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Biomedical subjects

T Rygnestad

Publications and source records attributed to T Rygnestad.

At least 37 records · Page 2Linked to original sources
PubMed1997

Mortality after deliberate self-poisoning. A prospective follow-up study of 587 persons observed for 5279 person years: risk factors and causes of death.

A follow-up study of mortality and factors associated with death from various causes were done on two unselected groups of patients surviving deliberate self-poisoning in 1978 and 1987. The persons were studied up to the end of 1993. In 1978 the group included 152 female and 101 male subjects and in 1987 the group included 190 female and 144 male subjects. By the end of 1993 a total of 37 (24%) of the female and 33 (33%) of the male patients admitted in 1978 had died (n.s.) and 18 (10%) of the female and 29 (20%) of the male patients admitted in 1987 had died (P < 0.01). The main causes of death were suicide and death from cardiovascular disease. The 5-year follow-up mortality more than doubled in males from 1978 to 1987 but decreased in females. In female subjects, the total follow-up mortality was 3.6 times the expected ratio, with a 95% confidence interval (95% CI of 2.7-4.6); in male subjects it was 5.0 times the expected ratio (95% CI = 3.8-6.4). The cause-specific mortality ratio was highest for deaths from suicide--in the female group it was 65.5 (39.4-102.3) times the expected and in the male group 41.5 (26.0-62.8)--and from accidental poisoning--for females 50.0 (6.1-180.6) times the expected and for males 66.7 (24.5-145.1). In the female group none of the variables examined reached significance as predictors for subsequent suicide or death from unnatural causes. In the male group being aged 30 years or more came out as a predictor for subsequent suicide [relative risk (RR) = 5.66 (1.05-30.37)], while imprisonment came out as a protective factor [RR = 0.08 (0.01-0.64)]. Significant predictors for death from unnatural causes were: having been convicted (but not been in jail) [RR = 34.01 (1.07-1078.15)] and a serious suicidal intent [RR = 138.62 (1.38-13,946.79)]. It is concluded that patients who survive deliberate self-poisoning are at increased risk of death. The predictors for death are not very specific and are considered difficult to apply in the clinical work with these patients.

Adolescent↗
PubMed1995

Streptococcal myositis and tissue necrosis with intramuscular administration of diclofenac (Voltaren).

The authors describe a fatal case of a group A beta-haemolytic streptococci infection. The symptoms seemed to have been initiated by minor skin trauma; intramuscular injections of diclofenac (Voltaren) and metoclopramide (Primperan) after which the patient developed extensive muscle necrosis. The clinical course was rapid and he died within 48 hours after the first injection from circulatory collapse, probably due to overwhelming septicaemia with group A beta-haemolytic streptococci. Streptococcal myositis is a rare and extremely serious complication of skin trauma. Muscle necrosis is also a known but rare side effect of intramuscular administration of drugs (the "Nicolau syndrome") in which non-steroid anti-inflammatory drugs are often implicated. The case is discussed in the context of this specific syndrome.

Adult↗
PubMed1994

[Sexually transmitted diseases, HIV infection and AIDS in Mudzi, Zimbabwe. A study of knowledge, attitudes and practice in a rural area in southern Africa].

We describe a study conducted in a rural area of Zimbabwe. We examined all patients who attend for treatment of a presenting sexually transmitted disease for a period of one month in 1989 and 1992. In addition we studied the knowledge of, attitudes towards and practices as regards HIV-infection and AIDS in 1992. The annual rate of sexually transmitted diseases was not different in the two periods studied. Most of the females with symptoms of sexually transmitted diseases were married and had been infected by their husbands. Most males too were married, but had been infected by prostitutes. There was a reduction in the proportion of patients who were employed as teachers, policemen or in the army. The use of condoms seems to have increased. Males were generally better informed about HIV-infection and AIDS than females were. As much as 26% of the females and 40% of the males had a close friend/relative who had died from AIDS and 69% of the females and 81% of the males had found it necessary to change their sexual behaviour after hearing about AIDS. Most people knew the most important parts of transmission, and about condoms as a means of protection, but the rate of sexually transmitted diseases remains very high. New strategies are needed in the preventive work.

