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Biomedical subjects

P E Andersen

Publications and source records attributed to P E Andersen.

At least 19 recordsLinked to original sources

Rapid estimation of left ventricular ejection fraction in acute myocardial infarction by echocardiographic wall motion analysis.

Echocardiographic estimates of left ventricular ejection fraction (ECHO-LVEF) in acute myocardial infarction (AMI) were obtained by a new approach, using visual analysis of left ventricular wall motion in a nine-segment model. The method was validated in 41 patients using radionuclide ventriculography (RNV) and contrast ventriculography measurements of LVEF for comparison. ECHO-LVEF from the 41 patients correlated well with the reference methods (y = 1.5x - 14.7, r = 0.93; linear regression analysis; 95% confidence limit for a single determination of ECHO-LVEF was 17.2). Interobserver variability by linear regression was r = 0.89, SEE = 7.1 with a mean difference between paired observations of -1.5 +/- 6.9 (SD). In a random sample of 18 patients (45 observations), ECHO-LVEF allowed separation between RNV-LVEF values greater than or equal to 40 and less than 40, representing low and high risk groups following AMI. Thus, the results showed that simple, readily available wall motion-derived estimates of LVEF were as closely associated with LVEF measured by standard reference methods as were previously published, more cumbersome, planimetric echocardiographic methods. Reporting on global LVEF function in LVEF units rather than in nonstandardized wall motion scores of index values may facilitate intra- and interhospital communication and the use of optimized echocardiographic risk stratification after AMI.

Echocardiography

Intrathecal narcotics for relief of pain from head and neck cancer.

We describe our experience with nine patients with head and neck pain of malignant origin who were treated with continuous low-dose intrathecal morphine via a lumbar catheter and implantable subcutaneous drug delivery pump. All patients had failed prior attempts at oral narcotic pain control due to either poor pain control or intolerable side effects. Using a visual analogue scale where the most severe pain is rated as 10 and no pain is rated as 0, the mean visual analogue scale was reduced from 7.6/10 (range, 5 to 10/10) before implantation to 1.9/10, 2.0/10, and 0.5/10 at 1 week, 1 month, and 2 months after implantation, respectively. Complications were acceptable. We conclude that intrathecal administration of morphine is a safe and effective means of pain control. This method deserves serious consideration in patients with intractable pain secondary to head and neck malignancy.

Analgesia

[Percutaneous transluminal coronary angioplasty in acute myocardial infarction].

The attitude towards the treatment of acute myocardial infarction is currently changing. As an example of one of the new methods, a successful case of acute percutaneous transluminal coronary angioplasty is presented. Which of the new therapeutic regimens provides the best prognosis is unknown, but considering the resources and the hitherto published studies, intravenous thrombolysis seems in general to be the most advantageous, while the others ought only to be used on special indications.

Adult

Prevalence of lethal osteochondrodysplasias in Denmark.

The point prevalence at birth of lethal osteochondrodysplasias in a subregion of Denmark was estimated by a study of all children born January 1970 through December 1983. Two cases of thanatophoric dysplasia, one case of thanatophoric dysplasia with cloverleaf skull, two cases of micromelic bone dysplasia with cloverleaf skull, two cases of achondrogenesis type III, and three cases of achondrogenesis type IV were found. Two cases were unclassifiable due to lack of radiographs. In total, the point prevalence at birth was 15.4 per 100,000. Thus lethal osteochondrodysplasias seem to be more common than is generally assumed. The clinical and radiographic findings in micromelic bone dysplasia with cloverleaf skull are discussed in relation to thanatophoric dysplasia and achondrogenesis type IV.

Abnormalities, Multiple

Micromelic bone dysplasia with cloverleaf skull.

Micromelic bone dysplasia with cloverleaf skull is a well-described entity with short, straight tubular bones, hydrocephalus and cloverleaf deformity of the skull, narrow chest and platyspondyly. A further two unrelated patients are presented, in whom the shape of the head varied. Both cases also showed a narrow foramen magnum, hypoplastic cerebellum, atrial septal defect, hypoplastic adrenals, and ureteric malformations. The findings in the skeleton show similarities to other types of generalised bone dysplasias but are distinguishable from these. This well-defined bone dysplasia should probably be regarded as a separate entity. Visceral malformations may be associated.

