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Biomedical subjects

P Vestergaard

Publications and source records attributed to P Vestergaard.

At least 109 records · Page 6Linked to original sources
PubMed1997

Generalisability of results from randomised drug trials. A trial on antimanic treatment.

BACKGROUND: Exemplified by a randomised trial on antimanic treatment, this paper addresses the question of whether selection of patients for drug trials may limit the applicability of study results from the randomised patients to a wider population. METHOD: During two-year period, all consecutively admitted patients from a defined catchment area were screened for inclusion criteria concerning age, diagnosis and severity of illness. The subsequently excluded subgroups of patients were compared with the randomised patients by multivariate data analysis. RESULTS: One hundred and sixty-four patients met the inclusion criteria. However, after exclusion for various reasons, only 27 (17%) patients remained for randomisation. The randomised patients and the excluded patients differed substantially. CONCLUSIONS: The generalisability of trial results is limited. Reports of randomised drug trials should carefully describe the screening procedure for inclusion and, when possible, present relevant comparisons-between the randomised patients and the various subgroups of excluded patients.

Adolescent↗
PubMed1997

Long-term home studies of water balance in patients with nocturnal enuresis.

A 2-week, home-based study was conducted on 75 children with nocturnal enuresis to monitor the frequency of enuretic episodes and the volume of nocturnal urine production. The objectives of the study were to correlate nocturnal urine production to the occurrence of nocturnal enuresis and response to desmopressin (Minirin, DDAVP) treatment. Furthermore, patient compliance was evaluated. Enuresis episodes and nocturnal urine production was recorded every night during two base-line weeks without treatment and during 2 weeks with 20-40 micrograms desmopressin at bedtime. During both periods fluid intake and micturition volumes were recorded for 2 days. Desmopressin response was defined as > 50% reduction in wet nights during treatment. It was found that patient compliance was acceptable in most patients. Regarding urine output it was found that base-line nocturnal urine production was significantly higher during nights when enuresis occurred than during "dry" nights and significantly higher in desmopressin responders compared with desmopressin non-responders. During treatment with desmopressin, nocturnal urine production in desmopressin responders decreased to levels similar to those of non-responders. The results confirm inpatient circadian studies of urine output and emphasise the importance of nocturnal polyuria in patients with monosymptomatic enuresis. The response to desmopressin was found to correlate with the occurrence of nocturnal polyuria. Home studies were considered to be a useful tool in the characterisation of patients with nocturnal enuresis.

Administration, Intranasal↗
PubMed1996

How to interpret findings on mortality of long-term lithium treated manic-depressive patients?! Critique of different methodological approaches.

Many studies have shown that patients with affective disorders have a mortality markedly higher than that of the general population. Studies of manic-depressive patients given prophylactic lithium treatment have yielded varying results. Some authors have reported mortalities which were more than four times that of the general population. Others have found mortalities which did not differ significantly from that of the general population. In order to examine these discrepancies we re-analysed the data of a previous study by IGSLI, using three different methods to calculate the Standardised Mortality Ratio (SMR). The data base was enlarged by adding mortality data from two additional centres. The results indicate that the discrepancies may result from the common use of a 'cumulative' approach which produces a distortion of the data if the treatment duration is not taken into consideration properly. An analysis which eliminates this artefact and takes the treatment duration into account ('year-by-year' approach) provides the strongest evidence that the mortality of lithium treated patients is not significantly different from that of the general population.

Adult↗
PubMed1996

[Active treatment of uremia in the study county of Vejle. Epidemiology 1979-1994 and future perspectives].

We studied 275 renal replacement therapy (RRT) patients in a Danish county (population 329,000) from January 1st 1979 to June 30th 1994. Incidence, prevalence and age of new patients increased. The fraction of patients with diabetic nephropathy also increased. Patient survival remained constant (five-year survival 62% for patients observed for more than 90 days). The total number of new patients entering haemodialysis and peritoneal dialysis seemed to be reaching a constant level, that could be calculated using a logistic function. The fraction of patients leaving therapy remained constant over the years and was higher for peritoneal dialysis than for haemodialysis (32 vs. 20% per year). The future prevalence can be estimated by combining these two last findings.

