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Biomedical subjects

P Søgaard

Publications and source records attributed to P Søgaard.

At least 37 records · Page 2Linked to original sources

Pasteurella aerogenes isolated from ulcers or wounds in humans with occupational exposure to pigs: a report of 7 Danish cases.

Pasteurella aerogenes is rarely isolated from human specimens. The species is found in the digestive tract of pigs. From 1976 to 1994 7 strains were cultured in Denmark from wounds or ulcers. Five patients were bitten by pigs and 2 patients with ulcers were employed in pig farming. A mixture of bacterial species was often found. All 7 strains of P. aerogenes were susceptible to ampicillin, cephalosporins and ciprofloxacin. Ability to hydrolyse urea, to produce oxidase and catalase, to decarboxylate ornithine and to produce gas from glucose and inability to produce indole was characteristic for P. aerogenes. Most bite wounds were located on the lower lateral part of the thigh. Foul smelling pus and abscess formation was the rule. Incision, drainage and antibiotic treatment were usually necessary.

Adult↗

[Respiratory tract infections in general practice--the effect of a medical audit project].

A medical audit of the management of respiratory tract infections was performed among 31 general practitioners in Funen county. The first registration of prescriptions in 1992 showed that broadspectrum antibiotics were used to a higher extent than seemed necessary. An intervention with courses, visits to the department of clinical microbiology and distribution of recommendations concerning diagnosis and treatment was performed. The intention was to give the necessary and only the necessary amount of antibiotics and when an antibiotic was indicated to use penicillin as often as possible. A new registration was made one year after the first one. The proportion of antibiotic prescriptions was reduced from 0.49 to 0.38 and the proportion of prescriptions of broadspectrum antibiotics was reduced from 0.21 to 0.12. Detection of group A streptococci in tonsillitis was used more frequently in 1993 than in 1992. Medical audit performed after this model seems a good instrument for changing prescription habits. Medical audit thus seems to be a useful tool in quality improvement in general practice.

Anti-Bacterial Agents↗

A survey of Campylobacter bacteremia in three Danish counties, 1989 to 1994.

Over a 5-year period (April 1989 to March 1994) bacteremia caused by Campylobacter species was diagnosed in 15 patients in a population of 1.3 million in three counties in Jutland province, Denmark. The incidence was 0.2/100,000/year and the ratio of blood to fecal isolates, was 0.008. Campylobacter coli and Campylobacter jejuni accounted for 6 cases each, Campylobacter fetus for 2, and in 1 case the species diagnosis was uncertain. Seven patients were males and 8 females; median age was 42 (range 15-90) years. 11 patients had underlying disorders, including immunological, neoplastic and vascular disease. In a 67-year-old man a Starr-Edwards prosthesis of the aortic valve was probably infected by C. fetus, as recurrent bacteremia resolved following valve replacement. Eight patients had pyrexia and diarrhea, whereas 7 had pyrexia with only slight intestinal discomfort or none at all. In 4 patients the bacteremia was associated with cutaneous cellulitis or vasculitis. 14 of 15 patients survived. Campylobacter bacteremia seems to be more common in Denmark than hitherto thought.

Adolescent↗

Silent myocardial ischaemia in untreated essential hypertensives.

In hypertension, hypertrophy of the left ventricle might enhance the risk of ischaemia because of an augmented oxygen demand and an insufficient oxygen supply. The aims of the study were to estimate the prevalence of silent ischaemia in a group of untreated hypertensives with Holter monitoring and 3 different stress tests, and to look for a possible association between the presence of ischaemia and the blood pressure level as well as the left ventricular mass. The prevalence of silent ischaemia was tested in a group of 34 untreated hypertensives by Holter monitoring and by bicycle ergometer test, hyperventilation and captopril tests. 68% of the patients exhibited silent ischaemic periods during Holter monitoring. There was a trend towards a higher 24-hour SBP and DBP level in patients with ischaemia (p < 0.05), in addition to a tendency towards a higher catecholamine excretion in patients with ischaemia (p < 0.05), and a higher left ventricular mass (NS). Silent ischaemic episodes during ergometer exercise test were found in 27%. Only 3% had ischaemia during hyperventilation and captopril tests. In conclusion, the prevalence of ischaemia during the various stress tests was low, whereas Holter monitoring revealed signs of silent ischaemia in a substantial proportion of the patients. Patients with ischaemia tended to present more severe degrees of hypertension.

