Biomedical subjects

L T Skovgaard

Publications and source records attributed to L T Skovgaard.

At least 55 records · Page 3Linked to original sources

PubMed1994

Statistical model estimating the occurrence of otitis media from temporal bone pneumatization.

In order to investigate the relationship between the pneumatization of temporal bones and the occurrence of otitis media in Greenlandic Inuit, 36 Greenlandic Inuit were examined by radiography of the temporal bones. The pneumatized cell area was measured planimetrically. All subjects answered a questionnaire on infectious middle ear disease (IMED), and an objective otologic examination was performed. Nine persons of 34 (26%) reported IMED in childhood, and there was IMED reported in all pneumatized areas below 400 mm2. Based on bilateral area measures, a polychotomous logistic regression model was applied. The occurrence of IMED was shown to be associated with smaller areas, and unilateral IMED was associated with pronounced asymmetry. The model has enabled risk assessment, and 8 persons were designated by the model as having had IMED with a sensitivity of 67% (confidence interval 30% to 93%) and a specificity of 92% (confidence interval 74% to 99%). When the model was applied to a historical anthropological Inuit material from 1700 to 1800 AD, 6 of 56 crania were designated as having had IMED. This method has improved the accuracy of estimating the occurrence of IMED in ancient populations.

Adolescent↗

PubMed1993

Intact transmembrane isoforms of the neural cell adhesion molecule are released from the plasma membrane.

Three soluble neural cell adhesion molecule (NCAM) polypeptide classes of M(r) values 190,000 (NCAM-s1), 135,000 (NCAM-s2) and 115,000-110,000 (NCAM-s3) have been demonstrated in rat brain and cerebrospinal fluid [Krog, Olsen, Dalseg, Roth and Bock (1992) J. Neurochem. 59, 838-847]. NCAM-s3 is known to arise from released glycosylphosphatidylinositol (GPI)-linked NCAM [He, Finne and Goridis (1987) J. Cell. Biol. 105, 2489-2500] as well as from extracellularly cleaved transmembrane NCAM isoforms [Nybroe, Linnemann and Bock (1989) J. Neurochem. 53, 1372-1378]. In this study the origin of NCAM-s1 and NCAM-s2 and the function of soluble NCAM forms were investigated. It was shown that all three soluble forms could be released from brain membranes with M(r) values identical to the three major membrane-associated forms: the large transmembrane 190,000-M(r) form (NCAM-A), the smaller transmembrane 135,000-M(r) form (NCAM-B) and the GPI-anchored 115,000-110,000-M(r) form (NCAM-C). A polyclonal antibody, directed against transmembrane and cytoplasmic epitopes common to NCAM-A and NCAM-B, was shown to react with NCAM-s1 and NCAM-s2. Furthermore, NCAM-B was shown to be shed in a presumably intact soluble form from membranes of cells transfected with this isoform. Thus, NCAM-s1 and NCAM-s2 probably represent intact released transmembrane NCAM-A and NCAM-B. The soluble transmembrane forms are likely to exist in vivo, as NCAM-s1 and NCAM-s2 were readily demonstrated in cerebrospinal fluid. By density-gradient centrifugation it was shown that shed transmembrane NCAM-B was present in fractions of high, as well as low, density, indicating that a fraction of the shed NCAM is associated with minor plasma membrane fragments. Finally, it was shown that isolated soluble NCAM inhibited cell binding to an immobilized NCAM substratum, attributing a pivotal role to soluble NCAM in vivo as a modulator of NCAM-mediated cell behaviour.

Animals↗

PubMed1993

Mivacurium-induced neuromuscular blockade in patients with atypical plasma cholinesterase.

