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Biomedical subjects

K Holte

Publications and source records attributed to K Holte.

18 recordsLinked to original sources
PubMed2004

Development and validation of a brief, descriptive Danish pain questionnaire (BDDPQ).

BACKGROUND: A new pain questionnaire should be simple, be documented to have discriminative function, and be related to previously used questionnaires. METHODS: Word meaning was validated by using bilingual Danish medical students and asking them to translate words taken from the Danish version of the McGill pain questionnaire into English. Evaluative word value was estimated using a visual analog scale (VAS). Discriminative function was assessed by having patients with one of six painful conditions (postherpetic neuralgia, phantom limb pain, rheumatoid arthritis, ankle fracture, appendicitis, or labor pain) complete the questionnaire. RESULTS: We were not able to find Danish words that were reliably back-translated to the English words 'splitting' or 'gnawing'. A simple three-word set of evaluative terms had good separation when rated on a VAS scale ('let' 17.5+/-6.5 mm; 'moderat' 42.7+/-8.6 mm; and 'staerk' 74.9+/-9.7 mm). The questionnaire was able to discriminate among the six painful conditions with 77% accuracy by just using the descriptive words. The accuracy of the questionnaire increased to 96% with the addition of evaluative terms (for pain at rest and with activity), chronicity (acute vs. chronic), and location of the pain. CONCLUSIONS: A Danish pain questionnaire that subjects and patients can self-administer has been developed and validated relative to the words used in the English McGill Pain questionnaire. The discriminative ability of the questionnaire among some common painful conditions has been tested and documented. The questionnaire may be of use in patient care and research.

Denmark↗
PubMed2003

Effects of posture on postoperative pulmonary function.

BACKGROUND: Pulmonary morbidity is still a relevant complication to major surgery despite improvements in surgical technique and anaesthetic methods. Postoperative posture may be a pathogenic factor, but the effects of changes in postoperative posture on pulmonary function have not been reviewed. METHODS: Review of controlled, clinical trials evaluating postoperative pulmonary function in patients positioned in the supine vs. the sitting or standing position and patients positioned in the supine vs. the lateral position. Data were obtained from a search in the Medline and Cochrane databases (1966 - August 2002) and manually searched bibliographies of the identified papers. RESULTS: Eighteen papers met the inclusion criteria. Twelve studies evaluated the supine vs. the sitting or standing position and six studies evaluated the supine vs. the lateral position. Six of 12 studies found a positive effect on postoperative pulmonary function in the sitting or standing position compared with the supine. Thus, avoidance of the supine position may improve postoperative pulmonary function. Three of six studies showed a positive effect on postoperative pulmonary function of the lateral side compared with the supine. Thus, the lateral position has limited effects on pulmonary function. CONCLUSION: Changes of postoperative position from supine to sitting or standing are of major importance in the interpretation of postoperative pulmonary outcome studies and in future strategies to improve pulmonary outcome.

Functional Residual Capacity↗
PubMed2002

Compensatory fluid administration for preoperative dehydration--does it improve outcome?

BACKGROUND: Preoperative fasting may lead to a fluid deficit of about 1 litre, which may contribute to perioperative discomfort and morbidity. We therefore examined the association between perioperatively administered fluids aiming to correct dehydration and clinical outcome. METHODS: Review of randomized, controlled, clinical trials evaluating clinical outcome, in which fluid versus no fluid was administered pre- or intraoperatively, attempting to correct preoperative fluid deficits. Data were obtained from a Medline search (1966-2001), and references cited in original papers. Seventeen trials met the inclusion criteria. RESULTS: Based on the amount of fluid administered, we divided the studies into two groups. In nine studies, fluid administration was <1 litre, and in eight studies > or =1 litre of fluid was administered. Administration of low-dose fluid reduced preoperative thirst, but the limited data do not allow conclusions on postoperative outcome such as nausea, vomiting, headache and pain. Administration of > or =1 litre fluid generally reduced postoperative drowsiness and dizziness, while the effects on postoperative nausea, vomiting and thirst has not been clarified. CONCLUSION: Fluid administration to compensate preoperative dehydration improves symptoms related to dehydration. Based on the available data, administration of about 1 litre fluid pre- or intraoperatively in patients having fasted for minor surgical procedures seems rational.

