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Biomedical subjects

J L Nielsen

Publications and source records attributed to J L Nielsen.

At least 19 recordsLinked to original sources
PubMed1995

Penetrating intrapericardial wounds: clinical experience with a surgical protocol.

BACKGROUND: From 1972 to 1977, a treatment protocol was developed at our institution for patients with suspected penetrating intrapericardial wounds. It consists of immediate transport to the operating room, pericardial decompression by subxiphoid pericardial window under local or light general anesthesia in patients in stable condition, and median sternotomy and operative repair with limited use of cardiopulmonary bypass. METHODS: The records of 79 consecutive patients with acute penetrating intrapericardial injury who underwent operation from March 1978 to July 1991 were reviewed. There were 59 patients (75%) with stab wounds and 20 (25%) with gunshot wounds. Wound location was as follows: right ventricle, 33 (42%); left ventricle, 28 (35%); multiple sites, 8 (10%); atrium, 5 (6%); and great vessels, 5 (6%). RESULTS: Subxiphoid pericardial window was performed under local or light general anesthesia in 53 patients (67%). Cardiopulmonary bypass was required in only 4 patients. Overall mortality was 6%. CONCLUSION: Approach to a trauma victim must be systematic. We believe one treatment protocol for patients with suspected penetrating intrapericardial wounds is effective.

Adolescent↗
PubMed1994

Studies of serum protein complexes with nickel using crossed immunoelectrophoresis.

Crossed immunoelectrophoresis of human serum spiked with nickel in the range 0.85-24 mmol Ni/L was used to study nickel-protein complexes. These high concentrations, which are far higher than the physiological level (approximately 7.8 nmol/L), were used to saturate both high and low affinity binding sites. Addition of increasing amounts of nickel resulted in dose-dependent changes of the electrophoretic patterns of prealbumin, alpha-1-lipoprotein, alpha-1-antitrypsin and alpha-2-macroglobulin. Radioactive 63Ni was used for crossed immunoelectrophoresis autoradiography experiments for further identification of nickel-protein complexes. When a 63Ni pulse of 740 kBq/application was used, many human serum proteins were labeled. When using a 63Ni pulse of 185 kBq/application only albumin and alpha-1-antitrypsin were visualized clearly. The binding of large amounts of nickel to albumin, visualized by autoradiography, may reflect the high abundance of albumin in human serum as compared to other serum proteins. Addition of nickel to serum proteins resulted in liquid phase precipitation of serum proteins, and rocket immunoelectrophoresis was used to demonstrate that IgG in particular is precipitated. This precipitation of serum proteins may disturb the elution profile when chromatographic techniques are used to analyze nickel-protein complexes. Consequently, immunoelectrophoretic methods may also be attractive alternatives to column chromatographic techniques. The present study demonstrated that, besides the nickel-binding of albumin and alpha-2-macroglobulin, several other serum proteins have nickel-binding affinity.

Blood Proteins↗
PubMed1994

Pneumococcal septicaemia and meningitis in vaccinated splenectomized adult patients.

A retrospective survey of the occurrence of pneumococcal septicaemia and meningitis in splenectomized adults was performed at a regional haematological centre after the introduction of pneumococcal vaccination in 1978. During this period 4 episodes of pneumococcal septicaemia were observed in 3 vaccinated, splenectomized patients. In all episodes the pathogenic strain was of an unusual serotype not included in the vaccine lending indirect evidence for the clinical efficacy of the pneumococcal vaccine, even in immunocompromised patients.

Adult↗
PubMed1992

Ph-positive chronic myeloid leukemia with loss of the segment distal to M-bcr.

We describe a patient with chronic myeloid leukemia (CML) and a 22q- but no 9q+ chromosome. Southern blot analysis showed a BCR rearrangement. The patient soon developed profound and superficial thrombophlebitis in arms and legs and died from pulmonary embolisation 15 days after diagnosis. Five CML cases with a deletion of 22q but no known translocation of 22q11----qter have been described earlier. The present patient is the first such case, however, in whom a BCR rearrangement has been demonstrated.

