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Bjerring C, Vested M, Arleth T, Eriksen K, Albrechtsen C, Rasmussen LS. Onset time and duration of action of rocuronium 0.6 mg/kg in patients above 80 years of age: A comparison with young adults. Acta Anaesthesiol Scand 2020; 64:1082-1088. [PMID: 32462665 DOI: 10.1111/aas.13645] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The number of elderly is increasing, and a large proportion of these people will require surgery and anaesthesia. However, little data exist regarding rocuronium in patients above 80 years of age. The aim of this study was to determine the onset time and duration of action for rocuronium 0.6 mg/kg in patients above 80 years compared with young adults. METHODS This prospective observational study included 16 young (18-40 years) and 16 elderly (>80 years) patients scheduled for total intravenous anaesthesia. Neuromuscular block following rocuronium 0.6 mg/kg was monitored with acceleromyography using train-of-four (TOF) stimulation. The primary outcome was onset time (from administration of rocuronium until TOF count = 0). Secondary outcomes were duration of action (from administration to TOF ratio >0.9) and intubating conditions according to Intubation Difficulty Score. RESULTS Elderly patients, median age of 84 years, had significantly prolonged onset time compared to younger patients; median 135 seconds (135-158) vs 90 seconds (90-105), respectively, a mean difference of 82 seconds (40-124) and Wilcoxon Mann-Whitney odds (WMW) of 19.48 (7.48-X). Duration of action in elderly patients was significantly longer, with a median time of 81 minute (71-97) vs 53 minute (42-73), respectively, a mean difference of 31 minute (14-48), and WMW odds of 6.35 (2.59-X). There was no significant difference in intubating conditions. CONCLUSIONS Patients above 80 years had significantly prolonged onset time and duration of action after rocuronium 0.6 mg/kg compared with patients aged 18-40 years.
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Affiliation(s)
- Cecilie Bjerring
- Department of Anaesthesia Centre of Head and Orthopaedics, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Matias Vested
- Department of Anaesthesia Centre of Head and Orthopaedics, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Tobias Arleth
- Department of Anaesthesia Centre of Head and Orthopaedics, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Kirsten Eriksen
- Department of Anaesthesia Centre of Head and Orthopaedics, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Charlotte Albrechtsen
- Department of Anaesthesia Centre of Juliane Marie Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Lars S. Rasmussen
- Department of Anaesthesia Centre of Head and Orthopaedics, Rigshospitalet University of Copenhagen Copenhagen Denmark
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Vested M, Tarpgaard M, Eriksen K, Rasmussen LS. Incidence of residual neuromuscular blockade in children below 3 years after a single bolus of cisatracurium 0.1 mg/kg: A quality assurance study. Acta Anaesthesiol Scand 2020; 64:168-172. [PMID: 31652351 DOI: 10.1111/aas.13495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/04/2019] [Accepted: 10/07/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND The aim of this quality assurance study was to determine the proportion of patients with residual block (train-of-four (TOF) ratio <0.9) upon conclusion of surgery after a bolus of cisatracurium 0.1 mg/kg. It was considered good quality if less than 10% of the study population had residual block upon conclusion of surgery. METHODS A total of 40 patients ≤3 years of age scheduled for cleft lip and palate repair were consecutively enrolled. They received general anaesthesia with either sevoflurane and fentanyl (n = 20) or propofol and remifentanil (n = 20). TOF stimulation using acceleromyography was applied on the tibial nerve. Cisatracurium 0.1 mg/kg was administered to facilitate tracheal intubation. RESULTS Three patients (8%; 95% CI: 1.7-21) had a TOF ratio <0.9 at conclusion of surgery, all three receiving sevoflurane. In the sevoflurane group, this corresponded to 16% (95% CI: 3.3-40) of the patients. Mean duration of action of cisatracurium 0.1 mg/kg was 119 minutes (SD 40) with sevoflurane and 73 minutes (SD 29) during total intravenous anaesthesia (P < .001). Onset time of cisatracurium 0.1 mg/kg was 166 seconds (SD 37) with sevoflurane and 199 seconds (SD 60) during total intravenous anaesthesia. CONCLUSION We found that 8% of the children had residual neuromuscular blockade (TOF ratio <0.9) after administration of a single bolus of cisatracurium 0.1 mg/kg but we cannot exclude that the true proportion is around 20%.
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Affiliation(s)
- Matias Vested
- Department of Anaesthesia Centre of Head and Orthopedics, Rigshospitalet University of Copenhagen Denmark
| | - Mona Tarpgaard
- Department of Anaesthesia Centre of Head and Orthopedics, Rigshospitalet University of Copenhagen Denmark
| | - Kirsten Eriksen
- Department of Anaesthesia Centre of Head and Orthopedics, Rigshospitalet University of Copenhagen Denmark
| | - Lars S. Rasmussen
- Department of Anaesthesia Centre of Head and Orthopedics, Rigshospitalet University of Copenhagen Denmark
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Tsai MY, Hoek G, Eeftens M, de Hoogh K, Beelen R, Beregszászi T, Cesaroni G, Cirach M, Cyrys J, De Nazelle A, de Vocht F, Ducret-Stich R, Eriksen K, Galassi C, Gražuleviciene R, Gražulevicius T, Grivas G, Gryparis A, Heinrich J, Hoffmann B, Iakovides M, Keuken M, Krämer U, Künzli N, Lanki T, Madsen C, Meliefste K, Merritt AS, Mölter A, Mosler G, Nieuwenhuijsen MJ, Pershagen G, Phuleria H, Quass U, Ranzi A, Schaffner E, Sokhi R, Stempfelet M, Stephanou E, Sugiri D, Taimisto P, Tewis M, Udvardy O, Wang M, Brunekreef B. Spatial variation of PM elemental composition between and within 20 European study areas--Results of the ESCAPE project. Environ Int 2015; 84:181-92. [PMID: 26342569 DOI: 10.1016/j.envint.2015.04.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 04/30/2015] [Accepted: 04/30/2015] [Indexed: 05/12/2023]
Abstract
An increasing number of epidemiological studies suggest that adverse health effects of air pollution may be related to particulate matter (PM) composition, particularly trace metals. However, we lack comprehensive data on the spatial distribution of these elements. We measured PM2.5 and PM10 in twenty study areas across Europe in three seasonal two-week periods over a year using Harvard impactors and standardized protocols. In each area, we selected street (ST), urban (UB) and regional background (RB) sites (totaling 20) to characterize local spatial variability. Elemental composition was determined by energy-dispersive X-ray fluorescence analysis of all PM2.5 and PM10 filters. We selected a priori eight (Cu, Fe, K, Ni, S, Si, V, Zn) well-detected elements of health interest, which also roughly represented different sources including traffic, industry, ports, and wood burning. PM elemental composition varied greatly across Europe, indicating different regional influences. Average street to urban background ratios ranged from 0.90 (V) to 1.60 (Cu) for PM2.5 and from 0.93 (V) to 2.28 (Cu) for PM10. Our selected PM elements were variably correlated with the main pollutants (PM2.5, PM10, PM2.5 absorbance, NO2 and NOx) across Europe: in general, Cu and Fe in all size fractions were highly correlated (Pearson correlations above 0.75); Si and Zn in the coarse fractions were modestly correlated (between 0.5 and 0.75); and the remaining elements in the various size fractions had lower correlations (around 0.5 or below). This variability in correlation demonstrated the distinctly different spatial distributions of most of the elements. Variability of PM10_Cu and Fe was mostly due to within-study area differences (67% and 64% of overall variance, respectively) versus between-study area and exceeded that of most other traffic-related pollutants, including NO2 and soot, signaling the importance of non-tailpipe (e.g., brake wear) emissions in PM.
