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Biomedical subjects

Jes S Lindholt

Publications and source records attributed to Jes S Lindholt.

17 recordsLinked to original sources
PubMed2006

[Should high-energy traumas always result in a trauma team call?].

BACKGROUND: This study was performed to evaluate the trauma triage system currently used by the general hospital of Viborg County, Denmark. According to the trauma triage system, an isolated high-energy trauma leads to a trauma team call. The aim of the study was to determine whether a high-energy trauma patient with no symptoms of injury is a sufficient indication to lead to a trauma team call. MATERIALS AND METHODS: The study was based on prospective registration of traumatised patients admitted to the hospital during the period from 1 March 2000 to 28 February 2003. A ROC curve analysis was used to validate the ability of the trauma points to predict severe injury by isolated high-energy traumas. RESULTS: The study included 514 trauma patients, 304 of whom had suffered high-energy traumas. The positive predictive value of a trauma team call was 45% of severe injury. Among the subgroup of patients with no immediate symptoms, the positive predictive value was 15%. The ROC curve analysis found the optimum cut point to be a high-energy trauma with at least one symptom of injury. The sensitivity was 70% and the specificity 52%. CONCLUSION: The study suggests that a high-energy trauma patient showing no symptoms of injury is not a sufficient indication to lead to a trauma team call. This has caused a change in the scoring system. A trauma team call based on a high-energy trauma now implies that the patient shows signs of at least one symptom of injury.

Adolescent↗
PubMed2006

[Cost-benefit analysis of population screening for abdominal aortic aneurism, based on five-year results of a randomised hospital-based screening trial].

The lethality of ruptured abdominal aortic aneurysm (AAA) is 80-95% compared to 5-6% after elective surgery. However, AAA seldom causes symptoms before rupture. From 1994 to 1998, 12,639 men aged 64-73, from Viborg County, were randomised 1:1 for an invitation to an ultrasonographic scan or for controls. There were 75% fewer emergency operations (P < 0.001), and 67% lower AAA-specific mortality in the screening group (P = 0.002). The costs were 6,221 pounds sterling (4,034-13,782) per saved living year, expected to decrease to about 1,860 pounds sterling after 10 years. Screening of Danish men, aged 65-73, is recommended.

English Abstract↗
PubMed2006

[Ruptured abdominal aortal aneurysm in spite of endovascular aneurysm repair].

An 84-year-old man with an abdominal aortal aneurysm (AAA) was treated with endovascular aneurysm repair (EVAR). Four years later, the aneurysm ruptured and an emergency operation was performed. On a short-term basis, EVAR has been proven to be a low-risk treatment compared to open surgery. However, the EUROSTAR registry shows above 1% annual AAA-related deaths after EVAR due to late rupture or reintervention. Newer devices reduce the risk by approximately 50%, but this seems insufficient. Thus EVAR is still not a standardised option, but it may be appropriate in cases of rupture and cases that are not suited to open surgery.

Aged↗
PubMed2006

Activators of plasminogen and the progression of small abdominal aortic aneurysms.

The aim of this study was to examine the role of activating pathways of plasminogen in the natural history of abdominal aortic aneurysms (AAA). To fulfill this objective 70 male patients with small AAA (> 3 cm) were interviewed and examined. Their blood samples were taken at diagnosis. The patients were scanned annually for a minimum period of 1 year and a maximum of 5 years (mean 2.5 years), and referred for surgery if the AAA exceeded 5 cm in diameter. Plasma levels of urokinase-like plasminogen activator (uPA), tissue-type plasminogen activator (tPA), plasminogen-activator-inhibitor-1 (PAI-1), macrophage-inhibiting factor (MIF), transforming-growth-factor-beta1 (TGF-beta1), homocysteine, and serum levels of IgA-antibodies against Chlamydia pneumoniae (IgA-CP) and cotinine (a nicotine metabolite) were measured. The annual expansion rate correlated positively with tPA, IgA-CP, and S-cotinine; rho = 0.37 (P = 0.004), 0.28 (P = 0.01), and 0.24 (P = 0.04), while PAI-1, uPA, TGF-beta1, homocysteine, and MIF did not. S-cotinine and PAI-1 also correlated positively with tPA, rho = 0.24 (P = 0.04), and 0.33 (P = 0.005). IgA-CP did not correlate with tPA. By receiver operating characteristics (ROC) curve analysis, tPA showed to be predictive of cases expanding to above 5 cm within the first 5 years with an optimal sensitivity and specificity of 0.73 and 0.71, respectively (P = 0.015). The aortic matrix degradation in AAA may be partly caused by an activation of plasminogen by tPA, but not by uPA, which usually dominates matrix degradation. Smoking seems to be an important factor for this pathway, while the pathway of IgA-CP seems different.