Blast Crisis↗
PubMed1992

Risk of major elective operation after myocardial revascularization.

Although an increased surgical risk of ischemic myocardial disease is widely accepted, amelioration of this risk after coronary artery bypass is poorly defined. We compared the outcomes of major elective general and peripheral vascular operations in 181 patients with prior coronary artery bypass grafting (CABG) with outcomes in an age-, gender-, and procedure-matched group without prior CABG (NOCABG). Despite the perception of a greater operative risk in the CABG patients (more CABG patients in American Society of Anesthesiologists [ASA] class III and fewer in ASA class I, p < 0.001), mortality (1.1% CABG versus 2.8% NOCABG) and morbidity (18.8% CABG versus 18.5% NOCABG) rates in the two groups were not significantly different. For patients who have undergone successful CABG, it appears that: (1) the risk of subsequent elective major general and vascular surgical operations is similar to that of an age-, gender-, and procedure-matched cohort, and (2) the mortality rate after elective operations is low.

Age Factors↗
PubMed1992

Non-Hodgkin's lymphoma in the elderly. A study of 602 patients aged 70 or older from a Danish population-based registry. The Danish LYEO-Study Group.

Within a 7-year period 1,597 newly diagnosed cases of non-Hodgkin's lymphoma (NHL) were included in a Danish population-based NHL registry. Of these, 602 (38%) were aged 70 years or older (age range 70-94, median: 76.8). They represent the population defined as 'elderly' patients in the present study. The average annual incidence rate for this elderly patient population was 35.7/10(5), as compared with 6.6/10(5) for patients aged less than 70 (overall annual incidence: 9.5/10(5)). Localised cases (stage I and II) and extranodal manifestations were found more frequently among elderly patients. The most common sites of extranodal involvement were the stomach (21% of all extranodal cases) and the bone marrow (16%). Histologically, follicular centroblastic/centrocytic cases were found to be less frequent (p less than 0.01) in elderly patients as compared to their younger counterparts (less than 70 years), who in contrast had a lower occurrence of diffuse centroblastic cases (p less than 0.01). Overall 7-year survival for the elderly patient population was 35% (median 1.7 years), and for patients aged less than 70 it was 57%. This difference persisted after correction for apparently NHL-unrelated deaths (52% vs. 66%, respectively, p less than 0.0001). Elderly patients with poor prognosis were characterised by the following features identified in a Cox-regression model: hepatic involvement, presence of B-symptoms, high-grade histology and elevated s-LDH. The corresponding relative risk values were in the order 2.4, 2.2, 1.9 and 1.6.

Aged↗
PubMed1992

Initial cytoreduction by mitoxantrone and cytarabine has no impact on the outcome of interferon-alfa-2b therapy in chronic myelogenous leukemia.

Eleven previously untreated patients with chronic-phase Philadelphia-chromosome-positive chronic myelogenous leukemia were treated with cytotoxic chemotherapy followed by interferon-alfa-2b (IFN-alpha) maintenance. Initial chemotherapy consisted of three cycles of mitoxantrone 10 mg/m2 on day 1 and 2, and cytarabine 100 mg/m2 daily for 5 d. Complete hematological response was obtained in 9 (82%) patients with moderately associated toxicity. However, cytogenetic responses after three cycles were poor and transient (1 partial suppression and 2 minor suppression of Ph chromosome). Maintenance therapy with IFN-alpha was started in 10 patients at 5 x 10(6) U/m2 daily with dose reduction if hematologic toxicity or severe side-effects occurred. Of 9 evaluable patients treated for more than 3 months, 6 patients maintained a complete hematological response, whereas 1 patient remained in partial remission and 2 patients showed progressive disease. Cytogenetic evaluation showed partial suppression of Ph chromosome in 1 patient, whereas 1 patient had a minor response and 5 patients had no change or evolution of new chromosome abnormalities. As the results are not superior to IFN-alpha treatment alone, it is concluded that initial cytoreduction by mitoxantrone and cytarabine has no impact on the outcome of therapy in CML.