The duration of action of mivacurium was evaluated during a modified neurolept anaesthesia in 17 patients heterozygous for the usual and the atypical plasma cholinesterase (pChe) gene (E1uE1a) and in five patients homozygous for the atypical gene (E1aE1a). The response to train-of-four nerve stimulation was recorded using a Myograph 2000. Five heterozygous patients were given a small dose of mivacurium 0.03 mg kg bw-1 intravenously (Group 1). The mean (range) suppression of the first twitch in the train-of-four response (T1) was 91% (69-100%). The time to 90% T1 recovery was 23.9 min (14.0-31.3 min). Twelve other heterozygous patients (Group 2) received mivacurium 0.2 mg kg bw-1 (2.5 x ED95). In these patients the time to 100% T1 suppression was 1.4 min (1.1-2.0 min). The time to reappearance of the T1 response, to 90% T1 recovery, and the recovery index (25.3 min (14.5-34.5), 45.5 min (30.9-59.2), and 9.8 min (6.8-19.6), respectively) were significantly longer than reported in phenotypically normal patients. Five patients homozygous for the atypical gene (Group 3) were given 0.03 mg kg bw-1 mivacurium. The time to reappearance of T1 response following this low dose of mivacurium ranged from 26-128 min. In all five patients the neuromuscular block was successfully antagonized with neostigmine preceded by atropine. In conclusion, mivacurium-induced neuromuscular blockade was moderately prolonged in patients heterozygous for the usual and the atypical gene for plasma cholinesterase. Patients homozygous for the atypical plasma cholinesterase gene appear to be markedly sensitive to mivacurium.

Adolescent↗

PubMed1993

Monitoring of neuromuscular transmission by electromyography (II). Evoked compound EMG area, amplitude and duration compared to mechanical twitch recording during onset and recovery of pancuronium-induced blockade in the cat.

The feasibility of the compound electromyogram (EMG) was evaluated during onset and recovery from pancuronium block in the tibialis anterior muscle of ten cats. The evoked EMG area, amplitude and duration of the total response and of the major negative deflection were evaluated and compared to the mechanomyogram during 0.1 Hz and train-of-four (TOF) stimulation. EMG areas and amplitudes were found to be linearly and similarly related to the mechanomyogram during onset and recovery. Slopes of the regression lines ranged between 1.00-1.02 and between 1.10-1.22 during onset and recovery, respectively, with high individual correlation coefficients (> 0.95). The TOF ratio of the mechanomyogram was linearly related to the EMG TOF ratio during onset and to the square root of the EMG TOF ratio during recovery, with no differences between EMG areas and amplitudes, suggesting a higher initial recovery of the TOF ratio of the mechanomyogram during recovery. EMG duration increased as the level of block increased but was unsuitable for neuromuscular monitoring. Evaluation of the agreement between the two methods showed that the EMG may be from 15% below to 10% above the mechanomyogram during onset and from 40% below to 45% above the mechanomyogram during recovery, in spite of high correlation coefficients. In contrast, agreement between EMG parameters was found to be high. In conclusion, EMG is more reliable than the mechanomyogram for evaluation of neuromuscular transmission in the cat. EMG amplitudes and areas both reflect the degree of neuromuscular blockade equally well.

Animals↗

PubMed1993

A multicentre comparison of treatment regimens for unilateral cleft lip and palate using a multiple regression model.

The European Cleft Lip and Palate Research Group consists of specialists in orthodontics from six centres for the treatment of cleft palate in northern Europe. The purpose of this part of the multicentre study was to investigate whether differences in outcomes could be explained by specific treatment regimens. Three regimens that were assumed to influence the outcome of treatment were selected: Presurgical orthopaedics, closure of the palate, and primary bone grafting. The sample comprised 151 children with complete unilateral cleft lip and palate from the six centres. The result of multiple regression analysis showed that within that sample it was not possible to reach definite conclusions as to which factors exerted the most favourable influence on facial growth, but primary bone grafting was associated with reduced maxillary inclination and presurgical orthopedics with increased mandibular inclination.

Bone Transplantation↗

PubMed1992

The accuracy of train-of-four monitoring at varying stimulating currents.