Adolescent↗
PubMed1996

[Multiple endocrine neoplasia type 2a and 2b].

Multiple endocrine neoplasia type 2a and 2b (MEN 2a and 2b) are rare diseases, inherited as autosomal dominant traits. The neoplasias in MEN 2a are medullary thyroid carcinoma, pheochromocytoma and hyperparathyroidism. In MEN 2b a characteristic phenotype is seen in combination with medullary thyroid carcinoma and pheochromocytoma. Through screening the diseases can be detected at an early stage, hereby improving prognosis. This is important as the diseases are inherited and occur in young individuals. In this review, epidemiology, clinical features, diagnosis and treatment are discussed.

Carcinoma, Medullary↗
PubMed1996

Treatment of manic episodes: zuclopenthixol and clonazepam versus lithium and clonazepam.

For the treatment of acute mania, no single drug is sufficiently effective in daily clinical routine for all patients. Drug combinations are often prescribed but poorly investigated. The present study examined whether a treatment with a neuroleptic drug (zuclopenthixol) combined with a benzodiazepine (clonazepam) was superior to a treatment with lithium and the same benzodiazepine (lithium citrate and clonazepam). Twenty-eight hospitalized patients with a DSM-III-R manic episode were included, randomized to fixed drug doses and observed up to 28 days. Degree of mania, side effects and patients satisfaction with the treatment were registered. Approximately two thirds of the patients improved fully or partially on both drug combinations. Furthermore no statistically significant differences were found regarding acceptance and tolerance of the two drug combinations. The present drug combination are only two among several which deserve a thorough examination in order to prevent a random polypharmacy for treatment of mania.

Administration, Oral↗
PubMed1996

Mortality of patients who dropped out from regular lithium prophylaxis: a collaborative study by the International Group for the Study of Lithium-treated patients (IGSLI).

Excess mortality has repeatedly been found in patients with recurrent affective disorders. In previous studies our group has shown that during long-term lithium treatment the mortality of such patients is not significantly higher than that of the general population. In the present study, we extended our investigation to 273 patients from the earlier IGSLI cohort who subsequently dropped out from regular lithium prophylaxis. The standardized mortality ratio (SMR) for the whole group was 2.5, significantly higher (P < 0.01) than 1.0, which is the SMR of the general population. Furthermore, the SMR of the patients from each of the participating countries, namely Denmark, Germany and Austria, was significantly higher than 1.0. These findings strengthen the evidence accumulated in previous investigations that regular long-term lithium treatment does in fact markedly reduce the excess mortality of patients with recurrent affective disorders.

Antimanic Agents↗
PubMed1995

[Psychiatric treatment--methods and ethics].

The success rate of psychiatric treatment is satisfactory for selected disease categories, but is hardly so when all psychiatric ailments are considered together. This is amongst other things reflected in psychiatric patients' high frequency of readmission, their increased mortality, their large and frequently long-term use of medications and in their social conditions. A low success rate is a problem not only for the individual patient who does not receive sufficient help, but also for psychiatry as a whole. Psychiatry's reputation depends largely on treatment success, and this reputation is vital for the confidence of patients when seeking treatment and of society when allocating resources. Treatment success may be improved by a methodical development of treatment technology, in psychiatric terms first and foremost a coordination of medical therapy, psychotherapy and social treatment. A technological advance is however not sufficient in itself. Treatment success also depends on a suitable demarcation of those problems that psychiatry takes it upon itself to solve. The professional debate has been particularly lacking in this area, and often out of touch with the debate in the rest of society. If people with thought or emotional disturbances or abnormal behaviour are to be satisfactorily helped, it is necessary that society's different groups giving professional treatment enter a dynamic development that constantly adjusts the balance between the groups to be helped and the helpers of different educational background that are available.

Denmark↗
PubMed1995

Test of growth hormone secretion in adults: poor reproducibility of the insulin tolerance test.

