lung cancer in a single University Centre in Cardiothoracic surgery during 1997 and 1998 were retrospectively reviewed. One hundred and seven patients, 42 women and 65 men, median age of 64 (33-79) years, were included and subdivided with regard to alcohol consumption. There were 26 pneumonectomies, 68 lobectomies and 13 lesser resections. Clinical complications occurring within 30 days after surgery and requiring therapy, were registered and subdivided into major, potentially lethal complications, and minor complications. Mortality within 30 days after surgery was also registered. RESULTS: Patients drinking at least 5 drinks per day had increased postoperative mortality, 3/13 versus 2/94 (odds ratio (95% confidence limits): 13.80 (2.06-92.68); P=0.007). The rate of major, live threatening complications including septicaemia and cardiopulmonary insufficiency was significantly increased among patients drinking at least 5 drinks per day 6/13 versus 19/94 (odds ratio (95% confidence limits): 3.38 (1.02-11.25); P=0.047) in univariate analysis. However, in multivariate analysis this association was not significant. CONCLUSION: Postoperative mortality after curative resection for lung cancer was significantly increased among patients drinking at least 5 drinks of alcohol per day.

Adult↗
PubMed2002

Endoscopic ultrasound guided biopsy of mediastinal lesions has a major impact on patient management.

BACKGROUND: A study was undertaken to evaluate the clinical impact of endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) in patients with mediastinal masses suspected of malignancy. METHODS: From April 1993 to December 1999, 84 patients were referred for EUS-FNA. In all patients CT scanning had shown a lesion of the mediastinum suspected of malignancy located adjacent to the oesophagus. In order to evaluate the clinical impact of EUS-FNA, the history of each patient up to referral for EUS-FNA was reviewed. A board of thoracic specialists was asked to decide the further course of the patient if EUS-FNA had not been available, and this diagnostic strategy was compared with the actual clinical course after EUS-FNA. RESULTS: For the 79 patients in whom sufficient verification was obtained, EUS-FNA had a sensitivity of 92%, specificity of 100%, PPV of 100%, NPV of 80%, and an accuracy of 94% for cancer of the mediastinum. In 18 of 37 patients (49%) a thoracotomy/thoracoscopy was avoided as a result of EUS-FNA, and in 28 of 41 patients (68%) a mediastinoscopy was avoided. The direct result of the cytological diagnosis obtained by EUS-FNA was that a final diagnosis of small cell lung cancer was made in eight patients resulting in referral for chemotherapy, and in another three patients with benign disease specific treatment could be initiated (sarcoidosis, mediastinal abscess, and leiomyoma of the oesophagus). CONCLUSIONS: EUS-FNA is a safe and sensitive minimally invasive method for evaluating patients with a solid lesion of the mediastinum suspected by CT scanning. EUS-FNA has a significant impact on patient management and should be considered for diagnosing the spread of cancer to the mediastinum in patients with lung cancer considered for surgery, as well as for the primary diagnosis of solid lesions located in the mediastinum adjacent to the oesophagus.

Adult↗
PubMed2001

[Accelerated course in hip arthroplasty].

INTRODUCTION: The aim of the study was to assess the results of a well-defined rehabilitation programme after hip arthroplasty. METHODS: The effects of a revised, optimised, perioperative care programme with continuous epidural analgesia, oral nutrition, and physiotherapy were assessed in 60 patients before intervention and 60 patients after intervention. RESULTS: The hospital stay was reduced from nine to six days (p < 0.01), there were fewer complications and less need for rehabilitation after discharge (p < 0.05) in the intervention group. CONCLUSION: A clinical programme focusing on pain relief, oral nutrition, and rehabilitation may reduce the stay in hospital and improve recovery after hip arthroplasty.

Aged↗
PubMed2001

Lung cancer screening by low-dose spiral computed tomography.

