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Andersen PA, Thomsen AH, Hasselstrøm JB, Andersen FD, Thomsen JH, Jornil JR, Andersen CU. Exploring death scenes and circumstances in fatal opioid poisonings: Insights for preventive strategies using forensic autopsy cases in Western Denmark. Forensic Sci Int 2024; 356:111948. [PMID: 38330673 DOI: 10.1016/j.forsciint.2024.111948] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/04/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Fatal opioid poisoning is a growing global issue. This study aims to describe circumstances surrounding fatal opioid poisonings by examining death scenes, demographics, and information from bystanders with the goal of informing prevention efforts. METHODS We extracted data from the autopsy reports of 327 forensic autopsy cases with fatal poisoning involving methadone and/or morphine from 2013-2020. RESULTS Fatal opioid poisonings occurred in both rural and urban areas. Death scene was the decedent's own home and a relative's or friend's home in 62% and 21%, respectively. The decedent died alone in 64% of the cases while other people were staying at the same address while death occurred in 30%. Decedents aged 15-34 years were more likely to die with other people staying at the same address than persons aged > 44 years (OR±SD: 2.3 ± 0.9, p = 0.005), and had lower postmortem blood methadone concentrations compared to persons > 34 years (Median [interquartile range]: 0.36 [0.23-0.62] vs 0.63 [0.28-1.2] mg/kg, p = 0.002). Female sex was more prevalent, and persons using illegal drugs were less prevalent in decedents aged > 44 years compared to those with age 15-44 years (29% vs 20%, p = 0.05% and 67% vs 89%, p < 0.001, respectively). Other psychoactive drugs were detected in 97% of decedents, mainly benzodiazepines (80%). CONCLUSIONS Preventive strategies based on our findings include the need for harm reduction initiatives in both urban and rural areas, recognizing symptoms of fatal poisoning, and awareness of low tolerance among younger age groups. Urgent attention should be given to avoiding opioid use alone, particularly among older individuals, including women using prescribed opioids. Conveying the risks of polydrug use to all age groups is essential, especially co-use of sedative drugs.
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Affiliation(s)
- Peter Andreas Andersen
- Department of Forensic Science, Aarhus University, Denmark; Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark.
| | | | | | | | - Jakob Hartvig Thomsen
- Antidote Danmark, Denmark; Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Denmark
| | | | - Charlotte Uggerhøj Andersen
- Department of Forensic Science, Aarhus University, Denmark; Department of Clinical Pharmacology, Aarhus University Hospital, Denmark
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Heisel LS, Andersen FD, Joca S, Sørensen LK, Simonsen U, Hasselstrøm JB, Andersen CU, Nielsen KL. Combined in vivo metabolic effects of quetiapine and methadone in brain and blood of rats. Arch Toxicol 2024; 98:289-301. [PMID: 37870577 PMCID: PMC10761411 DOI: 10.1007/s00204-023-03620-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023]
Abstract
Changes in pharmacokinetics and endogenous metabolites may underlie additive biological effects of concomitant use of antipsychotics and opioids. In this study, we employed untargeted metabolomics analysis and targeted analysis to examine the changes in drug metabolites and endogenous metabolites in the prefrontal cortex (PFC), midbrain, and blood of rats following acute co-administration of quetiapine and methadone. Rats were divided into four groups and received cumulative increasing doses of quetiapine (QTP), methadone (MTD), quetiapine + methadone (QTP + MTD), or vehicle (control). All samples were analyzed using liquid chromatography-mass spectrometry (LC-MS). Our findings revealed increased levels of the quetiapine metabolites: Norquetiapine, O-dealkylquetiapine, 7-hydroxyquetiapine, and quetiapine sulfoxide, in the blood and brain when methadone was present. Our study also demonstrated a decrease in methadone and its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) in the rat brain when quetiapine was present. Despite these findings, there were only small differences in the levels of 225-296 measured endogenous metabolites due to co-administration compared to single administrations. For example, N-methylglutamic acid, glutaric acid, p-hydroxyphenyllactic acid, and corticosterone levels were significantly decreased in the brain of rats treated with both compounds. Accumulation of serotonin in the midbrain was additionally observed in the MTD group, but not in the QTP + MTD group. In conclusion, this study in rats suggests a few but important additive metabolic effects when quetiapine and methadone are co-administered.