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Affiliation(s)
- Ming-Yi Tsai
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland; Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA.
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | - Marloes Eeftens
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland; Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | - Kees de Hoogh
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland; MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Rob Beelen
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | - Timea Beregszászi
- Department of Air Hygiene, National Institute of Environmental Health, Budapest, Hungary
| | - Giulia Cesaroni
- Epidemiology Department, Lazio Regional Health Service, Rome, Italy
| | - Marta Cirach
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain
| | - Josef Cyrys
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany; Environmental Science Center, Universität Augsburg, Augsburg, Germany
| | - Audrey De Nazelle
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Centre for Environmental Policy, Faculty of Natural Sciences, Imperial College London, London, United Kingdom
| | - Frank de Vocht
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, England, United Kingdom; School of Social and Community Medicine, University of Bristol, Bristol, England, United Kingdom
| | - Regina Ducret-Stich
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland
| | | | - Claudia Galassi
- AOU Città della Salute e della Scienza - CPO Piemonte, Turin, Italy
| | | | | | - Georgios Grivas
- School of Chemical Engineering, National Technical University of Athens, Greece
| | - Alexandros Gryparis
- Division of Hygiene - Epidemiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Joachim Heinrich
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
| | - Barbara Hoffmann
- IUF Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Minas Iakovides
- Environmental Chemical Processes Laboratory, Department of Chemistry, University of Crete, Heraklion, Greece
| | - Menno Keuken
- TNO, Applied Research Organization, The Netherlands
| | - Ursula Krämer
- IUF Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Nino Künzli
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland
| | - Timo Lanki
- Department of Environmental Health, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Christian Madsen
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Kees Meliefste
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | - Anne-Sophie Merritt
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mölter
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, England, United Kingdom; Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Gioia Mosler
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Mark J Nieuwenhuijsen
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Harish Phuleria
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland; Centre for Environmental Science and Engineering, Indian Institute of Technology Bombay Powai, Mumbai 400076, India
| | - Ulrich Quass
- Air Quality & Sustainable Nanotachnology, IUTA Institut für Energie- und Umwelttechnik e.V., Duisburg, Germany
| | - Andrea Ranzi
- Regional Reference Centre on Environment and Health, ARPA Emilia Romagna, Modena, Italy
| | - Emmanuel Schaffner
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland
| | - Ranjeet Sokhi
- Centre for Atmospheric and Instrumentation Research (CAIR), University of Hertfordshire, College Lane, Hatfield, United Kingdom
| | - Morgane Stempfelet
- French Institute for Public Health Surveillance (InVS), Saint-Maurice Cedex, France
| | - Euripides Stephanou
- Environmental Chemical Processes Laboratory, Department of Chemistry, University of Crete, Heraklion, Greece
| | - Dorothea Sugiri
- IUF Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Pekka Taimisto
- Department of Environmental Health, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Marjan Tewis
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | - Orsolya Udvardy
- Department of Air Hygiene, National Institute of Environmental Health, Budapest, Hungary
| | - Meng Wang
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands; Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Bonde C, Khorasani H, Eriksen K, Wolthers M, Kehlet H, Elberg J. Introducing the fast track surgery principles can reduce length of stay after autologous breast reconstruction using free flaps: A case control study. J Plast Surg Hand Surg 2015; 49:367-71. [PMID: 26161838 DOI: 10.3109/2000656x.2015.1062387] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The concept of fast-track surgery (FTS) is a peri- and postoperative care concept developed to reduce length of hospital stay (LOS) and morbidity after surgery. FTS programmes have been reported from other surgical specialities, but there are few reports of FTS in plastic surgery. MATERIALS AND METHODS Autologous breast reconstructions have been performed with abdominal free flaps since 1994. In 2006, an FTS program was introduced. Important changes in procedure were: early mobilisation, fewer/faster removal of drains and urinary catheter, discontinuation of epidural analgesia, planned early discharge, and multimodal opioid-sparing analgesia. The results from all unilateral, breast reconstructions in the first 5 years after the implementation of the FTS (n = 177) were compared to results prior to the FTS (n = 292). Flap type, operating time, blood loss and ischaemic time, LOS, early flap related and systemic complications (< 30 days) were analysed. RESULTS FTS significantly reduced mean LOS from 7.4 days to 6.2 days (p = 0.0002). When compared to pre-FTS results, similar flap types, operating time, blood loss and ischaemic time were found. LOS > 7 days were due to complications, the most common being haematoma. Prevalence of complications (6.5 vs 7.9%) and flap loss (2 vs 2%) did not increase. Haematomas seemed more frequent with the use of NSAID than with COX-2 inhibitors (9 vs 4%); however, the difference was not statistically significant. CONCLUSION By introducing a simple, peri- and postoperative care concept it is possible to reduce LOS after microsurgery by at least 1 day without an increase in complications or flap loss.
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Affiliation(s)
- Christian Bonde
- a 1 Department of Plastic Surgery, Breast Surgery and Burns, Section 2102
| | - Hoda Khorasani
- a 1 Department of Plastic Surgery, Breast Surgery and Burns, Section 2102
| | | | - Mette Wolthers
- a 1 Department of Plastic Surgery, Breast Surgery and Burns, Section 2102
| | - Henrik Kehlet
- c 3 Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark, Europe
| | - Jens Elberg
- a 1 Department of Plastic Surgery, Breast Surgery and Burns, Section 2102
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de Hoogh K, Wang M, Adam M, Badaloni C, Beelen R, Birk M, Cesaroni G, Cirach M, Declercq C, Dėdelė A, Dons E, de Nazelle A, Eeftens M, Eriksen K, Eriksson C, Fischer P, Gražulevičienė R, Gryparis A, Hoffmann B, Jerrett M, Katsouyanni K, Iakovides M, Lanki T, Lindley S, Madsen C, Mölter A, Mosler G, Nádor G, Nieuwenhuijsen M, Pershagen G, Peters A, Phuleria H, Probst-Hensch N, Raaschou-Nielsen O, Quass U, Ranzi A, Stephanou E, Sugiri D, Schwarze P, Tsai MY, Yli-Tuomi T, Varró MJ, Vienneau D, Weinmayr G, Brunekreef B, Hoek G. Development of land use regression models for particle composition in twenty study areas in Europe. Environ Sci Technol 2013; 47:5778-86. [PMID: 23651082 DOI: 10.1021/es400156t] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Land Use Regression (LUR) models have been used to describe and model spatial variability of annual mean concentrations of traffic related pollutants such as nitrogen dioxide (NO2), nitrogen oxides (NOx) and particulate matter (PM). No models have yet been published of elemental composition. As part of the ESCAPE project, we measured the elemental composition in both the PM10 and PM2.5 fraction sizes at 20 sites in each of 20 study areas across Europe. LUR models for eight a priori selected elements (copper (Cu), iron (Fe), potassium (K), nickel (Ni), sulfur (S), silicon (Si), vanadium (V), and zinc (Zn)) were developed. Good models were developed for Cu, Fe, and Zn in both fractions (PM10 and PM2.5) explaining on average between 67 and 79% of the concentration variance (R(2)) with a large variability between areas. Traffic variables were the dominant predictors, reflecting nontailpipe emissions. Models for V and S in the PM10 and PM2.5 fractions and Si, Ni, and K in the PM10 fraction performed moderately with R(2) ranging from 50 to 61%. Si, NI, and K models for PM2.5 performed poorest with R(2) under 50%. The LUR models are used to estimate exposures to elemental composition in the health studies involved in ESCAPE.
