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1.
J Immunol Methods ; 483: 112807, 2020 08.
Article in English | MEDLINE | ID: mdl-32540393

ABSTRACT

Monoclonal antibodies (mAb) are unique tools in therapeutics and immunodiagnostics applications but many of these applications rely on conjugated mAbs. Whether conjugating drugs or tracers, the conjugation process, frequently taking advantage of primary amines on lysine residues, may affect the binding activity of the antibodies. Furthermore, due to the sticky nature of many mAbs, unfavorable interactions may become eminent, with the result of high background signals. The workload associated with producing mAbs, able to withstand conjugation, preserving stability and affinity and avoiding off-target interactions, is comprehensive and related with only incidental success. We designed a method, where uncloned hybridomas were pre-selected for secretion of mAbs with the above characteristics. Using human collectin K1 (CL-K1, alias CL-11, Colec11) as a model antigen, mAbs present in culture supernatant from uncloned hybridomas were immobilized on Protein A beads, followed by solid phase biotinylation and subsequent elution. ELISA was employed to compare the binding activity of conjugated vs. unconjugated mAbs, and furthermore for their application in combination with other antibodies. From a group of 96 uncloned hybridomas we accomplished in obtaining five suitable mAbs, among which, two mAbs were superior. The successful conjugation of the selected mAbs with fluorophores and subsequent applications in microscopy and flow cytometry were further demonstrated. In conclusion, pre-selection of uncloned hybridomas, by testing of their mAbs' ability to withstand conjugation with tracers or drugs, is a successful strategy to avoid a huge workload of cloning numerous hybridomas, in order to obtain conjugatable mAbs.


Subject(s)
Antibodies, Monoclonal/biosynthesis , Collectins/metabolism , Enzyme-Linked Immunosorbent Assay , Immunoconjugates/metabolism , Animals , Antibodies, Monoclonal/genetics , Antibodies, Monoclonal/immunology , Antibody Affinity , Antibody Specificity , Biotinylation , CHO Cells , Cloning, Molecular , Collectins/genetics , Collectins/immunology , Cricetulus , Humans , Hybridomas , Immunoconjugates/genetics , Immunoconjugates/immunology , Mice , Protein Stability , Staphylococcal Protein A/immunology
2.
Acta Psychiatr Scand ; 140(4): 340-348, 2019 10.
Article in English | MEDLINE | ID: mdl-31355419

ABSTRACT

OBJECTIVE: To investigate the association of single- and multimorbidity with mortality rates in patients with schizophrenia compared to the general population. METHOD: A nationwide cohort study including residents in Denmark between 1995 and 2015. The cohort was dichotomously divided by a diagnosis of schizophrenia. Somatic diseases included infections, cancer, endocrine, neurologic, cardiovascular, respiratory, digestive, skin, musculoskeletal, and urogenital diseases. Hazard ratios (HRs) and population attributable fractions (PAFs) were calculated. RESULTS: The cohort included 30 210 patients with schizophrenia [mean age (SD) = 32.6 (11.4), males = 57.2%], and 5 402 611 from the general population [mean age (SD) = 33.0 (14.5), males = 50.4%]. All number of somatic diseases were associated with an increased mortality in schizophrenia [HR = 16.3 (95% CI = 15.4-17.3) for 1 disease to 21.0 (95% CI = 19.1-23.0) for ≥5 diseases], using the general population with no somatic disease as reference. Across all somatic diseases, patients with schizophrenia showed a HR > 2, compared to the general population, and respiratory (PAF = 9.3%), digestive (PAF = 8.2%), and cardiovascular (PAF = 7.9%) diseases showed largest contributions to death. CONCLUSIONS: Patients with schizophrenia showed higher mortality on all levels of multimorbidity, and a doubled mortality rate across all somatic diseases, compared to the general population. The findings suggest that the clusters and trajectories of symptoms associated with schizophrenia is the main driver of the excess mortality.