The poor prognosis of lung cancer has barely changed in the last decades, but the prognosis is better when the disease is detected earlier. Lung cancer screening by chest radiography did not lead to a decrease in lung cancer mortality, presumably because the chest radiograph is a poor screening tool with low sensitivity. With the advent of the low-dose spiral computed tomography (CT) scan it has become feasible to detect early invasive stage I lung cancer in 8-90% of cases. This technique could possibly decrease lung cancer mortality, but the extent of this effect is as yet unknown, and whether lung cancer screening will be cost-effective is yet to be determined. These questions can only be resolved in a randomized controlled trial with lung cancer mortality as an unbiased end-point. In this review, the initiatives to evaluate low dose spiral CT screening for lung cancer in Japan, USA and Europe are presented. In the USA and Japan, evaluation is in one-armed studies, whereas in many European countries randomized trials are now being planned and several one-armed studies have been initiated. A formal collaboration among these countries has now been set up. It is strongly recommended that lung cancer screening be evaluated in randomized trials in order to allow evidence-based health policy decisions to be made on this subject.

Adenocarcinoma↗
PubMed2000

Comparative kinetics of polymerisation of three fibrin sealants and influence on timing of tissue adhesion.

The clinical performance of fibrin sealants may be influenced by physical properties such as elasticity, tensile strength, and ability to adhere to human tissue. These properties are related to the internal structure of the fibrin sealant that builds as it polymerises. Analysis of the minimum polymerisation time to achieve a functional fibrin clot is clinically important. Instant tissue-fibrin sealant adhesion is desirable to ensure that the fibrin sealant functions on contact and remains at the site of application without being washed away by blood or displaced by movement of the target tissue (e.g., the heart or lungs). The physical characteristics of fibrin sealants are related to the extent of fibrin cross-linking. Determination of the polymerisation rate allows calculation of the minimum time required to produce a functional clot. The adhesion characteristics to vital human tissue and kinetics of polymerisation between 20 and 300 seconds postapplication of Vivostat system patient-derived sealant have been analysed and compared to those obtained for two conventional fibrin sealants, Tissucol and Beriplast. Mathematical analysis of the experimental data revealed that polymerisation of Vivostat sealant followed first-order kinetics, whereas that of Beriplast and Tissucol followed second-order kinetics. This study demonstrates that Vivostat sealant polymerises faster than these other conventional fibrin sealants.

Adhesiveness↗
PubMed2000

Prevention of air leakage by spraying vivostat fibrin sealant after lung resection in pigs.

STUDY OBJECTIVES: To evaluate Vivostat fibrin sealant in the prevention of air leakage after experimental lung resection in pigs. DESIGN: Randomized study. SETTING: University laboratory. METHODS: Six Landrace pigs were operated on in both lungs through a median sternotomy. Five different resection sites were created in each lung. INTERVENTION: Randomization was performed to either application of Vivostat fibrin sealant (ConvaTec; Skillman NJ) or human albumin 20% (control) at the resection sites. The lung parenchyma was occluded with a soft clamp for either 1, 2, 5, or 10 min in the treatment group and 10 min in the control group. After removal of the clamp, the lung was ventilated with an increasing intrabronchial pressure of 20, 30, and 45 cm H(2)O for 2 min at each step. RESULTS: At inspiratory pressures of 20 and 30 cm H(2)O air leaks were found in the control group but not in the Vivostat group (p < 0.001). At an inspiratory pressure of 45 cm H(2)O, there were two small air leaks in the Vivostat group at each clamping time (four at 5 min), compared with five small and seven large leaks in the control group. Analysis of the data after 10 min of clamping showed that the Vivostat group was superior to the human albumin group (p = 0.002). CONCLUSIONS: This randomized study shows that Vivostat fibrin sealant is effective in preventing air leakage after small lung resections in pigs, even at high inspiratory pressures.

Air Pressure↗
PubMed1998

A prospective study of combined phacoemulsification-trabeculectomy versus conventional phacoemulsification in cataract patients with coexisting open angle glaucoma.