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Affiliation(s)
- Laura Smedegaard Heisel
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Freja Drost Andersen
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Sâmia Joca
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, DK-8000, Aarhus C, Denmark
| | | | - Ulf Simonsen
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, DK-8000, Aarhus C, Denmark
| | - Jørgen Bo Hasselstrøm
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Charlotte Uggerhøj Andersen
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, DK-8000, Aarhus C, Denmark
- Department of Clinical Pharmacology, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Kirstine Lykke Nielsen
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
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Andersen FD, Steffensen SC, Vistisen ST, Pinilla E, Pedersen TM, Matchkov V, Simonsen U, Andersen CU. Combined effects of methadone and quetiapine on respiratory rate, haemodynamic variables, and temperature in conscious rats. Addict Biol 2023; 28:e13320. [PMID: 37644895 DOI: 10.1111/adb.13320] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023]
Abstract
Fatal poisonings where both methadone and quetiapine are detected post-mortem occurs frequently in legal autopsy cases. It is unclear whether quetiapine increases the risk of fatal methadone poisoning or if it is merely detected due to widespread use. We hypothesized that methadone and quetiapine would have additive toxic effects on respiratory rate, blood pressure, and the QTc-interval. To investigate this hypothesis, we used telemetry implants for measurements of respiratory rate, haemodynamic variables, the velocity of blood pressure changes, temperature, and movement in conscious, freely moving male Wistar rats aged 12-13 weeks. The combined effects of three accumulative i.p. doses of methadone (2.5, 10, 15 mg/kg) and quetiapine (3, 10, 30 mg/kg) were compared to rats treated with the same doses of each drug alone, and a vehicle-treated group in a randomized investigator blinded study. No additive effects of quetiapine and methadone on respiratory rate, haemodynamic variables, or movement were observed. However, body temperature was significantly lower by approximately 1.5°C on average in the group treated with both methadone and quetiapine (15 + 30 mg/kg) compared to the other groups. This indicates a synergistic effect of quetiapine and methadone on thermoregulation, which may increase the risk of fatal poisoning. We suggest studying this finding further in human settings.
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Affiliation(s)
| | - Simon Comerma Steffensen
- Department of Biomedicine, Aarhus University, Denmark
- Department of Biomedical Sciences/AnimalPhysiology, Central University of Venezuela, Venezuela
| | | | | | | | | | - Ulf Simonsen
- Department of Biomedicine, Aarhus University, Denmark
| | - Charlotte Uggerhøj Andersen
- Department of Forensic Medicine, Aarhus University, Denmark
- Department of Biomedicine, Aarhus University, Denmark
- Department of Clinical Pharmacology, Aarhus University Hospital, Denmark
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Andersen CU, Hansen S, Dalhoff KP, Nielsen LP, Møller JM, Olesen AE. Clinical characteristics of hospitalized patients with paracetamol poisoning before and after restrictions of over-the-counter sale of paracetamol. Clin Toxicol (Phila) 2023; 61:228-233. [PMID: 36919499 DOI: 10.1080/15563650.2023.2181104] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/27/2023] [Accepted: 02/12/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Paracetamol poisoning is a frequent cause of hospitalization in Denmark. On 30 September 2013, the Danish authorities restricted packages available without a prescription in pharmacy outlets to contain a maximum of 10 g of paracetamol. We aimed to investigate the effects of this regulation. METHODS This was a cross-sectional study of two groups of patients admitted consecutively to a Danish University Hospital due to poisoning with paracetamol in 365 days in 2012-13 before 30 September 2013, and a corresponding 365-day period in 2017-18. Data were extracted from patient records. RESULTS In 2012-2013 and 2017-18, 156 and 92 admissions in 127 and 78 unique patients, respectively, were identified. Ingestion of more than 20 g paracetamol occurred in a significantly higher proportion of cases in 2012-13 compared to 2017-18 (29% vs 13%, P < 0.01). In accordance, there were no cases of international normalized ratio >1.5 or alanine aminotransferase activity >1000 U/L in the post-legislation period, and seven and five cases in the pre-legislation period, respectively. Females accounted for 80% and 78% of patients in the two periods, respectively, and were considerably younger than males (median [interquartile range]: 22 [17-40] vs. 47 [30-56], P < 0.01 in 2012-13, and 23 [18-46] vs. 43 [27-49] years, P = 0.02 in 2017-18). Furthermore, in 2012-13, intentional poisonings occurred in a higher proportion of females than males 2012-13 (97% vs 85%, P < 0.01). CONCLUSIONS The present study demonstrated a lower number of paracetamol poisonings, a decreased proportion of poisonings involving ingestion of more than 20 g of paracetamol, and a lower occurrence of hepatotoxicity after the regulation. However, circumstances other than pack size restrictions, such as increased public awareness of the danger of paracetamol poisonings, may affect these associations. Furthermore, the study showed that females and males constitute two distinct groups in terms of age and intentional poisoning.