Train-of-four (TOF) monitoring of neuromuscular block at submaximal current stimulation has been recommended because it is less painful than monitoring at supramaximal stimulation. The measurement error, however, when using submaximal stimulation has not as yet been fully elucidated. The authors therefore quantified the measurement error of TOF monitoring at low currents near the initial threshold for stimulation (ITS) by assessing precision (the difference between duplicated TOF ratios measured at the same current) and accuracy (the difference between TOF ratios at lesser currents and the TOF ratio at 58 mA, which served as the reference standard method). A stable neuromuscular block at a TOF ratio of 0.40 and subsequently 0.70 was established in 20 patients using a continuous infusion of atracurium. The ulnar nerve was stimulated at the wrist using TOF stimulation, and the evoked twitch response of the adductor pollicis muscle was measured with a force-displacement transducer. The stimulating current was varied in 5-mA steps between ITS and 55 mA. Whereas there were no statistical significant differences between the mean TOF ratios at the different currents, the standard deviation increased with decreasing currents (P less than 0.01 at currents less than 40 mA). The precision was acceptable except at ITS, where the limits of precision (mean intracurrent difference in TOF ratio +/- two standard deviations) exceeded 0.05, which was the chosen acceptable difference. The standard deviation of the accuracy was significantly increased at currents less than or equal to ITS + 25 mA (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Electric Stimulation↗

PubMed1992

Monitoring of the neuromuscular transmission by electromyography (I). Stability and temperature dependence of evoked EMG response compared to mechanical twitch recordings in the cat.

The stability over time and the effect of muscle temperature change were evaluated for the evoked compound EMG and for the mechanomyogram of the tibialis anterior muscle of 7 anaesthetized cats. Both EMG areas and amplitudes were recorded. During stimulation for 3 h with 0.1 Hz (one leg) and train-of-four (TOF) (the other leg), the EMG was stable while the mechanomyogram initially increased 35-50% in the first 7-8 min and then decreased 19-22% and 5-8% over the first and second 1.5-h period, respectively. During subsequent mean muscle temperature reduction to 28.8 degrees C (0.1 Hz) and 29.7 degrees C (TOF) and rewarming, an inverse linear relationship was found between temperature and both the EMG and the mechanomyogram. During temperature reduction EMG increased about 6% (areas) and 2% (amplitudes) per degrees C. During rewarming, parameters decreased about 4.5% and 2% per degrees C, respectively (P less than 0.05 comparing EMG areas during cooling and rewarming). TOF ratio of the EMG was not affected by temperature. A very large interindividual variation was observed for the effect of temperature on the mechanomyogram with changes ranging up to 15% per degrees C for some cats. TOF ratio of the mechanomyogram was reduced from 1.02 to 0.94 at lowest muscle temperature. It is concluded that the evoked EMG may be preferable to the mechanomyogram in cat experiments investigating the neuromuscular transmission.

Animals↗

PubMed1992

Influence of plasma cholinesterase activity on recovery from mivacurium-induced neuromuscular blockade in phenotypically normal patients.

The significance of plasma cholinesterase (pChe) activity for the duration of action of mivacurium in phenotypically normal patients was evaluated in 35 patients during neurolept anaesthesia. The response to train-of-four nerve stimulation was recorded using a Myograph 2000. Ten patients with normal pChe (Group I) and five patients with decreased pChe activity (Group 2) were given a small test dose of mivacurium 0.03 mg kg-1. Mivacurium 0.1 mg kg-1 was administered following spontaneous recovery from the first dose. The mean suppression of the height of the first (T1) of the train-of-four responses following mivacurium 0.03 mg kg-1 patients with normal and decreased enzyme activity was 40% and 56%, respectively, and the mean T1 suppression after mivacurium 0.1 mg kg-1 was 100% in both groups. The times to different levels of twitch height recovery following the 0.1 mg kg-1 dose did not differ between the two groups of patients. Another 20 patients with normal or decreased pChe activity (Group 3) were given mivacurium 0.2 mg kg-1. In this group the time to maximum block was 1.4 min (1.0-4.0) mean (range) and the time to reappearance of the T1 response was 15.0 min (7.4-22.7) (range). An inverse relationship was found between the patients' pChe activity and the time to first response. It is concluded that mivacurium is short-acting in patients with normal pChe phenotype and normal to low-normal pChe activity. No patient with very low pChe activity was included in the study. A prolonged response to mivacurium may, however, be expected in these patients.

Anesthesia Recovery Period↗

PubMed1992

Correlations of body mass index of adult adoptees and their biological and adoptive relatives.

