Pain trajectories and neuropathic pain symptoms following lung cancer surgery: A prospective cohort study.

BACKGROUND: Persistent postsurgical pain (PPSP) after lung cancer surgery is common and current definitions are based on evaluations at a single time point after surgery. Pain intensity and symptoms may however fluctuate and change over time, and be impacted by multiple and shifting factors. Studies of postoperative recovery patterns and transition from acute to chronic pain are needed for further investigation of preventive measures and treatments to modify unfavourable recovery paths. METHODS: In this explorative study, 85 patients undergoing surgery due to either presumptive or confirmed lung cancer reported pain intensities bi-monthly for 12 months. Pain trajectories during recovery were investigated, using group-based trajectory modelling. Associations with possible risk factors for PPSP, including clinical variables and anxiety and depression score (HADS), were also explored. RESULTS: A trajectory model containing three 12-month pain recovery groups was computed. One group without PPSP fully recovered (50%) within two to three months. Another group with mild-intensity PPSP followed a protracted recovery trajectory (37%), while incomplete recovery was observed in the last group (13%). Acute postoperative pain and younger age were associated with a less favourable recovery trajectory. More neuropathic pain symptoms were observed in patients with incomplete recovery. CONCLUSIONS: Three clinically relevant recovery trajectories were identified, based on comprehensive pain tracking. Higher acute postoperative pain intensity was associated with an unfavourable pain recovery trajectory. SIGNIFICANCE STATEMENT: Understanding the transition from acute to chronic postoperative pain and identifying preoperative risk factors is essential for the development of targeted treatments and the implementation of preventive measures. This study (1) identified distinct recovery trajectories based on frequent pain assessment follow-ups for 12 months after surgery and (2) evaluated risk factors for unfavourable postoperative pain recovery paths. Findings suggest that early higher postoperative pain intensity is associated with an unfavourable long-term recovery path.

Should blood flow during cardiopulmonary bypass be individualized more than to body surface area?

Blood flow during cardiopulmonary bypass (CPB) is calculated on body surface area (BSA). Increasing comorbidity, age and weight of today's cardiac patients question this calculation as it may not reflect individual metabolic requirement. The hypothesis was that a measured cardiac index (CI) prior to normothermic CPB is a better estimate. A cross-over study, with random allocation to CPB blood flow for 20 minutes based on either a calculation (2.4 L/min/m(2)) or on CI, with a switch to the opposite flow for another 20 minutes, was performed. Twenty-two elective cardiac surgery patients with normal ventricular function were included. Effect parameters were cerebral oxygenation, mixed venous saturation and arterial lactate. CI varied from 1.9 to 3.1 L/min/m(2) (median 2.4 L/min/m(2)). No differences in effect parameters were seen. In conclusion, a CPB blood flow based on an individual estimate did not improve cerebral and systemic oxygenation compared to a blood flow based on BSA.

Fatty acid composition of the internal mammary artery in relation to dietary intake of marine n-3 polyunsaturated fatty acids and association with flow-mediated vasodilation.

Some evidence suggests that long-chain marine n-3 polyunsaturated fatty acids (n-3 PUFA) may increase production of vasodilatory nitric oxide from vascular endothelium. Fatty acids may therefore play a role for the left internal mammary artery (LIMA) graft function in coronary artery bypass grafting (CABG). However, little is known about the composition of fatty acids in the vessel wall of the LIMA. Using gas chromatography we investigated fatty acid composition in segments of the LIMA, in plasma nonesterified fatty acids (NEFA), in plasma phospholipid (PL) and in the pericardial adipose tissue (PAT) from 22 patients undergoing CABG. Furthermore, we investigated whether there was an association between the n-3 PUFA composition in LIMA and flow-mediated vasodilation (FMD). Self-reported fish consumption and supplementation of eicosapentaenoic acid and docosahexaenoic acids were reflected by the fatty acid composition in NEFA, PL and in PAT, but less so in the LIMA. There was no association between FMD and fatty acid composition of the LIMA.

Human galanin: primary structure and identification of two molecular forms.