Subject(s)
Mortality/trends , Multimorbidity/trends , Schizophrenia/mortality , Adult , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/mortality , Case-Control Studies , Cohort Studies , Denmark/epidemiology , Digestive System Diseases/epidemiology , Digestive System Diseases/mortality , Female , Humans , Male , Middle Aged , Respiratory Tract Diseases/epidemiology , Respiratory Tract Diseases/mortality , Schizophrenia/diagnosis
3.
Andrology ; 5(4): 622-630, 2017 07.
Article in English | MEDLINE | ID: mdl-28718529

ABSTRACT

Sperm DNA Fragmentation has been extensively studied for more than a decade. In the 1940s the uniqueness of the spermatozoa protein complex which stabilizes the DNA was discovered. In the fifties and sixties, the association between unstable chromatin structure and subfertility was investigated. In the seventies, the impact of induced DNA damage was investigated. In the 1980s the concept of sperm DNA fragmentation as related to infertility was introduced as well as the first DNA fragmentation test: the Sperm Chromatin Structure Assay (SCSA). The terminal deoxynucleotidyl transferase nick end labelling (TUNEL) test followed by others was introduced in the nineties. The association between DNA fragmentation in spermatozoa and pregnancy loss has been extensively investigated spurring the need for a therapeutic tool for these patients. This gave rise to an increased interest in the aetiology of DNA damage. The present decade continues within this research area. Some of the more novel methods recently submerging are sorting of cells with increased DNA fragmentation and hyaluronic acid (HA) binding techniques. The clinical value of these tests remains to be elucidated. In spite of half a century of research within the area, this analysis is not routinely implemented into the fertility clinics. The underlying causes are multiple. The abundance of methods has impeded the need for a clinical significant threshold. One of the most promising methods was commercialized in 2005 and has been reserved for larger licensed laboratories. Myriads of reviews and meta-analyses on studies using different assays for analysis of DNA fragmentation, different clinical Artificial Reproductive Treatments (ART), different definitions of successful ART outcome and small patient cohorts have been published. Although the area of DNA fragmentation in spermatozoa is highly relevant in the fertility clinics, the need for further studies focusing on standardization of the methods and clinical implementation persists.


Subject(s)
DNA Damage , Infertility, Male/diagnosis , Semen Analysis/history , Spermatozoa/pathology , Abortion, Spontaneous/etiology , Abortion, Spontaneous/pathology , Animals , Consensus , Fertility , History, 20th Century , History, 21st Century , Humans , Infertility, Male/pathology , Infertility, Male/physiopathology , Male , Predictive Value of Tests , Risk Factors , Semen Analysis/methods , Semen Analysis/standards
4.
Hum Reprod ; 19(10): 2258-62, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15319388

ABSTRACT

BACKGROUND: Focus on the hatching process has so far been in the field of fresh embryos. Cryopreserved-thawed embryos have a lower rate of pregnancy than fresh embryos, which might be due to hardening of the zona pellucida. METHODS: During a 2 year period, a prospective randomized study enrolling 253 cryopreserved-thawed cycles was performed on day 2 embryos. Pseudorandomization to assisted hatching or a control group was done on the basis of even and odd dates for thawing. One hour before embryo transfer, hatching was carried out using acidic Tyrode's solution. RESULTS: Among 136 embryos exposed to assisted hatching, 11.4% (30) were implanted compared with only 5.8% (13) of 117 embryos not exposed to assisted hatching (P<0.05, chi(2) test). No difference in the rate of clinical pregnancy and positive serum HCG was observed between the two groups. Very few women >38 years old were included in the study, and no significant difference according to age could be found between the groups. CONCLUSIONS: These results show that assisted hatching using acidic Tyrode's solution increases the implantation rate of cryopreserved-thawed embryos (P<0.05).


Subject(s)
Cryopreservation , Embryo Implantation , Isotonic Solutions/administration & dosage , Zona Pellucida/drug effects , Administration, Topical , Adult , Embryo Transfer , Female , Fertilization in Vitro , Humans , Isotonic Solutions/therapeutic use , Male , Pregnancy , Prospective Studies , Sperm Injections, Intracytoplasmic , Treatment Outcome
5.
J Cardiovasc Surg (Torino) ; 45(6): 531-4, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15746631

ABSTRACT

The Carbomedics bileaflet mechanical prosthesis was introduced in 1986 and until now more than 500,000 valves have been implanted. The aim of this study was to review the papers published on the Carbomedics aortic heart valve prosthesis. The Carbomedics prosthesis has a solid pyrolite carbon housing and flat leaflets of pyrolite carbon coated graphite that is impregnated with tungsten. The pyrolite carbon housing is reinforced by an outer stiffening ring composed of titanium which virtually eliminates the risk of leaflet escape. The design further enables valve rotation after implantation. The standard aortic valve prosthesis has the sewing cuff located at the outflow level of the valve cylinder. A high-performance valve, the Carbomedics TopHat valve for supraannular implantation, is a standard aortic valve prosthesis where the sewing cuff has been transferred to the inflow level of the valve cylinder. A 2 size increase in valve size can be achieved by using the TopHat valve which is very important in patient-prosthesis mismatch. With the recommended international normalised ratio (INR) level for the Carbomedics aortic heart valve prosthesis the rate of embolic and bleeding events are low. Thrombosis of a Carbomedics aortic heart valve prosthesis is rarely seen and is the result of inappropriate anticoagulation without pannus formation. The incidence of prosthetic endocarditis is very low and this is also the case for noninfectious paravalvular leakage necessitating reoperation. Intrinsic dysfunction and/or structural failure has never been reported. The total absence of intrinsic dysfunction and structural failure of the Carbomedics aortic valve prosthesis is a great advantage. Further the complication rate is very low. The TopHat, the supraannular version of this prosthesis, is a perfect solution in patient-prosthesis mismatch.