Adult↗

Therapeutic effects of captopril on ischemia and dysfunction of the left ventricle after Q-wave and non-Q-wave myocardial infarction.

Treatment with angiotensin-converting enzyme inhibitors has a beneficial effect on myocardial ischemia and left ventricular dysfunction after myocardial infarction. The effect of captopril on myocardial ischemia was evaluated in 58 patients with left ventricular dysfunction (ejection fraction < 45%) after Q-wave or non-Q-wave myocardial infarction in a placebo-controlled, parallel, double-blind study. Patients were randomized on day 7 to either placebo or captopril (50 mg daily) and monitoring for a period of 180 days by serial echocardiography and ambulatory ST-segment monitoring. There was a significant effect of captopril on the duration of ambulatory ST depression during the 180 days: The values per day were reduced from 28 +/- 5 min at baseline to 2 +/- 1 min on day 180 in the Q-wave group (p < 0.01) and from 39 +/- 10 min at baseline to 6 +/- 1 min on day 180 in the non-Q-wave group (p < 0.05). In the placebo group the duration of ST depression on day 180 were 21 +/- 8 min in the Q-wave group and 22 +/- 7 min in the non-Q-wave group, thus being significantly higher as compared with the corresponding captopril groups (p < 0.01 and p < 0.05, respectively). In the placebo Q-wave group there was a significant increase in left ventricular end-diastolic volume index from 74 +/- 3.5 to 89 +/- 4.5 ml/m2 (p < 0.01) during the study period, which was in contrast to unchanged values of 75.5 +/- 3.0 and 75.0 +/- 3.5 ml/m2 (not significant [NS]) in the captopril Q-wave group.(ABSTRACT TRUNCATED AT 250 WORDS)

Captopril↗

Exercise capacity in patients with left ventricular dysfunction following acute myocardial infarction: relation to systolic and diastolic function and intervention with captopril.

Patients with acute or chronic heart disease may have limited exercise capacity if they have reduced left ventricular function. Indexes of reduced left ventricular function during exercise are a predictor of subsequent survival although left ventricular ejection fraction is a poor predictor of physical endurance. We evaluated the effect of captopril on physical endurance in 48 males with left ventricular dysfunction following myocardial infarction. On the 7th day following myocardial infarction patients were randomized to either captopril 50 mg daily or corresponding placebo. Patients were followed up by means of serial echocardiography and exercise stress testing for a period of 180 days. Exercise capacity was significantly improved in the captopril group. Changes in exercise capacity were significantly correlated to changes in left ventricular (LV) volumes and compliance. The beneficial effect of captopril on exercise capacity was probably mediated via improvement in LV performance and compliance.

Captopril↗

Human ventricular myosin light chain isotype 1 as a marker of myocardial injury.

A monoclonal enzyme immunoassay for measuring human ventricular myosin light chain isotype 1 (HVMLC1) in serum has been developed. To evaluate the method in patients with suspected myocardial injury, we studied 51 patients (16 acute myocardial infarction (AMI), 19 unstable angina pectoris (UAP), 9 stable angina pectoris, 3 nonischemic heart disease, 4 hip surgery patients), and 190 controls (blood donors). Serial blood-samples were drawn from patients; a single blood-sample from controls. The diagnostic value of the HVMLC1 assay was compared with total creatine kinase (CK), CKMB activity, CKMB mass concentration, lactate dehydrogenase isoenzyme 1 (LD1), troponin T (TnT) and mitochondrial-aspartate aminotransferase (m-ASAT). The detection limit of HVMLC1 was 0.4 microgram/l (linear range 0-20 micrograms/l). Sera from 190 reference persons did not contain detectable levels of HVMLC1 (< 0.4 microgram/l; 99% percentile). The coefficients of variation were 13% (1.0 microgram/l) and 3.1% (17.7 micrograms/l). Cross-reactivity with myosin from skeletal muscle was seen. Times to peak value were: CK 19.3 +/- 2.0, LD1 43.4 +/- 3.2, HVMLC1 72.9 +/- 7.0, and m-ASAT 67.3 +/- 5.6 h. Time-curves of HVMLC1 and m-ASAT were similar, whereas time-curves for HVMLC1 and TnT were quite different in most cases. Peak value of HVMLC1 was five times higher than CK peak value and eight times that of LD1. HVMLC1 appeared in the blood within hours after the onset of chest pain and in the majority remained for more than a week after AMI. Among patients with UAP 16% (3/19) had elevated HVMLC1 in serum, whereas elevated TnT was seen in 26% (5/19) and elevated CKMB mass in 26% (5/19). We conclude that the new HVMLC1 assay offers a sensitive diagnosis of myocardial injury. It is characterized by a wide diagnostic time window. The similarity of the HVMLC1 and m-ASAT curves indicates that it may be used to estimate the extent of myocardial necrosis.