Abnormalities, Multiple

Electroacupuncture and postoperative pain.

We studied 20 otherwise healthy women undergoing lower abdominal surgery. Immediately after wound closure, while still anaesthetized, they received either electroacupuncture (EA) or no further treatment. They were allowed pethidine for postoperative analgesia by patient-controlled infusion pump. Signs of postoperative distress (pain, nausea, drowsiness) were evaluated after 2 and 6 h by visual analogue scale scores. The group receiving EA consumed half the quantity of pethidine as that used used by the no treatment group. Two patients in the EA group had no postoperative analgesia in the first 2 h. There was no difference in the assessments of postoperative distress between groups. No patient was aware of having received EA or not.

Acupuncture Therapy

Osteogenesis imperfecta: a genetic, radiological, and epidemiological study.

The point prevalence at birth of osteogenesis imperfecta was estimated by a systematic search of all children born 1. I. 1970 to 31. XII. 1983 in the county of Fyn (Denmark). Additionally, the population prevalence on 31. XII. 1983 of all patients with osteogenesis imperfecta in this county was determined. The county is a well-defined, representative subregion of Denmark which demographically comprises a cross-section including about 9% of the Danish population. Altogether, the study disclosed 48 patients with osteogenesis imperfecta. Of these, 17 patients were born 1. I. 1970 to 31. XII. 1983 and 12 had type I, 2 had type II, 2 had type III, and 1 had type IV. Thus, the point prevalence at birth was 21.8/100,000 and the population prevalence was 10.6/100,000 inhabitants. There was great variation in the clinical manifestations within and between the types.

Child

Congenital generalised bone dysplasias: a clinical, radiological, and epidemiological survey.

The point prevalence at birth of generalised bone dysplasias was estimated by a study of all children born between 1 January 1970 and 31 December 1983 in the county of Fyn (Denmark). Additionally the population prevalence on 31 December 1983 of all patients with generalised bone dysplasias in this county was determined. The county is a well defined, representative subregion of Denmark which demographically comprises a cross section of about 9% of the Danish population. In total, bone dysplasias were found to be more frequent than generally assumed. Achondroplasia was, however, less common with a point prevalence at birth of 1.3 per 100,000, while osteogenesis imperfecta (21.8), multiple epiphyseal dysplasia tarda (9.0), achondrogenesis (6.4), osteopetrosis (5.1), and thanatophoric dysplasia (3.8) were found more frequently. It is striking how many bone dysplasias are still erroneously classified as achondroplasia. Correct diagnosis is important for a valid prognosis, for treatment, and for genetic counselling. The diagnosis relies almost exclusively on the radiographical findings.

Bone Diseases, Developmental

Fracture patterns in two types of autosomal-dominant osteopetrosis.

Thirty-five individuals with autosomal-dominant osteopetrosis were interviewed and radiographs were reviewed. Twenty had the radiographic Type I osteopetrosis, characterized by diffuse, symmetric osteosclerosis and pronounced sclerosis of the skull with a thickened cranial vault. Fifteen had Type II, where the most striking findings were diffuse symmetric osteosclerosis, "Rugger Jersey Spine," and endobones (bone within a bone) in the pelvis, while the cranial vault was almost unaffected. Of the 12 probands who had had a fracture, 2/20 were Type I and 10/15 were Type II. Fracture complications were also more frequent in Type II.

Adolescent

Dyssegmental dysplasia in siblings: prenatal ultrasonic diagnosis.

Two cases of dyssegmental dysplasia (type Silverman-Handmaker) in siblings are presented. The first-born died at the age of 3 months and the second fetus was followed during pregnancy with ultrasound examinations. In the 20th week of gestation marked shortening of the extremities was found; a female infant showing the same radiologic bony malformations as the firstborn was born by cesarean section. These cases support the autosomal recessive inheritance and demonstrate the possibility of prenatal diagnosis in this type of micromelic dwarfism.

