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Biomedical subjects

P Mogensen

Publications and source records attributed to P Mogensen.

At least 19 recordsLinked to original sources
PubMed1999

Metabolic evaluation and medical management of upper urinary tract stone disease. Guidelines from the Scandinavian Cooperative Group for Urinary Stones.

A set of simple guidelines for metabolic evaluation and medical/dietary management of patients with urolithiasis is presented. The evaluation scheme is based on the documented risk factors in the Nordic area and the results of controlled clinical trials, and takes its basis in the severity of the stone disease in the individual stone patient. The initial evaluation in all patients aims at diagnosing conditions with a definitive metabolic, infectious or anatomical/functional cause of stone formation (MIAF urolithiasis). Patients with MIAF urolithiasis are treated according to the nature of the underlying disease. Having excluded/diagnosed MIAF urolithiasis, patients with idiopathic calcium nephrolithiasis remain, and in this group, which comprises approximately 85% of the total stone population in the Scandinavian region, only those with a complicated stone disease are subjected to additional evaluation, which aims at identifying underlying pathophysiological derangements for which medical therapy has been proven to be effective in controlled clinical trials.

Dietary Proteins↗
PubMed1997

Extracorporeal shock wave lithotripsy as first line monotherapy of solitary calyceal calculi.

Eighty-four patients with solitary calyceal stones were treated with Extracorporeal Shock Wave Lithotripsy (ESWL) as first line monotherapy. The indications for treatment were pain in 51 patients (61%), infection in 11 patients (13%), pain and infection in 18 patients (21%) and others in 4 patients (5%). Stone size (largest diameter) was median 9 mm (range 2-25 mm). Follow-up consisted of clinical control, isotope renography and a plain film after 1 month; hereafter plain films after 3 and 6 months. Auxiliary procedures due to steinstrasse were performed in 3 out of 4 patients (1 nephrostomy, 1 nephrostomy + ESWL of ureteral fragments, and 1 ureteroscopic manipulation). Retreatment of the calyceal stone was performed in 3 patients within 6 months (2 re-ESWL, 1 lower pole resection). Stone-free (without retreatment or auxiliary procedures) were 26/84 (31%) after 1 month, 34/84 (40%) after 3 months and 38/84 (45%) after 6 months. Free of pain were 43/69 (62%) after 1 month, 50/69 (72%) after 3 months and 59/69 (86%) after 6 months. Free of infection were 18/29 (62%) after 1 month, 19/29 (66%) after 3 months and 21/29 (72%) after 6 months. Complications included steinstrasse in 4 patients, sepsis in 3 patients, displacement of JJ-stent in 2 patients and atrio-ventricular dissociation in 1 patient. To conclude: ESWL as first line therapy for solitary calyceal calculi offers good results with regard to pain and clearance of infection, but leaves 55% with residual stone material.

Adult↗
PubMed1997

Estramustine phosphate versus placebo as second line treatment after orchiectomy in patients with metastatic prostate cancer: DAPROCA study 9002. Danish Prostatic Cancer Group.

PURPOSE: We compared the effect of 560 mg. estramustine phosphate daily to placebo as a supplement to standard palliative therapy in patients with progressive disease after bilateral orchiectomy as first line therapy for metastatic prostate cancer. MATERIALS AND METHODS: In a double-blind multicenter study 131 patients with progressing metastatic hormone refractory prostate cancer were randomized to receive 280 mg. estramustine phosphate 2 times daily versus placebo. End points were clinical progression and death. Adverse events, decrease in prostate specific antigen (PSA) and subjective response were also assessed. RESULTS: Adverse events were common in both groups but breast tenderness/gynecomastia and diarrhea were more frequent among patients in the estramustine phosphate group. Subjective responses were few (9 of 50 estramustine phosphate and 4 of 57 placebo cases, p = 0.15). Median observation time for survival was 43 months and 124 patients died. Median time to subjective progression and median overall survival did not differ significantly between the 2 groups at 4.6 and 9.4 months in the estramustine phosphate group versus 5.0 and 6.1 months in the placebo group. Of 61 patients in the estramustine phosphate group 29 achieved a reduction in PSA of more than 25% at 1 month of followup compared to only 3 of 68 receiving placebo. A decrease in PSA after 1 month correlated significantly with survival. CONCLUSIONS: Although this study did not prove estramustine phosphate to be superior to placebo in terms of protocol end points, it generates the hypothesis that prolonged survival may be achieved with estramustine phosphate treatment in a subgroup of patients and that this may be predicted by a decrease in PSA after 1 month of therapy.