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Affiliation(s)
- Charlotte Uggerhøj Andersen
- Department of Clinical Pharmacology, Aalborg University Hospital, Denmark
- Deartment of Clinical Medicine, Aalborg University, Denmark
- Department of Forensic Medicine, Aarhus University, Denmark
| | - Steffen Hansen
- Department of Clinical Pharmacology, Aalborg University Hospital, Denmark
| | - Kim Peder Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Denmark
- Acute and Trauma Center, Aalborg University Hospital, Denmark
| | - Lars Peter Nielsen
- Department of Clinical Pharmacology, Aalborg University Hospital, Denmark
| | | | - Anne Estrup Olesen
- Department of Clinical Pharmacology, Aalborg University Hospital, Denmark
- Deartment of Clinical Medicine, Aalborg University, Denmark
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Andersen FD, Joca S, Hvingelby V, Arjmand S, Pinilla E, Steffensen SC, Simonsen U, Andersen CU. Combined effects of quetiapine and opioids: A study of autopsy cases, drug users and sedation in rats. Addict Biol 2022; 27:e13214. [PMID: 36001431 PMCID: PMC9541371 DOI: 10.1111/adb.13214] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/17/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022]
Abstract
Fatal opioid poisonings often involve methadone or morphine. This study aimed to elucidate if quetiapine, a widely used sedative antipsychotic medication, may increase the risk of fatal opioid poisoning by additive inhibitory effects on the central nervous system. We used data from 323 cases of fatal methadone or/and morphine poisonings autopsied from 2013 to 2020, a survey of 34 drug users, and performed blinded placebo‐controlled studies in 75 Flinders Resistant Line rats receiving three cumulative intraperitoneal doses of vehicle, methadone (2.5, 10 and 15 mg/kg), morphine (3.75, 15 and 22.5 mg/kg), quetiapine (3, 10 and 30 mg/kg) or quetiapine combined with methadone or morphine. Quetiapine was detected in 20.4% of fatal opioid poisonings with a significantly increased frequency over time, primarily in low or therapeutic concentrations, and was not associated with methadone or morphine concentrations. Use of quetiapine, most commonly in low‐to‐moderate doses to obtain a sleep‐inducing or tranquillizing effect, was reported by 67.6% of survey respondents. In the animal studies, a significant impairment of sedation score, performance on the rotarod and open field mobility was observed in all treatment groups compared with vehicle. However, the effect of quetiapine plus the opioid was not significantly different from that of the opioid alone. Thus, no additive sedative effects were observed in rats. Our results suggest that quetiapine is more often an innocent bystander than a contributor to fatal opioid poisoning. However, the combined effects on other parameters, including blood pressure, cardiac rhythm and respiratory rate, need investigation.
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Affiliation(s)
| | - Sâmia Joca
- Department of Biomedicine Aarhus University Aarhus Denmark
| | - Victor Hvingelby
- Department of Clinical Medicine – Nuclear Medicine and PET Aarhus University Aarhus Denmark
| | - Shokouh Arjmand
- Translational Neuropsychiatry Unit, Department of Clinical Medicine Aarhus University Aarhus Denmark
| | | | - Simon Comerma Steffensen
- Department of Biomedicine Aarhus University Aarhus Denmark
- Department of Biomedical Sciences/Animal Physiology, Faculty of Veterinary Central University of Venezuela
| | - Ulf Simonsen
- Department of Biomedicine Aarhus University Aarhus Denmark
| | - Charlotte Uggerhøj Andersen
- Department of Forensic Medicine Aarhus University Hospital Aarhus Denmark
- Department of Biomedicine Aarhus University Aarhus Denmark
- Department of Clinical Pharmacology Aarhus University Hospital Aarhus Denmark
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Andersen CU, Nielsen LP, Møller JM, Olesen AE. Acute drug poisonings leading to hospitalization. Basic Clin Pharmacol Toxicol 2021; 130:328-336. [PMID: 34811929 DOI: 10.1111/bcpt.13688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/26/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 01/22/2023]
Abstract
Knowledge about current trends and epidemiology in poisonings is important to maintain quality in diagnostics, treatment and prevention. We performed a cross-sectional study of all cases (n = 261) admitted with drug poisoning to Aalborg University Hospital during 1 year in 2017-2018. Median age was 30 (22-49) years, and 58% were female. Fifty percent were suicide attempts. In most cases, involved drugs were identified by history taking; blood analysis barely revealed any additional paracetamol and salicylicate poisonings. Drugs prescribed to the patient or available over the counter were involved in nearly two thirds of cases. Weak analgesics dominated by paracetamol (n = 91, 35%) was the most frequently involved group of drugs followed by opioids and benzodiazepines. Gender differences were observed with respect to involvement of weak analgesics and central stimulants. A higher prevalence of unidentified involved drugs was observed in 26 cases (10%) in which the length of admission exceeded 2 days and/or intensive care was needed. No deaths, cardiac arrhythmias or physical complications occurred. Thus, current handling of the acute poisoning seems effective in most cases. However, a more tailored use of blood analyses including a toxicological screen in selected cases may represent an opportunity for improvement.
