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Biomedical subjects

J Nørregaard

Publications and source records attributed to J Nørregaard.

At least 19 recordsLinked to original sources
PubMed2006

Evaluation of Tc-99m-tetrofosmin single-photon emission computed tomography for detection of chronic exertional compartment syndrome of the leg.

Chronic exertional compartment syndrome (CECS) of the leg is a common, painful condition related to exercise and associated with increased muscle compartment pressure (CP). Invasive methods are currently the method of choice for diagnosing the condition. We investigated the use of Tc-99m-tetrofosmin perfusion single-photon emission computed tomography (SPECT) as a diagnostic tool compared with the gold standard, muscle CP measurement. In 14 subjects perfusion SPECT and CP were measured before and immediately after exercise leading to pain in the lower legs. Six subjects had increased pressures indicating the presence of CECS. In three (50%) of these muscular hypoperfusion was observed by perfusion SPECT. In eight subjects with normal CPs SPECT suggested muscular hypoperfusion. Because of the low diagnostic rates, sensitivity 50% and specificity 63%, Tc-99m-tetrofosmin perfusion SPECT seems not to be a useful method for diagnosing CECS.

Adult↗
PubMed2002

Diagnosing patients with longstanding shoulder joint pain.

OBJECTIVE: To examine the interobserver agreement of commonly used clinical tests and diagnoses in patients with shoulder pain, and the accuracy of these tests and ultrasonographic findings in comparison with arthroscopic findings. METHODS: Eighty six patients with longstanding shoulder joint pain were "blindly" examined by two trained doctors using several clinical tests. In all patients an ultrasonographic examination was performed, and in 42 (49%) an arthroscopy. RESULTS: Tests for impingement showed poor to moderate agreement. Tenderness of muscles, muscle weakness, and tests for labral lesion also showed poor agreement. Pain during muscle contraction showed moderate agreement. The agreement of clinical diagnoses was poor and the accuracy was low in comparison with arthroscopy. Ultrasonography was accurate in full thickness supraspinatus tendon tears, but inaccurate for partial tears and labral lesions. CONCLUSIONS: Most clinical tests showed poor agreement. Clinical and ultrasonographic diagnoses had low accuracy in comparison with arthroscopy.

Arthroscopy↗
PubMed1999

A narrative review on classification of pain conditions of the upper extremities.

Local and regional musculoskeletal discomfort and pain in the shoulder girdle or upper extremities are often reported, especially in the working population. In this review we describe the most important problems and factors when classifying musculotendinous pain in the upper extremities and shoulders. This includes an analysis of how four common diagnoses (wrist tenosynovitis, lateral epicondylitis, rotator-cuff tendinitis, myofascial pain syndrome) fulfil basic criteria of validity. It is evident that there are some serious problems regarding the validity of the current classification of the conditions. Clinical criteria are often poorly defined and the reliability insufficiently tested. The relationship to objective pathoanatomic or physiological findings seems inconsistent. Although magnetic resonance and ultrasonographic imaging are promising, they are still only preliminary methods for evaluation of tendon and connective tissue structures. The prognosis with and without treatment also seems heterogeneous and can vary between studies. A generally accepted terminology is lacking in the pathogenetically complex regional muscle pain conditions.

Acute Disease↗
PubMed1998

[Occurrence and type of traumatic experiences among young Bosnian refugees in Denmark].

Prior research has shown that young refugees may be especially traumatised. The study includes 123 young Bosnian refugees, living at two Bosnian boarding-schools in Denmark who were given a revised version of the Harvard Trauma Questionnaire (HTQ). The subjects themselves have on average experienced seven traumatic events, and have either witnessed or had a family member experience an additional six events. Three-quarters have been shot at, have lost their homes and private possession and have been exposed to violence in the form of harassment or humiliation. Two-thirds have lost friends. Three-fifths have lived with uncertainty as to whether friends and family were alive or dead. More than half have seen dead and wounded people, have had their lives threatened and have thought that they would die. More than a third have lost close family members, have been wounded and have had their homes destroyed. Just under a third have been exposed to physical violence or have witnessed somebody being killed. A quarter have starved and been ill without being able to receive treatment. About a fifth have experienced captivity, torture and forced labour. 6% have been raped or exposed to other forms of sexual abuse. It is concluded that the young Bosnians examined are a multitraumatised group. Use of the HTQ increased the number of traumatic events quite considerably compared to the case notes.

