One hundred and seventy eight insulin dependent diabetics (IDDM) have been studied regarding thei... more One hundred and seventy eight insulin dependent diabetics (IDDM) have been studied regarding their understanding of and compliance with a controlled carbohydrate diet. Forty per cent could not remember their dietary prescription, 35 per cent did not estimate carbohydrate and many scored badly in a 'quiz' on the carbohydrate content of common foods. Quiz scores were significantly associated with HbA1 levels (P less than 0.001). One hundred and thirty six patients completed a seven-day food record from which the pattern of eating was established. Of these 75 were injecting twice daily short and intermediate acting insulin; in this group there were significant relationships between HbA1 and both care with carbohydrate estimation and eating pattern (P less than 0.05). Thus, in IDDM, the understanding of a controlled carbohydrate diet and adherence to it are associated with better glycaemic control but adequate compliance is rare. Future dietary recommendations for insulin taking...
We have assessed a new positive expiratory pressure device, the Flutter VRP1, in 20 patients with... more We have assessed a new positive expiratory pressure device, the Flutter VRP1, in 20 patients with moderately severe asthma. Patients were studied for an initial 1-week 'run-in' period, followed by 2 weeks of the flutter device in one of which the ball-bearing was removed from the bowl. Peak expiratory flow rates, salbutamol inhaler requirements and visual analogue scores were recorded daily. Ease of sputum expectoration showed a significant improvement after 6 days of the flutter device, but there were no differences in objective measurements of lung function nor in salbutamol use. The device may be a useful adjunct to asthma therapy.
In 23 high risk patients the change in plasminogen activator activity in response to surgical ope... more In 23 high risk patients the change in plasminogen activator activity in response to surgical operation was studied by euglobulin lysis time (ELT) and fibrin plate lysis before, during and for up to 6 days following a major surgical procedure. Fibrin degradation products (FDP) were also measured. The aim was to relate any changes to postoperative deep vein thrombosis (DVT) as diagnosed by the 125I fibrinogen test. Peroperative increase and postoperative inhibition of fibrinolytic activity were seen in all the patients, Changes in fibrinolytic activity as measured by the ELT and during the first 24 hours by the fibrin plate technique were similar. This suggests that during this period the response was independent of plasma fibrinogen changes. There was no significant difference in these parameters between patients who developed DVT and those who did not. The relationship between venous thrombo-embolism and elevation of serum FDP was confirmed.
In 1990, 215 patients with operable breast cancer were entered into a prospective study of the pr... more In 1990, 215 patients with operable breast cancer were entered into a prospective study of the prognostic significance of five biochemical markers and 15 other factors (pathological/chronological/patient). After a median follow-up of 6.6 years, there were 77 recurrences and 77 deaths (59 breast cancer-related). By univariate analysis, patient outcome related significantly to 13 factors. By multivariate analysis, the most important of nine independent factors were: number of nodes involved, steroid receptors (for oestrogen or progestogen), age, clinical or pathological tumour size and grade. Receptors and grade exerted their influence only in the first 3 years. Progestogen receptors (immunohistochemical) and oestrogen receptors (biochemical) were of similar prognostic significance. The two receptors were correlated (r=+0.50, P=0.001) and displaced each other from the analytical model but some evidence for the additivity of their prognostic values was seen when their levels were disco...
MONITORING and therapy in the intensive care unit (ICU) carry inherent risks of injuries, infecti... more MONITORING and therapy in the intensive care unit (ICU) carry inherent risks of injuries, infections and even mortality. It is essential that we try to minimize these risks. After Connors and co-workers in 1996 suggested that the use of pulmonary artery catheters might be detrimental, the use of non-invasive cardiovascular monitoring has increased (1). Indeed, cardiovascular ultrasound has developed tremendously in recent years. In other areas there is also a trend towards procedures involving fewer risks: the route for nutrition has been changed from parenteral to mainly enteral. And procedures, for example drainage of abscesses, now mostly involve the minimum of invasive techniques by the use of ultrasound. Most patients in a general ICU are intubated and ventilator treated during some period of their stay. In order to get the patients to accept the endotracheal tube and mechanical ventilation, the majority of the patients are sedated and some even muscle-paralyzed. This will cause immobilization and increase the risks of thrombo-embolic events, muscle wasting and reduced clearance of airway secretions with consequent atelectasis and pneumonia (2, 3). Sedation in itself may depress the immune system and thus increase the rate of infection (4). In addition, sedation may compromise circulation necessitating vasoactive treatment, and all vasoactive and inotropic drugs bring the risks of, for example, producing cardiac arrhythmia and increasing cardiac and systemic oxygen consumption (5). Furthermore, if not adequately titrated, sedation can prolong the need for ventilator treatment (6). Muscle-relaxation is associated with prolonged muscle-weakness and persistent paralysis (7). Hence, in order to decrease risks, we need to move away from heavy sedation and muscle-relaxation during ventilator treatment and towards modes of ventilation that eliminate the need for these measures. One of the first steps in this direction was the development of methods for patient initiation of ventilator breaths,
One hundred and seventy eight insulin dependent diabetics (IDDM) have been studied regarding thei... more One hundred and seventy eight insulin dependent diabetics (IDDM) have been studied regarding their understanding of and compliance with a controlled carbohydrate diet. Forty per cent could not remember their dietary prescription, 35 per cent did not estimate carbohydrate and many scored badly in a 'quiz' on the carbohydrate content of common foods. Quiz scores were significantly associated with HbA1 levels (P less than 0.001). One hundred and thirty six patients completed a seven-day food record from which the pattern of eating was established. Of these 75 were injecting twice daily short and intermediate acting insulin; in this group there were significant relationships between HbA1 and both care with carbohydrate estimation and eating pattern (P less than 0.05). Thus, in IDDM, the understanding of a controlled carbohydrate diet and adherence to it are associated with better glycaemic control but adequate compliance is rare. Future dietary recommendations for insulin taking...