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Affiliation(s)
- Kees de Hoogh
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.
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Eeftens M, Tsai MY, Ampe C, Anwander B, Beelen R, Bellander T, Cesaroni G, Cirach M, Cyrys J, de Hoogh K, De Nazelle A, de Vocht F, Declercq C, Dėdelė A, Eriksen K, Galassi C, Gražulevičienė R, Grivas G, Heinrich J, Hoffmann B, Iakovides M, Ineichen A, Katsouyanni K, Korek M, Krämer U, Kuhlbusch T, Lanki T, Madsen C, Meliefste K, Mölter A, Mosler G, Nieuwenhuijsen M, Oldenwening M, Pennanen A, Probst-Hensch N, Quass U, Raaschou-Nielsen O, Ranzi A, Stephanou E, Sugiri D, Udvardy O, Vaskövi É, Weinmayr G, Brunekreef B, Hoek G. Spatial variation of PM2.5, PM10, PM2.5 absorbance and PMcoarse concentrations between and within 20 European study areas and the relationship with NO2 – Results of the ESCAPE project. Atmospheric Environment 2012; 62:303-317. [PMID: 0 DOI: 10.1016/j.atmosenv.2012.08.038] [Citation(s) in RCA: 285] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Eeftens M, Beelen R, de Hoogh K, Bellander T, Cesaroni G, Cirach M, Declercq C, Dėdelė A, Dons E, de Nazelle A, Dimakopoulou K, Eriksen K, Falq G, Fischer P, Galassi C, Gražulevičienė R, Heinrich J, Hoffmann B, Jerrett M, Keidel D, Korek M, Lanki T, Lindley S, Madsen C, Mölter A, Nádor G, Nieuwenhuijsen M, Nonnemacher M, Pedeli X, Raaschou-Nielsen O, Patelarou E, Quass U, Ranzi A, Schindler C, Stempfelet M, Stephanou E, Sugiri D, Tsai MY, Yli-Tuomi T, Varró MJ, Vienneau D, Klot SV, Wolf K, Brunekreef B, Hoek G. Development of Land Use Regression models for PM(2.5), PM(2.5) absorbance, PM(10) and PM(coarse) in 20 European study areas; results of the ESCAPE project. Environ Sci Technol 2012; 46:11195-11205. [PMID: 22963366 DOI: 10.1016/j.atmosenv.2013.02.037] [Citation(s) in RCA: 537] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Land Use Regression (LUR) models have been used increasingly for modeling small-scale spatial variation in air pollution concentrations and estimating individual exposure for participants of cohort studies. Within the ESCAPE project, concentrations of PM(2.5), PM(2.5) absorbance, PM(10), and PM(coarse) were measured in 20 European study areas at 20 sites per area. GIS-derived predictor variables (e.g., traffic intensity, population, and land-use) were evaluated to model spatial variation of annual average concentrations for each study area. The median model explained variance (R(2)) was 71% for PM(2.5) (range across study areas 35-94%). Model R(2) was higher for PM(2.5) absorbance (median 89%, range 56-97%) and lower for PM(coarse) (median 68%, range 32- 81%). Models included between two and five predictor variables, with various traffic indicators as the most common predictors. Lower R(2) was related to small concentration variability or limited availability of predictor variables, especially traffic intensity. Cross validation R(2) results were on average 8-11% lower than model R(2). Careful selection of monitoring sites, examination of influential observations and skewed variable distributions were essential for developing stable LUR models. The final LUR models are used to estimate air pollution concentrations at the home addresses of participants in the health studies involved in ESCAPE.
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Affiliation(s)
- Marloes Eeftens
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands.
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Eeftens M, Beelen R, de Hoogh K, Bellander T, Cesaroni G, Cirach M, Declercq C, Dėdelė A, Dons E, de Nazelle A, Dimakopoulou K, Eriksen K, Falq G, Fischer P, Galassi C, Gražulevičienė R, Heinrich J, Hoffmann B, Jerrett M, Keidel D, Korek M, Lanki T, Lindley S, Madsen C, Mölter A, Nádor G, Nieuwenhuijsen M, Nonnemacher M, Pedeli X, Raaschou-Nielsen O, Patelarou E, Quass U, Ranzi A, Schindler C, Stempfelet M, Stephanou E, Sugiri D, Tsai MY, Yli-Tuomi T, Varró MJ, Vienneau D, Klot SV, Wolf K, Brunekreef B, Hoek G. Development of Land Use Regression models for PM(2.5), PM(2.5) absorbance, PM(10) and PM(coarse) in 20 European study areas; results of the ESCAPE project. Environ Sci Technol 2012; 46:11195-205. [PMID: 22963366 DOI: 10.1021/es301948k] [Citation(s) in RCA: 714] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Land Use Regression (LUR) models have been used increasingly for modeling small-scale spatial variation in air pollution concentrations and estimating individual exposure for participants of cohort studies. Within the ESCAPE project, concentrations of PM(2.5), PM(2.5) absorbance, PM(10), and PM(coarse) were measured in 20 European study areas at 20 sites per area. GIS-derived predictor variables (e.g., traffic intensity, population, and land-use) were evaluated to model spatial variation of annual average concentrations for each study area. The median model explained variance (R(2)) was 71% for PM(2.5) (range across study areas 35-94%). Model R(2) was higher for PM(2.5) absorbance (median 89%, range 56-97%) and lower for PM(coarse) (median 68%, range 32- 81%). Models included between two and five predictor variables, with various traffic indicators as the most common predictors. Lower R(2) was related to small concentration variability or limited availability of predictor variables, especially traffic intensity. Cross validation R(2) results were on average 8-11% lower than model R(2). Careful selection of monitoring sites, examination of influential observations and skewed variable distributions were essential for developing stable LUR models. The final LUR models are used to estimate air pollution concentrations at the home addresses of participants in the health studies involved in ESCAPE.
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Affiliation(s)
- Marloes Eeftens
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands.