Aged↗
PubMed2005

Screening for abdominal aortic aneurysms: single centre randomised controlled trial.

OBJECTIVE: To determine whether screening Danish men aged 65 or more for abdominal aortic aneurysms reduces mortality. DESIGN: Single centre randomised controlled trial. SETTING: All five hospitals in Viborg County, Denmark. PARTICIPANTS: All 12,639 men born during 1921-33 and living in Viborg County. In 1994 we included men born 1921-9 (64-73 years). We also included men who became 65 during 1995-8. INTERVENTIONS: Men were randomised to the intervention group (screening by abdominal ultrasonography) or control group. Participants with an abdominal aortic aneurysm > 5 cm were referred for surgical evaluation, and those with smaller aneurysms were offered annual scans. OUTCOME MEASURES: Specific mortality due to abdominal aortic aneurysm, overall mortality, and number of planned and emergency operations for abdominal aortic aneurysms. RESULTS: 4860 of 6333 men were screened (attendance rate 76.6%). 191 (4.0% of those screened) had abdominal aortic aneurysms. The mean follow-up time was 52 months. The screened group underwent 75% (95% confidence interval 51% to 91%) fewer emergency operations than the control group. Deaths due to abdominal aortic aneurysms occurred in nine patients in the screened group and 27 in the control group. The number needed to screen to save one life was 352. Specific mortality was significantly reduced by 67% (29% to 84%). Mortality due to non-abdominal aortic aneurysms was non-significantly reduced by 8%. The benefits of screening may increase with time. CONCLUSION: Mass screening for abdominal aortic aneurysms in Danish men aged 65 or more reduces mortality.

Aged↗
PubMed2004

Serum antibodies against Chlamydia pneumoniae outer membrane protein cross-react with the heavy chain of immunoglobulin in the wall of abdominal aortic aneurysms.

BACKGROUND: Chlamydia pneumoniae (Cp) has been demonstrated in arteries and abdominal aortic aneurysms (AAAs). However, the validity of the methods used is questioned, and antibiotic treatment trials have thus far shown disappointing results. Nevertheless, antibodies against the Cp outer membrane proteins (OMPs) have been associated with progression of atherosclerosis and AAAs. The aim of this study was to detect Cp OMPs in the wall of AAA patients by use of purified serum antibodies directed against Cp OMP and to assess potential cross-reacting proteins in AAA walls. METHODS AND RESULTS: Seventeen patients undergoing infrarenal AAA repair were studied. Full AAA thickness tissue was collected from the anterior wall of the aneurysm. Anti-OMP was extracted from seropositive AAA patients by use of an ELISA kit (Labsystems). Analysis was performed by use of 2D polyacrylamide gel electrophoresis, immunoblotting, and mass spectrometric protein identification. OMP antigens were not detected in 16 of 17 AAA walls. However, 3 major AAA proteins cross-reacted with anti-OMP. The proteins were all identified as heavy chains of human immunoglobulin. CONCLUSIONS: We could not find evidence of Cp OMP in 16 of 17 AAA walls, but instead, all samples showed a strong cross-reaction between Cp OMP antibodies and human immunoglobulin. This might indicate that AAA is an autoimmune disease, perhaps triggered by an initial Cp infection.