The insulin tolerance test (ITT) is regarded as the most reliable provocative test in the diagnosis of growth hormone (GH) deficiency in adults. In the present study the test was evaluated by investigating the range of GH responses in normal adult males and females and the intra-individual reproducibility of the test. Sixteen healthy non-obese adults, eight males (median age 31.5 years) and eight females (median age 31.8 years) were tested twice with the ITT, with a minimum of 72 h between each test. The females were tested between day 3 and day 10 of their menstrual cycles. Adequate hypoglycemia was achieved in all cases with a median nadir blood glucose of 1.3 mmol/l (range 0.8-2.0). Growth hormone in serum was measured by immunoradiometric assay and low values were confirmed by a different assay. Median peak GH concentration responses to the ITT were: in males 27.9 micrograms/l, range 5.0-71.1 (test 1) and 30.5 micrograms/l, range 7.9-69.5 (test 2); and in females 9.0 micrograms/l, range 4.1-17.9 (test 1) and 8.4 micrograms/l, range 0.09-42.4 (test 2). The rise in GH concentration during the ITT was higher in males than in females. In the males, all stimulated GH values were > or = 5.0 micrograms/l. In the females, four out of 16 tests gave values below 5.0 micrograms/l and in one test the GH value was around the detection limit of the assays. There was poor reproducibility during repeated testing, with no correlation between the results of the two tests. The results did not correlate to the magnitude of the hypoglycemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

The nephrotoxicity of intravenously administered cadmium-metallothionein: effect of dose, mode of administration, and preexisting renal cadmium burden.

Exogenously administered cadmium-metallothionein (Cd-MT) is highly nephrotoxic, producing renal damage similar to that seen following chronic Cd exposure. However, nephrotoxicity following Cd-MT administration occurs at a much lower renal Cd concentration than that following chronic Cd exposure. In the present study, the sensitivity of female rats to bolus and infused doses of Cd-MT was evaluated. The Cd-MT was administered via the jugular vein either as a bolus or infused over a 24-hr period via osmotic minipumps in naive rats and in rats which had been pretreated with 5 microM CdCl2/kg, sc, five times/week, for 9 weeks. Renal toxicity was evaluated by urinary lactate dehydrogenase, protein, and MT excretion. In naive rats, a bolus dose of 0.15 mg Cd/kg as Cd-MT was nephrotoxic. In comparison, a two-fold higher infused dose was required to cause nephrotoxicity. In Cd-pretreated rats, a bolus dose of 0.45 mg Cd/kg as Cd-MT was necessary to produce nephrotoxicity, presumably because Cd pretreatment yielded renal MT levels that were about 15 times higher than the levels in naive animals. Although a bolus dose of 3 mg Cd/kg as CdCl2 resulted in a renal Cd concentration about 1.5 times that found after administration of 0.15 mg Cd/kg as Cd-MT, it did not produce any nephro-toxicity. The results of this study suggest that a renal Cd concentration, which is nephrotoxic if the Cd-MT is administered as a bolus dose, is well tolerated if the Cd-MT is delivered at a sustained level over a 24-hr period. Furthermore, the preexisting renal Cd burden reduces the sensitivity to nephrotoxicity of Cd-MT, presumably due to elevated MT levels available for sequestration of incoming Cd. We conclude that mere accumulation of Cd in the kidney does not necessarily result in nephrotoxicity; instead, the circulating Cd-MT level, as well as the intracellular MT concentration, appear to be the more important determinants of nephrotoxicity.

Animals↗
PubMed1994

Treatment of manic episodes in Scandinavia: the use of neuroleptic drugs in a clinical routine setting.

To provide longitudinal data on the treatment of acute mania with neuroleptics in a routine setting, 125 consecutively admitted manic patients were examined. Out of the 125 patients, 111 (89%) were primarily treated with neuroleptics during the index episode, and a substantial use of drug combinations was observed. Of the 111 patients, 27% were still hospitalized and in a manic state after 10 weeks. Our results indicate that treatment under routine conditions is an outcome variable which is determined by the severity and persistence of the manic symptoms. If typical neuroleptics are used as first choice antimanic agents, dosages can be minimized by the concomitant use of a benzodiazepine. In non-responders, a mere shift from one neuroleptic to another does not seem rational, so to improve outcome, a mood stabilizer should be added.