Adult family members resemble each other in body mass index (weight/height2). Our aim was to assess the extent to which the genetic relationship can account for the resemblance in natural families. We estimated the correlations in body mass index between adult adoptees, their adoptive parents, and their biological parents and siblings and compared the correlations to those between the biological relatives. Height, current weight, and greatest ever weight were obtained for 3651 adoptees. Groups representing thin, medium weight, overweight and obese subjects were selected by current body mass index (n = 540) and similarly selected by maximum body mass index (n = 524). The heights and weights of their biological and adoptive family members were assessed. The correlation in current body mass index between the adoptees and biological mothers, fathers, and full siblings were 0.15, 0.11, and 0.23, respectively (all P less than 0.001). These correlations were compatible with those found among the biological relatives living together. The correlations exhibited no consistent gender-related pattern. There was no correlation in body mass index between the adoptees and their adoptive parents. Similar results were obtained for maximum body mass index. Moreover, the correlations between the adoptees and their biological relatives are very similar to those found in large population studies of natural families. This study suggests that the genetic relationship fully accounts for the familial resemblance in body mass index among adults.

Adoption↗

PubMed1991

Pretreatment with pancuronium before suxamethonium administration in patients heterozygous for the usual and the atypical plasma cholinesterase gene.

The object of this study was to investigate whether pretreatment with pancuronium before i.v. injection of suxamethonium could cause prolonged neuromuscular blockade in patients heterozygous for the usual and the atypical plasma cholinesterase gene (E1uE1a). Forty-three patients, 23 with genotype E1uE1a and 20 with normal genotype (E1uE1u), were pretreated with pancuronium 0.01 mg.kg-1 followed by suxamethonium 1.5 mg.kg-1, and received either neurolept anaesthesia or halothane anaesthesia. Seven patients (E1uE1a) were given suxamethonium 1.5 mg.kg-1 without pretreatment. The duration and type of neuromuscular block were evaluated using train-of-four (TOF) nerve stimulation. Type of anaesthesia did not significantly influence the results. The duration of block following pretreatment was significantly longer in heterozygous patients than in normal patients. Time to 90% twitch height recovery was 10.7 +/- 1.2 min (mean +/- s.d.) in genotypically normal patients, and 18.0 +/- 4.2 min in patients with genotype E1uE1a. Pretreatment with pancuronium caused a significantly slower recovery of the TOF ratio (phase II block). Thus, a TOF ratio of 0.7 was always reached within 13 min in genotypically normal patients. In genotypically abnormal patients, the same TOF ratio was reached within 20 min in all but three patients. In these three patients time to 90% twitch height recovery was prolonged (18-31 min), and TOF ratio did not return to normal, but stabilized at about 0.35, 0.50, and 0.65, respectively. Injection of edrophonium restored normal neuromuscular function in 10 min. It is concluded that in patients heterozygous for the usual and the atypical gene, pretreatment with pancuronium in combination with an increased dose of suxamethonium may cause a phase II block and thus a prolonged neuromuscular block.

Adult↗

PubMed1991

Evaluation of 119 anaesthetics received after investigation for susceptibility to malignant hyperthermia.

A questionnaire was sent to the first 371 patients investigated for MH susceptibility at the Danish MH Register, in order to assess sequelae from the muscle biopsy and possible subsequent anaesthetic complications. The purpose was to evaluate both the safety of anaesthetizing MH-susceptible (MHS) patients without the use of trigger agents, and the safety of giving trigger agents to non-susceptible (MHN) patients. Eighty-eight per cent of patients alive replied to the questionnaire. Of these, 22% complained about discomfort at the site of the biopsy, 2% had experienced problems when needing a subsequent anaesthetic, and 0.9% had had trouble when applying for life or accident insurance. The median observation period for all patients following the muscle biopsy was 5.5 years (range 27 months-11 years). During this period, 36 MHS patients had been anaesthetized 52 times (28 general and 23 regional anaesthetics, data missing in one case) without any MH-related complications. None of the patients had received prophylactic dantrolene. Three MHE patients had received non-trigger anaesthetic agents on three occasions without development of MH. Thirty-five MHN patients had been anaesthetized 64 times, and 13 of these MHN patients had received trigger agents 26 times without any signs of MH. An estimate of the probability of clinical MH developing in MHN patients subsequently anaesthetized with trigger agents was found to be 0-24.7% (95% confidence limits), whereas the probability of clinical MH developing in MHS patients anaesthetized with non-trigger agents was 0-9.7% (95% confidence limits).