Dehydration↗
PubMed2002

Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutrition.

BACKGROUND: Surgical injury leads to an endocrine-metabolic and inflammatory response with protein catabolism, increased cardiovascular demands, impaired pulmonary function and paralytic ileus, the most important release mechanisms being afferent neural stimuli and inflammatory mediators. RESULTS: Epidural local anaesthetic blockade of afferent stimuli reduces endocrine metabolic responses, and improve postoperative catabolism. Furthermore, dynamic pain relief is achieved with improved pulmonary function and a pronounced reduction of postoperative ileus, thereby providing optimal conditions for improved mobilization and oral nutrition, and preservation of body composition and muscle function. Studies integrating continuous epidural local anaesthetics with enforced early nutrition and mobilization uniformly suggest an improved recovery, decreased hospital stay and convalescence. CONCLUSIONS: Epidural local anaesthetics should be included in a multi-modal rehabilitation programme after major surgical procedures in order to facilitate oral nutrition, improve recovery and reduce morbidity.

Analgesia, Epidural↗
PubMed2002

Prevention of postoperative ileus.

Postoperative ileus (PI) is a major contributor to postoperative morbidity and prolonged convalescence after major surgical procedures. The pathophysiology of PI is multifactorial, including activation of the stress response to surgery, with inhibitory sympathetic visceral reflexes and inflammatory mediators. We update evidence on the advances in the prevention and treatment on PI. As single interventions, continuous thoracic epidural analgesia with local anesthetics and minimally invasive surgery are the most efficient interventions in the reduction of PI. The effects of pharmacological agents have generally been disappointing with the exception of cisapride and the introduction of the new selective peripherally acting m-opioid antagonists. Presently, introduction of a multi-modal rehabilitation programme (including continuous epidural analgesia with local anesthetics, early oral feeding and enforced mobilization) is the most effective technique to reduce PI in abdominal procedures.

Anesthesia↗
PubMed2002

Effect of postoperative epidural analgesia on surgical outcome.

Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controversial. We therefore update the effects of postoperative analgesia on surgical outcome. After major abdominal surgery, postoperative epidural analgesia with local anesthetics significantly reduces postoperative ileus and pulmonary complications while effects on cardiac morbidity are debatable. Continuous epidural analgesia significantly lowers the risk of thromboembolic complications after lower body procedures, while no effect is seen after major abdominal surgery. Unfortunately, many studies have inadequate study design, with use of lumbar epidural analgesia for abdominal procedures, or the epidural regimen does not contain a sufficient amount of local anesthetics. Future evaluation of the effects of epidural analgesia on postoperative outcome also requires integration of epidural analgesia within a multimodal rehabilitation programme.

Analgesia, Epidural↗
PubMed2001

[Gastroesophageal reflux surgery in Denmark 1997-1999].

INTRODUCTION: The incidence and length of postoperative stay in hospital in Denmark after oesophageal reflux surgery has not been described previously. MATERIAL AND METHODS: We examined the national patient hospital register and discharge information from the hospitals for the number of reflux operations carried out, the length of postoperative hospital stay, readmissions, and postoperative complications occurring within 30 days in the period, 1997-1999. RESULTS: Twenty-four departments performed 4.9 operations/100,000 inhabitants per year, corresponding to 788 operations. The postoperative 30-day mortality was 0.4% and 6.6% of the operations were followed by serious surgical complications. The combined primary + readmission hospital stay was 3.7 days in the first postoperative month. DISCUSSION: The small number of oesophageal reflux operations performed in many departments in Denmark is not in agreement with the Danish National Board of Health recommendations from 1996, which say that the operations should be done in only five departments. The spreading of surgery means that only few surgeons can reach sufficient training of surgery and that statistical comparison between the departments of the early results of treatment is not meaningful. Overall, national results are comparable to international results. The incidence of oesophageal reflux surgery is about three times lower than in other Scandinavian countries. On these results, it is recommended that the operation is performed in fewer departments and by fewer surgeons.

