Case comparison of sleep features from ear-EEG and scalp-EEG.

BACKGROUND: We investigate the potential usability of a novel in-the-ear electroencephalography recording device for sleep staging. METHODS: In one healthy subject we compare simultaneous earelectroencephalography to standard scalp EEG visually and using power spectrograms. Hypnograms independently derived from the records are compared. RESULTS: We find that alpha activity, K complexes, sleep spindles and slow wave sleep can be visually distinguished using earelectroencephalography. Spectral peaks are shared between the two records. Hypnograms are 90.9% similar. CONCLUSION: The results indicate that ear-electroencephalography can be used for sleep staging.

The impact of M-component type and immunoglobulin concentration on the risk of malignant transformation in patients with monoclonal gammopathy of undetermined significance.

BACKGROUND AND OBJECTIVES: In this study the impact of gender, age, type of M-component and concentration of immunoglobulins on the risk of malignant transformation in monoclonal gammopathy of undetermined significance (MGUS) was assessed. DESIGN AND METHODS: We identified 1,247 cases of MGUS in the period 1978 to 1993 in North Jutland County, Denmark. Data on cancer occurrence in the MGUS cohort were obtained from the Danish Cancer Registry. The expected numbers of incident cancer cases were calculated from age-, sex-, county-, and period-specific cancer incidence rates. The impact of the variables mentioned above on the risk of malignant transformation was analyzed in Poisson regression models. RESULTS: The relative risk of IgA compared to IgG was 1.8 (95% confidence interval, 1.1-3.0), while the relative risk of IgM compared to IgG was 1.1 (0.7-1.9). For all three types of MGUS, the risk of malignant transformation was higher among females than among males, and the risk increased with increasing concentration of immunoglobulin with very high risks for the patients with the highest levels of immunoglobulin. Hypogammaglobulinemia was associated with malignant transformation in patients with IgG type MGUS. For IgG and IgM MGUS, the risk decreased with increasing age and with follow-up beyond one year. INTERPRETATION AND CONCLUSIONS: Female sex, IgA M-component type and high concentration of the immunoglobulin comprising the M-component were associated with a high risk of malignant transformation. Hypogammaglobulinemia, young age at diagnosis and short follow-up were risk factors in particular for those with IgG MGUS.

Mortality and causes of death in patients with monoclonal gammopathy of undetermined significance.

To evaluate the mortality and causes of death in monoclonal gammopathy of undetermined significance (MGUS), we identified 1324 cases of MGUS in the period 1978-93 in North Jutland County, Denmark. Data on mortality were obtained by record linkage to the Danish Death Registry. There were 868 deaths in the MGUS cohort during 7785 years of follow-up vs. 409.6 expected, giving a standardized mortality ratio (SMR) of 2.1 (95% confidence interval 2.0-2.3). Malignant transformation was the cause of death in 97 patients vs. 4.9 expected, yielding a SMR of 20.0 (16.2-24.4), which explained about 20% of the excess mortality in the cohort. The mortality was increased for several other malignant and non-malignant causes of death during the first 4 years of follow-up. For late follow-up, 5-18 years after detection of the M-component, the overall SMR was 1.7 (1.5-1.9), and malignant transformation was the only cause of death with a substantial increase of SMR. Although malignant transformation is an important cause of death in MGUS patients, it did not entirely explain the increased mortality. MGUS patients often suffer from coexisting clinical conditions that increase the mortality, especially during the first years after detection of the M-component.

Cancer risk in patients with monoclonal gammopathy of undetermined significance.

To assess the cancer risk of monoclonal gammopathy of undetermined significance (MGUS) we identified 1229 cases of MGUS in the period 1978 to 1993. Data on cancer occurrence in the MGUS cohort were obtained from the Danish Cancer Registry. The expected numbers of cancer cases were calculated from age-, sex-, county-, and period-specific cancer incidence rates. In the MGUS cohort 64 new cancers with a known association with M-components were diagnosed versus 5.0 expected giving a standardized incidence ratio (SIR) of 12.9 (95% confidence interval, 9.9-16.5). The relative risks of developing multiple myeloma (SIR 34.3), Waldenström's macroglobulinemia (SIR 63.8), and non-Hodgkin's lymphoma (SIR 5.9) were significantly increased and independent of time passed from detection of the M-component. The relative risk of chronic lymphocytic leukemia was not significantly increased, SIR 2.7 (0.5-7. 7). Among cancer sites without known association with M-components 141 cases were observed versus 94.6 expected giving a SIR of 1.5 (1. 3-1.8). This enhanced risk was seen for several non-hematological cancer sites but for most cancer sites the risk was dependent on time passed from detection of the M-component, indicating a bias rather than a causal role of MGUS.