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Affiliation(s)
- Charlotte Uggerhøj Andersen
- Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.,Department of Forensic Medicine, Aarhus University, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Lars Peter Nielsen
- Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Anne Estrup Olesen
- Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Hesse M, Thomsen KR, Thylstrup B, Andersen CU, Reitzel LA, Worm-Leonhard M, Lindholst C. Purity of street-level cocaine across Denmark from 2006 to 2019: Analysis of seized cocaine. Forensic Sci Int 2021; 329:111050. [PMID: 34736046 DOI: 10.1016/j.forsciint.2021.111050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/12/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Cocaine-related emergency department admissions are increasing, and cocaine seizures are at an all-time high in Europe. Our aim was to investigate the trends in purity and adulterants over time in cocaine available to cocaine users at street level in Denmark. We used a representative sample of cocaine seized at street level and analyzed by the national departments of forensic medicine between 2006 and 2019 (n = 1460). Latent profile analysis was used to classify the samples based on cocaine, levamisole, and phenacetin content. Low purity cocaine comprised most of the cocaine seizures in early years, but its share began to decline in 2013, and from 2016 to 2019, the high purity profile was dominant. While the total number of samples containing adulterants decreased, levamisole remained a common and dangerous adulterant. The findings underline the need to inform the public, medical doctors, and service providers for people with drug use disorders about the higher potency of street cocaine.
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Affiliation(s)
- Morten Hesse
- Aarhus University, Center for Alcohol and Drug Research, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Kristine Rømer Thomsen
- Aarhus University, Center for Alcohol and Drug Research, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Birgitte Thylstrup
- Aarhus University, Center for Alcohol and Drug Research, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Charlotte Uggerhøj Andersen
- Aarhus University, Department of Forensic Medicine, Palle Juul-Jensens Boulevard 99, Building Z, 3.017, 8200 Aarhus N, Denmark.
| | | | | | - Christian Lindholst
- Aarhus University, Department of Forensic Medicine, Palle Juul-Jensens Boulevard 99, Building Z, 3.017, 8200 Aarhus N, Denmark.
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Andersen CU, Strandhave C, Thaarup M, Poulsen MB, Andersen S, Olesen AE. Elderly patients with hip fracture and subnormal renal function have inadequate response to vitamin D supplementation. PharmaNutrition 2021. [DOI: 10.1016/j.phanu.2021.100274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hjelholt AJ, Andersen CU, Steffensen C. [Tardive akathisia after long-term metoclopramide treatment]. Ugeskr Laeger 2021; 183:V10200794. [PMID: 34060465] [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: 06/12/2023]
Abstract
This case report describes a 57-year-old male with symptoms of tardive akathisia after long-term metoclopramide treatment. As metoclopramide is a dopamine receptor antagonist, it has the potential to cause drug-induced movement disorders, including akathisia, which is characterised by an inner restlessness resulting in a need for constant movement. Tardive akathisia, in contrast to acute akathisia, evolves after prolonged exposure to the triggering medication and can be a permanent condition. Treatment duration of metoclopramide should be restricted, and awareness of neurological side effects is important.