This prospective study compares combined phacoemulsification and trabeculectomy (phaco-trab) to conventional phacoemulsification (phaco) in patients with coexisting cataract and open angle glaucoma. Twenty eyes were randomly assigned to either phaco-trab or phaco and followed for 12 months. Postoperatively, IOP decreased significantly in both groups, but patients with the combined procedure had fewer early IOP-elevations and significantly less medication. Visual acuity improved equally in the two groups.

Aged↗
PubMed1994

Clinical comparison of two low-dose oral contraceptives, Minulet and Mercilon, in women over 30 years of age.

A comparative study of two low-dose oral contraceptives, gestodene (GES) 75 mcg/ethinyl oestradiol (EE) 30 mcg and desogestrel (DES) 150 mcg/EE 20 mcg, was conducted in women over 30 years of age. This randomised, open-label study was organised in Denmark, Italy, New Zealand and United Kingdom. A total of 505 women received GES/EE and 501 received DES/EE for 6 consecutive menstrual cycles. The two groups were comparable in terms of demographic and gynaecologic characteristics at baseline. However, the menstrual flow length was slightly longer in the GES/EE group before the start of the treatment. The mean age (+/- SD) was 35 +/- 4 years in the GES/EE group and 35 +/- 5 years in the DES/EE group. The subjects in the GES/EE group contributed data for a total of 2800 cycles and those in the DES/EE group, data for 2796 cycles. There were no pregnancies on medication with either preparation. The results showed that there were significantly more normal cycles in the GES/EE group for cycles 1 to 6. Irregular bleeding between withdrawal bleeds occurred in 10% of GES/EE and 18.5% of DES/EE cycles. Absence of all bleeding was reported in 29 (1%) and 63 (2%) cycles, respectively. The incidence of missed pills was low in both groups (11% of cycles). No significant differences were observed in cycle length or withdrawal bleeding episode length. Withdrawal bleeding mean intensity was statistically significantly greater with GES/EE. However, for both preparations, the mean intensity was close to light bleeding. No clinically significant differences were noted in weight, blood pressure, Papanicolaou smears or laboratory data. Sixty-eight (13.5%) subjects in the GES/EE group and 64 (12.8%) in the DES/EE group discontinued before the end of the study. Among them, 37 (7%) and 40 (8%) in the respective groups withdrew because of adverse reactions. There was no difference between groups in terms of primary reasons for withdrawal. The most frequently reported complaints that led to discontinuation in both groups were headache, nausea and metrorrhagia. Breast tenderness led to the discontinuation of 1 subject in the GES/EE group and 3 in the DES/EE group. These results show excellent cycle control, efficacy and very low rate of side effects with both GES/EE and DES/EE. These low-dose oral contraceptives could be well suited to healthy nonsmoking women requiring contraception up to the age of menopause.

Adult↗
PubMed1994

Effect of fructose on the capacity of urea-N synthesis in rats.

We studied the effect of fructose on hepatic conversion of amino-N to urea-N as quantified by the Capacity of Urea-N Synthesis (CUNS) determined in rats during alanine loading. There were 2 control groups, one without and one with infusion of somatostatin, in order to control the effects of insulin and glucagon. Somatostatin reduced CUNS from 8.5 +/- 0.5 mumol/(min x 100 g BW) to 6.3 +/- 0.3 mumol/(min x 100 g BW) (mean +/- SEM) (p < 0.01) and reduced glucagon concentrations by 75% (p<0.05). Insulin and glucose concentrations did not change. Fructose, at blood concentrations of about 1 mmol/l further reduced CUNS to 3.6 +/- 0.3 mumol/(min x 100 g BW) (p < 0.01). Insulin increased slightly (p < 0.05), but neither glucose nor glucagon changed. At increasing fructose concentrations up to 2 mmol/l there was no further effect on CUNS. Fructose in concentrations as used for parenteral nutrition and independent of glucoregulatory hormones, decreased hepatic amino acid catabolism.

Journal Article↗
PubMed1992

[Captopril-induced toxic hepatitis].