Epidemiology of respiratory syncytial virus infection requiring hospitalization in East Denmark.

BACKGROUND: Prophylaxis against infection caused by respiratory syncytial virus (RSV) with high titered RSV immunoglobulin or humanized antibody may soon be available in Europe. OBJECTIVE: To study the epidemiology of RSV infections requiring hospitalization in infants <6 months in East Denmark to provide a rational basis for decisions concerning prophylaxis against RSV. METHOD: Populat ion-based retrospective review of case records of infants <6 months admitted to pediatric departments with RSV infection in East Denmark from November 1, 1995, to April 30, 1996. RESULTS: Data were obtained from 459 infants. Seventy-three had predisposing conditions: prematurity, 49; pulmonary disease, 2; congenital heart disease, 7; neurologic disease, 6; others, 9. One preterm infant had bronchopulmonary dysplasia. The incidence of RSV infection requiring hospitalization in East Denmark among infants <6 months was estimated to be 34/1000/season. It was 32/1000/season among term infants and 66/ 1000/season among preterm infants (P<0.001). Infants with predisposing conditions and/or nosocomial infection (n = 24) had significantly more severe courses than otherwise healthy infants (P<0.01). One-hundred thirty infants received respiratory support by nasal continuous positive airway pressure, but only six required mechanical ventilation. No infants died. CONCLUSION: The course of RSV disease in East Denmark was milder than reported elsewhere, possibly as a result of the low prevalence of bronchopulmonary dysplasia in Denmark. However, RSV constitutes a considerable burden to the Danish pediatric health care system, and therefore prophylaxis against RSV is desirable.

The risk of bacteremia in patients with monoclonal gammopathy of undetermined significance.

We estimated the risk of bacteremia in patients with monoclonal gammopathy of undetermined significance (MGUS) compared with the general population; 1237 cases of MGUS were identified by linking information on detected monoclonal components in the North Jutland County with the Danish Cancer Registry. We evaluated the risk of bacteremia in the MGUS cohort during the 13-yr period from 1981 to 1993 by linkage to the Bacteremia Registry in the County. Follow-up for the occurrence of bacteremia started 30 d after detection of the M-component and continued until malignant transformation, death or until 31 December 1993, whichever came first. The expected numbers of bacteremia was based upon county, age, sex and period-specific incidence rates. The median follow-up period was 3.8 yr. Forty episodes of bacteremia occurred during 5500 person-years versus 18 expected. The crude standardized incidence ratio of bacteremia was 2.2 (95% confidence interval, 1.6-3.0). There was no distinct pattern of bacterial etiology in the MGUS cohort. Although we found an association between MGUS and risk of bacteremia, the overall risk is small and this finding hardly affects the clinical handling of MGUS patients.

[Renal insufficiency in myelomatosis. Prognostic factors and survival]. / Nyreinsufficiens ved myelomatose. Prognostiske faktorer og overlevelse.

Clinical features, occurrence and reversibility of renal failure, response to treatment and survival duration in 190 multiple myeloma patients were reviewed in a retrospective study based on hospital records. Renal failure was present in 27% of the patients and constituted an important prognostic factor. Reversibility of renal failure occurred in 52% of the patients and was more frequent in those with low serum creatinine, hypercalcaemia, high erythrocyte sedimentation rate and high level of IgA. Response to chemotherapy resulted in a prolonged survival, whereas recovery of renal function did not significantly affect survival.

[Occult hereditary spherocytosis in aplastic crisis of unknown cause]. / Okkult hereditaer sfaerocytose ved aplastisk krise af ukendt genese.