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Simonsen KW, Christoffersen DJ, Linnet K, Andersen CU. Fatal poisoning among drug users in Denmark in 2017. Dan Med J 2020; 68:A07200560. [PMID: 33463508] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Knowledge of trends of illegal drug use is vital for planning initiatives to reduce accidents and deaths among drug users. The aim of this study was to describe the cause of death, abuse pattern and geographic differences in fatal poisonings among drug users in Denmark in 2017. METHODS All fatal poisonings among drug users examined at the three institutes of forensic medicine in Denmark in 2017 were included in the study. RESULTS Overall, fatal poisonings declined from a maximum of 226 in 2007 to 162 in 2017. Methadone (52%) was the most common cause of death, followed by heroin/morphine (25%). A marked increase in deaths was due to stimulants (13%), especially cocaine. The abuse pattern has changed since 2012. Methadone remained the most frequently detected drug, but clonazepam and cocaine surpassed heroin/morphine, diazepam and tetrahydrocannabinol as the second-most frequently detected drugs. Ketobemidone had disappeared, whereas buprenorphine, oxycodone, fentanyl, pregabalin and gabapentin had increased. Antidepressants/antipsychotics were detected in half (47%) of the cases. Cocaine was more frequent in the areas covered by Copenhagen and Aarhus, whereas heroin/morphine was most frequently detected in the area covered by Odense. Amphetamine was more frequent in the Aarhus area. CONCLUSIONS Methadone and heroin/morphine still account for most fatal poisonings. However, deaths due to stimulants, especially cocaine, have increased. The abuse pattern has changed and geographical differences have emerged. FUNDING none. TRIAL REGISTRATION not relevant.
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Andersen FD, Simonsen U, Andersen CU. Quetiapine and other antipsychotics combined with opioids in legal autopsy cases: A random finding or cause of fatal outcome? Basic Clin Pharmacol Toxicol 2020; 128:66-79. [PMID: 33245632 DOI: 10.1111/bcpt.13480] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/25/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 01/16/2023]
Abstract
Opioid poisoning is a frequent cause of death in drug addicts and occurs with opioid treatment. Quetiapine is often found in forensic autopsies and may increase the risk of fatal opioid poisoning by enhancing sedation, respiratory depression, hypotension and QT prolongation. We systematically searched for studies of acute toxicity of quetiapine or other antipsychotics combined with morphine or methadone. Case reports describing toxicity of quetiapine combined with morphine or methadone were also included. We retrieved one human study that observed pharmacokinetic interaction between quetiapine and methadone, and 16 other human studies. Fourteen investigated the combination of droperidol and morphine in treatment doses, and some indicated an additive sedative effect. Five animal studies with acepromazine in combination with morphine or methadone were located and indicated an additive effect on sedation and hypotension. Six forensic case reports in which death could have been caused solely by quetiapine, the opioid, or other drugs were found. Thus, acute toxicity of quetiapine combined with morphine or methadone has not been studied. Because of quetiapine's effects on alpha-adrenoceptors, muscarinic and histamine receptors, human ether-a-go-go-channels and methadone kinetics, we suggest further research to clarify if the indicated additive effects of opioids and droperidol or acepromazine are also true for quetiapine.
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Affiliation(s)
| | - Ulf Simonsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Uggerhøj Andersen
- Department of Forensic Medicine, Aarhus University, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
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Pedersen SA, Klesse T, Findal Andreasen M, Dalhoff KP, Andersen CU. Active chlordiazepoxide metabolites in a patient needing life support after treatment of alcohol abstinence. Basic Clin Pharmacol Toxicol 2020; 127:438-441. [DOI: 10.1111/bcpt.13449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/05/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sidsel Arnspang Pedersen
- Department of Public Health, Clinical Pharmacology and Pharmacy University of Southern Denmark Odense C Denmark
| | - Tilo Klesse
- Department of Anesthesiology Hospital of Southern Jutland Sønderborg Denmark
| | | | - Kim Peder Dalhoff
- Danish Poison Information Center & Department of Clinical Pharmacology Bispebjerg and Frederiksberg University Hospital Kobenhavn NV Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Charlotte Uggerhøj Andersen
- Department of Forensic Medicine Aarhus University Aarhus Denmark
- Department of Clinical Pharmacology Aarhus University Hospital Aarhus Denmark
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Kronborg-White S, Andersen CU, Kohberg C, Hilberg O, Bendstrup E. Palliation of chronic breathlessness with morphine in patients with fibrotic interstitial lung disease - a randomised placebo-controlled trial. Respir Res 2020; 21:195. [PMID: 32703194 PMCID: PMC7376842 DOI: 10.1186/s12931-020-01452-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/13/2020] [Indexed: 01/01/2023] Open
Abstract