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Ellingson RM, Eriksen K, Schaller JJ, Zajdel DP, Kudura AG, Oken BS. Second generation complementary and alternative medicine physiologic data collection and monitoring research platform. Annu Int Conf IEEE Eng Med Biol Soc 2009; 2008:1270-3. [PMID: 19162898 DOI: 10.1109/iembs.2008.4649395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Progress on our second generation portable system specifically designed to collect 24 hour ambulatory physiologic data from human subjects is reported. The upgraded system has more sensor flexibility and better performance and is smaller, lighter, and simpler to use than our previous version. The new system continues to support a wide variety of sensors found useful for complementary and alternative medicine (CAM) research and has been designed using a modular approach for future expansion of capabilities. The system has improved data storage and supports popular physiologic data formats. Support for wireless control and real-time data monitoring has been added which demonstrates capabilities to be used for physiologic feedback control. The system was designed specifically to support the needs of investigators studying CAM mind-body interventions but could be used for a variety of research needs.
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Affiliation(s)
- Roger M Ellingson
- RM Ellingson System Design&Development, 8515 SW Barnes Road, Portland, OR 97225, USA.
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10
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Steinmetz J, Holm-Knudsen R, Eriksen K, Marxen D, Rasmussen LS. Quality differences in postoperative sleep between propofol-remifentanil and sevoflurane anesthesia in infants. Anesth Analg 2007; 104:779-83. [PMID: 17377082 DOI: 10.1213/01.ane.0000255694.00651.5b] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Postoperative behavioral disorders are common in children, but the occurrence in infants is not yet clear. In the present study we focus on postoperative sleep disturbances, which we hypothesized would be more common after sevoflurane anesthesia than propofol-remifentanil anesthesia. METHODS In total, 39 infants 4-6-mo-old were prospectively enrolled and randomized to receive either a combination of propofol and remifentanil (n = 17) or sevoflurane and fentanyl anesthesia (n = 22) for surgical repair of cleft lip-gum-palate. Postoperative observations were blinded. The parents kept a sleep diary for 2 wk before admission and 2 wk after returning home. The diary included information about how many times the infant awoke during the night and was difficult to comfort and the longest duration of continuous sleep during the night. RESULTS Longest continuous sleep was significantly longer in the sevoflurane group (median 7.2 h) compared with the propofol-remifentanil group (median 5.1 h, P < 0.05). No other significant difference was found between groups. Sleep pattern was impaired after surgery in both groups compared with that before surgery (P < 0.01), but it was considered by the parents to be back to normal after a median of 10 days, with no significant difference between groups. CONCLUSION Postoperative sleep disturbances occur in infants after both propofol-remifentanil and sevoflurane anesthesia. Sevoflurane seems to be associated with less impairment of postoperative sleep than propofol-remifentanil in the first weeks after repair of cleft lip and palate in infants.
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Affiliation(s)
- Jacob Steinmetz
- Department of Anesthesia, Centre of Head and Orthopedics 4231, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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11
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Steinmetz J, Holm-Knudsen R, Sørensen MK, Eriksen K, Rasmussen LS. Hemodynamic differences between propofol-remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants. Paediatr Anaesth 2007; 17:32-7. [PMID: 17184429 DOI: 10.1111/j.1460-9592.2006.01999.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Propofol-remifentanil anesthesia is widely used in adults but few studies are available in infants. We aimed at comparing the hemodynamic effects of propofol-remifentanil vs sevoflurane-fentanyl anesthesia. In addition, we sought to investigate recovery and whether remifentanil induced acute opioid tolerance. METHODS In total, 39 infants 4-6 months old were prospectively enrolled and randomized to receive either a combination of remifentanil and propofol (n = 17) or a sevoflurane-fentanyl anesthesia (n = 22) for surgical repair of cleft lip and palate. In both groups, sevoflurane was used for induction of anesthesia and fentanyl was administered before tracheal extubation. Mean arterial blood pressure and heart rate were recorded every 5 min after induction. We also recorded time from termination of surgery to tracheal extubation, postoperative behavior and the need for analgesia for the first 24 h after surgery. Postoperative observations were blinded. RESULTS In the remifentanil-propofol group, the mean arterial blood pressure was higher [58 (51-65) vs 51 (45-55), P = 0.02] and the mean heart rate was lower [111 (108-113) vs 128 (122-143), P < 0.0001]. There were no differences in recovery time or behavior after surgery. In the remifentanil group, a median fentanyl dose of 4 microg x kg(-1) was required to insure a smooth recovery, but there was no difference in morphine consumption during the first 24 h after surgery. CONCLUSIONS A high-dose remifentanil-propofol infusion was associated with a higher blood pressure and lower heart rate than sevoflurane-fentanyl anesthesia in infants. Postoperative morphine consumption, recovery time and quality were similar.
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Affiliation(s)
- Jacob Steinmetz
- Department of Anesthesia, Centre of Head and Orthopedics, Copenhagen University Hospital, Copenhagen, Denmark.
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12
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Johansson PI, Eriksen K, Alsbjørn B. Rescue treatment with recombinant factor VIIa is effective in patients with life-threatening bleedings secondary to major wound excision: a report of four cases. ACTA ACUST UNITED AC 2006; 61:1016-8. [PMID: 17033583 DOI: 10.1097/01.ta.0000239261.48022.f1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Major burn wound excision is associated with excessive perioperative blood loss. Treatment of massive microvascular bleeding represents a special problem in the burn setting, characterized by extensive damage at the capillary level, and resulting in a profound blood loss; which together with the consumptive states makes adequate replacement therapy with coagulation factors and platelets difficult. We described our experience with rescue treatment with rFVIIa in four patients undergoing major wound excision, developing life-threatening perioperative bleeding, and not responding to conventional therapy. Hemostasis was achieved within 15 minutes of intravenous rFVIIa administration, at a dose of 100 microg/kg, in all patients. No treatment-related adverse events, in particular, no thromboembolic events were observed. We conclude that rFVIIa may be an effective hemostatic treatment for patients undergoing major wound excision developing life-threatening bleedings.
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Affiliation(s)
- Pär I Johansson
- Department of Clinical Immunology, University Hospital of Copenhagen, Copenhagen, Denmark.
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13
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Abstract
BACKGROUND Induction of anesthesia and tracheal intubation in small children with a difficult airway is a challenging task. We report the experience with a procedure based on sevoflurane inhalation via a nasopharyngeal airway inserted early during induction before airway obstruction occurs. A pediatric fiberscope is used to perform a nasotracheal intubation via the opposite nostril. METHODS All small children with suspected or known difficult airway needing tracheal intubation were scheduled for a fiberoptic intubation following the described protocol. RESULTS In 3 years, we performed 27 successful fiberoptic guided tracheal intubations in 19 children, median age 8.2 months (1.0-39.1 months) and median weight 7.6 kg (3.0-15.0 kg). The optimal depth for placement of the nasopharyngeal airway was found to be 8.0 cm (7.0-8.5 cm) from the nostril in the first year of life and 8.5 cm (8.0-10 cm) in the second year. Oxygenation was sufficient during the entire procedure in all cases except one child who had short-lasting laryngeal spasm caused by instillation of lidocaine during light anesthesia. The duration of fiberoptic intubation was significantly shorter when performed by an experienced anesthesiologist (55 s vs. 120 s), but there was no significant correlation between the duration of fiberoscopy and oxygen saturation during fiberoscopy or endtidal CO(2) after intubation. CONCLUSION The combination of nasopharyngeal airway and fiberoptic guided tracheal intubation seems to be a reliable and safe procedure for managing the difficult airway in small children.