We describe two cases of aplastic crisis of unknown origin, occurring within one week in a 49-year old man and his 20 year old son. They both had undiagnosed hereditary spherocytosis, and both of them had earlier had a B19-parvo infection without having symptoms of aplastic crisis at the same time. Chronic haemolytic anaemia should be considered in adult patients with acute severe anaemia caused by aplastic crisis.

Experimental nonsuture colonic anastomoses.

A comparative study of sutured colonic anastomoses and anastomoses made by isobutylcyanoacrylate was performed in 60 rats. No difference in the strength of the anastomoses, as expressed by the bursting pressure, was found, and there was no difference in the frequency of adhesions or stenoses, provided the cyanoacrylate was meticulously covered by omentum. Histologic evidence of delayed healing was observed in the cyanoacrylate group; however, this did not seem to reduce the strength of the anastomosis. Provided it is covered with an omental tag, isobutylcyanoacrylate may prove to be a valuable adjunct to conventional suture techniques under special circumstances.

Prognosis after treatment of villous adenomas of the colon and rectum.

With the existing evidence of neoplastic polyps of the colon and rectum as precursors of most or all colonic cancer, information of the short- and long-term course after treatment is a prerequisite of using the knowledge of the polyp-cancer sequence in an effective cancer prophylaxis. One hundred seventy-four patients treated for villous adenomas of the colon and rectum during the years 1960-1975 were re-examined. Survival and cure rates were estimated by actuarial analysis. The death rate of colonic cancer among patients treated for a benign villous adenoma was significantly higher than in an age and sex matched normal population, resulting in a significantly reduced crude survival rate among these patients. Almost all recurrences after treatment of benign villous adenomas occurred within the first four to five years recurrence rate of roughly 30%, indicating that five years seem to be an adequate total control period following treatment.

Effect of selective goitre resection on absent thyrotrophin response to thyrotrophin releasing hormone in idiopathic euthyroid goitres.

Absent thyrotrophin (TSH) response to thyrotrophin releasing hormone (TRH) was found in ten of fifty consecutive nodular goitrous patients who were clinically and biochemically euthyroid. These ten patients together with a reference group engaging fifty-eight healthy individuals matched for sex, age, and geographic region form the basis of the present study. Patients with autonomously functioning single adenomata were excluded from the investigation. In the patient group, values of serum thyroxine (T4), free T4-index, and serum TSH did not differ significantly from those recorded in the reference group, whereas serum triiodothyronine was found to be significantly higher in the patients, although within the normal range. After selective resection of the goitre, the TSH responsiveness to TRH recovered completely. Routine indices of thyroid function, however, demonstrated no major deviation from pre-operative levels. During a follow-up period of 1 year, no systematic alterations were recorded in TSH response to TRH nor in the thyroid function tests, indicating maintenance of euthyroidism with restored normality within the pituitary-thyroid axis. The present study lends support to the view that increasing functional autonomy apparently is a common trend in goitre evolution in a non-endemic area.

Long-term observation of thyroid function after surgical treatment of thyrotoxicosis.

During the 10-year period from 1960 to 1970 a total of 213 patients with diffuse or nodular toxic goitre underwent subtotal thyroidectomy. A short-term preoperative treatment with antithyroid drugs and iodine was given systematically. The observation period ranged from 5 to 15 years, average 9 years. A total of 203 patients (95%) were traced and followed up. The concentration of se-T4, se-T3, and se-TSH was measured and in selected cases a TRH test and BMR was carried out in addition. All thyroid specimens were re-examined by the same pathologist for histological grading. It was found that 85% of the patients had been rendered euthyroid for 5 years or more. The recorded incidence of thyroid hypofunction was 6% and the incidence of recurrent thyrotoxicosis was 9% of the series. Se-TSH was found to be elevated in 17%. The correlation between elevated se-TSH and se-T4 values was calculated and found to be fairly reasonable (r = -0.66). It is concluded that subtotal thyroidectomy preceded by short-term antithyroid drug therapy supplemented ultimately with iodine offers significant advantages in the management of thyrotoxicosis by rendering 85% of patients euthyroid on long-term surveillance.