Subject(s)
Aortic Valve , Heart Valve Prosthesis , Anticoagulants/therapeutic use , Heart Valve Prosthesis/adverse effects , Humans , Prosthesis Design , Thromboembolism/etiology , Thromboembolism/prevention & control
6.
J Heart Valve Dis ; 10(2): 177-84, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11297204

ABSTRACT

BACKGROUND AND AIM OF THE STUDY: The CarboMedics bileaflet prosthetic heart valve was first implanted as part of a prospective clinical study at the authors' institution in November 1987. The patient cohort included was part of a multicenter trial set up by the manufacturer for an FDA application. The present report details findings over a 12-year period, with a continuous follow up on this patient cohort. METHODS: Between November 1987 and August 1990, 132 patients (68 males, 64 females; median age 56 years; range 12-74 years) received a CarboMedics heart valve prosthesis. All patients were included in the study, whether surgery was elective or emergency, first time or reoperation. There were 69 aortic, 49 mitral and 12 double (aortic + mitral) valve replacements. Two patients had isolated tricuspid valve replacement. Concomitant surgery was performed in 15 patients. Anticoagulation with warfarin was started on postoperative day 1. After discharge, patients were examined regularly as outpatients for up to five years. Subsequent follow up was obtained prospectively by questionnaires to the patients' general practitioner, or by telephone calls. Actuarial estimates of survival and freedom from morbid events were calculated using the Kaplan-Meier method; 95% confidence limits for the distribution function were calculated according to the Greenwood formula. RESULTS: Complete follow up information was available for 94% of the patients; total follow up was 1,014.3 patient-years (pt-yr). Actuarial survival at 12 years was 62 +/- 0.5% overall (61 +/- 6.5% for aortic; 66 +/- 7.5% for mitral; 65 +/- 14.0% for double valve replacements). Actuarial rates of freedom from complications were: valve thrombosis 100%, embolism 92 +/- 2.8%, and anticoagulant-related bleeding 77 +/- 5.6%. The linearized rates per 100 pt-yr were: embolism 0.89 (aortic 0.74, mitral 1.30); anticoagulant-related bleeding 2.56; paravalvular leakage overall 0.20 (aortic 0.37); prosthetic valve endocarditis overall 0.20 (aortic 0.37). There was no hemolysis, prosthetic valve dysfunction or structural deterioration. CONCLUSION: Over a 12-year time frame, the CarboMedics prosthetic heart valve has proven to be a highly reliable device with no structural failures, and a low incidence of valve-related complications.


Subject(s)
Heart Valve Diseases/surgery , Heart Valve Prosthesis , Heart Valves/surgery , Adolescent , Adult , Aged , Cohort Studies , Equipment Failure Analysis , Female , Follow-Up Studies , Heart Valve Diseases/mortality , Humans , Male , Middle Aged , Time Factors
7.
Ann Thorac Surg ; 71(1): 100-3; discussion 104, 2001 Jan.
Article in English | MEDLINE | ID: mdl-11216726