Adolescent↗
PubMed1997

Evidence of qualitatively altered nociception in patients with fibromyalgia.

OBJECTIVE: To investigate the perception of pain in tender muscles of patients with fibromyalgia. METHODS: Twenty-five women with fibromyalgia and 25 healthy women were examined. Seven different pressure intensities were used to palpate a highly tender muscle and a largely normal muscle. Subjects then recorded their response to induced pain on a visual analog scale. The examiner was blinded to each subject's response. RESULTS: The stimulus-response function for pressure versus pain recorded for normal muscle was well described by a power function. For highly tender muscle, the stimulus-response function was displaced toward lower pressures and, more importantly, it was linear, i.e., qualitatively different from that of normal muscle. CONCLUSION: This study demonstrates that nociception is qualitatively altered in patients with fibromyalgia, which is consistent with recent findings in other patients with tender muscles. The data strongly indicate that fibromyalgic pain, at least in part, is due to aberrant central pain mechanisms.

Adult↗
PubMed1997

The twitch interpolation technique for the estimation of true quadriceps muscle strength.

The aim of this study was to examine the reliability of the twitch interpolation technique when used to estimate the true isometric knee extensor muscle strength. This included an examination of whether submaximal activation causes any bias in the estimation of the true muscle strength and an examination of the precision of the method. Twenty healthy subjects completed three contraction series, in which the subjects were told to perform as if their voluntary strength was 60%, 80% or 100% of that determined by a maximal voluntary contraction (MVC). Electrical muscle stimulations were given at each of five different contraction levels in each series. At torque levels above 25% of MVC the relationship between torque and twitch size could be approximated to be linear. The true muscle strength (TMS) could therefore be estimated using linear regression of the twitch-torque relationship to the torque point of no twitch in each of the three series, termed TMS60, TMS80 and TMS100. The TMS80 was slightly lower (P < 0.01), median 94% (IQ range 87-101%) of the TMS100. The TMS60 was median 99% (IQ range 83-125%) (NS) of TMS100, but a few severe outliers were observed. In conclusion, we found the reliability of the method acceptable for many research purposes, if series with estimated central activation of below 40-50% were excluded. The only moderate precision and the slightly lower estimations in subjects applying submaximal does, however, limit its usefulness.

Adult↗
PubMed1997

Double-blind, placebo-controlled cross-over study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia.

The objective of this study was to test the efficacy of intravenously administered S-adenosyl-L-methionine (SAMe) in patients with fibromyalgia (FM). Thirty-four out-patients with fibromyalgia symptoms received SAMe 600 mg i.v. or placebo daily for 10 days in a cross-over trial. There was no significant difference in improvement in the primary outcome: tender point change between the two treatment groups. There was a tendency towards statistical significance in favour of SAMe on subjective perception of pain at rest (p = 0.08), pain on movement (p = 0.11), and overall well-being (p = 0.17) and slight improvement only on fatigue, quality of sleep, morning stiffness, and on the Fibromyalgia Impact Questionnaire for pain. No effect could be observed on isokinetic muscle strength, Zerrsen self-assessment questionnaire, and the face scale. No effect of SAMe in patients with FM was found in this short term study.

Adult↗
PubMed1997

Muscle strength, working capacity and effort in patients with fibromyalgia.

