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Biomedical subjects

S N Holmegaard

Publications and source records attributed to S N Holmegaard.

At least 19 recordsLinked to original sources
PubMed1996

The MICRAL test for diabetic microalbuminuria: predictive values as a function of prevalence.

The MICRAL test is an immunospecific dipstick for detection of low concentrations of albumin in urine (microalbuminuria). The test is intended to be used for screening in an ambulatory setting. The utility of the test depends on its ability to accurately predict which patients will be classified as either microalbuminuric or normoalbuminuric by means of a standard laboratory method for determination of albumin in urine. We have analysed data from studies with a total of 2904 samples of urine from diabetic patients. The data are from our own study (190 samples) and from a selected set of 10 publications. The results from standard laboratory measurements of albumin in urine were used as " gold standards". The sensitivity and specificity as calculated from the pooled data were 83.2 and 92.3%, respectively. The predictive values were calculated using simulated changes in the prevalence of microalbuminuria (MAU). At a prevalence of MAU of 1% the predictive value of a negative test is 99.9% but that of a positive test only 9.8%. At a prevalence of MAU of 80% the positive predictive value is 97.7% and the negative predictive value 57.9%. In general, any change in the prevalence will lead to a change in the predictive values. Thus the prevalence of MAU in the given clinical setting is a decisive factor in determining the utility of the MICRAL test.

Albuminuria↗
PubMed1994

[Alternatives to acute admissions to a city hospital. Is it possible to reduce the number of acute admissions?].

The purpose of the study was to evaluate the number of inappropriate admissions to a smaller city hospital and find possible alternatives. Physicians and surgeons from three units (abdominal surgery, internal medicine and orthopaedic surgery) together with general practitioners, doctors on homecall duty and health personnel from the region contributed to the study. In all 421 consecutive patients were included during a three-week period. The patients' median age was 60.5 years. It was found that at least 13.6% of all patients seemed to have been admitted for an inappropriate reason. According to the admitting doctor 3.4% of the patients were not ill at all. The investigation implies that one out of seven acute admissions could be replaced by alternatives such as immediate care in residential homes, more flexible contact to the outpatient's clinic, better access to geriatric evaluation and improved laboratory service. We conclude that acute admission to hospital can be replaced by other alternatives, thereby achieving greater efficiency and better economics.

Adult↗
PubMed1994

Tamoxifen and bone metabolism in postmenopausal low-risk breast cancer patients: a randomized study.

PURPOSE: This trial was undertaken to evaluate the effect of adjuvant tamoxifen on bone metabolism in postmenopausal women undergoing surgery for low-risk breast cancer. PATIENTS AND METHODS: In an open trial, 25 women were randomized to receive tamoxifen 30 mg/d for 2 years, and 25 women constituted the control group. Twenty women treated with tamoxifen and 23 women in the control group provided data for the analysis. Inclusion criteria were operation for low-risk breast cancer and cessation of menstruations for more than 1 year. Exclusion criteria were presence of metastases, disorders of bone metabolism, contraindications against tamoxifen, use of drugs with influence on bone metabolism, ailments that made bone mineral measurements impossible, and age greater than 65 years. Repeated measurements of bone mineral density and content at the lumbar spine and forearms, serum alkaline phosphatase, phosphate, and ionized calcium were performed in all patients. RESULTS: Lumbar spine bone mineral density increased during the first year in women treated with tamoxifen and then stabilized, compared with decreased bone mineral density in the control group (P = .00074). Bone mineral content at the forearms remained almost stable in tamoxifen-treated women compared with a decrease in the control group (P = .024). Serum alkaline phosphatase, phosphate, and ionized calcium decreased in the tamoxifen group (P < .00001, P = .002, and P = .002, respectively). CONCLUSION: Tamoxifen has estrogen-like effects on bone metabolism that result in an increase and stabilization of bone mineral density in the axial skeleton and a stabilization of bone mineral content in the appendicular skeleton.