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Affiliation(s)
- Rolf Holm-Knudsen
- Department of Anaesthesia and Operating Theatre Services, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej, Copenhagen, Denmark.
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Andersen HE, Schultz-Larsen Jürgensen K, Kreiner S, Forchhammer BH, Eriksen K, Brown A. [Can readmission after apoplexy be prevented? Post-hospital follow-up intervention for apoplexy patients]. Ugeskr Laeger 2001; 163:6421-7. [PMID: 11816920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate two models of an organised postdischarge follow-up service for stroke survivors in comparison with standard aftercare. METHODS One hundred and fifty-five stroke patients discharged to their homes with lasting impairment were randomised as follows: 54 to follow-up home visits by a physician (INT1-HVP), 53 to instruction by a physiotherapist in their home (INT2-PI), and 48 to standard aftercare (control). Six months after discharge, data on readmission were collected. RESULTS The readmission rate over the six-month period was 26% in the INT1-HVP group, 34% in the INT2-PI group, and 44% for the controls (p = 0.028). Multivariate analysis of the readmission risk showed a significant, favourable effect of intervention in interaction with the length of hospital stay (p = 0.0332), which indicates that the effect of intervention was strongest for patients with a long inpatient rehabilitation. DISCUSSION Follow-up intervention after discharge seems to be a way of preventing readmission, especially for patients with a long inpatient rehabilitation.
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Affiliation(s)
- H E Andersen
- H:S Bispebjerg Hospital, Københavns Universitet, Panum Instituttet, Center for Forskning og Udvikling på AEldreområdet, Institut for Folkesundhedsvidenskab, Afdeling for Biostatistik.
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15
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Hahn TW, Henneberg SW, Holm-Knudsen RJ, Eriksen K, Rasmussen SN, Rasmussen M. Pharmacokinetics of rectal paracetamol after repeated dosing in children. Br J Anaesth 2000; 85:512-9. [PMID: 11064607 DOI: 10.1093/bja/85.4.512] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Twenty-three children (aged between 9 weeks and 11 yr) were given paracetamol suppositories 25 mg kg-1 every 6 h (maximum 5 days) after major surgery and serum and saliva concentrations were measured. There was a good correlation (r = 0.91, P < 0.05) between saliva and serum concentrations. A one-compartment linear model with first-order elimination and absorption and lag-time was fitted to the data (ADAPT II). At steady state, the mean (SD) concentration was 15.2 (6.8) mg litre-1. Mean (SD) time to reach 90% of the steady state concentration was 11.4 (8.6) h. Body weight, age and body surface area were well correlated (P < 0.05) with clearance and apparent volume of distribution. There was no evidence of accumulation leading to supratherapeutic concentrations during this dosing schedule for a mean of approximately 2-3 days.
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Affiliation(s)
- T W Hahn
- Department of Pharmaceutics, Royal Danish School of Pharmacy, Universitetsparken, Copenhagen, Denmark
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16
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Andersen HE, Schultz-Larsen K, Kreiner S, Forchhammer BH, Eriksen K, Brown A. Can readmission after stroke be prevented? Results of a randomized clinical study: a postdischarge follow-up service for stroke survivors. Stroke 2000; 31:1038-45. [PMID: 10797163 DOI: 10.1161/01.str.31.5.1038] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE About 50% of stroke survivors are discharged to their homes with lasting disability. Knowledge, however, of the importance of follow-up services that targets these patients is sparse. The purpose of the present study was to evaluate 2 models of follow-up intervention after discharge. The study hypothesis was that intervention could reduce readmission rates and institutionalization and prevent functional decline. We report the results regarding readmission. METHODS This randomized study included 155 stroke patients with persistent impairment and disability who, after the completion of inpatient rehabilitation, were discharged to their homes. The patients were randomized to 1 of 2 follow-up interventions provided in addition to standard care or to standard aftercare. Fifty-four received follow-up home visits by a physician (INT1-HVP), 53 were provided instructions by a physiotherapist in their home (INT2-PI), and 48 received standard aftercare only (controls). Baseline characteristics for the 3 groups were comparable. Six months after discharge, data were obtained on readmission and institutionalization. RESULTS The readmission rates within 6 months after discharge were significantly lower in the intervention groups than in the control group (INT1-HVP 26%, INT2-PI 34%, controls 44%; P=0.028). Multivariate analysis of readmission risk showed a significant favorable effect of intervention (INT1-HVP or INT2-PI) in interaction with length of hospital stay (P=0.0332), indicating that the effect of intervention was strongest for patients with a prolonged inpatient rehabilitation. CONCLUSIONS Readmission is common among disabled stroke survivors. Follow-up intervention after discharge seems to be a way of preventing readmission, especially for patients with long inpatient rehabilitation.
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Affiliation(s)
- H E Andersen
- Center for Elder Research, University Hospital H:S Bispebjerg, Copenhagen, Denmark.
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Eriksen K. Management of cervical disc herniation with upper cervical chiropractic care. J Manipulative Physiol Ther 1998; 21:51-6. [PMID: 9467101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To discuss the chiropractic management of a patient suffering from multiple complaints, including a herniated nucleus pulposus in the cervical spine diagnosed by magnetic resonance imaging (MRI). CLINICAL FEATURES A 34-yr-old man suffered from severe neck, lower back and radicular pain of 1 yr duration. He had previously received care from multiple medical specialists, with little or no results. An MRI of the cervical spine demonstrated a C6-C7 herniated nucleus pulposus. A needle electromyogram examination confirmed the presence of a C6-C7 radiculopathy with radiculopathic changes from C4-C7. X-ray analysis showed that the atlas and axis were misaligned. These X-rays were read manually (with a template) and with computer-assisted digitization. Computerized analysis also measured misalignments at the levels of L4-L5. INTERVENTION AND OUTCOME The patient was managed primarily with the Grostic Procedure of upper cervical adjusting by hand. After a period of about 1 month, a series of re-examinations revealed a dramatic improvement in all subjective and objective findings. A follow-up of > 1 yr has shown that surgery was not necessary. CONCLUSION This single case study suggests that chiropractic care may be a viable treatment option for patients with cervical disc herniation. Further investigation into chiropractic adjustments as a treatment for this condition should be pursued.