From acid/ethanol extracts of surgical specimens of human large intestine we isolated two peptides, in approximately equal amounts, that reacted with an antiserum against porcine galanin. By amino acid analysis, sequence analysis and mass spectrometry, the larger of the two peptides was found to consist of 30 amino acid residues, the sequence of which was identical to that of porcine galanin except for the following substitutions: Val16, Asn17, Asn26, Thr29 and Ser30. Unlike porcine galanin, the carboxy-terminus was not amidated. The smaller peptide corresponded to the first 19 amino acid residues counted from the N-terminus of the 30 residue peptide (again without amidation). The structural analysis was repeated on another batch of tissue with identical results. By HPLC analysis of extracts of specimens from a further 4 patients, the same peptides were identified. Thus, human galanin includes two peptides of 19 and 30 amino acids that share the sequence of the N-terminal 15 residues with other mammalian galanins, but exhibit characteristic differences in the remaining part of the molecules.

Failure to detect Chlamydia pneumoniae in calcific and degenerative arteriosclerotic aortic valves excised during open heart surgery.

Chlamydia pneumoniae has been associated with atherosclerosis, although no causal association has been established. Employing culture and polymerase chain reaction in aortic valves with calcific and degenerative arteriosclerotic changes from 23 non-consecutive patients undergoing aortic valve replacement, C. pneumoniae was not detected in any of the valves. 19/22 patients had serological evidence of past infection with C. pneumoniae. Our findings do not provide supportive evidence for the hypothesis that C. pneumoniae is associated with calcific or degenerative arteriosclerotic aortic heart valve disease.

No signs of Campylobacter jejuni/coli-related antibodies in patients with active ankylosing spondylitis.

Twenty-two patients with active ankylosing spondylitis were investigated to assess the levels of specific serum IgG, IgA and IgM titres against Campylobacter jejuni/coli before and during treatment with sulfasalazine. An enzyme-linked immunosorbent assay was used, and the results were compared with the antibody levels in 300 healthy blood donors. Three patients had elevated levels of serum anti-Campylobacter-IgA before treatment, and a two-fold decrease in the antibody titre was observed during treatment. Three patients had elevated anti-Campylobacter-IgG titres before treatment. One of these patients also had elevated anti-Campylobacter-IgA and IgM titres. Elevated IgM titres were not seen in any other patient. The results do not support the hypothesis that C. jejuni/coli plays an important role in the pathogenesis of active AS.

Evaluation of Stuart's transport medium containing penicillinase. An in vitro study. Brief report.

An in vitro study was performed to evaluate the value of penicillinase in Stuart's transport medium. Swabs were taken from serum broth cultures of Staphylococcus aureus, Escherichia coli and Proteus rettgeri, incubated with cefuroxime. Following 24 hours' storage in the transport medium, the recovery of P. rettgeri was significantly higher from Stuart's transport media containing penicillinase in a concentration of 100,000 units/ml, than from swabs stored in Stuart's medium without penicillinase. Although susceptible to cefuroxime, we did not find the same effect on S. aureus and E. coli, presumably because these strains had higher MIC values than the P. rettgeri strain tested.

In vitro antibacterial activities of eleven antibiotics against S. faecalis.

The in vitro antibacterial activities of penicillin, ampicillin, piperacillin, azlocillin, vancomycin, erythromycin, clindamycin, gentamicin, streptomycin, cefotaxime, and ceftriaxone against 198 S. faecalis strains were investigated, employing an agar dilution technique. Results were generally in accord with those of other studies. Ampicillin and penicillin showed equal activities. Twenty percent of the strains were resistant to erythromycin, which correlated with resistance to clindamycin. The activity of cefotaxime was fairly good, but the clinical importance of this observation warrants further investigation. Twenty percent showed high-level resistance to streptomycin. High-grade resistance to gentamicin was noted for one isolate only, making gentamicin the first-choice aminoglycoside for combination treatment at present.

In vitro susceptibility of diarrhoea producing gram negative enteric bacteria to sulfasalazine, 5-aminosalicylic acid, sulfapyridine and four quinolones. Brief report.

