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1.
J Clin Apher ; 33(3): 404-408, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29114919

ABSTRACT

OBJECTIVE: Familial hypercholesterolemia (FH) is a genetic disease with very high levels of circulating low density lipoprotein cholesterol (LDL-C) levels that leads to accelerated atherosclerosis. Lipoprotein apheresis is an effective treatment option for patients with FH and results in reduced cardiovascular morbidity and mortality. Circulating progenitor cells (CPCs) are markers of overall vascular health and diminished levels have been associated with decreased reparative potential and worse outcomes. We assessed the short-term change in CPC levels following a single lipoprotein apheresis session in FH patients who are already on stable lipoprotein apheresis therapy. We hypothesized that in addition to a reduction in atherogenic lipids, the cardiovascular benefit from lipoprotein apheresis therapy is mediated by enhanced vascular reparative capacity through mobilization of CPCs. METHODS: Eight FH patients (1 homozygous and 7 heterozygous) on stable lipoprotein apheresis therapy for at least three months had CPCs measured at baseline (prior to apheresis) and two hours after apheresis. Results were compared with data from age-matched hyperlipidemic (HLP) patients on statin therapy and healthy volunteers. RESULTS: FH patients had higher baseline circulating levels of CD34+/CD133+ and CD34+/CD133+/CXCR4+ cells compared to HLP and healthy subjects. There was no significant change in CPCs after apheresis in FH patients. CONCLUSIONS: FH patients had higher CPC counts at baseline compared to age-matched HLP and healthy controls, suggesting activation of reparative mechanism in this high risk population. Larger studies are needed to better characterize differences in CPC counts between FH subjects and HLP patients over time.


Subject(s)
Blood Component Removal/methods , Hyperlipoproteinemia Type II/blood , Stem Cells/cytology , Adult , Antigens, CD34/analysis , Case-Control Studies , Cell Count , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hyperlipidemias/drug therapy , Hyperlipoproteinemia Type II/therapy , Lipoproteins/isolation & purification , Middle Aged
3.
Arch Pathol Lab Med ; 121(12): 1292-5, 1997 Dec.
Article in English | MEDLINE | ID: mdl-9431322

ABSTRACT

The spectrum of organisms causing native valve endocarditis is changing. Despite an increasing incidence of infections caused by gram-negative organisms, they remain a rare cause of native valve endocarditis. Escherichia coli is especially uncommon. We describe the case of a 47-year-old man with no previous history of cardiac problems, who presented with culture-positive E coli endocarditis of his native aortic valve. His complicated clinical course necessitated emergent valve replacement, emphasizing the virulence of this organism. The high mortality rate and significant morbidity associated with this entity necessitates aggressive medical management and early surgical intervention.


Subject(s)
Aortic Valve/microbiology , Aortic Valve/pathology , Endocarditis, Bacterial/diagnosis , Escherichia coli Infections/diagnosis , Escherichia coli/isolation & purification , Aortic Valve/chemistry , Echocardiography/methods , Endocarditis, Bacterial/pathology , Endocarditis, Bacterial/surgery , Escherichia coli Infections/pathology , Escherichia coli Infections/surgery , Fibrin/analysis , Humans , Male , Middle Aged , Necrosis
4.
Am J Med Sci ; 311(4): 186-8, 1996 Apr.
Article in English | MEDLINE | ID: mdl-8602649

ABSTRACT

Abnormal calcium metabolism is a common complication of rhabdomyolysis -induced acute renal failure. During the oliguric phase, patients are frequently hypocalcemic. Hyperphosphatemia and skeletal resistance to parathyroid hormone are believed to be possible underlying mechanisms. In addition, there have been reports of hypercalcemia during the diuretic recovery phase after rhabdomyolysis. The pathophysiology of the hypercalcemia observed in the recovery phase is a subject of debate. Several mechanisms have been proposed, including mobilization of calcium from muscle deposits, secondary hyperparathyroidism, and elevated levels of 1,25 dihydroxyvitamin D. The authors report the case of a 30-year-old man admitted for evaluation of marked hypercalcemia (18.3 mg/dL) who was hospitalized 3 weeks earlier for acute renal failure secondary to rhabdomyolysis. Plasma parathyroid hormone and 1,25 dihydroxyvitamin D levels were suppressed during the period of maximal hypercalcemia. A technetium pyrophosphate scan demonstrated extensive deposition of calcium throughout the pelvic and lower extremity muscles. This case of delayed hypercalcemia after rhabdomyolysis supports the hypothesis that mobilization of calcium deposits from soft tissue, including muscle, is central to the pathogenesis of this syndrome.