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Affiliation(s)
- K Eriksen
- Eriksen Chiropractic Center, Dothan, AL 36301-1105, USA
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18
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Kart T, Walther-Larsen S, Svejborg TF, Feilberg V, Eriksen K, Rasmussen M. Comparison of continuous epidural infusion of fentanyl and bupivacaine with intermittent epidural administration of morphine for postoperative pain management in children. Acta Anaesthesiol Scand 1997; 41:461-5. [PMID: 9150772 DOI: 10.1111/j.1399-6576.1997.tb04724.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to compare epidural infusion of bupivacaine and fentanyl and intermittent epidural morphine with regard to analgesic effect, and incidence and severity of side effects in children undergoing major abdominal or genito-urological surgery in order to improve the postoperative pain management of children. METHODS A double-blind, block-randomised study design was used. Thirty-one children aged 3 months to 6 years undergoing major abdominal or genito-urological surgery were studied. After induction of anaesthesia a lumbar epidural catheter was placed at L3-4 or L4-5. Postoperatively, the children received either 30 micrograms/kg of morphine every 8 h or a continuous infusion of fentanyl 2 micrograms/ml and bupivacaine 1.0 mg/ml at a rate of 0.25 ml.kg-1.h-1. All children additionally received rectal paracetamol in doses of 50-100 mg.kg-1.d-1 on a regular basis, and amol in doses of 50-100 mg.kg-1.d-1 on a regular basis, and if necessary supplementary intravenous morphine in doses of 50 micrograms/kg. Postoperatively, pain, administration of supplemental morphine and side effects were recorded 5 times by one observer during the day of surgery and the first postoperative day. All children had an epidural catheter throughout the study period. RESULTS Both regimens provided effective analgesia, but significantly better pain relief was obtained in children receiving the fentanyl/bupivacaine regimen. Sedation, pruritus, vomiting, and administration of antiemetics were seen in both treatment groups, and even though both the incidence and severity of side effects tended to be higher in children receiving morphine, no statistically significant difference was found. No episodes of respiratory depression or motor blockade were noticed. CONCLUSIONS Continuous epidural infusion of fentanyl and bupivacaine was found to be superior to intermittent epidural morphine. The initial regimen should be fentanyl 2 micrograms/ml and bupivacaine 1.0 mg/ml infused at a rate of 0.25 ml.kg-1.h-1.
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Affiliation(s)
- T Kart
- Department of Anaesthesia, Rigshospitalet, Copenhagen, Denmark
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Koscielniak-Nielsen ZJ, Horn A, Sztuk F, Eriksen K, Skovgaard LT, Viby-Mogensen J. Timing of tracheal intubation: monitoring the orbicularis oculi, the adductor pollicis or use a stopwatch? Ugeskr Laeger 1996; 13:130-5. [PMID: 8829945 DOI: 10.1046/j.1365-2346.1996.00934.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The most suitable time for tracheal intubation, following vecuronium 0.1 mg kg-1, was estimated in 120 patients. The trachea was intubated at cessation of the visually observed response of the orbicularis oculi muscle to facial nerve stimulation (group 1; n = 30), or of the manually detected response of the adductor pollicis to ulnar nerve stimulation (group 2; n = 30), or after waiting 3 min (group 3; n = 30), or 4 min (group 4; n = 30). There were no significant differences in intubation scores between the four groups of patients. Loss of response to train-of-four stimulation occurred significantly sooner in group 1 (orbicularis oculi) than in group 2 (adductor pollicis) P = 0.021). However, intubating conditions were poor in four patients (14%) in group 1, compared with none in group 2 and one in groups 3 and 4, respectively. Thus, contrary to expectations, the cessation of the response of the orbicularis oculi muscle did not guarantee good or even satisfactory intubating conditions. The results suggest that in fit adult patients it is as good to wait 3 min after injection of vecuronium 0.1 mg kg-1 before tracheal intubation, as to use a nerve stimulator.
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Affiliation(s)
- Z J Koscielniak-Nielsen
- Department of Anaesthesia, National University Hospital, Rigshospitalet, Copenhagen, Denmark
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20
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Eriksen K, Reinstrup P. [Acute acalculous cholecystitis]. Ugeskr Laeger 1994; 156:3311-4. [PMID: 8066850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Acute acalculous cholecystitis (AC) is an inflammatory process of the gallbladder, often caused by other severe diseases. The etiology is multifactorial, but the pathogenesis is in all cases a reduction in the gallbladder's emptying capacity. The mortality of AC reaches 85% without treatment. This fact makes it important to consider AC as a possible complication to major surgery, multi-trauma, and artificial ventilation. Symptoms resemble "normal" cholecystitis, but may be masked by the underlying severe disease. Fever without known focus may be the only symptom. Ultrasound, CT-scanning or cholangiography are used to verify the diagnosis, supplemented by laboratory investigations. Treatment is cholecystectomy. Percutaneous ultrasonic guided cholecystotomy is a good alternative if the diagnosis made in an early stage. The mortality is considerably reduced by early intervention.
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Affiliation(s)
- K Eriksen
- Anaestesiologisk afdeling, Amtssygehuset Sankt Elisabeth, København
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Eriksen K, Forland F, Rygnestad T. [Experiences and strategies of AIDS preventive work in Mudzi and Mutoko. Experiences from 2 rural districts in Zimbabwe]. Tidsskr Nor Laegeforen 1994; 114:1089-91. [PMID: 8009525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Forland F, Eriksen K. [HIV-prevalence in Mutoko, Zimbabwe. A study among pregnant women and patients with sexually transmitted diseases]. Tidsskr Nor Laegeforen 1994; 114:1050-2. [PMID: 8009515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The Ministry of Health and Child Welfare in Zimbabwe has carried out a number of surveys in different districts of Zimbabwe to determine the extent of the HIV-epidemic. In Mutoko district such a study was carried out to determine the HIV-prevalence among pregnant women and patients with sexually transmitted diseases. The results show that 25% of the pregnant women were HIV-positive. The highest prevalence is found among women between 25 and 30 years, and women who were pregnant for the second or third time, where more than 35% were HIV-positive. Of the patients with sexually transmitted diseases, 50% were found to be HIV-positive. The HIV-prevalence was higher among men than among women, and higher among single patients than among married patients. For patients who had genital ulcers the HIV-prevalence was 67%.