ABSTRACT

BACKGROUND: Operation for active infective endocarditis carries high mortality and morbidity rates, especially when the annulus is involved. Overall the literature favors the use of autograft and homograft valves because of better resistance to infection. In our clinic during the last 5 years we used an aggressive surgical approach to infective endocarditis in combination with implantation of mechanical or stented bioprosthetic devices. METHODS: From 1994 to 1999, 50 adults with aortic and/or mitral valve endocarditis underwent valve replacement. The median age of the 36 men and 14 women was 58 years (range, 17 to 78 years). All patients had active endocarditis at the time of operation. Native valve endocarditis was present in 48 patients and prosthetic valve endocarditis was present in 2 patients. The aortic valve was affected in 24 patients, the mitral valve in 21 patients, and both the aortic and mitral valves in 5 patients. Two of the patients with mitral endocarditis also had infection of the tricuspid valve. Annular destruction was present in 24 patients (48%). The patients were treated with radical excision of all infected tissue. The annular defects were closed, if possible, with direct sutures. Otherwise, a reconstruction was performed. Follow-up was 100% complete with a median follow-up period of 45 months (range, 6 to 66 months). RESULTS: The procedures were performed without lethal bleeding complications. Early mortality was 12% and the actuarial survival at follow-up was 80%. In none of the patients who died was death related to the prosthetic valve or recurrence of the endocarditis. Only 1 patient (2%) developed recurrence of the infective endocarditis and was reoperated with a Ross procedure. Three and a half years later the patient developed severe valve insufficiency of the autograft and was operated again with implantation of a mechanical device. CONCLUSIONS: Native and prosthetic valve endocarditis can be treated successfully with aggressive surgical debridement and implantation of mechanical or stented bioprosthetic devices with a low risk of recurrent endocarditis.


Subject(s)
Bioprosthesis , Debridement , Endocarditis/complications , Endocarditis/surgery , Heart Valve Diseases/surgery , Heart Valve Prosthesis , Adolescent , Adult , Aged , Aortic Valve , Female , Heart Valve Diseases/complications , Humans , Male , Middle Aged , Mitral Valve , Retrospective Studies , Treatment Outcome
8.
J Cardiovasc Surg (Torino) ; 40(2): 177-81, 1999 Apr.
Article in English | MEDLINE | ID: mdl-10350099

ABSTRACT

BACKGROUND: Preservation of the mitral valve and subvalvular apparatus was introduced into the clinic in the early sixties, but for two decades the standard technique for mitral valve replacement included excision of both leaflets and their attached chordae tendineae. Lately, increased emphasis has again been placed on retention of the mitral subvalvular apparatus during valve replacement because of its role on left ventricular function. METHODS: We have preserved the valvular and subvalvular mitral apparatus, when possible, in connection with mitral valve replacement during the last seven years and the present investigation (partly prospective and partly retrospective) was done with the aim of making up the results of our mitral preservation technique. In the period between January 1990 and December 1995, 30% of the patients who underwent mitral valve replacement had complete retention of all mitral tissue. In 1996, the percentage had increased to 50, and during the first seven months of 1997, 70% of the patients had complete retention of all mitral tissue. Since January 1997, we have exclusively used the CarboMedics mitral heart valve prosthesis. A total of 56 patients were identified to have had a CarboMedics heart valve prosthesis implanted. There were 33 men and 23 women with a mean age of 63 years, range 23-77 years. Coronary bypass was a concomitant procedure in 22 patients. In seven patients, both the mitral and aortic valves were replaced. A severely altered valve with thickened and or calcified leaflets, stenotic leaflets, or shortened, retracted and thickened chordae tendineae were not a contraindication for the procedure. Calcified plaques were removed. Adhesion between anterior and posterior leaflets was treated with sharp dissection. Valve and subvalvular tissue were preserved. The leaflets were reefed within the valve-sutures and compressed between the sewing ring and the native annulus when implanting the valve prosthesis. Chordal tension on the ventricle was thereby maintained and the chordae pulled away from the valve effluent. Echocardiography with measurement of ejection-fraction was performed preoperatively during the postoperative course in case of cardiac problems and on a routine basis 1 month after surgery and at various intervals when the patient was seen in the outpatient clinic. Left ventricular outflow tract gradients were measured during the postoperative course in case of cardiac problems and routinely 1 month postsurgically. RESULTS: Five patients died in the postoperative period and one patient had transient neurological symptoms. In none of the patients was death or transient neurological symptoms a consequence of the retention of mitral leaflets with subvalvular apparatus. The remaining 51 patients were all alive at follow-up. Postoperative echocardiography demonstrated a preserved left ventricular function and a left ventricular outflow tract without obstruction. CONCLUSIONS: We find that the described technique in combination with implantation of a CarboMedics heart valve prosthesis is very useful even in patients with a severely altered valve, when preserving the mitral leaflets with subvalvular apparatus during valve replacement. The technique is without procedure related complications and preserves left ventricular function without obstructing the left ventricular outflow tract.