Acquired Immunodeficiency Syndrome↗
PubMed1992

[Development of physostigmine from a poisonous plant to an antidote. One of the most important drugs in the development of modern medicine?].

Physostigmine was originally isolated from the Calabar Bean, which was used for ordeal by poison in West Africa. The main alkaloid was isolated in 1864. It acts through inhibition of acetylcholinesterase, and has been of major importance in elucidating the kinetics and configuration of the enzyme. Physostigmine has been important for our understanding of neurohumoral chemical transmission, and in mapping the cholinergic nerves. It was the first antagonist to curare, and has been widely used for various therapeutic purposes. Today it has been largely replaced by more efficient and safe drugs. It is still used as an antidote to poisoning from various psychopharmacological drugs, and to treat postoperative somnolence and respiratory depression. It is considered a potent antidote to organophosphorous poisoning and is used experimentally to treat Alzheimer's disease.

Antidotes↗
PubMed1992

[Suicide in Norway. Changes in the 20th century with special emphasis on the development during the last 20 years].

The suicide rate in Norway was low and relatively stable during the first half of the 20th century. During the last 20 years it has increased dramatically. This increase has been most pronounced among young people of both sexes aged 15-19 years, and is the second highest in Europe. Females usually kill themselves by poisoning and men by shooting. The regional and temporal trends over the last 20 years show different patterns for the two sexes. The highest increase among men has occurred in the group aged 15-29 years in the northern part of the country, and for women in the group aged over 30 years in rural areas. The demonstrated increase does not seem to be due to more reliable registration of suicides. Attempts to explain the dramatic changes during the past decades have focused on social, demographic and economical changes in Norwegian society.

Adolescent↗
PubMed1991

Epidemiological, social and psychiatric aspects in self-poisoned patients. A prospective comparative study from Trondheim, Norway between 1978 and 1987.

A prospective study of an unselected group of patients admitted in a Medical Department in 1978 (n = 257) and 1987 (n = 361) after deliberate self-poisoning is presented. The rate increased significantly over the period of the study (P less than 0.05). Family problems, unemployment, poor social conditions and alcohol and drug abuse had increased. The main psychiatric diagnosis was neurosis. From 1978 to 1987 "abuse" had increased substantially. The 10-year mortality rate was 4.5 and 4.1 times the expected value for female and male patients, respectively. We conclude that social and psychiatric problems are increasing and that the treatment of these patients today is far from satisfactory.

Adolescent↗
PubMed1990

[Organophosphate poisoning].

Three cases of poisoning by organophosphate dimethoate are described and the importance of correct diagnosis and adequate treatment emphasized. Therapy consists of large doses of atropine, to counteract the muscarinic and other effects on the central nervous system, followed by a reactivator (e.g. toxogonin) to reverse muscle weakness (nicotinic effects).

Aged↗
PubMed1990

The clinical value of drug analyses in deliberate self-poisoning.

1. In a prospective, unselective study of self-poisoned patients in 1978 and 1987 blood samples for drug analyses were drawn on admission in 265 and 400 cases, respectively. 2. The results from the drug analyses were compared with the clinical information obtained on admission. The main drug taken was identified on admission in 228 (86%) in 1978 and in 383 cases (96%) in 1987 (P less than 0.001). 3. The clinical impression was completely in accordance with the results from the drug analyses in 192 cases (72%) in 1978 and 232 cases (58%) cases in 1987 (P less than 0.001). The discrepancies mainly involved secondary drugs. 4. There was no significant difference in the clinical course of the poisonings in situations where the correct main drug was identified on admission and where the wrong main drug was suspected. 5. Knowledge of the correct drugs used when admitted would not have prevented complications or deaths. 6. We conclude that extensive pharmacological drug analyses play a limited role in the routine management of patients admitted for deliberate self-poisoning.