Aged↗
PubMed2003

Evaluation of five DNA extraction methods for purification of DNA from atherosclerotic tissue and estimation of prevalence of Chlamydia pneumoniae in tissue from a Danish population undergoing vascular repair.

BACKGROUND: To date PCR detection of Chlamydia pneumoniae DNA in atherosclerotic lesions from Danish patients has been unsuccessful. To establish whether non-detection was caused by a suboptimal DNA extraction method, we tested five different DNA extraction methods for purification of DNA from atherosclerotic tissue. RESULTS: The five different DNA extraction methods were tested on homogenate of atherosclerotic tissue spiked with C. pneumoniae DNA or EB, on pure C. pneumoniae DNA samples and on whole C. pneumoniae EB. Recovery of DNA was measured with a C. pneumoniae-specific quantitative real-time PCR. A DNA extraction method based on DNA-binding to spin columns with a silica-gel membrane (DNeasy Tissue kit) showed the highest recovery rate for the tissue samples and pure DNA samples. However, an automated extraction method based on magnetic glass particles (MagNA Pure) performed best on intact EB and atherosclerotic tissue spiked with EB. The DNeasy Tissue kit and MagNA Pure methods and the highly sensitive real-time PCR were subsequently used on 78 atherosclerotic tissue samples from Danish patients undergoing vascular repair. None of the samples were positive for C. pneumoniae DNA. The atherosclerotic samples were tested for inhibition by spiking with two different, known amounts of C. pneumoniae DNA and no samples showed inhibition. CONCLUSION: As a highly sensitive PCR method and an optimised DNA extraction method were used, non-detection in atherosclerotic tissue from the Danish population was probably not caused by use of inappropriate methods. However, more samples may need to be analysed per patient to be completely certain on this. Possible methodological and epidemiological reasons for non-detection of C. pneumoniae DNA in atherosclerotic tissue from the Danish population are discussed. Further testing of DNA extraction methods is needed as this study has shown considerable intra- and inter-method variation in DNA recovery.

Arteriosclerosis↗
PubMed2003

Validation of two global and generic quality of life questionnaires for population screening: SCREENQOL and SEQOL.

Population screening may harm quality of life (QoL), and traditional health-related QoL tools could be inadequate to evaluate this risk. Two global and generic QoL instruments were developed for studying the QoL consequences of screening (SCREENQOL), and QoL variation in a normal population (SEQOL). SCREENQOL and SEQOL (Self-Evaluation of Quality of Life Questionnaire) are self-administered questionnaires with items rated on 5-point Likert scales. SCREENQOL consists of 21 items measuring QoL across 6 different dimensions based upon validated QoL questionnaires. SEQOL consists of 317 items measuring QoL across 8 different dimensions, based on an integrative theory of QoL, a theoretical framework from a Danish QoL survey involving 7,222 persons 31 to 33 years old. For further validation, SEQOL and SCREENQOL were sent to 2,460 persons 18 to 88 years old randomly selected from the Danish Central Person Register together with Nottingham Health Profile (NHP) and Sickness Impact Profile (SIP). For SCREENQOL and SEQOL, test-retest reliability correlation was both >0.8, Cronbach's alpha was 0.65 and 0.75, correlation (r) to NHP was 0.67 and 0.49, to SIP 0.46 and 0.27, respectively (p < 0.05). Adjustment for health status made the correlation to SIP stronger among the sick (r = 0.68 and 0.41, respectively). For SCREENQOL and SEQOL, 61 and 111 respondents were needed to detect 3% difference in QoL. SCREENQOL and SEQOL are both valid as they show high levels of reliability, sensitivity, and consistency.

Mass Screening↗
PubMed2003

[Hospital costs and benefits of screening for abdominal aortic aneurysm. Results from a randomized screening trial].