Absorptiometry, Photon↗
PubMed1993

[An analysis of 99 consecutive shifts in the selection of antibiotics used in therapy in a medical department].

During 208 days 2836 patients were admitted to Sundby Hospital, medical ward. A total of 734 antibiotic cures were initiated. About 632 (22-23%) of the patients had antibiotic treatment. Penicillin, ampicillin and sulfamethizole were the most frequently used antibiotics. The use of erythromycin was 42-50% and 64-78% of that of penicillin and ampicillin respectively. Antibiotic treatment was changed in 99 cures in 73 patients. Fifty-seven of ninety-nine (43-71%) shifts were based on culture or serology and 42/99 (29-57%) shifts were based on clinical evaluation including microscopy and urinary stix. In 26 of the latter 42 cases positive culture or serology was obtained after the antibiotic was changed. Thirteen of the 26 shifts improved treatment, six were unlucky and seven indifferent, thus giving a net advantage of 13-6 = 7 of 26 shifts. This net advantage was due to shifts from penicillin. In ten cases the antibiotic was shifted to erythromycin due to suspected atypical pneumonia, but only one case was verified. In ten antibiotic shifts in pneumonia patients the etiologic agents were not identified. In 4/99 shifts in 4/73 patients relevant specimens were not obtained. The antibiotic most often changed compared with its total use was ampicillin (32/152 congruent to 1/5 of initiated cures) and shifts from ampicillin were more often (21/32) based on culture than shifts from penicillin (16/36) (p < 0.1). Initial supplementation of ampicillin with aminoglycosides was retrospectively relevant in 13/28 cases. Cephalosporines (p < 0.001) and dicloxacillin (p < 0.02) were significantly more often used as second drug, whereas penicillin was most often used as first drug (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1992

Prednisolone in the treatment of severe malignant hypercalcaemia in metastatic breast cancer: a randomized study.

To determine the effect of prednisolone on severe hypercalcaemia in women with metastatic breast cancer, 30 patients with serum ionized calcium above 1.60 mmol l-1 (reference range 1.15-1.35 mmol l-1) entered a randomized trial. Performance status before entry to the trial and survival time after hypercalcaemia were also noted. All patients received 4 l of isotonic saline daily and 80 mg intravenous furosemide three times daily for 2 d; thereafter they received 3 l of isotonic saline daily and 80 mg furosemide twice daily for 6 d. Fifteen patients were randomized to receive prednisolone, 25 mg orally, three times daily for 8 d. Serum ionized calcium decreased significantly in both groups, but most markedly in the prednisolone group. The median difference was 0.28 mmol l-1 (95% confidence interval (CI), 0.09-0.52) on day 4 and 0.21 mmol l-1 (95% CI, 0.12-0.44) on day 8. In seven prednisolone-treated patients serum ionized calcium normalized, compared to none in the control group (Fisher's exact test; P = 0.028). No severe adverse effects were observed. Prior to detection of hypercalcaemia all patients were severely immobilized, primarily due to bone pain. Only 10 patients were still living after 3 months. Prednisolone, furosemide and rehydration is superior to furosemide and rehydration alone in severely hypercalcaemic patients with metastatic breast cancer in whom immobilization appears to be an early warning sign of life-threatening hypercalcaemia. The short survival time was not influenced by prednisolone.

Administration, Oral↗
PubMed1990

The effect of different doses of nasal salmon calcitonin on plasma cyclic AMP and serum ionized calcium.

To investigate the effect of low doses of intranasal salmon calcitonin on plasma cyclic AMP (cAMP) and serum ionized calcium, 40 healthy postmenopausal women were randomized to receive a single dose of either placebo or 50, 100, or 200 IU of salmon calcitonin as a nasal spray. Blood samples were collected throughout an 8-hour period. None of the doses could provoke detectable hypocalcemia, whereas 100 and 200 IU of salmon calcitonin were associated with an increase in plasma cAMP after 15 minutes. Measurable plasma levels of salmon calcitonin were demonstrated in all active treatment groups, and the calculated areas under the curves showed a dose-dependent increase.