We have assessed a new positive expiratory pressure device, the Flutter VRP1, in 20 patients with... more We have assessed a new positive expiratory pressure device, the Flutter VRP1, in 20 patients with moderately severe asthma. Patients were studied for an initial 1-week 'run-in' period, followed by 2 weeks of the flutter device in one of which the ball-bearing was removed from the bowl. Peak expiratory flow rates, salbutamol inhaler requirements and visual analogue scores were recorded daily. Ease of sputum expectoration showed a significant improvement after 6 days of the flutter device, but there were no differences in objective measurements of lung function nor in salbutamol use. The device may be a useful adjunct to asthma therapy.
In 23 high risk patients the change in plasminogen activator activity in response to surgical ope... more In 23 high risk patients the change in plasminogen activator activity in response to surgical operation was studied by euglobulin lysis time (ELT) and fibrin plate lysis before, during and for up to 6 days following a major surgical procedure. Fibrin degradation products (FDP) were also measured. The aim was to relate any changes to postoperative deep vein thrombosis (DVT) as diagnosed by the 125I fibrinogen test. Peroperative increase and postoperative inhibition of fibrinolytic activity were seen in all the patients, Changes in fibrinolytic activity as measured by the ELT and during the first 24 hours by the fibrin plate technique were similar. This suggests that during this period the response was independent of plasma fibrinogen changes. There was no significant difference in these parameters between patients who developed DVT and those who did not. The relationship between venous thrombo-embolism and elevation of serum FDP was confirmed.
In 1990, 215 patients with operable breast cancer were entered into a prospective study of the pr... more In 1990, 215 patients with operable breast cancer were entered into a prospective study of the prognostic significance of five biochemical markers and 15 other factors (pathological/chronological/patient). After a median follow-up of 6.6 years, there were 77 recurrences and 77 deaths (59 breast cancer-related). By univariate analysis, patient outcome related significantly to 13 factors. By multivariate analysis, the most important of nine independent factors were: number of nodes involved, steroid receptors (for oestrogen or progestogen), age, clinical or pathological tumour size and grade. Receptors and grade exerted their influence only in the first 3 years. Progestogen receptors (immunohistochemical) and oestrogen receptors (biochemical) were of similar prognostic significance. The two receptors were correlated (r=+0.50, P=0.001) and displaced each other from the analytical model but some evidence for the additivity of their prognostic values was seen when their levels were disco...
MONITORING and therapy in the intensive care unit (ICU) carry inherent risks of injuries, infecti... more MONITORING and therapy in the intensive care unit (ICU) carry inherent risks of injuries, infections and even mortality. It is essential that we try to minimize these risks. After Connors and co-workers in 1996 suggested that the use of pulmonary artery catheters might be detrimental, the use of non-invasive cardiovascular monitoring has increased (1). Indeed, cardiovascular ultrasound has developed tremendously in recent years. In other areas there is also a trend towards procedures involving fewer risks: the route for nutrition has been changed from parenteral to mainly enteral. And procedures, for example drainage of abscesses, now mostly involve the minimum of invasive techniques by the use of ultrasound. Most patients in a general ICU are intubated and ventilator treated during some period of their stay. In order to get the patients to accept the endotracheal tube and mechanical ventilation, the majority of the patients are sedated and some even muscle-paralyzed. This will cause immobilization and increase the risks of thrombo-embolic events, muscle wasting and reduced clearance of airway secretions with consequent atelectasis and pneumonia (2, 3). Sedation in itself may depress the immune system and thus increase the rate of infection (4). In addition, sedation may compromise circulation necessitating vasoactive treatment, and all vasoactive and inotropic drugs bring the risks of, for example, producing cardiac arrhythmia and increasing cardiac and systemic oxygen consumption (5). Furthermore, if not adequately titrated, sedation can prolong the need for ventilator treatment (6). Muscle-relaxation is associated with prolonged muscle-weakness and persistent paralysis (7). Hence, in order to decrease risks, we need to move away from heavy sedation and muscle-relaxation during ventilator treatment and towards modes of ventilation that eliminate the need for these measures. One of the first steps in this direction was the development of methods for patient initiation of ventilator breaths,
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