Biomedical subjects
Publications and source records attributed to J Kirkegaard.
Since late summer 1989 we have used the Wurzburg titanium miniplate system in the treatment of severe midface fractures and as implants in reconstruction of the mandible after cancer surgery of the mouth. The aim of this study was to test the applicability of the system.
Three hundred and four patients with squamous cell carcinomas of the oral cavity were treated at the Finsen Institute in cooperation with the ENT-surgical departments between 1978 and 1982. The primary treatment consisted of radiotherapy alone in 74%, surgery alone in 4%, and a combination of radiotherapy and surgery in 15% of the patients. Two per cent received other treatment (cryotherapy), 5% did not complete the planned radiotherapy, and 1% were not treated at all. Of 203 patients with tumour remnant or first recurrence, 45% were operated, 2% received radiotherapy, and 2% combined treatment. This treatment strategy made 38% of the patients free of disease in the follow-up period (3 1/2 to 8 years) or until the patients died from other causes. Fifty-nine per cent of the patients died from their oral carcinomas. Tumour size (T), lymph node status (N), and tumour stage were as expected important prognostic factors.
Study of patients with oral carcinomas from the Finsen Institute in a five-year period, shows the survival to be significantly correlated to the tumour stage on referral. In order to improve the prognosis for these patients, earlier diagnosis and earlier referral for treatment to the oncological centre are necessary.
308 patients with intraoral carcinomas were treated in the Finsen Institute, Copenhagen, from 1978 to 1982. As primary treatment, 73% of the patients had radiotherapy alone, 5% had operations alone, and 14% had combined treatment. After first recurrences, 45% of 204 patients were operated on. This treatment strategy kept 40% of all 308 patients free of disease for at least 3.5 years or until death. Fifty-eight percent of all 308 patients died of their oral carcinomas. The present study shows that tumor size, lymph node involvement, and total tumor stage are important prognostic factors. Old and new treatment strategies are discussed and more use of operations using modern reconstructive techniques followed by radiotherapy is recommended.
Study of patients with oral carcinomas from the Finsen Institute in a five-year period, shows the survival to be significantly correlated to the tumour stage on referral. In order to improve the prognosis for these patients, earlier diagnosis and earlier referral for treatment to the oncological centre are necessary.
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The aim of the present study was to test the efficacy of the topically active cholinoceptor antagonist, ipratropium, in the treatment of rhinorrhea in perennial nonallergic rhinitis, with special reference to identification of subgroups of responders and increased efficacy from high-dose therapy. Thirty-six adult patients with watery rhinorrhea as a dominant symptom completed the study, which consisted of a 2-week run-in period followed by two 3-week treatment periods with placebo and ipratropium in an ordinary dosage (80 micrograms four times a day) in a double-blind, crossover design, and, finally, an open 2-week period with high-dose therapy (400 micrograms four times a day). The number of nose blowings was 47% lower during treatment with ipratropium in the ordinary dosage than during the placebo period (p less than 0.001). There was an additional reduction during high-dose therapy that was slight but statistically significant (p less than 0.05). Ipratropium had no effect on the number of sneezes or on nasal blockage index. During ordinary-dose therapy, side effects were slight and confined to the nose, whereas the high-dose therapy caused unpleasant nasal dryness and, in a few cases, systemic side effects. It was not possible to separate responders from nonresponders by case history, physical examination, or nasal methacholine testing. It is concluded that intranasal ipratropium is effective in the treatment of watery rhinorrhea in perennial nonallergic rhinitis and that 320 micrograms a day is sufficient in most patients.
In the 5-year period 1978-1982, 34 patients with facial fractures underwent repair of the orbital floor. Reconstruction of the orbital floor by means of an implant was used in 28 of 34 patients (82%). Nineteen patients (56%) had a balloon inflated in the maxillary sinus to stabilize the orbital floor. Radiographic contrast solution was used in the balloon to facilitate the postoperative radiographic control of the balloon and the orbital floor. It was possible to make a follow-up study of 30 of the 34 patients. Nine of the patients had persisting reduced sensitivity in the infraorbital nerve region and 7 patients had slight enophthalmos. Out of the 30 patients, only 2 patients had persisting diplopia of a slight to moderate degree and none found it disturbing enough to need further surgery. This series shows that good results can be expected after early surgery and active management with open reposition, reconstruction and placing of an intral balloon are recommended.
The effect of an H1 antihistamine (chlorpheniramine) and an H2 antihistamine (ranitidine) nasal spray on histamine-provoked symptoms was studied in normal volunteers. Firstly it was shown that the H1 antihistamine has a marked inhibiting effect on tickling, sneezing and discharge, and secondly, that both H1 and H2 antihistamines have a weak effect on blockage. Finally, it was found that the H1 antihistamine, in the concentration used, has no demonstrable anti-cholinergic or local anaesthetic effect. It is concluded that antihistamines act locally in the nose, H1 antihistamines inhibit tickling, sneezing and hypersecretion via nervous H1 receptors, while blood vessels possess both H1 and H2 receptors.
The aim of this experiment was to study the importance of histamine H1 and H2 receptors in the human nose. We therefore provoked 25 healthy human subjects with histamine after local pretreatment with the H1 receptor antagonist, chlorpheniramine maleate, the H2 receptor antagonist, ranitidine hydrochloride, and a combination of these two antihistamines. The histamine-induced increase in nasal airway resistance was 52% inhibited by combined use of the two antihistamine sprays (p less than 0.05), 22% by chlorpheniramine alone (p less than 0.05), and 29% by ranitidine. The two sprays together were significantly better than the H1 antagonists alone (p less than 0.05). These results suggest an equal importance of H1 and H2 receptors in nasal blood vessels, and an additive effect of H1 and H2 antihistamines. Although chlorpheniramine effectively blocked tickling and the reflex-mediated symptoms, sneezing and hypersecretion, ranitidine had no effect, which suggests an H1 and not an H2 effect on sensory nerve endings in the airway epithelium.
Earlier studies have shown that intranasal chlorpheniramine (0.77%) can inhibit histamine-induced tickling, sneezing, and hypersecretion by a local effect on nerve fibres. The aim of the present study was to examine whether this solution had local anaesthetic of parasympatholytic properties. If neither of these properties are present it suggests that the anti-pruritic effects of the solution are caused by inhibition of H1 receptors, which in turn is indirect evidence for the presence of H1 receptors on nerve fibers. In a double-blind design 15 normal subjects were provoked with histamine in the eye after pretreatment with chlorpheniramine or with a local anaesthetic, oxybuprocain. Both drugs inhibited itching, but the H1 antihistamine was significantly more effective than the local anaesthetic (P less than 0.01). Corneal sensitivity was measured by an esthesiometer, and pupil difference was used as a measure for atropine activity. Chlorpheniramine had neither a local anaesthetic nor a parasympatholytic effect. This study has therefore strengthened the hypothesis that there are nervous H1 receptors in the mucous membranes of the eye and airways and has extended its application in animals to also include man.
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