The objective of the study was to evaluate the physical capacity and effort in patients with fibromyalgia. Muscle strength and the coefficient of variation of the strength measurements of 181 female fibromyalgia patients and 126 healthy females were compared. These measurements and ergometer exercise capacity, work status and psychometric scoring (SCL-90-R) were correlated. The fibromyalgia patients exhibited significant reduction in voluntary muscle strength of the knee and elbow, flexors and extensors in the order of 20-30%. However, the coefficient of variation was higher among patients, thus indicating lower effort. The physical performance during an ergometer test corresponded to a maximal oxygen consumption of 21 ml/kg-1 x min-1. The maximal increase in heart rate was only 63% (44-90%) of the predicted increase. Degree of effort or physical capacity did not correlate to psychometric scores. Work status was related to psychometric scoring, but not to physical capacity or effort. In conclusion, we found a low degree of effort but near normal physical capacity in the fibromyalgia patients.

Elbow Joint↗
PubMed1996

The effect of ephedrine plus caffeine on smoking cessation and postcessation weight gain.

OBJECTIVES: To evaluate the efficacy of a combination of ephedrine and caffeine on smoking cessation rates, postcessation weight gain, and withdrawal symptoms and to examine changes in glycosylated hemoglobin (HbA1c) after smoking cessation. METHODS: This randomized double-blind placebo-controlled study with a 1-year follow-up period was carried out at the Department of Pulmonary Medicine in Denmark. Study subjects were 225 heavy smokers who wanted to quit smoking without gaining weight. Two-thirds of the subjects were randomized to receive 20 mg ephedrine plus 200 mg caffeine three times a day; one-third of the subjects received placebo treatment. The dosage was gradually decreased from week 12 to discontinuation at week 39. Group support and control were performed at entry and after 1, 3, 6, 12, 26, 39, and 52 weeks. Main outcome measures were (1) self-reported abstinence with validation by carbon monoxide in expired air and serum cotinine and (2) weight gain. RESULTS: The success rates after 1 year were 17% in the group treated with ephedrine plus caffeine and 16% in the group treated with placebo; the success rates were not significantly different at any time. The success rates for the four counseling physicians varied between 7% and 27% after 1 year (p < 0.05). The weight gain was significantly lower in the ephedrine plus caffeine-treated group during the first 12 weeks, but weight gains were similar after 1 year. No differences in the smoking withdrawal symptoms could be observed between the treatment groups. HbA1c was lower 6 weeks and 1 year after smoking cessation (p < 0.05). CONCLUSIONS: We found an effect of this combination of ephedrine and caffeine on weight gain during the first 12 weeks, but we found no effect on the success rates or craving for cigarettes.

Adult↗
PubMed1996

Recycling of hard-core smokers with nicotine nasal spray.

The primary aim of this smoking cessation study was to evaluate the effect of long-term treatment with nicotine nasal spray in a group of hard-core smokers. A further aim was to compare the effect of ad libitum with fixed dosage of nasal nicotine spray. Eighty nine smokers, failures from two earlier studies with nicotine patches, were enrolled in an open smoking cessation study with nicotine nasal sprays, to be used ad libitum (n=45) or on a fixed schedule of 1 mg x h-1 during the day (n= 44). Carbon monoxide-verified continuous abstinence from smoking beyond Week 2, was 39% at 3 weeks, 12% at 3 months, 10% at 6 months and 6% after 1 yr, with no significant difference in success rate between ad libitum and fixed dosing. Mean daily nicotine dose was 15-16 mg during the first 3 months (range 2-65 mg). Tolerance to local irritating side-effects of nicotine developed during the first weeks of use. Although short-term outcome was promising, the long-term success rate in this group of hardcore smokers was low. Other recycling set-ups are warranted, which might include more aggressive nicotine dosing.

Administration, Intranasal↗
PubMed1995

The twitch interpolation technique for study of fatigue of human quadriceps muscle.