The in vitro susceptibility of diarrhoea producing Gram negative enteric bacteria to sulfasalazine, 5-aminosalicylic acid, sulfapyridine and four quinolones was investigated using an agar dilution method. All strains were resistant to 1600 micrograms/ml of sulfasalazine and 5-aminosalicylic acid. MIC range of sulfapyridine for Y. enterocolitica was 3.1-25 micrograms/ml (median:6.2) and for Salmonella 25-100 micrograms/ml (median: 100) Campylobacter jejuni/coli were less susceptible to sulfapyridine with MIC values ranging from 200 to 800 micrograms/ml. Shigella and three of five E. coli strains were resistant to 1600 micrograms/ml of sulfapyridine. Two strains of E. coli were inhibited by 25 micrograms/ml. All strains were fairly susceptible to enoxacin, ciprofloxacin, pefloxacin and ofloxacin. Cirpofloxacin was the most active drug on weight basis.

[Chlamydia pneumoniae and atherosclerosis]. / Chlamydia pneumoniae og aterosklerose.

Several seroepidemiological studies have shown an association between chronic infection with Chlamydia pneumoniae and atherosclerosis of the coronary and carotid arteries as well as with acute myocardial infarction. Chlamydia-specific antibodies and circulating immune complexes are found more often in patients than in controls. The organism can often be shown in atherosclerotic plaques from coronary, carotid, iliac and femoral arteries as well as from the aorta, employing electron microscopy, immunocytochemical staining and the polymerase chain reaction, but is seldom demonstrated in arteries without atherosclerosis. Only one successful isolation by culture from an atherosclerotic coronary artery has been described. Whether there is any etiological or pathogenetic link between atherosclerosis and chronic infection with C. pneumoniae remains to be elucidated.

[Transmyocardial laser revascularization. A new possible method for treatment of ischemic heart disease]. / Transmyokardial laserrevaskularisering. En mulig ny metode til behandling af iskoemisk hjertesygdom.

Transmyocardial laser revascularization (TMR) using a CO2 laser or a holmium YAG laser represents a novel approach to treating coronary artery disease. Through a left thoracotomy, 15-30 transmural channels approximately 1 mm in diameter, are created with the laser through reperfusable areas of the left ventricular free wall of the beating heart. This allows blood to flow directly from the left ventricle into the myocardial vascular network. The epicardial holes seal within few minutes. More than 1000 patients have had TMR worldwide. Indications are not fully established. Preliminary results suggest that TMR may be of value either as an adjunct to coronary bypass surgery, or in patients in whom another invasive treatment is not an option. Results from randomized, controlled studies are not yet available.

[Microbiology related to anal abscess complicated with fistula formation]. / Mikrobiologi i relation til analabsces kompliceret med fisteldannelse.

The results of operative treatment of anal abscesses with reviewed retrospectively for a period of three years with the object of correlating the microbiological findings on culture from the abscess with the presence of a fistula. Patients who had not been controlled postoperatively were requested to attend for anal examination. Fistula were demonstrated in 27 out of 83 patients. No fistulae nor recurrences of abscesses were found in patients in whom only bacteria not derived from the intestine were cultured. Culture from an anal abscesses is thus of considerable prognostic value.

[Treatment of non-small-cell lung cancer and solitary adrenal gland metastasis]. / Behandling af ikkesmåcellet lungecancer og solitaer binyremetastase.

A patient with non-small-cell lung cancer and a solitary adrenal metastasis was treated with right subsegmental pulmonary resection and right adrenalectomy. Four months later an upper right lobectomy was performed because of local recurrence. Forty-one months following the initial operation the patient is doing fine without signs or symptoms of recurrence. Adrenalectomy because of a solitary adrenal metastasis in patients with non-small-cell lung cancer may offer the opportunity of prolonged survival, when a radical thoracotomy can be performed.

[Antibacterial treatment of Campylobacter pylori-associated gastritis and peptic ulcer]. / Antibakteriel behandling af Campylobacter pylori associeret gastritis og peptisk ulcus.

