This study was conducted to compare the accuracy of clinic blood pressure (CBP) and telemedical home blood pressure (HBP) measurement in the diagnosis of hypertension in primary care. The study subjects were 411 patients with average CBP > or =140 mmHg systolic or > or =90 mmHg diastolic, who performed telemedical HBP measurement (5 days, four times daily) and ambulatory blood pressure (ABP) monitoring in random order. Main outcome measure was the agreement of CBP and HBP with daytime ABP. CBP was much higher than daytime ABP and average HBP (P
Two hundred and three patients, 148 males and 55 females, who during the last month before admission had experienced at least one reversible cerebral ischemic attack of less than 72 hours duration, were randomly assigned to treatment with either acetylsalicylic acid (ASA) 1000 mg daily (101 patients) or placebo (102 patients). The average follow-up period was 25 months. The two treatment groups were comparable with respect to age, sex, associated diseases, risk factors, number and duration of cerebral ischemic attacks. No statistically significant differences were found between the treatment groups as to the primary end point: stroke or death (ASA group 20.8%, placebo group 16.7%). Occurrence of transient ischemic attacks during the treatment period was not reduced by ASA treatment, whereas there was a trend suggesting fewer myocardial infarctions in the ASA group (5.9%) than in the placebo group (13.7%). The difference, however, was not statistically significant (p = 0.10). We were thus unable to demonstrate any favorable influence of ASA 1000 mg daily in patients with reversible ischemic attacks. This study does not, of course, prove that ASA treatment is ineffective in stroke prevention.
A retrospective investigation based on case reports was undertaken concerning abuse of alcohol and drugs among medical staff, 44 doctors and 23 nurses, who were treated in the Department of Psychiatry, Rigshospitalet during the period 1970-1982, all of whom received treatment for more than six months. By the end of 1987, a marked excessive mortality was found and this was greatest among doctors among whom 50% had died with an average age of 45.5 years. Factors which were found to be of significance for the prognosis for duration of survival in this selected material were 1) duration of the abuse of medicine, 2) presence of mixed alcohol and drug abuse and 3) previous suicidal attempts.
Neutralising antibodies (NAbs) against interferon (IFN)-beta reduce the treatment effect in multiple sclerosis (MS). However, data from pivotal trials of IFN-beta in MS suggest that NAb-positive patients may have a reduced relapse rate during the first six to 12 months of therapy. We collected clinical data and plasma samples for NAb measurements prospectively, every six months, in 468 patients treated with the same IFN-beta preparation for at least 24 months. NAbs were measured blindly with a cytopathic effect (CPE) assay. During treatment months 0-6, patients who became NAb-positive had significantly fewer relapses compared to patients who maintained the NAb-negative status, whereas the opposite was observed after month 6. This is in accordance with observations in randomised studies of the three different IFN-beta preparations, showing that patients who become NAb-positive have lower relapse rates during the first six or 12 months of therapy. We hypothesise that low affinity NAbs, present early after the start of IFN-beta therapy, though neutralising in vitro in sensitive assays increase the half-life of IFN-beta in vivo and, thereby, enhance the therapeutic effect. With affinity maturation, NAbs effectively prevent IFN-beta binding to its receptors also in vivo and, hence, abolish the treatment effect.
Fifty-six patients undergoing hip or knee replacements were randomized to receive autologous drain-blood transfusion or homologous blood transfusion at postoperative need. A reinfusion of 65% of the postoperative drainage blood loss was achieved. The number of homologous blood transfusions fell concomitantly from 2.3 to 0.6 after hip replacement and from 3.3 to 0.3 after knee replacement. No signs of activation of the complement or coagulation systems were found.