Clinical Competence↗
PubMed2001

Review of postoperative ileus.

Postoperative ileus (POI) is an inevitable adverse consequence of surgical procedures. In fact, prolonged POI can lead to patient discomfort, decreased mobility, delayed enteral feeding, and ultimately, prolonged hospitalizations and increased costs. It is believed that POI occurs as a result of inhibitory neural reflexes and inflammatory processes. The use of postoperative opioids also appears to contribute to ileus. Recently, the potential influence of endogenous opioids, in addition to exogenous opioids, on the pathogenesis of ileus has come to light and spurred investigations into new treatment strategies. Over the years, several treatment modalities have become accepted management options for POI; chief among these are nasogastric suction and prokinetic agents. However, data demonstrating that these agents reduce the duration of POI are limited. Of current treatment modalities, use of epidural local anesthetics appears to be the most effective means of reducing POI. Other potentially effective treatments include early enteral feeding and less invasive surgical procedures. Together, these techniques have reduced the length of stay after colonic surgery to 2 to 3 days. Future studies, including those incorporating investigational agents, such as kappa-opioid agonists and peripheral mu-opioid antagonists, into a multimodal regimen, may offer new treatment options to further impact POI duration.

Analgesics, Opioid↗
PubMed2000

[How to teach ballet to a swat?].

There is increasing interest in including humanities subjects in the medical curriculum, as a means of accelerating students' personal development and of helping them in their meeting with patients, in order to counteract a perceived communication deficit in the health care system. Traditionally, medical schools have favoured students who concentrate on what is most relevant for their exams, possibly at the expense of reflection, idealism and empathy. As medical students in the University of Oslo, we do not feel that the situation is as bad as some claim it is. Most medical students have a wide range of ability and show interest and involvement in their own as well as their patients' situation. Humanities subjects are included in the curriculum, but it is tempting to see them as "spice" added for flavour and spread out over the course with no clear logic behind it. We do not necessarily see the need for more humanities courses, but we do see a need for more critical evaluation of what is taught. Humanities in the medical education should aim not just at improving communication skills, they should also include perspectives on how health care professionals can take of themselves, and put medicine into a wider scientific and historical perspective.

Education, Medical↗
PubMed2000

Postoperative ileus: a preventable event.

BACKGROUND: Postoperative ileus has traditionally been accepted as a normal response to tissue injury. No data support any beneficial effect of ileus and indeed it may contribute to delayed recovery and prolonged hospital stay. Efforts should, therefore, be made to reduce such ileus. METHODS: Material was identified from a Medline search of the literature, previous review articles and references cited in original papers. This paper updates knowledge on the pathophysiology and treatment of postoperative ileus. RESULTS AND CONCLUSION: Pathogenesis mainly involves inhibitory neural reflexes and inflammatory mediators released from the site of injury. The most effective method of reducing ileus is thoracic epidural blockade with local anaesthetic. Opioid-sparing analgesic techniques and non-steroidal anti-inflammatory agents also reduce ileus, as does laparoscopic surgery. Of the prokinetic agents only cisapride is proven beneficial; the effect of early enteral feeding remains unclear. However, postoperative ileus may be greatly reduced when all of the above are combined in a multimodal rehabilitation strategy.

Forecasting↗
PubMed1984

Newly administered [3H]retinol is transferred from hepatocytes to stellate cells in liver for storage.