The aim of the study was to examine if the twitch interpolation technique could be used to objectively measure fatigue in the quadriceps muscle in subjects performing submaximally. The 'true' maximum isometric quadriceps torque was determined in 21 healthy subject using the twitch interpolation technique. Then an endurance test was performed in which the subjects made repeated isometric contractions at 50% of the 'true' maximum torque for 4 s, separated by 6 s rest periods. During the test, the force response to single electrical stimulation (twitch amplitude) was measured at 50% and 25% of the estimated maximum torque. In 10 subjects, the test was repeated 2-4 weeks later. Twitch amplitudes at 50% of maximum torque declined exponentially with time in 20 of 21 subjects. The distribution of the exponential rate constant was skewed with a mean of 4.6 h-1 and range of 0.3-21.5 h-1. After logarithmical transformation, the distribution of the exponential rate constant fitted closely to a normal distribution, and the inter-individual variation was SD = 1.15 compared to an intra-individual variation of 0.29. The coefficient of correlation for repeated determination was 0.91 (P < 0.001, n = 10). In conclusion, the twitch technique can be used for objectively measuring fatigue of the quadriceps muscle.

Adult↗
PubMed1995

Muscle strength, voluntary activation and cross-sectional muscle area in patients with fibromyalgia.

The objectives were to determine whether the low muscle strength in fibromyalgia is due to lack of exertion and to determine the relation between strength and muscle area. Secondarily we examined the voluntary muscle strength of the different muscles of the leg. The twitch interpolation technique was used to estimate the degree of central activation and the 'true' quadriceps muscle strength. Muscle cross-sectional area was determined with magnetic resonance imaging (MRI). The estimated 'true' muscle strength was 91 Nm (S.D. = 34 Nm) in 15 fibromyalgia patients compared with 125 Nm (28 Nm) in 14 healthy controls (P < 0.02). The 'true' strength divided by the sum of the maximal areas of the four bellies of the quadriceps muscle was lower, being 1.56 Nm/cm2 (0.32 Nm/cm2) in fibromyalgia patients compared with 2.11 Nm/cm2 (0.39 Nm/cm2) in the controls (P < 0.001). The voluntary muscle strength of the flexor muscles of the knee and of the plantar flexors of the ankle was markedly reduced in patients, but no significant differences could be observed in the strength of the dorsal flexors of the ankle. In conclusion, a reduction of the estimated 'true' quadriceps muscle strength per unit area of about 35% was found in fibromyalgia patients.

Activities of Daily Living↗
PubMed1995

31P NMR spectroscopy and electromyography during exercise and recovery in patients with fibromyalgia.

OBJECTIVE: To investigate whether patients with fibromyalgia (FM) have normal motor unit recruitment in relation to muscle metabolism during exhausting exercise and recovery, and whether the reduced voluntary muscle force normally seen is related to a smaller muscle size. METHODS: Female patients with FM and sedentary controls were examined using simultaneous 31P nuclear magnetic resonance spectroscopy (NMR) and surface electromyography (SEMG) during exhaustive static exercise of the anterior tibial muscle and during recovery. The maximum voluntary contraction force was estimated, and the maximum cross sectional muscle area was evaluated using 1H NMR imaging. The sedentary controls were matched to patients for sex, age and, as far as possible, daily physical activity levels. RESULTS: Patients with FM had reduced maximum voluntary contraction force in relation to the sedentary controls, despite having similar muscle size. In general the myoelectrical-metabolic relation during exercise and recovery was normal in patients with FM. CONCLUSION: The less extreme changes in motor unit recruitment and metabolism during exhaustive exercise indicated a lower exercise tolerance that could be connected with the lower physical activity levels.

Adult↗
PubMed1994

[Causes of relapse during attempted smoking cessation using nicotine or placebo plasters].