Subject(s)
Heart Valve Prosthesis Implantation/methods , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Adult , Aged , Female , Heart Valve Prosthesis , Humans , Male , Middle Aged , Prosthesis Design , Treatment Outcome
9.
Ugeskr Laeger ; 161(10): 1398-402, 1999 Mar 08.
Article in Danish | MEDLINE | ID: mdl-10085746

ABSTRACT

The aim of the study was to assess the present psychiatric services in somatic departments in Denmark. A questionnaire was sent to all psychiatric departments in Denmark. All questionnaires were returned. During 1996 11,602 adult psychiatric consultations covering 87% of all beds in general hospitals in Denmark were performed. Mean and SD of the consultancy frequency, i.e. consultations/somatic bed/year, were 0.62 (0.34). The consultancy frequency was significantly higher, when the service included somatic emergency rooms or outpatients, or if the consultant performed the consultation together with a team member. Furthermore, it was significantly higher, when the consultant attended treatment conferences at the somatic departments or yielded supervision. The frequency of the psychiatric consultations performed by the staff from the former State Mental Hospitals was half of the frequency of the psychiatric departments at General Hospitals.


Subject(s)
Mental Health Services , Practice Patterns, Physicians' , Referral and Consultation , Adult , Denmark , Emergency Medical Services/standards , Emergency Medical Services/statistics & numerical data , Humans , Mental Health Services/standards , Mental Health Services/statistics & numerical data , Psychiatric Department, Hospital/standards , Psychiatric Department, Hospital/statistics & numerical data , Referral and Consultation/statistics & numerical data , Surveys and Questionnaires
10.
Ugeskr Laeger ; 160(37): 5335-8, 1998 Sep 07.
Article in Danish | MEDLINE | ID: mdl-9748857

ABSTRACT

The aim of the present study was to illustrate the effects of community-based psychiatry. The catchment area was divided into three homogeneous districts, East, North and West. Teams were established on 1.9. 1990, 1.10.91 and 1.5.1992, respectively. Social, diagnostic and treatment related data were gathered from two cross-sectional investigations (I: February 1992 and II: February 1993) and from in-patients and out-patients files. In cross-section I a majority of long-term ward patients and hospital-based employment offers was found in the district where the community district team had not yet been established. In the district where the first community district team was established most primary target patients were treated. In cross-section II the hospital-based psychiatric service were more homogeneously distributed between the districts. The establishment of community-based psychiatric teams resulted in new referrals, and increasing numbers of patients becoming attached to the psychiatric teams, but crowding and use of compulsory measures in hospital also increased.


Subject(s)
Community Mental Health Services , Community Networks , Community Psychiatry , Mental Disorders/therapy , Adult , Aged , Cross-Sectional Studies , Denmark , Female , Humans , Male , Mental Disorders/rehabilitation , Middle Aged , Referral and Consultation
11.
Ugeskr Laeger ; 160(37): 5339-44, 1998 Sep 07.
Article in Danish | MEDLINE | ID: mdl-9748858

ABSTRACT

The study was based on data from the Danish Psychiatric Central Register. It consisted of 11,753 persons with permanent residence in the municipalities of Aalborg or Arhus, who had 32,557 admissions to a psychiatric hospital in Denmark during the period 1982-1991. The admission rates declined by 30%. The involuntary admission rate increased during the later years of the period, it was higher at the Psychiatric Hospital in Arhus (PHA). The bedday use per admission was 5.5 weeks on average at Aalborg Psychiatric Hospital (AAPH) and nine weeks on average at PHA. Through the period the bed rate (beds in use) was gradually reduced by 40%, most significantly at PHA. It can be concluded that the treatment at AAPH was less time-consuming. This is mainly caused by there being fewer beds available. Indices for quality of outcome did not give reason for conclusions in regard to differences in quality of treatment.


Subject(s)
Community Mental Health Services , Hospitals, Psychiatric , Mental Disorders , Adult , Aged , Commitment of Mentally Ill , Community Mental Health Services/statistics & numerical data , Denmark/epidemiology , Female , Hospitals, Psychiatric/standards , Hospitals, Psychiatric/statistics & numerical data , Humans , Length of Stay , Male , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Mental Disorders/therapy , Middle Aged , Patient Admission , Registries , Treatment Outcome
12.
Acta Obstet Gynecol Scand ; 77(7): 741-5, 1998 Aug.
Article in English | MEDLINE | ID: mdl-9740522