Adult↗

Ventricular arrhythmias in the acute and chronic phases after acute myocardial infarction. Effect of intervention with captopril.

BACKGROUND: Ventricular arrhythmias (VAs) are independent predictors of mortality in survivors of myocardial infarction (MI), and they are more likely to be induced in dilated hearts with increased wall stress. Angiotensin-converting enzyme (ACE) inhibitors have been shown to prevent progressive dilation of the left ventricle after MI. METHODS AND RESULTS: The effects of captopril were evaluated in 58 patients with left ventricular (LV) dysfunction after MI. Patients were randomized on day 7 to either placebo or captopril (50 mg daily) in a double-blind parallel study over a period of 6 months. Patients were followed up by means of ambulatory ECG monitoring and echocardiography. There was a significant increase in VA in the placebo group (P < .05) in contrast to a significant decrease in the captopril group (P < .05). As a consequence, there was a significant between-group difference after 6 months (P < .05). Furthermore, the number of patients without VA at baseline who presented with this at the completion of the study was 6% in the captopril group versus 38% in the placebo group (P < .05). At baseline as well as at the termination of the study, LV end-diastolic volume index (LVEDVI) and LV end-systolic volume index (LVESVI) were significantly increased among patients with VA (P < .01). On day 180, both myocardial ischemia and an increase in the LVEDVI were independent predictors of VA; however, progressive dilation of the left ventricle was confined to the placebo patients with significant increases in the LVEDVI compared with the captopril group: 17% versus 0%, respectively (P < .01). Furthermore, the duration of ambulatory ST-segment depression was significantly longer in this group compared with the captopril group (P < .01). CONCLUSIONS: Dilation of the left ventricle and myocardial ischemia predict VA during both the acute and chronic phases after MI. In post-MI patients with LV dysfunction, captopril has a beneficial effect on both the number of complex VAs as well as the number of patients who develop VA during the chronic phase. This is in all probability mediated through effects on both LV remodeling, LV function, and myocardial ischemia in patients who are exposed to an increased risk of undergoing progressive dilation of the left ventricle.

Acute Disease↗

Phenotypical characters and ribotyping of Pasteurella aerogenes from different sources.

On the occasion of five Danish human Pasteurella aerogenes from pig bite lesions, a comparison was made between 6 isolates from man and 15 animal isolates, mainly from pigs. The strains originated from 6 different countries (USA, Canada, Czechoslovakia, France, Belgium and Denmark). The 21 isolates were characterized by conventional biochemical tests, antibiogram and the API 20 NE kit; finally ribotyping was carried out by hybridizing EcoRI-digested chromosomal DNA with a probe derived from E. coli ribosomal RNA. By ribotyping, 19 of the 21 strains clustered at a similarity level of 81% or more; both phenotypical tests and ribotyping indicated that the remaining two strains did not belong to the species P. aerogenes. In conclusion, despite minor differences our P. aerogenes isolates constituted a well-defined group and they could not be subdivided on basis of animal or geographical origin.

Animals↗

Myocardial ischaemia and spinal analgesia in patients with angina pectoris.