The causes of relapses to smoking when attempting smoking cessation are not fully understood, but several factors are of importance. Addiction to nicotine is one of the most prominent factors. In order to determine predictors of outcome in smoking cessation, we performed univariate and multivariate analysis of a large smoking cessation trial comprising 289 subjects. Weight gain and withdrawal symptoms were analyzed separately as predictors. To determine the relative magnitude of self-perceived reasons for relapse we created a questionnaire, which was answered by 132 relapsers. Previous attempts to stop smoking and a low Horn-Russell scale were significantly associated with abstinence in the nicotine-treated group. A trend towards higher abstinence rates was found in males and in subjects with low smoking saliva cotinine levels. A logistic regression analysis showed higher success rates in subjects with the largest weight gain during the first week but there was a tendency towards higher relapse rates in subjects with the greatest weight gain later. Only 20% reported weight gain to be a major problem. Minor smoking was highly correlated to later relapse. The weight gain after smoking cessation should not be prevented in the first weeks after cessation. Complete abstinence should be emphasized in smoking cessation.

Administration, Cutaneous↗
PubMed1994

[Should the presence of Mycobacterium tuberculosis be demonstrated before the treatment of patients with suspected pulmonary tuberculosis?].

In Denmark, treatment of tuberculosis is generally only recommended if the diagnosis is confirmed bacteriologically, which may cause a delay in treatment. We investigated the duration of the treatment delay, and if the delay would cause any serious health problems for the individual or risk of contact infections by a retrospective examination of 324 cases of pulmonary tuberculosis. The mean treatment delay was longer in older age groups. Regarding death due to delay, we found no risk for the patients who are not weakened by old age or another disease. Only 11 (3.6%) above the age of ten years were treated without bacteriological confirmation (1% for Danes). The infection risk from the smear negative, but culture positive patients was minimal, as only one subject was definitely infected from a smear negative subject. In conclusion, we find the epidemiologic and individual risk sufficiently low to continue our rather restrictive treatment policy.

Adult↗
PubMed1994

Biochemical changes in relation to a maximal exercise test in patients with fibromyalgia.

Patients with fibromyalgia often complain of fatigue and pain during exercise and of worsening of pain days after exercise. The aim of the study described here was to determine if abnormal changes in potassium or lactate could be observed during an exercise test in fibromyalgia. Whether an abnormal incline in plasma creatine kinase or myoglobin could be observed days after the test was studied also. Fifteen female fibromyalgia patients and 15 age- and sex-matched controls performed a stepwise incremental maximal bicycle-ergometer test. Blood samples were collected from a catheter in a cubital vein. The changes in heart rate, potassium levels, and haematocrit during the exercise test were similar in the two groups. The maximal obtained lactate concentration was 4.2 mmol l-1 (3.5-5.6) in the patients as compared to 4.9 mmol l-1 (3.9-5.9) in the controls (NS). The estimated anaerobic threshold of 2 mmol l-1 was reached at a heart rate of 124 min-1 in the patients with fibromyalgia as compared to 140 min-1 in the controls (P = 0.02). In relation to workload, the patients scored higher on a Borg scale for perceived exertion during exercise, but if the Borg score was related to lactate no significant difference was found. The patients reported 86% and 79% of maximal pain in the thighs on the visual analogue scale 1 and 2 days after the test, but the creatine kinase and myoglobin concentrations were not increased.

Adult↗
PubMed1994

A blinded, controlled evaluation of anxiety and depressive symptoms in patients with fibromyalgia, as measured by standardized psychometric interview scales.

The objective of the study was to evaluate the presence of psychopathology in fibromyalgia patients compared with a control group of other rheumatologic patients with pain. Forty-nine fibromyalgia patients and 33 control patients were interviewed blinded, using standardized psychometric scales. Pain was scored on a visual analogue scale. Fibromyalgia patients scored significantly higher than the controls on the Bech-Rafaelsen Melancholia Scale, the Atypical Depression Scale and the Hamilton Anxiety Rating Scale. On the Newcastle Depression Scale there was no difference. In both groups a correlation was found between pain score and psychometric scoring. The fibromyalgia patients scored significantly higher on pain than the controls. After correcting for this difference, the fibromyalgia patients still scored higher on anxiety and depression.

Anxiety Disorders↗