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Eriksen K. ["The doctor said"]. Tidsskr Nor Laegeforen 1992; 112:1990. [PMID: 1509469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Eriksen K. [Into the heat]. Sygeplejersken 1992; 92:19. [PMID: 1496473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Stiefel EJ, Pilato R, Eriksen K, Greaney M, Goswami S, Taylor E, Kilpatrick L, Spiro T, Rheingold A. Chemistry related to the structure, spectra and reactivity of molybdopterin (Mo-co) dependent enzymes. J Inorg Biochem 1991. [DOI: 10.1016/0162-0134(91)84547-m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jansen I, Blackburn T, Eriksen K, Edvinsson L. 5-hydroxytryptamine antagonistic effects of ICI 169,369, ICI 170,809 and methysergide in human temporal and cerebral arteries. Pharmacol Toxicol 1991; 68:8-13. [PMID: 2008418 DOI: 10.1111/j.1600-0773.1991.tb01200.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
ICI 169,369 and ICI 170,809 are two chemically novel 5-HT antagonists that have high affinity for the 5-HT2 binding site in rat cortex (Ki 1.79 x 10(-8)M and 6.6 x 10(-10)M, respectively). In human temporal artery preparations ICI 169,369 was shown to cause a progressive rightward shift of the 5-HT-response curve over the range 10(-7)-10(-5)M, while ICI 170,809 in these concentrations shifted the curve to the same degree (no dose dependency). In human cerebral vessels no effect was observed until a high concentration (10(-5)M) was used for either compounds. The mixed 5-HT1/5-HT2 antagonist, methysergide, induced a non parallel rightward shift of the 5-HT-induced concentration-effect curve with a depression of the maximum achievable response in both the temporal and cerebral artery. The mode of effect of ICI 169,369 and ICI 170,809 to block the 5-HT-induced contractions in human temporal vessels resembles that of the pure 5-HT2 antagonist ketanserin, thus suggesting that the two ICI compounds are mainly 5-HT2 antagonists. In high concentrations both ICI 169,369 and ICI 170,809 have vasorelaxant properties, explaining the reduction in maximum 5-HT-induced contraction seen at high antagonist concentrations.
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Affiliation(s)
- I Jansen
- Department of Experimental Research, University of Lund, Malmö General Hospital, Sweden
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Eriksen K, Landsverk T, Bodahl EG. Cell differentiation in intestinal adenomatosis of pigs studied by histochemistry of laminin and enzymes of epithelial and subepithelial tissue. Res Vet Sci 1990; 49:1-7. [PMID: 2143304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The distribution of enzymes and laminin was examined in ileal tissue from pigs suffering from intestinal adenomatosis to reveal the nature of the lesion. A disruption of the normal and specific pattern of distribution was found. Thus, the normal ileal epithelium was characterised by brush border enzymes: alkaline phosphatase, magnesium-dependent adenosine triphosphatase (Mg-ATPase), fluoride resistant acid phosphatase and 5'-nucleotidase; enzymes of the basolateral border: Mg-ATPase; and cytoplasmic enzymes: beta-glucuronidase, non-specific esterase and acid phosphatase. Subepithelial fibroblasts seemed to be characterised by 5'-nucleotidase. Laminin was present as a continuous band under the surface and crypt epithelium, somewhat thicker in the former. In contrast, the branching proliferating crypts of intestinal adenomatosis largely lacked enzymes characteristic of both villus and crypt cells. Reactions for the subepithelial components, laminin and fibroblasts were also reduced. The deficient differentiation of the epithelial as well as subepithelial components in porcine intestinal adenomatosis distinguish the condition from crypt hyperplasia and indicate an adenoma-like character.
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Affiliation(s)
- K Eriksen
- Department of Pathology, Norwegian College of Veterinary Medicine, Oslo
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Abstract
Scanning electron microscopy of adenomatous intestinal tissue in the blue fox revealed an irregular surface topography of the colon with increased diameter of the crypt openings and prominent ridge formations between crypts. The ileum showed villous atrophy and fusion. Microvilli were short and irregular. Small ulcerations of intestinal mucosa were seen. Freeze-fracture revealed curved intracellular organisms in the altered epithelial cells. Transmission electron microscopy showed features associated with immaturity and high protein synthesis. Filamentous extensions from the basolateral plasma membrane of altered epithelial cells sometimes penetrated the basal lamina. The cytoplasm contained numerous polyribosomes, nuclei had many indentations and large and irregular nucleoli. Intracellular bacteria, with morphology corresponding to Campylobacter spp. were found in the apical epithelial cytoplasm. No host-cell-derived membrane was seen to surround the bacteria.
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Affiliation(s)
- K Eriksen
- Department of Pathology, Norwegian College of Veterinary Medicine, Oslo
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Abstract
In a blue fox farm about 300 of 400 weanling pups were affected with diarrhoea and prolapse of the rectum. About 40 pups died in an emaciated state after a few days of disease. Eight pups were submitted for examination. Pathological findings were restricted to the caecum, proximal colon and rectum, with occasional extension to the ileum. Affected areas revealed a thick and rigid intestinal wall, a narrow lumen and a thickened, wrinkled and sometimes ulcerated mucosa. Histologically, the mucosa showed long tortuous crypts outlined by a high pseudostratified epithelium which lacked goblet cells. Epithelial cells revealed increased basophilia, and mitoses were seen along the entire crypt length and in the surface epithelium. Silver impregnation showed curved organisms in the apical cytoplasm of the altered epithelial cells. Penetration of the muscularis mucosa by the altered epithelial cells was frequent. The avidin-biotin-immunoperoxidase complex (ABC) technique revealed positive organisms in the apical cytoplasm of altered epithelial cells, when rabbit antisera against different biotypes and serotypes of Campylobacter jejuni and Campylobacter coli were used. Antisera against Campylobacter sputorum subsp. muscosalis and Campylobacter hyointestinalis were negative.
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Affiliation(s)
- K Eriksen
- Department of Pathology, Norwegian College of Veterinary Medicine, Oslo
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Eriksen K, Landsverk T, Gondrosen B, Vormeland J. Immuno-histochemical and -cytochemical evidence suggesting the presence of Campylobacter jejuni and Campylobacter coli in cases of porcine intestinal adenomatosis. Acta Vet Scand 1990; 31:445-51. [PMID: 2099622 PMCID: PMC8133281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Antisera against a number of Campylobacter species were used in immuno-histochemical and -cytochemical studies on cases of porcine intestinal adenomatosis. Avidin-biotin-complex (ABC) and streptavidin immunoperoxidase methods were used on formalin-fixed, paraffin-embedded and frozen sections. Protein A gold method was used on formaldehyde fixed and frozen sections for immuno-cytochemistry. The antisera used were raised in rabbits by subcutaneous or intravenous injection of living or formalin treated organisms. Anti-sera against different serotypes of the thermotolerant, catalase positive campylobacters, Campylobacter jejuni and Campylobacter coli, gave positive reactions in the immuno-histochemical studies. The staining was found in intestinal epithelial cells both in the ileum and in the colon and was restricted to the apical cytoplasm of adenomatous epithelial cells. The staining had a granular pattern, the positive structures sometimes having the shape of Campylobacter. Epithelial cells in areas with normal differentiation of goblet cells did not stain. In contrast, no staining resulted with antisera against Campylobacter sputorum subsp. mucosalis and Campylobacter hyointestinalis. Immuno-cytochemistry, using antisera against Campylobacter jejuni, showed that the positive staining in altered epithelial cells were restricted to intracellular organisms having a structure resembling Campylobacter spp.