We have studied prospectively myocardial ischaemic events by Holter monitoring of ST-segment depression in patients with angina pectoris given spinal analgesia for minor surgery compared with a reference day of normal daily activities. Monitoring was undertaken continuously for 24 h on both days, starting just before anaesthesia on the day of surgery. On the reference day, seven of 14 patients had 27 ischaemic events with mean max ST-depression of 0.15 mV and total duration of 143 min, compared with 10 of 14 patients with 70 ischaemic events with mean max ST-depression of 0.22 mV and total duration of 1078 min (P < 0.01 for all). On the day of surgery, the first ischaemic event occurred a mean 338 min (range 75-480 min) after spinal analgesia, and the duration of all first events was 480 min. On this day, the first ischaemic event was associated with increased heart rate (103 beat min-1 (range 66-131 beat min-1) compared with 92 (60-122) beat min-1 during all events (P = 0.011)). In patients with angina pectoris, myocardial ischaemia did not occur immediately after the onset of spinal analgesia, but several hours later, corresponding to the cessation of block. This could be explained by increased cardiac pre- and afterload, probably further aggravated by the volume load.

Aged↗

Effects of captopril on ischemia and dysfunction of the left ventricle after myocardial infarction.

BACKGROUND: Treatment with angiotensin converting enzyme inhibitors has been shown to be beneficial in patients with heart failure and myocardial infarction. Experimental studies have shown beneficial effects on the ischemic myocardium. METHODS AND RESULTS: The effects of captopril were evaluated in 64 patients with left ventricular dysfunction after myocardial infarction. The patients were randomized at day 7 to either placebo or captopril (50 mg daily) in a double-blind parallel study over a period of 6 months. The patients were followed up by means of ambulatory ECG monitoring, bicycle ergometer testing, and echocardiographic examination. The duration of ST segment depression detected during ambulatory ECG monitoring was lower in the captopril group (87 minutes) than in the placebo group (638 minutes) (p < 0.001), and the number of patients in the captopril group with exercise-induced ST segment depression (p < 0.01) was lower at the completion of the study. The working capacity increased during the study period from 540 +/- 47 seconds to 738 +/- 41 seconds (p < 0.01) in the captopril group and was higher than that in the placebo group (530 +/- 43 seconds, p < 0.01) at the end of the study. Furthermore, a significant dilation of the left ventricular end-diastolic and end-systolic volumes was observed in the placebo group (p < 0.05); this was prevented in the captopril group where, in addition, a reduction in end-systolic volume was observed (p < 0.05). CONCLUSIONS: Captopril has a favorable effect on the dysfunctioning myocardium after myocardial infarction inasmuch as the ischemic burden is reduced, the working capacity is increased, dilation of the left ventricle is prevented, and systolic function is improved.

Captopril↗

Effects of captopril on left ventricular systolic and diastolic function after acute myocardial infarction.

The left ventricle progressively dilates in some patients after acute myocardial infarction (AMI). Both systolic and diastolic left ventricular (LV) dysfunction can be of significance in the development of heart failure. Captopril has been shown to prevent dilatation, but the effect on LV diastolic function is unknown. In a placebo-controlled double-blind parallel study, 58 AMI patients with heart failure or low ejection fraction, or both, were consecutively randomized at day 7 to either placebo or captopril (25 mg twice daily). No differences were present between the groups at baseline. Fifty-three patients completed the 6-month study period. Both LV diastolic and systolic volume indexes increased significantly in the placebo group (17 and 14%, respectively); in the captopril group there was no change in LV diastolic volume index, but a 13% reduction in LV systolic volume index. Ejection fraction increased significantly in the captopril group. The peak flow velocities of the early and atrial filling phases were measured, and the ratio between the velocities was calculated. A significant reduction was observed during the study period in early peak flow velocity (65 to 52 cm/s) and in the ratio between early and atrial peak flow velocity (1.3 to 0.8) in the placebo group (p less than 0.05), but no significant changes occurred in the captopril group. No correlation was found between dilatation of the left ventricle and reduction in early peak flow velocity or the ratio between early and atrial peak flow velocity. In conclusion, captopril prevented LV dilatation, improved ejection fraction and prevented LV diastolic dysfunction in AMI patients with early signs of LV systolic dysfunction.