Captopril, the competitive inhibitor of angiotensin-converting enzyme, has proved efficient in the treatment of arterial hypertension and heart failure. Its use is generally associated with low incidence of adverse reactions and hepatic injury has not been emphasized as an important adverse reaction in Denmark. However worldwide, several cases of hepatic injury have been reported. We report one case of Captopril-induced hepatic injury. Despite discontinuation of Captopril a hepatorenal syndrome developed and the patient died five weeks after admission. This report emphasizes the need to be aware of the possibility of hepatic injury in patients receiving Captopril.

Aged↗
PubMed1990

Distribution of neurotensin-like immunoreactivities in porcine and human gut.

The distribution of neurotensin-like immunoreactivity (NTLI) in porcine and human intestine was studied by extraction of mucosal and muscular layers of esophagus, stomach, duodenum, jejunum, ileum, and colon. NTLI was quantitated and characterized by radioimmunoassays and gel filtration chromatography. Porcine tissue was obtained in anesthetized animals (n = 6) and human tissue during surgery (n = 28). Concentrations of NTLI increased gradually from the distal esophagus to the ileum. Highest concentrations were found in 2.0 M acetic acid extracts of proximal ileal mucosa (150 (131-223) and 525 (500-729) pmol/g wet tissue, respectively (medians and interquartile range]. After acid extraction, concentrations of intact NT and COOH-terminal and NH2-terminal NTLI were similar, but in water concentrations of NH2-terminal NTLI were high and intact NT and COOH-terminal NTLI low. The distribution of NTLI was similar in the two species. Gel chromatography of ileal, jejunal, and duodenal mucosa indicated that in these tissues NTLI consisted primarily of intact NT. In antral mucosa COOH-terminal immunoreactivity different from NT was detected. The chemical identity is unknown, but it may represent precursor forms of NT.

Adult↗
PubMed1989

Pharmacokinetics and metabolism of neurotensin in man.

We studied the pharmacokinetics, arteriovenous extraction, and degradation sites of neurotensin (NT) in man during iv infusions of synthetic intact NT [NT-(1-13)] and the NH2-terminal metabolite NT-(1-8) during lipid ingestion and by catheterization of various vascular beds in normal subjects and patients with hepatic disease. NT-like immunoreactivities in plasma were quantitated using 2 sequence-specific RIAs and gel filtration chromatography. During iv infusion of NT-(1-13) in 6 normal subjects, the median t1/2 was 1.7 min (interquartile range, 0.7-2.8), the MCR was 36 mL/kg.min (range, 21-54), and distribution space was 78.8 mL/kg (range, 56-91). The results were similar at infusion rates of 72, 144, and 288 pmol/kg.h (n = 6). During infusion of NT-(1-8) in 7 normal subjects, the median t1/2 was 8.3 min (range, 4.7-13.8), the MCR was 11.0 mL/kg.min (range, 6.7-21.7), and the distribution space was 142.6 mL/kg (range, 45.3-281.0). Significant peripheral arteriovenous extraction of NT-(1-13) was found at infusion rates of 144 and 288 pmol/kg.h. Extraction of NH2-terminal immunoreactivity was not significant. Intact NT was identified by gel chromatography in arterial plasma after lipid ingestion and iv infusion of NT-(1-13), but postprandially in only low concentrations. In 17 patients with various nonhepatic diseases, plasma intact NT levels were not different in blood sampled from the renal vein, inferior vena cava, brachial artery, or hepatic vein. In contrast, NH2-terminal immunoreactivity was significantly higher in hepatic venous than in systemic plasma. In 6 patients with hepatic disease, systemic plasma intact NT levels were increased, but even more so in hepatic venous plasma. These results demonstrate that metabolism of intact NT is rapid, and a significant peripheral arterio-venous extraction is present. Further studies are necessary to establish if the liver is a site of degradation of intact NT in man.

Adult↗
PubMed1989

Value of monitoring serum gastrin after renal transplantation.