Subject(s)
Acute Kidney Injury/etiology , Hypercalcemia/etiology , Rhabdomyolysis/complications , Adult , Calcitriol/blood , Calcium/metabolism , Humans , Hypercalcemia/blood , Male , Muscle, Skeletal/metabolism , Parathyroid Hormone/blood , Rhabdomyolysis/metabolism
5.
Biochem Biophys Res Commun ; 218(3): 934-9, 1996 Jan 26.
Article in English | MEDLINE | ID: mdl-8579617

ABSTRACT

Insulin-like growth factor I is an autocrine/paracrine factor for vascular smooth muscle cells and is required for angiotensin II- and thrombin-induced mitogenesis. The insulin-like growth factor I-triggered signaling pathway involves autophosphorylation of the beta-subunit of its tyrosine kinase receptor and phosphorylation of insulin receptor substrate-1, the latter providing binding sites for proteins with src homology-2 domains. In rat aortic smooth muscle cells we observed that both angiotensin II and thrombin induced rapid tyrosine phosphorylation of insulin receptor substrate-1. Our results also demonstrated that these mitogens rapidly stimulated phosphorylation of the insulin-like growth factor 1 receptor beta-chain. These data demonstrate a novel interaction between the G-protein coupled angiotensin II and thrombin receptors and the tyrosine-kinase insulin-like growth factor I receptor.


Subject(s)
GTP-Binding Proteins/metabolism , Muscle, Smooth, Vascular/metabolism , Phosphoproteins/metabolism , Receptor Protein-Tyrosine Kinases/metabolism , Receptor, IGF Type 1/metabolism , Angiotensin II/pharmacology , Animals , Aorta , Cells, Cultured , Insulin Receptor Substrate Proteins , Rats , Signal Transduction , Thrombin/pharmacology
7.
Ugeskr Laeger ; 156(29): 4229-33, 1994 Jul 18.
Article in Danish | MEDLINE | ID: mdl-8066920

ABSTRACT

Seven hospital departments were enrolled in the first step in a quality assurance process regarding pressure sores. A total of 2317 patients representative of a Danish hospital population were included. At the time of admission 2.2% had pressure sores and 1.1% pressure marks (point prevalence), and during hospitalization 2.9% developed pressure sores pressure sores and 1.1% pressure marks (point prevalence), and during hospitalization 2.9% developed pressure sores and 1.4% pressure marks (absolute incidence). The incidence of pressure sores and pressure marks varied between the department from 0-11.3% and from 0 to 7.7% respectively. The relative risk (RR) of developing pressure sores was highest (RR 11.7) for patients who had pressure marks on admittance. Other significant risk factors were admission to one specific surgical department compared to the reference department (RR 7.9), age > 81 years compared to age < 54 years (RR 6.0), length of stay > 8 days compared to < 8 days (RR 5.9) and the diagnosis fractura partis proximalis femoris compared to other diagnoses (RR 4.7). The longer the duration of surgery the higher the incidence of pressure sores, but there was no significant relation between the waiting time from admission to surgery and incidence of pressure sores. The study documents that the development of pressure sores in Danish hospital patients is not a serious quality problem. However, individual differences between departments show the need for some departments to continue the quality improvement efforts.


Subject(s)
Hospital Departments/standards , Pressure Ulcer/epidemiology , Quality Assurance, Health Care , Adult , Aged , Denmark/epidemiology , Humans , Incidence , Length of Stay , Longitudinal Studies , Middle Aged , Pressure Ulcer/etiology , Risk Factors
8.
Acta Obstet Gynecol Scand ; 73(2): 129-35, 1994 Feb.
Article in English | MEDLINE | ID: mdl-8116351

ABSTRACT

OBJECTIVE: To compare the clinical indications for delivery by cesarean section (CS) in singleton pregnancies in two Danish counties with different CS rates, and to describe the relation between CS in the two counties and parity, mother's age, type of delivery department, gestational age at birth, and birthweight. DESIGN: A population-based, follow-up study based on antecedent data. SETTING: Two Danish counties, where women deliver in obstetric as well as surgical departments, with a CS rate of 8.3% and 15.2%, respectively. SUBJECTS: All pregnant women in the two counties who delivered in 1989. MAIN OUTCOME MEASURES: Comparison of the rates of CS in the two counties carried out for five well-defined clinical indications: Previous cesarean section, breech presentation, dystocia, fetal distress, and other. SECONDARY MEASURES: Neonatal and maternal outcomes. RESULTS: In the county with the higher frequency of CS, all indications for CS were used significantly more often, except from 'fetal distress' in primiparous women. In this county 'breech presentation' was the commonest indication among primiparous women, whereas 'fetal distress' was the most common in the county with the lower CS rate. For multiparous women the highest CS rates in both counties were found among women who had had a previous CS. The major difference between the two counties was the threefold greater risk of CS indicated by 'dystocia' among multiparous women in the county with the higher CS rate. CONCLUSION: The regional differences in CS could not be explained by differences between the two populations or by an increased rate of a single indication, but could be due to differences in obstetric practice or expectations or demands from the pregnant women.