Background Patients suffering from fibrotic interstitial lung diseases (fILD) have a poor prognosis and a high symptom burden. Palliative treatment includes relief of symptoms such as breathlessness. There is no evidence-based treatment for chronic breathlessness but opioids are often used despite concerns due to the hypothetical risk of respiratory depression. This study investigated the effect of oral morphine drops in patients with fILD on chronic breathlessness and safety. Methods In a double-blinded placebo-controlled study, 36 patients with fILD were randomised to either four daily doses of 5 mg of oral morphine drops or placebo for 1 week. Endpoints and safety parameters were obtained at baseline, at follow-up after 1 h and 1 week. Results The primary endpoint, the visual analogue score (VAS) of dyspnea was reduced by 1.1 ± 0.33 cm in the morphine group at follow-up compared to baseline (P < 0.01), whereas the reduction was 0.35 ± 0.47 cm in the placebo group. However, the difference between the two groups was not statistically significant (p = 0.2). Oral morphine drops did not affect respiratory frequency, pulse rate, blood pressure, peripheral saturation or the 6-min walk test. More patients treated with morphine reported constipation, nausea and confusion. Conclusion Oral administration of morphine drops, 20 mg a day, in patients with fILD did not significantly reduce dyspnea VAS score during 1 week compared to placebo. Oral morphine did not induce respiratory depression, but was related to an increased risk of constipation, nausea and confusion. Trial registration The trial is registered in clinicaltrials.gov (Identifier: NCT02622022). Registered 4 December 2015.
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Affiliation(s)
- Sissel Kronborg-White
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200, Aarhus N, Denmark. .,Department of Internal Medicine, Viborg Regional Hospital, 8800, Viborg, Denmark.
| | | | - Charlotte Kohberg
- Department of Oncology, Odense University Hospital, Odense, 5000, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital, 7100, Vejle, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200, Aarhus N, Denmark
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Kumarathas I, Harsløf T, Andersen CU, Langdahl B, Hilberg O, Bjermer L, Løkke A. The risk of osteoporosis in patients with asthma. Eur Clin Respir J 2020; 7:1763612. [PMID: 32595917 PMCID: PMC7301699 DOI: 10.1080/20018525.2020.1763612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/24/2020] [Indexed: 12/16/2022] Open
Abstract
It is well-known that use of continuous systemic corticosteroids (SG) affects bone metabolism, bone mineral density (BMD), and ultimately increases the risk of osteoporosis. In patients with asthma, on the other hand, the effects of long-term high-dose inhaled corticosteroids (ICS) on BMD and risk of osteoporotic fractures is controversial. The reasons for this inconsistency could be explained by the fact that only few long-term studies investigating the effect of ICS in patients with asthma exist. The studies are characterized by different study designs and duration of ICS exposure, small study populations, and differences between the used ICS. The aim of this article is to unravel which factors, if any, that contribute to an increased risk of osteoporosis in patients with asthma and to summarize the evidence regarding adverse effects of ICS on bone metabolism, BMD and osteoporotic fractures in patients with asthma.
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Affiliation(s)
| | - Torben Harsløf
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Uggerhøj Andersen
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.,Institute for Biomedicine, Aarhus University, Aarhus, Denmark
| | - Bente Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Hilberg
- Department of Medicine, Vejle Hospital, Vejle, Denmark
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skaane University Hospital, Lund, Sweden
| | - Anders Løkke
- Department of Medicine, Vejle Hospital, Vejle, Denmark
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15
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Andersen CU, Lassen PO, Usman HQ, Albertsen N, Nielsen LP, Andersen S. Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study. BMC Geriatr 2020; 20:121. [PMID: 32228478 PMCID: PMC7106700 DOI: 10.1186/s12877-020-01532-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/23/2020] [Indexed: 12/28/2022] Open
Abstract
Background Hip fractures constitute a major health problem in elderly people and are often fall-related. Several factors can contribute to a fall episode leading to hip fracture, including fall-risk-increasing drugs (FRIDs), which are often used by elderly people. We aimed to investigate the prevalence of medication-related falls and to assess the role of FRIDs and potentially inappropriate medications (PIMs) in a population of elderly patients hospitalized for a hip fracture. Methods We reviewed the patient records of 200 consecutive patients, aged ≥65 years, who were admitted for a hip fracture and evaluated whether medications were likely to have contributed to the fall episode. PIMs were identified using the Screening Tool of Older Persons’ Prescriptions version 2 (STOPP) and by evaluating indications, contra-indications and interactions of the prescribed medications for each patient. Results FRIDs were used by 175 patients (87.5%). Medications were considered a likely contributor to the fall in 82 patients (41%). These were most often psychotropic medications alone or in combination with antihypertensives and/or diuretics. The 82 patients with suspected medication-related falls used more medications, FRIDs and PIMs than the rest of the patients, and in 74 (90%) of the 82 patients, at least one medication considered to be a contributor to the fall was also a PIM. Conclusions The prevalence of suspected medication-related falls was 41%. It seems likely that a medication review could have reduced, though not eliminated, the risk of falling in this group of patients.