Adult↗
PubMed1991

[Malignant hematologic diseases. Diagnosis and treatment. A clearing report].

The malignant haematological disorders comprise the main groups leukemia, malignant lymphoma and multiple myeloma and the potentially malignant disorders: myelodysplastic syndrome, polycythaemia vera, myelofibrosis and M-component of uncertain significance. The common feature of all these disorders is monoclonality, i.e. they originate from one single cell. Around 2,000 new cases are diagnosed per year in Denmark. Because of the relative small number of patients, complex diagnosis and treatment (especially the possibility of cure on intensive treatment) a high degree of centralization is warranted to secure an evenly distributed high level of patient care and research. The present rules for referral of patients are unsatisfactory. A new referral system is proposed based on a common set of rules, agreed upon by five haematological centers in Denmark and the surrounding region, comprising diagnostic procedures, treatment, research and development for all haematological patients in the area. Based on these common rules (functional centralization) it is decided whether the individual patient can be treated in the primary hospital or should be referred to a center (geographical centralization). Recommendations about diagnosis, treatment and referral are made in this report. Detailed suggestions are given for diseases which may be treated locally whereas no detailed regimens are given for diseases and disease stages which should be centralized. In the latter cases, the main emphasis is placed on a presentation of treatment results.

Denmark↗
PubMed1990

Antibody persistence in splenectomized adults after pneumococcal vaccination.

16 splenectomized adults, all vaccinated with a 14-valent pneumococcal vaccine (Pneumovax) 1978-79 had their pneumococcal antibody concentrations measured before and up to 10 years after vaccination. The antibody concentrations after vaccination declined to 71% in 2 years and remained at this level during the 10-year study period. Further studies are needed to see whether this applies to all vaccinated splenectomized adults.

Antibodies, Bacterial↗
PubMed1988

Reversal of flunitrazepam sedation with flumazenil. A randomized clinical trial.

Fifty-nine male patients scheduled for transurethral resection of the prostate under flunitrazepam sedation and spinal analgesia were randomized in a double-blind trial to reversal of sedation with either the benzodiazepine antagonist flumazenil or placebo. Judged by degree of sedation, comprehension and cooperation as well as by estimation of orientation in time and space, flumazenil was superior to placebo (P less than 0.001). The median duration of anterograde amnesia was 16 min after flumazenil and 75 min after placebo (P less than 0.001). Adverse events were more frequent with placebo (P greater than 0.05), while no differences were evident with regard to laboratory data or cardiorespiratory function.

Aged↗
PubMed1983

Complement studies in splenectomized patients.

Total haemolytic complement activity, C2, C5, total alternative pathway activity, factor B, and C3d were measured in 85 splenectomized patients from 1 month to 32 years after splenectomy. Furthermore the patients were investigated for circulating immune complexes. No major deficiencies of the complement factors were detected. In a few patients a reduced C2 level was caused by genetically determined defects or was due to complement consumption in conjunction with circulating immune complexes. The complement levels were normal in 2 patients who had survived overwhelming infections after splenectomy. C5 was elevated in a major proportion of the patients, and it is suggested that this might be caused by post-splenectomy monocytosis. Circulating immune complexes were found in 20% of all cases, irrespective of the presence of residual splenic tissue. Thus the commonly cited impairment of the complement system after splenectomy does not seem to be substantiated, and the deficient resistance against bacterial infections in splenectomized patients does not seem to include abnormalities of the complement system.

Adolescent↗
PubMed1983

Protective effect of implanted autologous splenic tissue in splenectomized rats exposed to i.v. Streptococcus pneumoniae.