The prevalence of osteoporosis in developing countries is low compared to most industrialised countries despite an apparent low Ca intake. It is possible, however, that food surveys have overlooked important Ca sources in developing countries. Small fish eaten with the bones can be a rich source of Ca, even though Ca from bone may be considered unavailable for absorption. In the present study, absorption of Ca from indigenous Bengali small fish was compared with the Ca absorption from milk. Ca absorption from single meals was determined in 19 healthy men and women (21-28 y). Each subject received two meal types on two separate occasions. Both meals consisted of white wheat bread, butter and ultra pure water with the main Ca source being either small Bengali fish (397 mg Ca in total) or skimmed milk (377 mg Ca in total). The meals were extrinsically labelled with 47Ca, and whole-body retention was measured on day 8, 12, 15 and 19 after intake of each meal. The labelling procedure was evaluated by an in vitro method. The calculated absorption of Ca as measured with 47Ca whole-body retention was 23.8 +/- 5.6% from the fish meal and 21.8 +/- 6.1% from the milk meal (mean +/- SD), which was not significantly different (p = 0.52). Even after correction for an incomplete isotope exchange, as indicated by the in vitro study, Ca absorption was similar from the two meal types. It was concluded that Ca absorption from small Bengali fish was comparable that from skimmed milk, and that these fish may represent a good source of Ca.
Vertebral endplate signal changes (VESC) are more common among patients with low back pain (LBP) and/or sciatica than in people who are not seeking care for back pain. The distribution and characteristics of VESC have been described in people from clinical and non-clinical populations. However, while the clinical course of VESC has been studied in patients, the natural course in the general population has not been reported. The objectives of this prospective observational study were to describe: 1) the distribution and characteristics of VESC in the lumbar spine, 2) its association with disc degeneration, and 3) its natural course from 40 to 44 years of age.
Three-hundred-and-forty-four individuals (161 men and 183 women) sampled from the Danish general population had MRI at the age of 40 and again at the age of 44. The following MRI findings were evaluated using standardised evaluation protocols: type, location, and size of VESC, disc signal, and disc height. Characteristics and distribution of VESC were analysed by frequency tables. The association between VESC and disc degeneration was analysed by logistic regression analysis. The change in type and size of VESC was analysed by cross-tabulations of variables obtained at age 40 and 44 and tested using McNemar's test of symmetry.
Two-thirds (67%) of VESC found in this study were located in the lower part of the spine (L4-S1). VESC located at disc levels L1-L3 were generally small and located only in the anterior part of the vertebra, whereas those located at disc levels L4-S1 were more likely to extend further into the vertebra and along the endplate. Moreover, the more the VESC extended into the vertebra, the more likely it was that the adjacent disc was degenerated. The prevalence of endplate levels with VESC increased significantly from 6% to 9% from age 40 to 44. Again, VESC that was only observed in the endplate was more likely to come and go over the four-year period compared with those which extended further into the vertebra, where it generally persisted.
The prevalence of VESC increased significantly over the four-year period. Furthermore, the results from this study indicate that the distribution of VESC, its association with disc degeneration and its natural course, is dependent on the size of the signal changes.
Cites: Radiology. 2001 Feb;218(2):420-711161156
Cites: Eur Spine J. 2008 Nov;17(11):1407-2218787845
Cites: Spine (Phila Pa 1976). 2002 Jan 15;27(2):125-3411805656
Cites: Spine (Phila Pa 1976). 2002 Oct 15;27(20):2274-812394906
Population-based data on the rate and outcome of complications related to blood donation are sparse.
Data from a survey conducted in 2003 in Aarhus County, Denmark, were used to assess the overall rate of donor complications. Additional nationwide data on moderate and severe donor complications were obtained from the Danish Register of Complications Related to Blood Donation, with records of all moderate and severe donor complications in Denmark occurring during the period 1997-2003.
In the regional survey, we identified 340 complications of any type among 41 274 donations, corresponding to a rate of 824/100,000 donations [95% confidence interval (CI): 741-916]. All complications were either needle injuries or vasovagal reactions. In the nationwide register, a total of 752 moderate and severe complications were recorded among 2,575,264 donations, corresponding to a rate of 29/100,000 donations (95% CI: 27-31). The rates of complications leading to long-term morbidity or disablement (> 5% loss of working capacity) were 5/100,000 donations (95% CI: 4.2-5.9) and 2.3/100,000 donations (95% CI: 1.8-2.9), respectively.
The risk of complications related to blood donation is low. However, attention towards donor complications is warranted, given the non-negligible rate of complications resulting in long-term morbidity and disablement.