Subject(s)
Cesarean Section/statistics & numerical data , Adolescent , Adult , Apgar Score , Birth Weight , Breech Presentation , Cesarean Section, Repeat/statistics & numerical data , Denmark/epidemiology , Dystocia/surgery , Female , Fetal Distress/surgery , Follow-Up Studies , Gestational Age , Humans , Infant, Newborn , Maternal Age , Middle Aged , Obstetrics and Gynecology Department, Hospital/statistics & numerical data , Parity , Pregnancy , Pregnancy Outcome , Retrospective Studies , Risk Factors , Surgery Department, Hospital/statistics & numerical data
9.
Acta Obstet Gynecol Scand ; 72(8): 627-32, 1993 Nov.
Article in English | MEDLINE | ID: mdl-8259749

ABSTRACT

OBJECTIVE: To compare the rate of obstetric interventions, length of labor, and maternal morbidity in pregnancies with prelabor rupture of membranes at term after either early or late induction of labor in both primiparous and pluriparous women. DESIGN: Prospective, randomized study. SUBJECTS: 362 women with singleton pregnancies, cephalic presentations, gestational age of 36 completed weeks or more were allocated at random to induction with oxytocin either 6 hours after PROM (n = 62) (early) or 24 hours (n = 62) (late). Those eligible, but not participating in the study, totalled 238 women. MAIN OBSTETRIC MEASURES: Time of spontaneous labor in the late induction group, length of labor, obstetric intervention rate, maternal morbidity, and the degree of histologic chorioamnionitis. RESULTS: The length of labor was longer in the late induction group than in the early induction group in both primiparous and pluriparous (p < 0.05). There were no overall differences in the rate of obstetric interventions or maternal morbidity, but there were marked differences between primiparous and pluriparous women. Increasing time span between the period from rupture of membranes to delivery increased the degree of histologic chorioamnionitis. CONCLUSION: If a woman wants a short labor, she will benefit from early induction. We did not find statistical differences in the rate of obstetric intervention or in the maternal morbidity, but there was a tendency towards adverse effects of late induction.


Subject(s)
Fetal Membranes, Premature Rupture/therapy , Adult , Delivery, Obstetric/methods , Female , Humans , Labor, Induced , Oxytocin/therapeutic use , Parity , Pregnancy , Prospective Studies , Time Factors
11.
Ugeskr Laeger ; 152(48): 3614-6, 1990 Nov 26.
Article in Danish | MEDLINE | ID: mdl-2256224

ABSTRACT

Fifty-five women aged 21-51 years were treated in 1977 and 1978 with cryocoagulation (single-freezing technique) for cervical intraepithelial neoplasia (CIN I-III). 92% of these patients were followed up 7-8 years after this treatment. The primary success rate i.e. the proportion between the number of women in whom dysplastic changes were not re-encountered within the first 15 months after treatment and the total number of women treated was 94.5%. After the period of observation of 7-8 years, the success rate was 100% for CIN I + II and 79.5% for CIN III.


Subject(s)
Carcinoma in Situ/surgery , Cryosurgery , Uterine Cervical Dysplasia/surgery , Uterine Cervical Neoplasms/surgery , Adult , Female , Follow-Up Studies , Humans , Middle Aged , Time Factors , Uterine Cervical Neoplasms/pathology
12.
Ugeskr Laeger ; 152(43): 3152-5, 1990 Oct 22.
Article in Danish | MEDLINE | ID: mdl-2238194

ABSTRACT

An investigation is presented on the basis of the medical register of births concerning all primiparae who were delivered of a liveborn singleton infant in 1982 and 1986. On the basis of the section on complications in the notification of the births, we have made a subdivision into four "approximate indications". We find a variation in frequencies of Caesarean section from 9.7% (1982) to 17.1% (1986) between the various counties and an increase during the period investigated of 19%. 50% of the increase occurred in the group termed "other causes", 25% in the group of foetal distress and 25% in the group of dystocia. The group of breech presentations is, by and large, unchanged in Denmark as a whole but great differences are present between counties. This register investigation does not permit the possibility of deeper analysis of the reasons for the variations.


Subject(s)
Cesarean Section/statistics & numerical data , Denmark , Female , Humans , Pregnancy , Registries
13.
Acta Obstet Gynecol Scand ; 69(5): 437-9, 1990.
Article in English | MEDLINE | ID: mdl-2270770

ABSTRACT

A case of non-obstructive cecal dilatation and perforation after cesarean section is reported, with a review of the literature on the diagnosis and management of this entity. Fifteen cases have been described. Attention is called to this rare complication and to the accompanying pseudo-obstructive syndrome, the diagnosis of which is important in order to avoid cecal perforation. Non-obstructive cecal dilatation is a life threatening complication to cesarean section, and immediate surgical intervention is important.


Subject(s)
Cecal Diseases/etiology , Cesarean Section/adverse effects , Intestinal Perforation/etiology , Adult , Dilatation, Pathologic/etiology , Female , Humans , Pregnancy
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