We have recently shown that newly administered vitamin A (retinol) is initially taken up by the parenchymal cells of the liver, and subsequently (within 1-2 h) transferred to non-parenchymal liver cells (NPC) (Blomhoff et al., ref. [10]). In the present study we have separated the NPC by different methods to determine the cell type responsible for this uptake of [3H]retinol. When liver cells were prepared between 5 and 18 h after intraduodenal administration of [3H]retinol, the radioactive retinol was recovered mainly in the stellate cells. Other liver cells (i.e., hepatocytes, endothelial cells and Kupffer cells) contained only small amounts of [3H]retinol. Further, fluorescence microscopy studies indicated that stellate cells contain large quantities of retinol. Our results show that newly administered [3H]retinol, which is initially located in the hepatocytes, is transferred to the stellate cells and stored there.

Animals↗
PubMed1982

Effects of local anesthetics and related compounds on the endocytosis and catabolism of asialo-glycoproteins in isolated hepatocytes.

The effects of local anesthetics, including procaine and dibucaine, and some related amine compounds, such as dansyl-cadaverine, were studied with respect to their effects on the uptake and degradation of asialo-glycoproteins in isolated hepatocytes. 0.5 mM of either dibucaine or dansyl-cadaverine reduced the rates of uptake to 18-19% of control value; other amines were less effective. Dibucaine and dansyl-cadaverine both acted by reducing the surface binding capacity of the cells as well as by reducing the rate of internalization of surface-bound asialo-glycoprotein. All of the compounds that affected the uptake, including dansyl-cadaverine, also reduced the rate of degradation. This effect could be studied separately from their effect on uptake. The concentrations that were required in order to reduce degradation were, in general 0.5-0.25 of those which caused a reduction in the uptake. Even though dibucaine, lidocaine and dansyl-cadaverine were found to accumulate in the lysosomes, it was concluded from studies with isopycnic centrifugation in sucrose gradients that all three compounds inhibited the rate of transfer of endocytosed protein from endocytic vesicles to lysosomes. This effect could be due to a reduced rate of fusion between endocytic vesicles and lysosomes.

Anesthetics, Local↗
PubMed1981

Quantitative study of the uptake of IgA by isolated rat hepatocytes.

Recently dispersed rat hepatocytes showed high capacity for uptake of monomeric and polymeric human IgA by simple absorptive endocytosis. Maximum uptake exceeded 15 million monomer units per cell. The asialo-glycoprotein receptor was not involved in this process. J chain-containing polymers were on the average taken up somewhat better than monomers and substantially better than J chain-deficient polymers. This result would agree with a partial involvement of the secretory component (SC) in the absorptive uptake of IgA. Different receptor mechanism might hence explain the hepatic transport of IgA from blood to bile in the rat and perhaps be involved in the catabolism of IgA. After binding to the plasma membrane of the rat hepatocyte, most of the human IgA was internalized in endocytic vesicles. A considerable proportion of radiolabelled IgA apparently reached the lysosomes after internalization and became degraded.

Absorption↗
PubMed1980

Kinetics of internalization and degradation of asialo-glycoproteins in isolated rat hepatocytes.

The rate constants for internalization of surface-bound asialo-orosomucoid by hepatocytes were 0.040 min-1 at 20 degrees C, 0.18 min-1 at 30 degrees C and 0.28 min-1 at 40 degrees C. At 40 degrees C, internalization accounted for most of the increase in cell-associated radioactivity. The activation energy over the temperature range 20 to 40 degrees C was 68 +/- 7 (S.D.) kJ/mol. At 10 degrees C, most of the cell-associated asialo-orosomucoid was bound to the cell surface in a reaction which followed ordinary chemical kinetics. Pre-incubation of hepatocytes with a large concentration of unlabelled asialo-orosomucoid did not influence the uptake of subsequently added 125I-asialofetuin; neither was degradation of 125I-asialo-fetuin affected in this experiment. The fractional rate of degradation (the fraction of cell-associated asialo-fetuin which was degraded per unit time) was constant over a twelve-fold range of intracellular asialo-fetuin concentrations. Increasing the temperature from 20 to 30 degrees C produced approximately a ten-fold increase in the rate of degradation of either asialo-fetuin or asialo-orosomucoid. The average activation energies of degradation over the range 20 to 40 degrees C were 125 kJ/mol for asialo-fetuin and 149 kJ/mol for asialo-orosomucoid; however, the Arrhenius plots were not straight lines over this temperature range.