Adjuvants, Anesthesia↗

PubMed1990

Agreement among multiple observers on endoscopic diagnosis of esophageal varices before bleeding.

The interobserver variation in diagnosis and grading of esophageal varices may be ascribed by characteristics of the observers as well as to the patients. Assessment of this variation therefore requires the contributions of multiple observers and patients. Twenty-eight patients with cirrhosis without previous bleeding or known presence of varices were subjected to upper gastrointestinal endoscopy. Each endoscopy was videotaped and shown to 22 endoscopists. The varices were graded on a scale of 0 to 3 according to size. Each endoscopist diagnosed varices in 8 to 20 patients (mean = 15.9). Overall agreement on the presence (grades 1 to 3) or absence (grade 0) of varices was 70%. The average kappa value was 0.38 (standard deviation = 0.16). Discrimination between varices graded 0 to 1 and varices graded 2 to 3 gave a higher kappa value (p less than 0.01) of 0.52 (standard deviation = 0.17). There was a large variation in kappa values (range = -0.025 to 0.975). No significant correlation was observed between kappa values for the two dichotomies (range = 0.16). The kappa values were not related to the experience of the endoscopist. Considerable variation in the agreement on diagnosis and grading of esophageal varices was found. These results must be taken into account in the assessment of trials of prophylaxis of first-time variceal bleeding.

Adult↗

PubMed1990

Reversal of intense neuromuscular blockade following infusion of atracurium.

In order to evaluate reversal time from very intense neuromuscular blockade caused by a continuous infusion of atracurium, the time course of neostigmine induced reversal from different levels of neuromuscular blockade was evaluated using the post-tetanic count (PTC) and the train-of-four (TOF) in 30 patients anesthetized with nitrous oxide, fentanyl, and thiopental. Reversal time (time from administration of neostigmine at different PTC levels to a TOF ratio of 0.7) was found to depend upon the degree of blockade at the time of reversal. Median reversal time from a PTC of 1-2, 3-4, 5-6, 7-8, 9-10, 11-12, and greater than 13 (but less than 10% twitch height) to a TOF ratio of 0.7 was 31, 23, 19, 18, 14, and 13 min, respectively. Spontaneous recovery from PTC level of 1-2, when atracurium infusion was stopped, to a PTC level at which antagonism was induced and reversal time were both correlated to the square root of the PTC. Total recovery time (spontaneous recovery plus reversal time) was not shortened by an early injection of neostigmine. It is concluded that neostigmine administration during intense neuromuscular blockade following atracurium infusion does not shorten total recovery time and offers no clinical advantages.

Adult↗

PubMed1990

The effect of bambuterol (carbamylated terbutaline) on plasma cholinesterase activity and suxamethonium-induced neuromuscular blockade in genotypically normal patients.

Bambuterol (the bisdimethylcarbamate prodrug of terbutaline) is a new bronchodilator with a prolonged duration of action due to its inhibition of plasma cholinesterase during metabolism. The effect of bambuterol on suxamethonium-induced neuromuscular blockade was studied in 10 patients undergoing elective laparotomy. Thirty mg of bambuterol was given 2 h before anaesthesia, which was performed with thiopentone, fentanyl, halothane and nitrous oxide in oxygen. Neuromuscular function was monitored using supramaximal train-of-four stimulation of the ulnar nerve and a force displacement transducer. Suxamethonium 1 mg.kg-1 was given i.v. for endotracheal intubation. Plasma cholinesterase activity was measured before and after intake of bambuterol and during anaesthesia. The results from the 10 patients were compared with those of 41 patients not given bambuterol but otherwise studied during the same conditions. Following bambuterol, all patients had a significant decrease of plasma cholinesterase activity (P less than 0.001) and the suxamethonium-induced blockade was 3-4 times prolonged compared to patients not given bambuterol (P less than 0.001). Five patients with very low plasma cholinesterase activity developed a long-lasting phase II block.