Aged↗

Aseptic colon resection by an invagination technique. Experimental study on dogs.

A new aseptic colon resection by an invagination technique is presented. The bowel to be resected is invaginated down into the healthy intestine, and the anastomosis is sutured in one layer of continuous suture before transection by a diathermy wire, placed in the intestinal lumen via the anus. Sections of bowel that cannot be invaginated, e.g., because of a tumor, are first removed by transection between pairs of cable ties, which close the lumen. Twenty dogs were operated on without receiving prophylactic antibiotics. In 10, the intestine was transected between cable ties. An imprint, taken from the anastomosis and subcutis, was cultured. The bacterial count at the anastomosis exceeded 100 in only three cases; in the subcutis, this was the case in one dog. One wound infection developed. Serial barium enemas at 1, 2, 3, and 4 weeks revealed no anastomotic leakage. One early death because of a total anastomotic dehiscence was encountered, and two dogs were killed because of wound dehiscence and anastomotic stricture, respectively. It is concluded that, in dogs, the method is easily and safely performed, but further experimental studies are needed.

Anastomosis, Surgical↗

Bacteriological autopsy. I. A methodological study.

The two aims of this investigation were: 1. To compare a swab culture technique with an imprint method in bacteriological autopsy. 2. To examine the influence of body manipulation on culture. Specimens were taken from the lungs and the spleen in 42 autopsies. For imprint a piece of sterile blotting paper was used. Point 1. Good qualitative agreement was found between the two methods. Print cultures enabled a quantitation at low numbers of bacteria. However, in most cases when growth was present the colonies were confluent, which did not allow counting. The lung cultures were 67%/69% positive (swab/print). For the spleen, the positive rate was 21%/42% (swab/print). In the cases representing the difference, only a few colonies grew on the print plates. Culture by means of a swab was found to give the same information as culture by imprint. Swabs are easier to handle but should be processed within a couple of hours. Point 2. In ten autopsies, cultures were taken with organs in situ after the organ block was removed and after an ordinary autopsy had been performed. A scoring system was used to compare the results. There was a clear correlation between positive cultures and manipulation of the organs. The specimens should be taken with the organs in situ.

Autopsy↗

Bacteriological autopsy. II. Comparison of a group of cancer patients with a control group.

A study of the results of bacteriological autopsy in a group of cancer patients compared with a control group was carried out. Autopsy was performed on 42 bodies within 24 hours of death. Thirty-two patients had died with a cancer and the remaining ten had died of cardiovascular disease. Tissue for microscopy and material and culture were taken from the same sites. The results of the inoculations were semiquantified, resulting in a culture score, and the results of the microscopy were classified according to presence of bacteria and kind of inflammation. Furthermore, grading was done according to the degree of inflammation and whether bacteria were seen at microscopy. The culture scores were significantly higher in the cancer group than in the control group. We found a significant correlation between score and presence of acute inflammation. Likewise, a significant correlation was found between score and presence of bacteria at microscopy. As a difference between the cancer group and the control group was seen, further research on bacteriological autopsy seems worthwhile.

Adult↗

Gradation of unstable angina based on a sensitive immunoassay for serum creatine kinase MB.

A newly developed, highly sensitive immunoassay for creatine kinase MB isoenzyme was evaluated in 68 patients with or without different types of ischaemic heart disease. Patients were classified on the basis of clinical criteria in four groups: no ischaemic heart disease, stable angina, unstable angina, and acute myocardial infarction. Enzyme concentration in patients with stable angina was the same (even during exercise) as seen in the patients without ischaemic heart disease. Patients with unstable angina, however, could be divided into two groups. One group showed clear evidence of severe myocardial ischaemia by serial changes and higher mean values of creatine kinase MB up to 40 hours after the onset of symptoms, whereas in the remainder values were stable and resembled those seen in the patients without ischaemic heart disease. The changes in concentration correlated with signs of repetitive ischaemic episodes deduced from continuous ST segment monitoring during the first 24 hours after admission. These findings indicate that patients with unstable angina are a heterogenous group. In some, severe and prolonged ischaemia can be detected by a serological assay with high sensitivity.

Angina Pectoris↗