ABSTRACT

OBJECTIVE: To evaluate the effects of leaving the parietal peritoneum open at lower segment cesarean section (LSCS) measured by postoperative pain. DESIGN: A randomized, prospective and double-blind study. SETTING: Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark. POPULATION: Forty women referred for an elective cesarean section were assigned to one of two groups: peritoneum open (n=21) or peritoneum closed (n=19). METHODS: Pain was evaluated twice a day from the first to the fifth postoperative day by Visual Analog Scales. MAIN OUTCOME MEASURES: Postoperative pain. Other outcomes include usage of analgesics, bowel function, postoperative complications, and hospital stay. RESULTS: We found no overall difference in postoperative pain. A tendency to less pain was found in the non-closure group from the third postoperative day to the fifth postoperative day. No differences were found either in the incidence of postoperative complications, or the time to return of bowel function. Concerning opiate analgesics the non-closure group had a significantly higher use in the second postoperative 24-hour period, but in the remains of the registration period it was significantly lower. For oral analgesics no difference was found in the first 24-hour period, but in the remains of the period the non-closure group had a significantly lower use. CONCLUSIONS: The VAS-scales showed no difference in postoperative pain comparing closure to non-closure of the parietal peritoneum. However, the use of analgesics is lower in the non-closure group. We suggest leaving the parietal peritoneum open when performing LSCS.


Subject(s)
Cesarean Section/methods , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Peritoneum/surgery , Adult , Cesarean Section/adverse effects , Double-Blind Method , Female , Humans , Pain Measurement , Pain, Postoperative/drug therapy , Pregnancy , Prospective Studies , Severity of Illness Index , Time Factors
13.
J Heart Valve Dis ; 6(3): 274-8; discussion 279-80, 1997 May.
Article in English | MEDLINE | ID: mdl-9183727

ABSTRACT

BACKGROUND AND AIMS OF THE STUDY: Preservation of the mitral valve and subvalvular apparatus was introduced clinically in the early 1960s, but for two decades the technique for mitral valve replacement included excision of both leaflets and their attached chordae tendineae. Lately, emphasis has been replaced on retaining the mitral subvalvular apparatus during valve replacement because of its role in left ventricular function. Hence, during the past six years, when performing mitral valve replacement we have, when possible, preserved the valvular and sub-valvular mitral apparatus. METHODS: Between January 1990 and November 1996, complete retention of all mitral tissue in connection with mitral valve replacement was performed in 58 patients (23 women and 35 men). Mean age was 63 years (range: 23 years to 77 years). Coronary bypass was a concomitant procedure in 19 patients; both the mitral and aortic valve was replaced in four cases. Calcified and/or stenotic valves were not a contraindication for the procedure; calcified plaques were removed. Adhesion between anterior and posterior leaflets was treated with sharp dissection. Valve and subvalvular tissue were preserved. The leaflets were reefed within the valve-sutures and compressed between the sewing ring and the native annulus when implanting the valve prosthesis. Chordal tension on the ventricle is thus maintained and the chordae pulled away from the valve effluent. RESULTS: Six patients died in the postoperative period and three had transient neurological symptoms. In no patient was death or transient neurological symptoms a consequence of the retention of mitral leaflets with subvalvular apparatus. CONCLUSIONS: We find the described technique to be useful not only in valve insufficiency but also in valve stenosis when preserving the mitral leaflets with sub-valvular apparatus during valve replacement. The technique is without procedure-related complications and prevents obstruction of left ventricular outflow tract.


Subject(s)
Bioprosthesis , Heart Valve Prosthesis/methods , Adult , Aged , Echocardiography, Doppler , Female , Humans , Male , Middle Aged , Mitral Valve , Mitral Valve Insufficiency/surgery , Mitral Valve Stenosis/surgery , Postoperative Complications/mortality , Survival Rate , Treatment Outcome
14.
Ugeskr Laeger ; 158(15): 2126-8, 1996 Apr 08.
Article in Danish | MEDLINE | ID: mdl-8650787

ABSTRACT

Assuming that post-prostatectomy incontinence frequently resolves to various extents, forty patients from a background material of 105 consecutively referred patients with this complaint were reexamined three to 106 months (median 55 months) after first examination. During the time interval between first examination and the revisit only four patients had some improvement of their incontinence. Eleven patients were evaluated urodynamically at both occasions showing no change in MUCP (maximal urethral closure pressure) or other urodynamic parameters. Consequently we could not confirm the dogma that sphincter lesion due to prostate surgery may gradually resolve. Our investigation indicates a poor continence prognosis in patients incontinent after transurethral or transvesical surgery of the prostate and that there therefore should be a more active treatment attitude. The patients should be offered an operation after evaluation of their incontinence, when a sphincter lesion is first diagnosed.