The protective effect of splenic implantation or hemisplenectomy on the survival rate was studied in 34 Wistar rats inoculated intravenously with 8.5 x 10(6) CFU Streptococcus pneumoniae type 25, 4 months prior to the bacterial challenge, different surgical procedures were performed, dividing the animals into 5 equally large groups: (1) sham operation, (2) hemisplenectomy, (3) splenectomy with a 100% reimplantation, (4) splenectomy with a 50% reimplantation, and (5) splenectomy without reimplantation. The observation period after the bacterial inoculation was 13 d. Differences in mean survival rates were found: (1) 13 d, (2) 10.6 d, (3) 7.1 d, (4) 5.6 d, and (5) 3.1 d. The increasing survival rates correlated with increasing weights of the residual splenic tissue. This animal study indicates that residual splenic tissue may account for a lesser tendency to infection.

Animals↗
PubMed1983

Irradiated autologous T cells restore the in vitro responsiveness of PWM-activated peripheral blood lymphocytes from splenectomized individuals.

The in vitro immunoglobulin (Ig) secretion of pokeweed mitogen (PWM)-activated peripheral blood lymphocytes (PBL) from individuals splenectomized post-trauma was monitored with a protein A plaque-forming cell (PFC) assay. Cultures of unfractionated as well as reconstituted cultures of isolated erythrocyte rosette-forming (E-RFC)-positive (T lymphocytes) and E-RFC-negative (B lymphocytes) cells were established. Using unfractionated cells, the response was substantially reduced or absent, whereas cultures of autologous untreated B and 2000 rads irradiated T cells restored the response to normal levels. Normal T cells were not able to stimulate patients' B cells to Ig-secretion and patients' untreated T cells did not induce plaque formation in normal B cells, whereas irradiated patients' T cells induced development of approximately 50% of the response induced by normal irradiated T cells. These results indicate that the immunological defect in splenectomized individuals is not merely restricted to a high level of radiosensitive T cell suppression but also involves an impaired B cell function and T/B cell cooperation.

Adolescent↗
PubMed1983

CNS involvement in leukaemia. An autopsy study of 100 consecutive patients.

The central nervous system has been examined in a consecutive autopsy material of 100 adult patients with acute (N = 67) or chronic (N = 33) leukaemia. In all patients the disease was active at the time of death, infiltrating several organs, and in 45% of the cases CNS was involved. 81% of the patients with ALL had leukaemic infiltrates in CNS, and in the total AML group they were seen in 46% (P less than 0.05). A comparison between the subtypes of the AML group revealed CNS involvement in 39% of M1 + M2 and in 69% of M4 + M5 (P less than 0.05). Only in a single case of CML was the central nervous system affected, whereas 8 of 16 patients with CLL has CNS involvement. Furthermore, other pathological findings such as haemorrhages and infarcts were registered at the time of death in 33% of all patients. Terminal neurological symptoms could be ascribed either to leukaemia, other CNS pathology or a combination of both. The rate of CNS involvement is higher than reported in similar studies, and it is supposed that this may partly be ascribed to the inclusion of the spinal cord in this investigation.

Acute Disease↗
PubMed1983

Immunoglobulin classes and persistence of anti-pneumococcal antibodies in splenectomized adults and adolescents after pneumococcal vaccination.

The IgG-, IgM- and IgA- anti-pneumococcal antibody response to pneumococcal vaccination in 29 splenectomized adults and adolescents with hereditary spherocytosis or previous traumatic splenic rupture was determined by an enzyme-linked immunosorbent assay. It was not significantly different from that of 12 healthy controls except for a lower IgM class antibody increase in the splenectomized against one of four antigens studied. The antibody response was predominantly of IgG class, but significant increases in IgM and IgA class antibodies against all four antigens (polysaccharide types 2, 6A, 12F and 14) studied were observed. In 1/29 splenectomized and 2/12 healthy individuals (7%) the IgG antibody class did not predominate. In 36 adults and adolescents splenectomized due to traumatic rupture or during surgery for gastric ulcer, 77% of the peak geometric mean total antibody concentration four weeks after vaccination was still present after 21 months (16-26 months).

Adolescent↗