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Affiliation(s)
- Charlotte Uggerhøj Andersen
- Department of Clinical Pharmacology, Aalborg University Hospital, Mølleparkvej 8, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. .,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.
| | | | - Hussain Qassim Usman
- Department of Geriatric and Internal Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Nadja Albertsen
- Department of Geriatric and Internal Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Peter Nielsen
- Department of Clinical Pharmacology, Aalborg University Hospital, Mølleparkvej 8, 9000, Aalborg, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Andersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Geriatric and Internal Medicine, Aalborg University Hospital, Aalborg, Denmark
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16
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Nørgaard TL, Andersen CU, Hilt C, Andersen CU. Macular oedema and changes in macular thickness in multiple sclerosis patients treated with fingolimod. Basic Clin Pharmacol Toxicol 2020; 126:492-497. [PMID: 31880065 DOI: 10.1111/bcpt.13381] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/07/2019] [Accepted: 12/19/2019] [Indexed: 11/30/2022]
Abstract
Macular oedema is a known side effect to fingolimod, but changes in specific areas of the retina are only sparsely described. Our aim was to investigate the prevalence of macular oedema and characterize macular changes after initiation of fingolimod based on routine ophthalmological examinations in all consecutive patients treated at our hospital. We evaluated macular thickness change from baseline to 3-4 months after initiation of treatment. Central retinal thickness, total macular volume, total macular thickness, average thickness and inner-/outer macular thickness were automatically measured using optical coherence tomography (OCT). A total of 190 eyes completed the study, and none of those developed visible macular oedema. All macular areas showed a small, but statistically significant increase in thickness. Total macular volume increased by a mean of 0.05 mm3 (P = <.001). Mean best-corrected visual acuity only changed by .03 (P = .074). We observed a minimal change in macular thickness and no clinically relevant affection on visual acuity after 3-4 months of fingolimod treatment. Thus, our results do not underpin the need for routine screening for macular oedema in asymptomatic MS patients without diabetes or uveitis receiving 0.5 mg fingolimod daily.
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Affiliation(s)
| | - Carl Uggerhøj Andersen
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark.,Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
| | - Claudia Hilt
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Charlotte Uggerhøj Andersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
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17
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Johansen NJ, Harsløf T, Hermann AP, Andersen CU, Hilberg O, Løkke A. [Examination for osteoporosis in patients with chronic obstructive pulmonary disease]. Ugeskr Laeger 2018; 180:V12170934. [PMID: 30274583] [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: 06/08/2023]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are at risk of developing osteoporosis, as the COPD in itself as well as continued smoking and treatment with systemic corticosteroid all increase the risk of developing osteoporosis. Other risk factors for osteoporosis are low vitamin D levels, malnutrition and physical inactivity. All patients who have risk factors in the form of severe COPD, and all patients with COPD in active treatment with systemic corticosteroid and/or other risk factors should be examined with a DEXA-scan. Treatment of osteoporosis in patients with COPD does not differ from general recommendations.
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18
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Kohberg C, Andersen CU, Bendstrup E. Opioids: an unexplored option for treatment of dyspnea in IPF. Eur Clin Respir J 2016; 3:30629. [PMID: 26969472 PMCID: PMC4788766 DOI: 10.3402/ecrj.v3.30629] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/19/2016] [Accepted: 01/25/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is the most common among the idiopathic interstitial pneumonias and has the worst prognosis, with a median survival of 3-5 years. The most common symptom in IPF is dyspnea, impacting on the patient's quality of life and life expectancy. Morphine in the treatment of dyspnea has been investigated but with conflicting results. This review aims to clarify the role of opioids in the treatment of dyspnea in patients with IPF. METHODS A literature search was performed using the MeSH and PubMed databases. As only very few studies included patients with IPF, studies conducted primarily with patients with chronic obstructive pulmonary disease were also included. In total, 14 articles were found. RESULTS Seven studies reported use of systemic morphine and seven studies of inhaled morphine. Five of the seven studies investigating systemic administration detected an improvement in either dyspnea or exercise capacity, whereas no beneficial effect on dyspnea was detected in any study using inhaled morphine. No severe adverse effects such as respiratory depression were reported in any study, although constipation was reported as a notable adverse effect. CONCLUSIONS Results were inconsistent, but in some studies systemic morphine administration showed a significant improvement in the dyspnea score on a visual analog scale without observation of severe side effects. Nebulized morphine had no effect on dyspnea.