Aged↗
PubMed1996

Long-term predictive role of urodynamics: an 8-year follow-up of prostatic surgery for lower urinary tract symptoms.

OBJECTIVE: To investigate the long-term predictive value of urodynamics for the outcome of patients undergoing prostatic surgery for lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO) and to determine the long-term effectiveness on symptoms, maximum flow rate and the rate of re-operation. PATIENTS AND METHODS: Of 139 elderly men who had undergone prostatic surgery, selected without reference to urodynamic assessment but having extensive (blinded) urodynamic testing included in their evaluation, 79 were followed for 8 years using a history, symptom score analysis, uroflowmetry and review of their records. RESULTS: Comparing the results in groups of men with a pre-operative maximum flow rate < or > or = 15 mL/s, there was a similar difference in the rate of success to that noted 6 months post-operatively. Similar results were obtained when comparing those with BOO or a normal bladder outlet function. However, although the tendency was clear it was not statistically significant because of the small sample size (type-2 error). There was a significant reduction in all symptom scores from those assessed pre-operatively and during the 8 years (P < 0.001). The median pre-operative maximum flow rate was 8.5 mL/s, compared with 12.5 mL/s after 8 years (P < 0.001). Of the 79 patients, 14 (18%) had 28 re-operations during the 8-year follow-up, 12 being repeat resections of the prostate, giving a repeat resection rate of 1.8% per year and a success rate of 71%. During the 8 years, 82% of the patients had an unchanged overall evaluation of the post-operative outcome. In general, those having an unsatisfactory outcome were slightly younger than the whole group. CONCLUSION: Uroflowmetry and pressure-flow studies can predict to some degree the long-term result after prostatic surgery. There was a durable effect on symptom scores and maximum flow rates after the operation. The annual rate of repeat resection (1.8%) was relatively low.

Adult↗
PubMed1996

Placebo effects in the pharmacological treatment of uncomplicated benign prostatic hyperplasia. The ALFECH Study Group.

In order to establish accurately the exact effect of any drug therapy for symptomatic benign prostatic hyperplasia (BPH) it is important to define the effect of placebo treatment. This effect was assessed by throughly analyzing the placebo arm, which included 101 patients, from a randomized, double-blind, placebo-controlled trial of the selective alpha-blocker alfuzosin and comparing the data with those of a variety of independent studies which followed a placebo group of patients with clinical BPH. Following 16 weeks of placebo treatment a decrease of 24% (p < 0.05) in Madsen-Iversen score and an increase of 14% (p < 0.05) in peak flow rate was demonstrated. The percentages of patients who reported worsening, improvement or no change in symptoms were 9.2%, 73.6% and 17.2% respectively. The maximal effect of placebo, approximately 40% reduction in symptom scores, is likely to be achieved within the first four to six months. After this, the placebo effect stabilizes and gradually wears off but is still present following 12 months of treatment. The duration of the placebo effect and the time until it has totally worn off, if ever, remains to be studied in long-term, placebo-controlled trials, including an untreated cohort. The present study emphasizes the importance of properly designed, double-blind, placebo-controlled studies in evaluating any pharmacological intervention in clinical BPH.

Adrenergic alpha-Antagonists↗
PubMed1995

CSF and plasma concentrations of free norepinephrine, dopamine, 3,4-dihydroxyphenylacetic acid (DOPAC), 3,4-dihydroxyphenylalanine (DOPA), and epinephrine in Parkinson's disease.