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Affiliation(s)
- K Eriksen
- Department of Pathology, Norwegian College of Veterinary Medicine, Oslo
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Eriksen K, Bigler D, Jensen NH, Eriksen J. [Long-term treatment with intrathecal morphine in severe painful cancer]. Ugeskr Laeger 1989; 151:2365-6. [PMID: 2477927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Intrathecal treatment with morphine was instituted in seven cancer patients with severe pain. All of the patients had already received treatment with epidural morphine and the reason for the change in treatment was insufficient effect, side effects and/or pain connected with the injections in the epidural form of therapy. The duration of treatment was 5-136 days (median 40 days). The daily intrathecal dosage of morphine which was administered by 1-4 daily injections was initially 2.4-16.0 mg (median 3.6 mg) and had to be increased to 3.2-112 mg (median 16 mg) at the conclusion of treatment. Five patients became free from pain and one had acceptable relief of pain on this treatment. One patient received accidentally too great a dose of morphine intrathecally as compared with the usual dose and required treatment for respiratory insufficiency. Apart from postural headache on account of leakage of cerebro-spinal fluid, which could be treated by epidural blood "patch", the method was without complications which could be attributed to the intrathecally placed catheter. Treatment of pain with opioids injected intrathecally may thus be recommended in the cases in which epidural treatment cannot be carried out on account of the reasons mentioned above.
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Svendsen PE, Eriksen K. [Group G streptococcal cellulitis]. Ugeskr Laeger 1988; 150:2184-5. [PMID: 3206583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Nafstad I, Tollersrud S, Eriksen K, Helgeland A, Solberg LA, Bredesen J, Dale O. The influence of atenolol and prazosin on serum lipids and atherosclerosis in minipigs fed a hyperlipidemic diet. Gen Pharmacol 1988; 19:719-24. [PMID: 2905683 DOI: 10.1016/0306-3623(88)90135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
1. The effect of the adrenergic blockers prazosin and atenolol were tested in hypercholesterolemic Göttingen minipigs. 2. After 1 yr there was a significant reduction of plasma triglycerides and total cholesterol in the medicated animals as compared to untreated ones. 3. No significant difference in atherosclerotic lesions was observed.
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Affiliation(s)
- I Nafstad
- Department of Pharmacology and Toxicology, Norwegian College of Veterinary Medicine
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Eriksen K. [When a child is born developmentally handicapped]. Sykepleien 1984; 71:15-8. [PMID: 6564788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Helgeland A, Eriksen K, Foss PO, Nafstad I, Solberg LA, Tollersrud S. The influence of prazosin and propranolol on serum lipids and atherosclerosis in standard fed pigs. Acta Pharmacol Toxicol (Copenh) 1984; 54:270-2. [PMID: 6730983 DOI: 10.1111/j.1600-0773.1984.tb01929.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The influence of prazosin and propranolol on serum lipids and atherosclerosis was evaluated in standard fed pigs during a nine months experimental period. The incidence and severity of atherosclerotic lesions was very low, and no difference could be observed neither between the two drugs nor between the drug groups and the placebo group. Prazosin and propranolol induced no marked change in the serum lipid profile. The results could be explained by the very low fat content, 3.6 per cent, in the present standard diet.
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Eriksen EL, Eriksen K. [Midwife's role evaluated in an expanded perspective]. Sykepleien 1983; 70:4-8, 18. [PMID: 6554946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Abstract
In an uncontrolled investigation 63 selected patients with verrucae vulgares were sensitized with DNCB (1-chloro-2,4-dinitrobenzene) with subsequent regular painting of the warts with DNCB. Only 86% of these patients could be sensitized, in contrast to 96% in a normal population. 20 patients had to be excluded from the material on account of defaulting or defective sensitization. In the remainder of the patients allergic type IV inflammation developed around the painted warts and 1 patient developed an urticarial type I reaction around the warts and on the body. In the patients with multiple warts, 80% (24/30) were cured. This corresponds to the percentage cure in patients with solitary warts. Complement-binding wart virus antibodies were present in 15% of the patients prior to the treatment and in 43% after the conclusion of treatment. This investigation provides a new method of treatment of verrucae vulgares and suggests that regression in warts is immunologically conditioned. On account of the risk of allergic side effects, the method should be carried out in special departments only.
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Abstract
The sensitization capacity of ethylenediamine was examined by the guinea pig maximization test and compared with dinitrochlorobenzene. Ethylenediamine was found to be a potent sensitizer. An attempt at oral induction of unresponsiveness (tolerance) was unsuccessful with ethylenediamine and DNCB and the same negative result was obtained with intravenous injection of ethylenediamine. Only by the intravenous injection of dinitrobenzene sulfonic acid was unresponsiveness successfully established in 90% of the guinea pigs.
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Eriksen K. [Clobetasol propionate (Dermovat): a new glucocorticoid preparation for local application. Comparison with betamethasone dipropionate (Diproderm)]. Ugeskr Laeger 1979; 141:2387-9. [PMID: 483428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Dupont A, Bernsen AH, Eriksen K, Stürup T. [Study concerning the time-consuming, economic and psychological stress connected with having a severely retarded, homebound child between 6 and 14 years of age. Basic needs met only through considerable family effort]. Sygeplejersken 1979; 79:16-21, 38. [PMID: 157551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Eriksen K, Goldschmidt A. [Instruction and training keeps the back free from injuries]. Sygeplejersken 1979; 79:12-4. [PMID: 156411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Eriksen K. [Treatment of verruca vulgaris with induced allergic inflammation]. Ugeskr Laeger 1979; 141:923-5. [PMID: 425195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Eriksen K. [Erythema nodosum. A 10-year retrospective study]. Ugeskr Laeger 1979; 141:503-5. [PMID: 419604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Dupont A, Bernsen AH, Stürup T, Eriksen K. [Temporal, financial and mental stress involved when a severely mentally retarded child between 6 and 14 years of age lives at home]. Ugeskr Laeger 1978; 140:2815-20. [PMID: 715902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
Cross allergy between paranitro compounds including DNCB and chloramphenicol, was studied in 42 patients. A total of 27 had been primarily sensitized to DNCB, and 15 patients with eczema exhibited a delayed-type reaction to chloramphenicol, showing a positive patch test. All 15 patients with chloramphenicol allergy cross reacted with chloramphenicol succinate and chloramphenicol palmitate. Three of them cross reacted with paranitrobenzoic acid, and two of these also with paradinitrobenzene. None of the 15 patients cross reacted with DNCB in acetone or DNCB in petrolatum, and none reacted to picric acid, paranitrophenol or dinitroorthocresol. The 27 patients primarily sensitized to DNCB did not cross react with any of the paranitro compounds studied, in particular not with chloramphenicol or its salts. Thus, the study confirms the specificity of the DNCB sensitivity.
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Abstract
Direct and indirect immunofluorescence investigations performed for 11 patients with scabies. All patients had punch biopsies taken from (1) a lesion containing Sarcoptes scabiei, (2) an inflammatory papule which did not contain a mite, and (3) normal skin. In four patients IgE deposits were found in the vessel walls of the upper dermis both in biopsies containing mits and biopsies of inflammatory papules with no mites. No IgE deposits were found in biopsies of normal skin from the same patients. Two patients had IgM and/or C3 deposits along the basal membrane in biopsies containing mites and one of them also had C3 in this area in the biopsy from a papule with no mite, as well as normal skin.
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Eriksen K. [Ethylenediamines and eczema]. Ugeskr Laeger 1975; 137:502-4. [PMID: 124494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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