INTRODUCTION: The hospital costs and benefits of screening older males for abdominal aortic aneurysms (AAA) are unknown. MATERIAL AND METHODS: In 1994, a hospital-based screening trial of 12,658 65-73-year-old males in the County of Viborg, Denmark, was started. AAA > 5 cm were referred for surgery. The remaining AAA were offered annual control scans. Those with aortic ectasia (def.: 2.5-2.9 cm) were rescreened at 5-year intervals. AAA-operations and deaths of AAA at hospital were registered. Finally, costs of screening, surveillance, and treatment were registered. Data on causes of death outside hospitals could not be obtained. RESULTS: The attendance rate was 76%, of whom 191 (4.0%) had AAA. The average observation time was 5.13 years. 60 in the screened and 41 in the control group were operated (P = 0.06), 7 and 27 were operated as an emergency (P < 0.001), and 6 and 19 died at the hospitals due to AAA (p = 0.009). The costs per scan were 83.50 DKK, 81,400 DKK per elective operation (71,485 DKK after screening), and 117,000 DKK for an emergency operation. The costs per prevented hospital death were 67,855 DKK or approx. 7,540 DKK per life year saved (1 GBP = 12 DKK). DISCUSSION: Screening older males for AAA in Denmark seems very cost-effective and reduces hospital mortality of AAA by 68% and probably the overall AAA-specific mortality by 73%.

Aged↗
PubMed2003

Macrophage migration inhibitory factor is associated with aneurysmal expansion.

BACKGROUND: Macrophage migration inhibitory factor (MIF) is an inflammatory cytokine released mainly from macrophages and activated lymphocytes. Both atherosclerosis and abdominal aortic aneurysm (AAA) are inflammatory diseases tightly linked to the function of these cells. The correlation and contribution of MIF to these human diseases remain unknown, although a recent rabbit study showed expression of this cytokine in atherosclerotic lesions. MATERIAL AND METHODS: MIF immunohistochemistry was performed on tissue sections from five normal aortas, seven atherosclerotic carotids, and six AAAs. A group of 112 men with small AAAs (defined as 3 to 5 cm) was recruited at the time of diagnosis, had serum samples taken, and was followed annually for 1 to 5 years (mean, 2.9 years) and referred for surgery if the AAA exceeded 5 cm in diameter. Of this study group, 98 had serum MIF measured with an enzyme-linked immunosorbent assay and 61 had detectable levels. RESULTS: In human atherosclerotic and aneurysmal lesions, MIF protein colocalized in macrophages, endothelial cells, and smooth muscle cells, but normal arteries had negligible MIF expression. Furthermore, serum-MIF levels correlated significantly with annual expansion rate (r = 0.28; P =.005), persisting after adjustment for initial AAA size, smoking habits, diastolic blood pressure, ankle blood pressure index, and age. After exclusion of 38 cases with MIF levels below the detection limit, initial AAA size was also significantly correlated with the MIF levels (r = 0.42; P =.001), persisting after adjustment for similar confounders, and the correlation coefficient with expansion rate increased to 0.42 (P =.001). CONCLUSION: Highly expressed MIF in macrophages, endothelial cells, and smooth muscle cells in lesions from atherosclerosis and AAA and significant association between serum MIF level and AAA initial size and AAA expansion rate in a group of patients with AAA suggest a potential involvement of this proinflammatory cytokine in the pathogenesis of these cardiovascular diseases.

Aged↗
PubMed2003

A review of macrolide treatment of atherosclerosis and abdominal aortic aneurysms.