Administration, Inhalation↗
PubMed1990

Adjusted ionized calcium (at pH 7.4) and actual ionized calcium (at actual pH) in capillary blood compared for clinical evaluation of patients with disorders of calcium metabolism.

We report results for adjusted ionized calcium (at pH 7.4) and actual ionized calcium (at actual pH) in capillary blood from 183 patients with disorders of calcium metabolism (primary hyperparathyroidism, secondary hyperparathyroidism of malabsorption, primary hypoparathyroidism, Paget's disease, acromegaly, hypercalcemia of malignancy, osteoporosis, sarcoidosis, idiopathic hypercalciuria, and familial hypocalciuric hypercalcemia). The correlation and the equation for the linear regression between adjusted ionized calcium (y) and actual ionized calcium (x) were y = 1.011x + 0.005 mmol/L, r = 0.992, Sy,x = 0.021 mmol/L. Results were similar within each diagnostic group. Consistent agreement between adjusted and ionized calcium was observed in 96.7% of patients representing a variety of the most frequently encountered disorders of calcium metabolism. Thus we find adjusted ionized calcium to be as useful as actual ionized calcium for evaluation of patients with such disorders. Adjusted ionized calcium may therefore also be a logical choice for establishing agreement between laboratories for reference intervals in healthy adults.

Acromegaly↗
PubMed1989

Amelioration of postmenopausal primary hyperparathyroidism during adjuvant tamoxifen for breast cancer.

The effects of adjuvant treatment with tamoxifen on bone metabolism in a postmenopausal woman with primary hyperparathyroidism is presented. A 69-year-old woman with increased serum ionized calcium, parathyroid hormone, and 1,25-(OH)2 vitamin D levels and a normal bone scan received tamoxifen 10 mg three times daily for 1 year. During treatment bone turnover decreased whereas parathyroid hormone increased further. After cessation of treatment the calcium metabolic variables returned to pretreatment levels. The antiestrogen tamoxifen seems to behave as an estrogen on bone metabolism in primary hyperparathyroidism.

Aged↗
PubMed1988

Simplified protocol for biochemical evaluation of recurrent renal calcium stone disease.

Groups comprising 42 recurrent and 38 single calcium stone formers, and 48 controls underwent a standardized study protocol. During 12 h of fasting along with a standardized water load urine was collected for the last 4 h. One blood sample was drawn midway during urine collection. As compared with controls recurrent stone formers demonstrated significantly raised values of plasma ionized calcium, 1,25-dihydroxyvitamin D [1,25-(OH)2D], urinary ionized calcium, urinary pH, and standardized excretion rate of calcium [ECa(U)]. The tubular reabsorption of sodium and chloride, the maximal tubular reabsorption of phosphate, nephrogenous cyclic AMP (NcAMP), glomerular filtration rate (GFR) and plasma albumin were all significantly depressed. Data from the single stone former group were intermediate between controls and recurrent stone formers. For the pathogenesis of recurrent calcium stone formation these data suggest a general, though variably expressed, defect in the proximal tubular reabsorption of calcium, phosphate, bicarbonate, sodium and chloride leading to hypersecretion of 1,25-(OH)2D, hyperabsorption of calcium from the gut and a modest increase in plasma ionized calcium. Computer analysis of data do not support the concept that stone patients can be classified as either intestinal hyperabsorbers or renal losers. A stepwise discriminant analysis selected plasma albumin, urinary pH, ECa(U), plasma phosphate, GFR and NcAMP as the most important variables contributing to the difference between controls and recurrent stone formers. By this procedure we obtain a sensitivity of 93% and a specificity of 96% respecting proper classification of the recurrent stone former. The analysis may therefore be of value predicting the risk of recurrent stone formation in the single stone former.

Adolescent↗
PubMed1986

Effect of sunlight exposure on circulating 1,25-dihydroxyvitamin D in hemodialyzed patients and of exogenous parathyroid hormone in anephric patients.