Bone Diseases, Developmental

Reversibility of cortical hyperostosis following long-term prostaglandin E1 therapy in infants with ductus-dependent congenital heart disease.

Two neonates with complex cyanotic congenital heart disease, receiving long-term prostaglandin E1 infusion, for 59 and 78 days respectively, demonstrated significant radiographic changes of symmetric cortical hyperostosis of the long bones. Bone biopsies from one of the patients elucidated the histological changes and serial X-rays revealed regression of the hyperostosis. Long-term follow-up after 13 months did not reveal any late bony changes or growth disturbance.

Alprostadil

Radiological, biochemical and hereditary evidence of two types of autosomal dominant osteopetrosis.

Review of the radiographs of 34 patients with autosomal dominant osteopetrosis revealed two distinct phenotypical types. Both were strictly family-related and exhibited progressive sclerosis with aging. Descriptive, radiogrammetric and biochemical analyses were performed. Type I showed a pronounced sclerosis of the skull with an enlarged thickness of the cranial wall. The sclerosis of the skull in Type II was most striking at the base. In Type II there was a typical "Rugger-Jersey spine," and endobones ("bone within a bone") were seen in the pelvis. The radiogrammetric investigations of the long bones did not show any difference between the two types. Compared to normal controls, there was a normal total subperiosteal width (W), but a significant enlarged cortical thickness (C) (P less than 0.01), and thus a reduced medullary cavity (M), suggesting normal bone formation and disturbed bone resorption. Serum phosphate was lower in Type I compared to Type II (P less than 0.01), and serum acid phosphatase was markedly increased in Type II (P less than 0.01), suggesting differences between the two types in bone mineral metabolism and structural functions of the osteoclasts. The two types may represent two different entities with the same mode of inheritance, and in both cases with affected bone resorption.

Adolescent

Autosomal dominant osteopetrosis: an otoneurological investigation of the two radiological types.

Otoneurological examination was performed on 14 patients with autosomal dominant osteopetrosis. Eight patients had radiological type I osteopetrosis, characterized by a pronounced osteosclerosis of the skull and an enlarged thickness of the cranial vault. Six patients had type II, in which osteosclerosis is most pronounced at the base of the skull. All investigated patients except one had otoneurological manifestations, but only two of of the 14 had otoneurological complaints. Symptoms were related to radiological types. Involvement of the trigeminal nerve was seen only in type I, whereas involvement of the facial nerve was found primarily in type II. Conductive hearing loss was particularly common in type I, and may reflect a high frequency of otosclerosis. Tomography of the petrous bones showed a significant narrowing of the internal acoustic meatus in type I (p less than 0.01) when compared to normal controls, but no significant narrowing in type II.

Facial Paralysis

Spondyloepiphyseal dysplasia tarda. Report of a family with autosomal dominant transmission.

We present a clinical and radiographic study of a family with the autosomal dominant form of spondyloepiphyseal dysplasia tarda, in some patients associated with hearing deficiency. Although no causal treatment is possible, correct diagnosis is important to avoid unnecessary treatment and for information about prognosis, genetic counseling, and recommendation of future occupation.

Adolescent

Chondrodysplasia punctata. Report of two cases.

Chondrodysplasia punctata is a rare familial disorder characterized by punctate calcifications in the epiphyseal regions. The radiological picture is typical, but early diagnosis is important as the characteristic calcifications disappear within the first year of life. Three subtypes with different clinical, radiological, and hereditary characteristics have been separated. Detailed diagnosis is crucial for effective genetic counselling. However, the autosomal dominant Conradi-Hünermann type is very heterogeneous and a lethal nonrhizomelic subtype has been suggested as well. Two cases of chondrodysplasia punctata are presented to demonstrate the wide range of radiological appearances. One of the cases represents the Conradi-Hünermann type and the other may represent the lethal nonrhizomelic subtype of Conradi-Hünermann.

Abnormalities, Multiple