Adult↗

PubMed1989

Manual evaluation of residual curarization using double burst stimulation: a comparison with train-of-four.

Double burst stimulation (DBS) is a new mode of stimulation developed to reveal residual neuromuscular blockade under clinical conditions. The stimulus consists of two short bursts of 50 Hz tetanic stimulation, separated by 750 ms, and the response to the stimulation is two short muscle contractions. Fade in the response results from neuromuscular blockade as with train-of-four stimulation (TOF). The authors compared the sensitivity of DBS and TOF in the detection of residual neuromuscular blockade during clinical anaesthesia. Fifty-two healthy patients undergoing surgery were studied. For both stimulation patterns the frequencies of manually detectable fade in the response to stimulation were determined and compared at various electromechanically measured TOF ratios. A total of 369 fade evaluations for DBS and TOF were performed. Fade frequencies were statistically significantly higher with DBS than with TOF, regardless of the TOF ratio level. Absence of fade with TOF implied a 48% chance of considerable residual relaxation as compared with 9% when fade was absent with DBS. The results demonstrate that DBS is more sensitive than TOF in the manual detection of residual neuromuscular blockade.

Anesthesia↗

PubMed1989

Clinical recovery and train-of-four ratio measured mechanically and electromyographically following atracurium.

Indices of clinical recovery were compared with mechanically (adductor pollicis muscle) and electromyographically (first dorsal interosseal muscle) recorded train-of-four (TOF) ratios during antagonism of atracurium blockade in 23 healthy neurolept anesthetized patients. Clinical recovery was evaluated from the ability to lift the head, sustain headlift for 5 or 10 s, protrude the tongue, open the eyes, and the presence of ptosis of the eyelids. In all patients the mechanical TOF ratio was recorded. In 17 patients TOF ratios based on measurements of the potential area and the amplitude of the major negative deflection of the compound EMG response were recorded as well. At each TOF ratio interval of 0.05 from a TOF ratio of 0.5-0.85, the number of patients being able to perform the individual tests was recorded. Further, the mechanical TOF ratio during recovery was compared with the EMG TOF ratios. Headlift could not be sustained for 5 s in any patient at a TOF ratio of 0.5, whether recorded mechanically or by EMG, and TOF ratio had to recover to 0.8 before all patients could sustain headlift for 5 s. All patients could open the eyes and protrude the tongue at a TOF ratio of 0.65, and ptosis remained present during the entire testing period. There was no statistically significant difference between the mechanical and the EMG methods with regard to the TOF ratios at which the tests could be performed. During recovery a linear relationship was found between mechanical TOF ratios and the square root of the EMG TOF ratios.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Age, fiber type composition and in vitro contracture responses in human malignant hyperthermia.

Muscle fiber typing and in vitro contracture tests were performed in 59 patients investigated for susceptibility to malignant hyperthermia (MH). Eighteen patients were found to be susceptible to MH. There was no difference in age or fiber type distribution between MH susceptible and non-susceptible patients. No correlation was found between age and fiber type distribution. Separate analyses for each diagnostic group revealed no relationship between age or fiber type distribution and response to halothane or caffeine. When all caffeine results were pooled, however, there was a significant effect of age on the caffeine specific concentration (the concentration eliciting a contracture of 1 g), but not on the caffeine threshold concentration (the minimal concentration eliciting an increase in tension). It is concluded that age and fiber type distribution have no influence on MH diagnosis, if the protocol of the European MH Group for evaluation of susceptibility to MH is followed.

Adolescent↗

PubMed1988

Half-life of plasma cholinesterase.

The half-life of plasma cholinesterase (acylcholine acylhydrolase EC 3.1.1.8) was determined in three patients homozygous for the atypical gene for plasma cholinesterase by measuring the rate of disappearance of enzyme activity following intravenous injection of concentrated human cholinesterase. Half-life values of 10.9, 11.1, and 11.3 days were estimated. The distribution volume was estimated to be 18.0, 18.2, and 13.8% of body weight, respectively.

Adult↗