OBJECTIVE: To investigate endogenous cerebrospinal fluid catecholamines in Parkinson's disease. MATERIAL AND METHODS: Basal concentrations of free norepinephrine (NE), dopamine (DA), epinephrine (E), 3,4-dihydroxyphenylacetic acid (DOPAC) and 3,4-dihydroxyphenylalanine (DOPA) in cerebrospinal fluid (csf) and plasma were measured using reverse-phase HPLC with electrochemical detection in 16 patients with Parkinson's disease and 21 control patients with low back pain. RESULTS: Parkinsonian patients had significantly decreased values of csf NE and DOPAC, the strong relationship between plasma and csf NE was disrupted and neither was there any age related increase of plasma NE. In l-DOPA treated patients plasma DA and DOPA concentrations were raised and csf DOPAC values were inversely related to severity of disease (Hoehn and Yahr score). Csf E concentrations were also reduced in parkinsonian patients whereas csf DA concentrations were unchanged. Csf DOPA concentrations were insignificantly decreased in parkinsonian patients. CONCLUSIONS: These results point towards a diffuse neuronal dysfunction in Parkinson's disease and indicate that lumbar csf NE and csf DOPAC are of central nervous origin.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1994

Long-term probability of prostatism vs general morbidity and mortality. Prospectively obtained data in a randomly selected cohort aged > 50 years.

In a 7-year study of 178 randomly selected healthy men older than 50, data were respectively obtained concerning treatment for benign prostatic hypertrophy (BPH) and overall morbidity and mortality. Plain symptom scores were calculated in all cases and urinary voiding was recorded in 112. The maximum flow rate was read and the pattern of flow curve determined. Log rank test and survival curves were used in evaluation of results. The general risk of death or disease overshadowing BPH greatly exceeded the probability of surgery for prostatism. The only factor predicting need for prostatectomy was a symptom score higher than 6 points. If the symptom score is low and indications for treatment are otherwise, relative, an expectant attitude to surgery for BPH is advocated.

Age Factors↗
PubMed1994

Primary in situ extracorporeal shock wave lithotripsy for ureteral calculi.

The use of a second generation lithotriptor (Siemens Lithostar) for ESWL treatment of 199 consecutively referred patients with ureteral calculi is evaluated. Follow up data were available in all patients. In 79 patients the calculus was located in the upper third of the ureter, in 43 patients in the middle third and in 77 patients in the lower third of the ureter. In situ ESWL was performed in 187 patients (94%) under local infiltration analgesia, if invasive procedures in conjunction with ESWL were not planned. The overall stone free rates for all patients after 1, 3 and 6 months were 62.3%, 82.4% and 89.9% respectively. The size of the calculus influenced the outcome of treatment, the number of treatments and number of shock waves given. The stone free rates 3 and 6 months after ESWL in patients with upper ureteral calculi were 86.1% and 91.1%; the number of treatments per patient was 1.2. The corresponding rates for patients with mid or lower ureteral calculi were 76.7%, 86.0% (1.0 treatment) and 81.8%, 90.9% (1.2 treatment) respectively. ESWL alone failed to clear calculi in 4 patients with upper ureteral stones, 6 patients with mid-ureteral calculi and 14 patients with lower ureteral calculi. The number of additional procedures post-ESWL was significantly higher among patients with calculi in the lower third of the ureter. It is concluded, that ESWL in situ with a second generation lithotriptor using X-ray localization is an effective and noninvasive method to treat ureteral calculi. In situ ESWL is recommended as first line treatment for ureteral calculi in the upper and mid-thirds.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Longitudinal observations on normal and abnormal voiding in men over the age of 50 years.

A cohort of 200 men over the age of 50 years was selected at random. Initially 112 men participated. After 5 years 61 were participating, and 2 years later 34 men still had no voiding problems, while 19 had had treatment for prostatism. A history was obtained and all 112 had symptom analysis and uroflow examination. The uroflow variables Qmax, Qave, Qmax-time, Q "corrected", volume and the ratio Qmax/Qmax-time were recorded together with the symptom score and subjective evaluation. After 5 and 7 years all primary data were reviewed in the 61 and 34 men respectively, while a full history was obtained in the rest. The 3 sets of data were evaluated separately as 3 cross-sectional investigations and as paired data sets by means of non-parametrical statistical analysis. Comparing the 3 sets of data longitudinally, significant differences were found in Qmax, Qave, Qcor and Acc. A correlation analysis showed that Qmax, Qave, Q "corrected" and volume decreases significantly with advancing age in asymptomatic men, while no correlation with age was found in the 19 treated men. On the basis of the 93 men, untreated for 7 years, nomograms of Qmax, Volume and Acc were constructed using 2.5, 25, 50, 75 and 97.5% percentiles in 5-year groups. Likewise, a nomogram on symptom score was constructed on the basis of the 82 men, asymptomatic and untreated for 7 years. In conclusion, uroflow in subjectively normal men over the age of 50 years shows increasing abnormality with advancing age. At the same time elderly men tolerate a considerable amount of symptoms of infravesical obstruction. The severity of symptoms increased with advancing age, but differently in persons likely and not likely to need operation.

