Danish medical journal
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Danish medical journal · Apr 2013
Testing impact of perinatal inflammation on cerebral autoregulation in preterm neonates: evaluation of a noninvasive method.
Increased preterm delivery rate and survival of preterm infants of whom a considerable proportion survive with neurodevelopmental impairment calls for better knowledge of mechanisms associated with brain injury. This thesis focuses on cerebral autoregulation and is based on clinical studies of very preterm infants and experimental studies in newborn piglets. Maintaining adequate cerebral perfusion is critical to avoid brain injury. ⋯ However, low precision hampers its clinical application. In preterm infants with perinatal inflammation, cerebral blood flow is at most moderately affected by variations in arterial blood pressure, provided inflammation induced hypotension is prevented. In newborn piglets, hypovolaemia alone did not affect cerebral autoregulation significantly, and dopamine therapy elicited an unexplained mismatch between cerebral perfusion and oxygenation.
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Danish medical journal · Mar 2013
ReviewMRI in knee osteoarthritis. Application in diet intervention.
This thesis examines two main hypotheses: 1. Obese knee osteoarthritis (KOA) patients can achieve symptomatic improvements following diet intervention regardless of their level of structural damage and overall joint malfunctioning: 2. Rapid weight-loss in obese patients with KOA will lead to improvements in KOA related pathology that can be assessed and evaluated by MRI. ⋯ The results of this thesis support existing guidelines suggesting that diet intervention in obese KOA patients is beneficial for symptomatic improvements. The new information from the thesis is that improvement in clinical symptoms is possible for the majority of patients, independent of their pre-study level of structural damage and measures of joint malfunctioning. The present results also demonstrated that a rapid weight-loss had no association to changes in BML scores and established that changes observed in symptoms and BML scores, following a 16 weeks diet intervention, were not related.
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Hydronephrosis is diagnosed in 0.5-1% of all newborns, and ureteropelvic junction obstruction (UPJO) accounts for 35% of those cases. A urinary tract obstruction that occurs during early kidney development affects renal morphogenesis, maturation, and growth, and in the most severe cases, this will ultimately lead to progressive renal tubular atrophy and interstitial fibrosis with the loss of nephrons. The clinical management of these patients remains a controversial topic. The aim is to preserve renal function by identifying the 15-20% of children who require early surgical intervention from those for whom watchful waiting may be appropriate because of spontaneous resolving/stabilization without significant loss of renal function. Although the patients attend regular follow-ups, including repetitive blood tests, ultrasonographies, and the more invasive diuretic renograms, the surgeons still miss reliably biomarkers that could be used as predictors for renal parenchymal damage and decreased renal function, and thereby provide more clear indications for surgical intervention. The aim of this PhD thesis was to further elucidate the pathophysiology of obstructive nephropathy (study I) and to search for potential candidate biomarkers that may have a predictive and/or diagnostic value in the management of hydronephrosis (study II). Study I: Urine and kidney cytokine profiles in experimental unilateral acute and chronic hydronephrosis. ⋯ Twenty-eight children with UPJO were included in the study from 2007-2011 together with 13 healthy children. Pre-, peri- and post-operatively (1 year) urine samples were collected. The median age of the patients was 8.1 (3.5-14.5) years. Five proteins (EGF, IP-10, MCP-1, RANTES, and MIP-1α) were examined in study IIa, and 4 proteins (NGAL, CyC, βM-2, and OPN) were examined in study IIb. In brief, significantly increased urinary concentrations of EGF and MCP-1 were demonstrated in children with UPJO compared to controls, which was followed by a decline in the post-operative period to levels similar to the controls. This indicates that the urinary concentrations of EGF and MCP-1 are regulated as a response to the obstruction, suggesting that they may have a potential as urinary biomarkers in hydronephrosis. In general, urine from the obstructed kidney exhibited higher concentrations of the proteins compared to urine from the nonobstructed kidney. Furthermore, CyC, β-2M, and OPN were negatively correlated with age, and IP-10 and MCP-1 were negatively correlated with DRF. In conclusion, this PhD study confirmed increased concentrations of selected proteins in urine from kidneys suffering from obstruction. Interestingly, it was observed that some urinary proteins had an age-dependent excretion. Further investigations are required to test the ability of the examined proteins to identify an obstruction and reveal disease progression and, thereby, be useful clinical tools.
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Only few studies have investigated pain, nausea, sedation and analgesic strategies in post-craniotomy patients. The aim of this observational study was to explore pain, nausea, sedation and analgesic procedures after craniotomy, and to evaluate the quality of current analgesic therapy administered to post-craniotomy patients. ⋯ not relevant.
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Danish medical journal · Feb 2013
The most important reason for lack of organ donation is family refusal.
There is a worldwide shortage of organs for transplantation. This survey aims to compare two periods in the 2000s at a large neuro-intensive care unit with respect to de facto organ donors, potential organ donors and reasons for non-donation. ⋯ not relevant.