Serum concentration of gastrin was measured before and after renal transplantation in 97 consecutive patients in order to assess possible correlations to gastrointestinal bleeding, allograft function, or graft rejection. In patients with transient signs of allograft rejection (N = 29) or upper gastrointestinal bleeding (N = 12) there was a nonsignificant trend towards higher postoperative gastrin levels, and in patients in whom the graft was removed (N = 29), this tendency was more pronounced (p = 0.06). The study demonstrated that monitoring of serum concentrations of gastrin following renal transplantation is of little clinical value. However, increased gastrin levels in serum may indicate that graftectomy may be the ultimate result.

Cadaver↗
PubMed1987

Occurrence of VIP and peptide HM in human pancreas and their influence on pancreatic endocrine secretion in man.

By immunohistochemistry it was found that VIP- and peptide HI/peptide HM (PHI/PHM)-like immunoreactivity occurred in autonomic neurons in the human pancreas. Antisera against both VIP and PHI/PHM reacted with neuronal cells in local ganglia and these ganglia also contained PHI/PHM- and VIP-immunoreactive fibre plexuses. VIP- and PHI/PHM-positive fibres were also seen close to the Langerhans' islets. In addition, PHI/PHM- but not VIP-like immunoreactivity was observed in the endocrine cells often located in the periphery of the islets. The nature of these PHI/PHM-positive cells remains to be established. I.v. infusion of VIP at constant rates of 300 and 900 pmol/kg X h for 30 min in 6 healthy volunteers resulted in plateau values of 102 +/- 26 and 291 +/- 25 pM, respectively. These levels of VIP which are above those found in the circulation under physiological conditions stimulated secretion of insulin, C-peptide and pancreatic glucagon dose-dependently. On the contrary prolonged (60 min) infusion of PHM in doses resulting in plasma levels up to 1340 +/- 405 pM had no effect on pancreatic hormone secretion. These findings suggest that VIP is a likely neurotransmitter in the control of endocrine pancreatic secretion while PHM has a less prominent role, if any.

Adult↗
PubMed1987

Neurotensin-like immunoreactivity after intestinal resection in the rat.

Neurotensin is a tridecapeptide located mainly in the distal small intestine. The present study was carried out in order to investigate the neurotensin response after proximal small intestinal resection in the rat. After resection, the median plasma concentration of neurotensin like immunoreactivity (NTLI) was unchanged compared with sham operated rats. Intragastric instillation of fat increased the plasma concentration of NTLI from 45 pmol/l (34-63) in sham operated rats to 92 pmol/l (46-121) in resected rats. No significant increase in the plasma concentration of NTLI was found after intragastric instillation of amino acids or glucose. The tissue concentration of NTLI increased significantly in the jejunum and ileum after proximal small intestinal resection, while the number of immunoreactive neurotensin cells was unchanged. This study shows that the adaptive responses in the distal small intestine after proximal small intestinal resection also involve the neurotensin producing cells.

Animals↗
PubMed1987

Fasting and meal-stimulated plasma levels of neurotensin in obese patients after jejunoileal bypass with 3:1 or 1:3 jejunoileal ratio.

The functional role of the jejunum and ileum with regard to peripheral plasma levels of intact neurotensin and NH2-terminal immunoreactivity of neurotensin was studied by using jejunoileal bypass as a model. Plasma levels were measured by radioimmunoassay before and after jejunoileal bypass randomized to different jejunoileal ratios. Seven patients were studied before bypass surgery and 28 were examined after end-to-side jejunoileal bypass with 50 cm intestine in continuity and a 3:1 or 1:3 ratio between the length of the jejunal and ileal segments. Fasting levels of intact neurotensin were unchanged by surgery, whereas levels of NH2-terminal immunoreactivity were higher in bypass patients with a long ileal segment (37.5 cm) than in unoperated patients and in those with a short ileal segment (12.5 cm). Meal-stimulated levels of intact neurotensin were higher after 1:3 than 3:1 jejunoileal bypass. The levels of NH2-terminal immunoreactivity in patients with a short ileal segment and in controls were lower than in patients with a long ileal segment. The results show that postprandial levels of both intact neurotensin and NH2-terminal immunoreactivity are related to the length of the functioning ileum and that even a difference in length of 25 cm is reflected in the circulating levels of neurotensin.

Adult↗