Aged↗
PubMed1992

Anesthesia and complications of extracorporeal shock wave lithotripsy of urinary calculi.

The techniques of anesthesia for extracorporeal shock wave lithotripsy of urinary calculi and the associated complications in 600 treatments with the second generation lithotriptor Siemens Lithostar were studied. General anesthesia was used in 17 treatments (2.8%) and epidural anesthesia was applied in 73 (12%), primarily in children and patients in need of simultaneous surgical auxiliary procedures. A total of 510 treatments (85%) was performed with a combination of local infiltration anesthesia and supplementary intravenous opiates. In 65% of the cases only 2 injections of opiates were sufficient for pain relief. There were no complications in 394 treatments (77%) and minor complications, such as arrhythmia (9.2%) and nausea/vomiting (7.6%), were easily treated. Respiratory depression was observed in 10 cases (2%) and this potentially dangerous complication was associated with simultaneous administration of opiates and midazolam. Only 9 treatments (1.8%) had to be terminated due to complications. It is concluded that most treatments of urinary calculi with this second generation extracorporeal shock wave lithotriptor can be performed with local infiltration anesthesia combined with supplementary short-acting opiates intravenously for pain relief and sedation. When administering supplementary midazolam for sedation the risk of respiratory depression should be considered.

Adolescent↗
PubMed1992

Local anesthesia for extracorporeal shock wave lithotripsy: a study comparing eutetic mixture of local anesthetics cream and lidocaine infiltration.

A study of the anesthetic efficacy of a eutetic mixture of local anesthetics (EMLA cream) versus lidocaine infiltration in extracorporeal shock wave lithotripsy (ESWL) was done. A total of 46 patients had 30 gm. of EMLA cream applied to the skin over the kidney and 45 had subcutaneous infiltration anesthesia with 20 ml. 1% lidocaine with epinephrine. All patients received an intravenous dose of morphine just before ESWL. The patients were comparable with regard to age, sex, weight, morphine dosage, number of shock waves given and duration of treatment. Median pain score and the amount of supplementary analgesics were not significantly different between the 2 groups. There were no significant differences between the groups with regard to post-ESWL skin changes. Therefore, EMLA cream can be recommended for ESWL provided it is applied correctly.

Adolescent↗
PubMed1992

Age-related variation in urinary flow variables and flow curve patterns in elderly males.

A group of randomly selected males, over 50 years of age, was examined with regard to history and urinary flow rate. Originally, the group had comprised 93 men without voiding problems, 15 who, although suffering from voiding problems, had not yet contacted their doctor, and 4 who had contacted their doctor because of voiding problems. Five years later the data were re-examined and 61 men were fully investigated again; in the remaining 51 patients only the history was updated. The 2 sets of data were evaluated separately as 2 cross-sectional investigations and as paired data sets by means of non-parametric statistical analysis. All uroflow variables were considered, i.e. Qmax, Qave, Qmax-time, Q "corrected", volume and the ratio Qmax/Qmax-time. In addition, the flow curve configuration was classified as normal or abnormal. When compared as 2 cross-sectional investigations, the latter confirmed the results of the first. Qmax, Qave, Q "corrected" and volume decreased with advancing age, but no correlation could be demonstrated between Qmax-time and age. The flow curve pattern altered, so that a normal flow curve was seldom seem at an advanced age. Uroflow variables tended towards the abnormal with advancing years and symptoms increased concurrently. These changes were largely accepted by the elderly males. Thus the decision to operate for benign prostatic hyperplasia should be based on both history and urinary flow.

Aged↗
PubMed1991

Cytotoxic activity in plasma from patients with amyotrophic lateral sclerosis.