Adult↗
PubMed1994

Growth hormone and thyroid function: is secondary thyroid failure underdiagnosed in growth hormone deficient patients?

Thyroid hormones and the GH/IGF-1 system show considerable mutual interference which may have physiological, pathophysiological and clinical importance. GH therapy of children and adults may induce a fall in serum T4, which seems to be due to an effect on the deiodination of T4 to T3. Animal studies suggest that the alterations in thyroid hormones in tissue may be much more prominent than the changes observed in serum. It is possible that the GH deficiency seen in the majority of patients with pituitary/hypothalamic disorders may mask secondary hypothyroidism in some patients by giving a relatively high serum T4. GH therapy may then unmask the hypothyroidism. In accordance with such a mechanism GH deficient children evaluated thoroughly to exclude secondary thyroid failure before GH administration do not develop thyroid insufficiency during GH substitution therapy. It is suggested that thyroid insufficiency should be considered in GH deficient patients with low normal serum T4.

Adult↗
PubMed1993

[Treatment and prevention of mania: lithium and alternatives].

Untreated bipolar manic-depressive illness has a very high recurrence rate and, in spite of the development of modern psychopharmacological treatments, the prognosis is still rather poor. Lithium is still the drug of choice for treatment of manic episodes and for prevention of bipolar manic-depressive illness. However, in 30 to 50% of bipolar manic-depressive patients alternative or supplementary treatment with anti-epileptic drugs, neuroleptics or electroconvulsive therapy may prove necessary. It is important to provide manic-depressive patients with an outpatient service which can manage not only the psychopharmacological treatments but also health education, psychotherapy, laboratory monitoring and psychosocial support necessary to secure the patients an effective and careful treatment.

Anticonvulsants↗
PubMed1993

Therapeutic potentials of recently introduced antidepressants. Danish University Antidepressant Group.

The DUAG studies showed that in well-designed and rigorously executed multisite drug trials three representatives (citalopram, paroxetine, and moclobemide) from two classes of recent antidepressant drugs were less effective than the standard reference drug, clomipramine. The most important reasons for the superiority of clomipramine was probably that clomipramine was given in a high and fixed dose of 150 mg per day throughout the entire treatment period and that patient compliance was ensured through drug monitoring. When the DUAG studies are compared with "no difference" studies, the difference between DUAG and others lies not so much in a different efficacy of the test drugs but in the efficacy of the reference drugs, where clomipramine in the DUAG studies was more effective than reference tricyclics in most other studies with flexible dose regimens. A relatively high rate of adverse drug reactions with clomipramine administered in high and fixed doses was probably due to a considerable interindividual variability in the pharmacokinetic properties. (Gram 1990), and the development of side effects may be predicted and prevented when better knowledge of plasma concentration and dose-response relations for classical tricyclic antidepressants allow individual dose adjustments. Such studies are under way with in the DUAG. The results of such studies may reduce the need for new antidepressants which, although less toxic than the classical tricyclics, may prove to be also less potent. The DUAG studies were performed in hospitalized, moderately to severely, endogeneously depressed adult patients and conclusions from the DUAG studies about the superiority of clomipramine over three recent antidepressants cannot readily be generalized to cover less homogeneous groups of outpatients with milder depression.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidepressive Agents↗
PubMed1991

Five-year mortality in lithium-treated manic-depressive patients.

A hundred and thirty-three affective disorder patients who received prophylactic treatment with lithium were followed prospectively for 5 years and their mortality was recorded. Twenty-two patients died during the period, 13 from natural causes and nine from definite or probable suicide. The observed mortality was significantly greater than the expected overall, and also when natural causes and suicide were considered independently. No patients died from lithium intoxication or lithium-induced side effects. Patients who died from suicide were all bipolars or suffered from affective disorder with uncertain polarity. They were significantly younger than the patients who died from natural causes, they tended to lead isolated lives and they suffered a violent death. The older patients who died from natural causes had often had physical illness and alcohol abuse prior to the start of lithium treatment. The results of the study speak in favour of the establishment of comprehensive treatment programmes possibly in the framework of specialised affective disorder clinics.

Adolescent↗