Adult↗
PubMed1989

A comparative prospective study of self-poisoned patients in Trondheim, Norway between 1978 and 1987: epidemiology and clinical data.

1. In a prospective study of patients hospitalized for deliberate self-poisoning between 1978 and 1987 the number of admissions increased from 303 to 425. The annual incidence increased significantly for both women (P less than 0.05) and men (P less than 0.01). The mean age decreased significantly in the male group (P less than 0.05), but increased in the female group (P less than 0.05). 2. The median latency time for patients presenting at the hospital was short; 3.7 h in 1978 and 2.9 h in 1987. 3. There was a significant reduction in the percentage using barbiturates (9% in 1978 and 1% in 1987; P less than 0.001) and the use of benzodiazepines increased (18% in 1978 and 32% in 1987; P less than 0.05). The percentage of unconscious patients did not change significantly. 4. In 1987 N-acetyl-cysteine was the most frequently used antidote. Physostigmine has almost been abandoned since 1978. 5. Significantly more patients were hypotensive in 1978: 24% vs 11% in 1987; (P less than 0.001) and significantly less patients needed treatment in the central intensive care unit (2% in 1987 and 5% in 1978; P less than 0.05). Complications were few (8-10%) and the mortality low (approximately 1%) in both years studied. 6. The mean duration of hospitalization in 1978 was 65 h vs 30 h in 1987, (P less than 0.001).

Adult↗
PubMed1988

A prospective 5-year follow-up study of self-poisoned patients.

A 5-year follow-up study of 253 patients discharged after self-poisoning is presented. Repeated acts of self-poisoning occurred mainly in the first year after discharge; 20% and 22% of female and male patients, respectively. This number is a minimum, the migration frequency being high. Very few patients responded to a letter asking them for a follow-up interview, only 56% and 42% of female and male patients, respectively. Five years after discharge 18% of male patients and 11% of female patients had died. The 5-year mortality rate was 73 times the expected value for male patients and 109 times the expected value for female patients.

Adolescent↗
PubMed1986

Self-poisoning with theophylline. The effect of repeated doses oral charcoal on drug elimination.

A heavy smoking male patient with moderate to severe theophylline poisoning is presented. Repeated doses of oral charcoal were given in addition to usual supportive treatment. During this treatment the elimination half-life of the drug (T1/2) was 2 hours. The toxic symptoms disappeared rapidly when the serum concentration was reduced to the therapeutic concentration range. T1/2 was approximately 24 hours in the same patient in a steady state study without oral charcoal treatment. Repeated doses of oral charcoal seem to increase theophylline elimination and should be administered in moderate to severe theophylline poisoning in addition to the usual supportive treatment and correction of metabolic disturbances.

Charcoal↗
PubMed1985

Oral intake of a toluene-containing thinner. Effects and headspace gas chromatographic analytical diagnosis.

After an accidental oral intake of a paint thinner, the constituents were identified in stomach content using headspace gas chromatography. The composition indicated ingestion of a commonly used thinner containing 60-70% toluene, 20-25% n-butylacetate and 10-15% of ethanol. A toluene concentration of 22.0 mg/kg was measured in serum in contrast to n-butylacetate which was not detected. Ethanol concentration was 1.85 g/kg, most of this was due to ethanol ingestion before the intake of thinner. The half life of toluene in serum was 8.5 h initially, which increased to 14 h after 19 h. An effect on liver function was demonstrated by increased activity of serum transaminases. Compared with the upper normal limits ASAT and ALAT were increased by 6 and 2.5 times, respectively. For both parameters the highest activity was seen 40 hours after admission and normal levels were achieved after 7 days. It is concluded that toluene is readily absorbed by ingestion of toluene-containing thinners, and that the function of the human liver is transiently affected. For screening purposes gas chromatography proved to be a useful method for the analytical diagnosis in cases of organic solvent intoxication. The use of the headspace technique further improved the speed of analysis and eliminated contamination of the gas chromatographic system.

Acetates↗