The present study evaluates an assay of cytotoxic effect of plasma from patients with amyotrophic lateral sclerosis. Plasma from 20 recently diagnosed ALS patients induced hemolysis of normal red blood cells with a significantly greater intensity than that of normal controls. After at least 1 month of treatment with prednisone and azathioprine, the hemolytic activity of ALS plasma was reduced but was still higher than that of control plasma.

Aged↗
PubMed1991

Transurethral ultrasound scanning in the evaluation of invasive bladder cancer.

One hundred and sixty-six patients suspected of having bladder tumours underwent transurethral ultrasound scanning before cystoscopy. Forty-nine patients had no tumour either at cystoscopy or on ultrasonography. Nine of the remaining 117 patients (8%) had false positive results and in a further 8 (7%) the ultrasound failed to show the tumour. The diagnostic accuracy for superficial tumours was 73%, whereas the accuracy in assessing muscle infiltrating and more advanced tumours was almost identical, 58-59%. It is concluded that transurethral ultrasound scanning does not add to the information obtained from cystoscopy and bimanual palpation in patients with bladder tumours.

Adult↗
PubMed1991

Extracorporeal shock wave lithotripsy of urinary calculi. Results from the first 306 patients treated at the Copenhagen Municipal Stone Center with a second generation lithotriptor.

The first Danish experience with Extracorporeal Shock Wave Lithotripsy (ESWL) using a second generation Lithotriptor (Siemens Lithostar) is reported. 306 patients underwent 392 treatments for 363 stones. There were 339 renal calculi including 5 staghorn calculi and 54 ureteral calculi. Treatments were performed under local analgesia (82%) or epidural or general anesthesia (18%) when invasive procedures had to be done in connection with the treatment. Stone fragmentation was achieved with 2487 +/- 1262 shocks. The first months stone clearance rate was 45%; 26% had fragments less than 6 mm; 29% had residual stones. Corresponding rates after 3 and 6 months were 58%, 24% and 18% and 70%, 21% and 9% respectively. Septicemia occurred in 4 patients and cardial arrhythmia in 34 patients (11%). No serious intra- or perirenal hematomas were registered. In 9% additional procedures were required and 11 patients had residual stones removed at open surgery. The used second generation lithotriptor with X-ray based stone localisation is effective for treatment of both renal calculi and ureteral calculi in situ in all three segments of the ureter.

Adolescent↗
PubMed1990

A phase III trial of zoladex and flutamide versus orchiectomy in the treatment of patients with advanced carcinoma of the prostate.

In a multicenter Phase III trial 264 patients with advanced prostatic cancer were randomized to either bilateral orchiectomy or treatment with zoladex supplemented by flutamide. Presently, median follow-up time is 30 months. A small difference in objective response was recorded in favor of the combination therapy, whereas no statistically significant difference was found in subjective response to therapy, time to progression, and overall survival. Adverse effects were more commonly encountered in the pharmacologically treated patients. It is concluded that the combination of zoladex plus flutamide is not clinically superior to orchiectomy in the treatment of patients with advanced carcinoma of the prostate.

Aged↗
PubMed1990

[Extracorporeal shock wave treatment of urinary calculi. Results after treatment of the first 207 patients at the Copenhagen City Stone Center with a second generation lithotriptor].

Early experience of extracorporeal shock wave lithotripsy (ESWL) using a second generation lithotriptor (Siemens Lithostar) is reported. Two hundred and seven patients underwent 272 treatments for 291 stones. There were 259 renal calculi, including three staghorn calculi and 32 ureteric calculi. Treatments were performed under local analgesia (78%) or epidural or general anaesthesia (22%) when invasive procedures had to be done in connection with the treatment. Stone fragmentation was achieved with 2,487 +/- 1,262 shocks. The first month stone clearance rate was 43%, 24% had fragments less than 6 mm and 33% had residual stones. The same figures after three and six months were 57%, 23% and 20% and 71%, 23% and 6%, respectively. Septicaemia occurred in four patients and cardiac arrhythmia in 24 patients (12%); no serious intra- or perirenal heamatomas were registered. In 7% additional procedures were required, seven patients had residual stones removed at an open operation. The Lithostar is an effective second generation lithotriptor which can be used for renal, staghorn and ureteric calculi in situ in all three segments without stone manipulation prior to ESWL.

Adolescent↗