On the basis of possible etiological or pathogenetic significance of Campylobacter pylori for the development, maintenane og recurrence of gastritis and peptic ulceration, a review based on the literature is presented for the sensitivity of the bacteria in vitro and in vivo to antibiotics and preparations employed in the medicinal treatment of gastritis and peptic ulceration. The bacterium is sensitive in vitro to a long series of antibiotics and all of the anti-ulcer agents have, similarly, antibacterial activity in vitro, but, apart from bismuth, only in high concentrations. Among the anti-ulcer agents, only bismuth and, similarly, amoxycillin are capable of eliminating the bacteria from the stomach and this is associated with healing of any gastritis present. Recurrence of infection is observed in more than 50% of the patients after the conclusion of treatment regardless of whether this was antibiotic or bismuth treatment. High in vitro activity of a substance is not synonymous with in vivo activity. A correlation was demonstrated between recurrence of duodenal ulcer and recurrent/persistent infection with Campylobacter pylori. The optimal antibacterial therapeutic strategy is not established and, similarly, no generally accepted indication for specific antimicrobial treatment of Campylobacter pylori associated gastritis or peptic ulceration exists.

[Socio-medical consequences of patients with Bechterew's disease in Denmark]. / Socio-medicinske konsekvenser hos morbus Bechterew patienter i Danmark.

During the period 1972-1985, 179 patients with Bechterew's disease replied to a questionnaire based on the age at commencement of the disease, treatment and the patient's experience of this and the working capacity related to the duration of the disease inter alii. The distribution of patients who were capable of working was constant regardless of the duration of the disease. 40% were completely fit for work, 35% partially fit for work and 25% were unfit for work. 63% sought alternative forms of treatment which were without clinical effect. Regular training and employment of non-steroid, anti-inflammatory agents resulted in clinical improvement. During the latest five years of the period of investigation, a tendency was observed for reduction in the delay in establishing the diagnosis. Despite early onset and varying clinical course, the prognosis in patients with Bechterew's disease is good.

[Appendicitis in pregnancy. Complications and treatment]. / Appendicitis i graviditeten. Komplikationer og behandling.

In order to establish guidelines for the management of a pregnancy that is complicated by acute appendicitis we carried out a retrospective review of 16 patients that had their appendix removed at the Department of Obstetrics and Gynaecology, Rigshospitalet, University of Copenhagen in the period 1974-1988. The diagnostic accuracy was 12/16 (75%). The signs and symptoms were classic. Uterine contractions may occur. There was one foetal death in a case complicated by an intraperitoneal abscess, and two patients delivered prematurely. Three patients had infectious complications, none of these patients were given prophylactic antibiotics. In all uncomplicated cases the pregnancy proceeded to term and the deliveries were normal. The pregnancy ought not to divert the surgeon's attention from performing prompt appendectomy once the diagnosis is suspected. Prophylactic antibiotics and tocolytic drugs should be used in all cases. Simultaneous caesarean section should be performed only on obstetric indications.

In vitro susceptibility of Campylobacter jejuni and Campylobacter coli isolated in Denmark to fourteen antimicrobial agents.

The in vitro susceptibility of 95 recent Danish human clinical isolates of Campylobacter jejuni and Campylobacter coli to 14 antimicrobial agents was determined by an agar dilution technique. C. jejuni and C. coli were considered together. Doxycycline, ciprofloxacin, gentamicin, clindamycin, nitrofurantoin and erythromycin were the most active drugs. 2% of the strains tested were resistant to erythromycin (MIC greater than 3.1 micrograms/ml). Therefore susceptibility testing is suggested if antimicrobial therapy with erythromycin is considered to be indicated. Ciprofloxacin might prove to be an alternative to erythromycin. Susceptibility testing in a CO2 atmosphere affected the determination of MICs of doxycycline, erythromycin, gentamicin and clindamycin, probably reflecting pH-changes in the media during incubation under increased CO2 tension.

In vitro susceptibility of Campylobacter pyloridis to cimetidine, sucralfate, bismuth and sixteen antibiotics.

The in vitro susceptibility of recent Danish human clinical isolates of Campylobacter pyloridis to cimetidine, sucralfate, bismuth subsalicylate and sixteen antimicrobial agents was determined by an agar-dilution technique. Benzylpenicillin was the most active drug (MIC90 = 0.1 microgram/ml); ampicillin, erythromycin, gentamicin and ciprofloxacin were slightly less active. All strains were resistant to 100 micrograms sulfamethizole, and nalidixic acid also had little activity on weight basis. Of the three anti-peptic ulcer drugs, bismuth subsalicylate was most active (MIC90 25 micrograms/ml), but sucralfate and cimetidine also had antibacterial activity, although only little (MIC90 3200 micrograms/ml).