Seroepidemiological studies have shown an association between Chlamydia pneumoniae and atherosclerosis, the risk of acute myocardial infarction and abdominal aortic aneurysms (AAA). Several studies have detected C. pneumoniae in atherosclerotic lesions from coronary and carotid arteries, in AAA, and in sclerotic aortic valves. However, culturing of C. pneumoniae is difficult and has seldomly succeeded from atherosclerotic lesions. Thus, the pathogenicity is unknown, and the significance of detecting the organism is unresolved. Nevertheless, in a large observational study comparing the risk of cardiovascular events among recipients of macrolide versus pencillins, macrolide treatment reduced the risk of such events after relevant adjustment. Furthermore, in two out of three minor randomized clinical trials were patients with ischaemic heart disease were randomized into antibiotic treated and placebo groups, a significant reduction in serious end-points were noticed in patients receiving macrolide. Similarly, two other minor randomized trials showed that macrolide treatment inhibited growth of small AAA. Macrolide therapy thus seems potential to improve the outcome of severe ischaemic heart disease, and growth of AAA. If true, it not known whether this is transient because of macrolide's non-specific anti-inflammatory effect or latent infection, or permanent because of eradicating C. pneumoniae organisms. In order to clarify this, large and long term randomized trials are needed, as well as diagnostic methods that can differentiate between individuals who are or are not infected with C. pneumoniae. The latter are needed in order to clarify the impact of the presence of C. pneumoniae and to avoid overconsumption of antimicrobials, which can result in serious ecological problems.

Anti-Bacterial Agents↗
PubMed2002

[Reduction of the expansion rate of small abdominal aortic aneurysms with roxithromycin. Results from a randomized controlled trial].

INTRODUCTION: Macrolide treatment has been reported to reduce the risk of recurrent ischaemic heart disease. The influence of a macrolide on the expansion rate of small abdominal aortic aneurysms (AAA) is unknown at present. The aim of this study was to investigate the effect of roxithromycin on the expansion rate of small AAA. MATERIALS AND METHODS: A total of 92 patients with a small AAA were recruited from two populations. One population consisted of 6.339 men aged 65-73 years who were offered participation in a mass screening programme for AAA at the local hospital. From this population 66 subjects were recruited. The remaining 26 were recruited from among 49 subjects diagnosed at interval screening for an initial aortic diameter between 25 mm and 29 mm. The patients were randomized to receive either oral roxithromycin 300 mg once daily for 28 days or matching placebo, and followed for a mean of 1.5 years. RESULTS: During the first year the mean annual expansion rate of AAA was reduced by 44% in the macrolid group (1.56 mm/year) compared to 2.80 mm/year after placebo (p = 0.02). During the second year the difference was only 5%. Multiple linear regression analysis showed that roxithromycin treatment and initial AAA size were significantly related to AAA expansion when adjusted for smoking, diastolic blood pressure, and IgA level > or = 20. The logistic regression analysis confirmed a significant difference in expansion rates above 2 mm annually between the intervention and placebo groups, OR = 0.09 (95% CI: 0.01-0.83). DISCUSSION: In comparison to placebo, roxithromycin 300 mg daily for four weeks reduced the expansion rate of AAA.

Aged↗
PubMed2002

Development and validation of QoL5 for clinical databases. A short, global and generic questionnaire based on an integrated theory of the quality of life.

OBJECTIVE: To develop and validate a short, global, and generic quality of life (QoL) questionnaire for clinical databases. The construct validity and item weighting of existing questionnaires are increasingly questioned. DESIGN: Cross-sectional population study. SUBJECT: 2460 Danes aged 18-88 years, randomly selected through the Danish Central Person Registry. INTERVENTIONS: Ten questions covering the spectrum of the integrative theory of QoL together with the Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), and self-estimated QoL questionnaire were sent by mail. A test-retest study of 50 people was conducted after one month. MAIN OUTCOME MEASURES: Construct and criterion validity, reliability, and sensitivity. RESULTS: QoL5 correlations with SIP, NHP, Self-estimated QoL were 0.37, 0.52, and 0.76, respectively, and increased among those who were unwell. Cronbach's alpha was 0.69. All correlations in Siegel's test were over 0.6, and the test-retest correlation was 0.82. Only 12 respondents in each group will be needed to detect a difference of 10% in the QoL score between two groups. CONCLUSIONS: QoL5 is a valid global and generic QoL measurement. Despite the use of only five questions, internal consistency and sensitivity were acceptable. So a relevant and practical outcome measurement is available for clinical databases.

Adolescent↗