Sunshine exposure increased the serum concentration of 25-hydroxyvitamin D (25-OHD) in 9 hemodialyzed patients. Mean 1,25-dihydroxyvitamin D (1,25-(OH)2D) was unchanged, but in two patients with low initial 25-OHD values this increase was accompanied by a rise in circulating 1,25-(OH)2D, although not to normal levels. One hemodialyzed patient developed liver insufficiency with a resultant reduction of serum 25-OHD concentration accompanied by a decrease in serum 1,25-(OH)2D concentration. The results indicate that the circulating levels of 1,25-(OH)2D in patients with end-stage renal failure are to some extent regulated by the serum 25-OHD concentrations. Injection of parathyroid hormone (PTH) induced minor increases in serum concentrations of 1,25-(OH)2D in patients with end-stage renal failure and even in anephric patients, suggesting the existence of an extrarenal PTH-sensitive 1-alpha-hydroxylase. However, the enzyme was stimulated by supraphysiological concentrations of PTH, and therefore not necessarily of importance in the normal regulation of calcium metabolism.

24,25-Dihydroxyvitamin D 3↗
PubMed1985

Urinary cyclic AMP in spot urine of healthy children.

We present reference values for the excretion of cAMP in spot urine collected between 09.00 and 12.00 hours in 143 healthy children aged 2-200 months. The excretion of cAMP was creatinine-corrected and expressed as a substance concentration ratio (UcAMP/crea)U due to a positive significant correlation between the excretion of cAMP and creatinine (r = 0.68, p less than 0.001). The mean value (95% significance limits) for (UcAMP/crea)U was 748 mumol/mol (254-2206 mumol/mol). A logarithmic transformation of the ratio was used, since preliminary analysis showed uneven distribution; when the logarithmic transformation was used, the data appeared evenly distributed. There was no significant difference between the results for girls and boys. The value of lg(UcAMP/crea)U was related to the age or body surface area with decreasing values at higher age or body surface area. (r = -0.55 and r = -0.57, p less than 0.001). Spot urine for measurement of urinary cAMP instead of a 24 h collection appears preferable due to the practicability of the test in children.

Adolescent↗
PubMed1984

Serum ionized calcium, nephrogenous and total urinary cyclic AMP and urinary phosphate in normal subjects.

Total urinary cyclic AMP (UcAMP) and nephrogenous cyclic AMP (NcAMP) were measured in 4, 20 and 24 h urine in forty-eight healthy volunteers. There were no significant differences between 4, 20 and 24 h excretion rate of UcAMP and NcAMP whether it was corrected for the glomerular filtration rate [( UcAMP]GF, [NcAMP]GF), creatinine corrected (UcAMP/Crea)U, or expressed as actual excretion rate (NcAMP,n), nor any sex differences. Mean values +/- one standard deviation (SD) for these parameters: [UcAMP]GF: 30.4 +/- 9.4 nmol/l; 27.7 +/- 7.0 nmol/min; 28.1 +/- 6.9 nmol/l in 4, 20 and 24 h urine, respectively. [NcAMP]GF: 13.4 +/- 8.5 nmol/l; 10.6 +/- 7.7 nmol/l; and 11.1 +/- 7.2 nmol/l in 4, 20 and 24 h urine, respectively. (NcAMP,n): 1.45 +/- 0.90 nmol/min; 1.14 +/- 0.80 nmol/min; 1.17 +/- 0.73 nmol/min in 4, 20 and 24 h urine, respectively, NcAMP accounts for about 40% of UcAMP. A positive correlation was found between plasma cyclic AMP and [UcAMP]GF (r = 0.41, P less than 0.001), whereas this relationship could not be demonstrated between plasma cyclic AMP and [NcAMP]GF (r = -0.008, P greater than 0.1). The calculation of [NcAMP]GF therefore corrects for unsuspected high or low plasma cyclic AMP values, and is therefore the preferred parameter of the PTH effect on the kidney tubular cells. No correlation could be demonstrated between [NcAMP]GF and concentration of ionized calcium in plasma.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