Subject(s)
Postoperative Complications/physiopathology , Prostatectomy/adverse effects , Prostatic Hyperplasia/surgery , Urethra/physiopathology , Urinary Incontinence/etiology , Urodynamics , Aged , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications/diagnosis , Prognosis , Surveys and Questionnaires , Urinary Incontinence/diagnosis , Urinary Incontinence/therapy
15.
J Heart Valve Dis ; 4(6): 628-33, 1995 Nov.
Article in English | MEDLINE | ID: mdl-8611978

ABSTRACT

Seven and a half year clinical experience with the CarboMedics prosthetic heart valve is presented. A total of 287 valves were inserted in 277 patients. The first 132 patients were followed in a prospective, and the remaining 145 patients in a partly prospective and partly retrospective manner. The follow up was 98.9% complete with a total of 1,055 patient-years. Actuarial survival at 7.5 years was 74.0% +/- 3.5% overall; 76.0% +/- 4.3% for single aortic, 75.0% +/- 6.5% for single mitral and 76.0% +/- 11.4% for double valve replacements. The actuarial rates of freedom from complications were as follows: valve thrombosis 99.6% +/- 0.4%, embolism 96.0% +/- 1.7%, and anticoagulant-related bleeding 88.0% +/- 2.4%. There was no hemolysis, prosthetic valve dysfunction, or structural deterioration. The linearized rates per 100 patients-years were as follows: valve thrombosis 0.09 (mitral 0.30); embolism 0.75 (aortic 0.31, mitral 1.80); anticoagulant related bleeding 2.84; paravalvular leakage overall 0.19 (aortic 0.31); prosthetic valve endocarditis 0.19 (aortic 0.31). Over a 7.5-year time frame, the CarboMedics prosthetic heart valve has been highly reliable with a low incidence of valve related complications.


Subject(s)
Heart Valve Diseases/surgery , Heart Valve Prosthesis/instrumentation , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Follow-Up Studies , Heart Valve Diseases/mortality , Humans , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Survival Rate
16.
Mol Ecol ; 4(4): 441-6, 1995 Aug.
Article in English | MEDLINE | ID: mdl-8574443

ABSTRACT

Racial differentiation and genetic variability were studied between and within the coastal, north interior, and south interior races of Douglas-fir using RAPD and allozyme markers. Nearly half of all RAPD bands scored (13: 45%) were found to be amplified from mitochondrial DNA. They exhibited maternal inheritance among hybrids and backcrosses between the races, and were much more highly differentiated (GST = 0.62 for haplotype frequencies) than were allozymes (GST = 0.26). No evidence of hybridization or introgression was detected where the coastal and interior races come into proximity in central Oregon.


Subject(s)
DNA, Mitochondrial/genetics , DNA, Plant/genetics , Genetic Variation , Trees/genetics , Base Sequence , Isoenzymes/genetics , Molecular Sequence Data , Random Amplified Polymorphic DNA Technique , Trees/classification
17.
Scand J Urol Nephrol ; 29(1): 69-74, 1995 Mar.
Article in English | MEDLINE | ID: mdl-7542401

ABSTRACT

Assuming that post-prostatectomy incontinence frequently resolves to various extents, forty patients selected from a background material of 105 consecutively referred patients with this complaint were reanalysed 3 to 106 months (median 55 months) after first examination. During the time interval between first examination and the revisit only 4 patients had some improvement of their incontinence. Eleven patients were evaluated urodynamically at both occasions showing no change in MUCP or other urodynamic parameters. Consequently we could not confirm the dogma that sphincter lesion due to prostate surgery may gradually resolve. Our investigation indicates a poor continence prognosis in patients incontinent after transurethral or transvesical surgery of the prostate and a more active treatment attitude. The patients should be offered an operation after evaluation of their incontinence, when a sphincter lesion is first diagnosed.


Subject(s)
Intraoperative Complications/etiology , Prostatectomy/adverse effects , Prostatic Hyperplasia/surgery , Urethra/injuries , Urinary Incontinence/etiology , Urodynamics , Aged , Aged, 80 and over , Follow-Up Studies , Humans , Intraoperative Complications/physiopathology , Male , Middle Aged , Urethra/physiopathology , Urinary Incontinence/physiopathology
18.
Pathol Res Pract ; 190(8): 808-13; discussion 814, 1994 Sep.
Article in English | MEDLINE | ID: mdl-7831158