Animals↗
PubMedDate not supplied

Epidural analgesia and risk of anastomotic leakage.

BACKGROUND AND OBJECTIVES: Based on case reports of early anastomotic leakage in patients receiving epidural analgesia with local anesthetic and data to document a stimulatory effect of epidural block on gastrointestinal motility, it has been suggested that continuous infusion of epidural local anesthetic may lead to an increased incidence of anastomotic leakage. Therefore, we examined the association between continuous epidural local anesthetic and anastomotic leakage by reviewing the literature. METHODS: Review of controlled, randomized clinical trials aiming to investigate postoperative complications in which continuous postoperative epidural local anesthetic was administered in patients scheduled for colorectal surgery with an anastomosis. Data were obtained from a Medline search (1966-May 2000), previous review articles, references cited in original papers, and personal communication with investigators. Twelve trials including a total of 562 patients met the inclusion criteria. RESULTS: Sixteen of 266 patients (6.0%, 95% confidence interval [CI]: 3.5% to 9.6%) receiving postoperative epidural local anesthetic or epidural local anesthetic-opioid mixtures developed anastomotic leakage, compared with 10 of 296 patients (3.4%, 95% CI: 1.6% to 6.1%) receiving epidural or systemic opioid-based analgesia (P >.05 between groups, Fisher's test). The risk of overlooking a significant difference (type II error) was approximately 67% (power: 33%). Studies including more than 1,037 patients in each group are needed to demonstrate an increased risk of anastomotic leakage from 3.4% to 6.0% with 80% power and 2alpha = 0.05. There was no significant difference (P >.05 between groups, Fisher's test) between subgroups of study design: Epidural local anesthetic-versus systemic or epidural opioid, or epidural local anesthetic-opioid mixtures versus systemic or epidural opioid. CONCLUSIONS: So far, there is no statistically significant evidence from randomized trials to indicate epidural analgesia with local anesthetic to be associated with an increased risk of anastomotic breakdown. However, relatively few patients have been included in randomized trials, indicating a need for more studies to secure valid conclusions.

Analgesia, Epidural↗
PubMedDate not supplied

Effects of gabapentin in acute inflammatory pain in humans.

BACKGROUND AND OBJECTIVES: The aim of the study was to examine the analgesic effects of the anticonvulsant, gabapentin, in a validated model of acute inflammatory pain. METHODS: Twenty-two volunteers were investigated in a double-blind, randomized, placebo-controlled cross-over study. Gabapentin 1,200 mg or placebo was given on 2 separate study days. Three hours after drug administration, a first-degree burn injury was produced on the medial aspect of the nondominant calf (12.5 cm(2), 47 degrees C for 7 minutes). Quantitative sensory testing (QST) included pain ratings to thermal and mechanical stimuli (visual analog scale [VAS]), assessments of thermal and mechanical detection thresholds, and areas of secondary hyperalgesia. Side effects drowsiness and postural instability were assessed by subjective ratings (VAS). RESULTS: The burn injury induced significant primary and secondary hyperalgesia (P <.0001). Gabapentin diminished the decrease in mechanical pain threshold in the burn area (P =.04) and reduced secondary hyperalgesia, but the reduction was not significant (P =.06). Heat pain thresholds, pain during the burn, and mechanical pain in the area of secondary hyperalgesia were not significantly changed by gabapentin (P <.2). Ratings of drowsiness and unsteadiness during walking were significantly higher for gabapentin than for placebo (P <.05). CONCLUSIONS: The study indicates that gabapentin has no analgesic effect in normal skin, but may reduce primary mechanical allodynia in acute inflammation following a thermal injury. These observations suggest a clinical potential of gabapentin in the treatment of postoperative pain.

Acetates↗