ABSTRACT

We here report a case of placental vascular malformation with mesenchymal hyperplasia of the villi and a localized chorioangioma. After an uneventful pregnancy our patient delivered a non-malformed live female infant. The placenta was grossly enlarged, and macroscopically it was characterized by strongly enlarged varicous chorionic vessels. On the maternal plate vesicle-like structures, giving the impression of partial mole, were seen. At microscopy level, areas of normal looking tissue alternated with areas of excessively enlarged villi, in which the ground substance contained large amounts of acid mucopolysaccharide, corresponding to "mesenchymal hyperplasia". Moreover, a localized chorioangioma was found. In none of the histological sections were cisterns, abnormal trophoblastic proliferation, stunted ramification or stromal trophoblastic inclusions observed. In week 15 maternal se-AFP was elevated to 3.03 multiples of the median. Genetic analyses revealed a normal female karyotype and biparental genomic contributions to 7 unlinked loci. Placental vascular malformation with mesenchymal hyperplasia is a differential diagnosis to partial mole which should be considered when vesicle like placental enlargement is observed along with a living fetus.


Subject(s)
Hemangioma/pathology , Hydatidiform Mole/pathology , Placenta/blood supply , Placenta/pathology , Uterine Neoplasms/pathology , Adult , Diagnosis, Differential , Female , Humans , Mosaicism , Pregnancy
19.
Br J Urol ; 74(3): 333-6, 1994 Sep.
Article in English | MEDLINE | ID: mdl-7524997

ABSTRACT

OBJECTIVE: To assess the long-term results of total transurethral resection (T-TURP) and minimal transurethral resection of the prostate (M-TURP) in patients with obstructive symptoms caused by benign prostatic hyperplasia. PATIENTS AND METHODS: Between September 1979 and September 1980, 167 patients were studied: 83 were randomized to T-TURP and 84 to M-TURP. The patients were examined pre-operatively and 6 and 12 months post-operatively. Ten years post-operatively they were invited to attend for further examination, including uroflowmetry, determination of residual volume and evaluation of subjective symptoms. RESULTS: At the 10-year follow-up 39 patients were found to have died and 47 were lost to follow-up. Twelve patients had undergone repeat TURP and seven had been treated for urethral stricture. Thus 33 T-TURP and 29 M-TURP patients underwent detailed examination. Significant relief in obstructive and irritative symptoms was seen in both groups. The improvement in maximum flow rate remained stable throughout the follow-up period, with no significant differences between the two groups. Post-void residual urine decreased throughout follow-up, with minor differences between the groups. CONCLUSION: M-TURP is recommended as an alternative to T-TURP.


Subject(s)
Prostatectomy/methods , Prostatic Hyperplasia/surgery , Urinary Retention/surgery , Adult , Aged , Aged, 80 and over , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Period , Prospective Studies , Prostatectomy/adverse effects , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/physiopathology , Urinary Retention/etiology , Urinary Retention/physiopathology , Urination , Urodynamics
20.
J Heart Valve Dis ; 3(4): 371-6, 1994 Jul.
Article in English | MEDLINE | ID: mdl-7952309

ABSTRACT

Bacterial endocarditis of the native or prosthetic aortic valve is associated with significant morbidity and mortality despite aggressive medical and surgical treatment, especially when invasion of perivalvular tissue occurs. The currently recommended treatment for these advanced infections, in addition to thorough debridement, is aortic valve or root replacement with a homograft, although it appears that equally good results can be achieved with prosthetic valved conduits. Enthusiasm for the use of the pulmonary autograft as described by Ross for the treatment of non-infective aortic valve disease is increasing, but use of the pulmonary autograft in the treatment of aortic valve endocarditis is uncommon. This paper describes successful use of the Ross operation as total root replacement in six young patients between 10 and 32 years of age with aortic valve endocarditis. Three of the patients had active endocarditis and five patients had advanced disease, i.e. endocarditis with perivalvular tissue invasion and destruction. Follow up extending to 18 months continues to show excellent results with no mortality and no re-infection. We conclude that the Ross operation as total root replacement may be the best procedure for young patients with aortic valve endocarditis. The pulmonary autograft appears to be technically particularly well-suited, has growth potential, excellent hemodynamics, and a low risk of re-infection, thrombosis, and embolic complications without anticoagulation. Based on the long term results of the Ross operation in non-infected patients, excellent long term results are expected in this group as well.


Subject(s)
Aortic Valve/surgery , Endocarditis, Bacterial/surgery , Heart Valve Prosthesis/adverse effects , Prosthesis-Related Infections/surgery , Pulmonary Valve/transplantation , Adolescent , Adult , Cardiac Surgical Procedures/methods , Child , Coronary Angiography , Echocardiography, Doppler , Female , Heart Valve Diseases/surgery , Humans , Male , Postoperative Complications , Transplantation, Autologous , Treatment Outcome
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