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Affiliation(s)
- Charlotte Kohberg
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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19
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Uggerhøj Andersen C, Sønderskov LD, Nielsen-Kudsk JE, Simonsen U, Bendstrup E, Hilberg O, Mellemkjær S. [Pulmonary hypertension--classification, work-up and treatment]. Ugeskr Laeger 2013; 175:1642-1645. [PMID: 23731992] [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: 06/02/2023]
Abstract
Pulmonary hypertension (PH) is classified into five groups. It is an important cause of dyspnoea. Echocardiography is the best non-invasive method for detecting PH and should be part of the evaluation of patients with dyspnoea. If signs of PH are detected on echocardiography, a number of other examinations should be undertaken to verify the diagnosis and classify PH correctly, as the treatment depends on the subtype of PH. The prognosis of PH is poor, but early detection and treatment can improve the course for some of the patients. Surgery can often cure chronic thromboembolic pulmonary hypertension.
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20
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Nissen KR, Fuchs J, Goldschmidt E, Andersen CU, Bjerrum K, Corydon L, Degn T, Eisgart F, Henning V, Jensen JE, Krogh E, Lowes M, Mortensen K, Nielsen CH, Olsen T, Storr-Paulsen A, Sørensen TB, Winther-Nielsen A. Retinal detachment after cataract extraction in myopic eyes. J Cataract Refract Surg 1998; 24:772-6. [PMID: 9642586 DOI: 10.1016/s0886-3350(98)80129-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the incidence of retinal detachment (RD) after cataract extraction in people 40 years of age or older with axial myopia (i.e., axial length > or = 25.5 mm). SETTING Fifteen Danish eye clinics. METHODS Two hundred forty-five eyes had cataract extraction performed at 15 eye clinics; 237 eyes had extracapsular cataract extraction (ECCE) and 8 eyes, intracapsular cataract extraction (ICCE). Postoperative data were reported by the practicing ophthalmologists. Mean follow-up was 27 months (range 14 to 32 months). RESULTS Five RDs occurred in the 245 eyes (2.0%). Excluding the ICCE cases and the two cases of combined cornea transplantation and ECCE, RD occurred in 4 of the 235 eyes that had ECCE (1.7%). The incidence after ECCE with posterior chamber lens implantation was 1.4%. Complete postoperative status was reported on 158 eyes. Forty-eight eyes (30.4%) had a neodymium:YAG capsulotomy and 3 (6.0%) developed an RD 1, 3.5, and 21 months after the capsulotomy. CONCLUSION The RD incidence after ECCE with posterior chamber lens implantation was low but higher than that in unselected populations. The incidence increased after laser capsulotomy.
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Nissen KR, Fuchs HJ, Goldschmidt E, Andersen CU, Bjerrum KB, Corydon L, Degn T, Eisgart F, Henning VA, Jensen JE. [Risk of cataract surgery in patients with myopia. A prospective Danish multicenter study with special reference to a complication]. Ugeskr Laeger 1994; 156:6014-8. [PMID: 7992440] [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
A prospective Danish multicentre study was conducted to evaluate the incidence of retinal detachment after cataract extraction in myopic eyes (axial length, > or = 25.5 mm). Two hundred and forty-seven cataract extractions in myopic eyes were reported during a period of 13 months. Two hundred and forty-one eyes underwent extracapsular and six eyes intracapsular cataract extraction. The mean follow-up time for 158 eyes was seven months (ranging from 1-30 months). In five cases a retinal detachment was observed, one case was probably present preoperatively, this person had undergone intracapsular cataract extraction. The incidence of retinal detachment was thus 1.62-2.02% in the total material and 1.66% in eyes operated with extracapsular cataract extraction.
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Schønheyder HC, Andreasen H, Andersen CU. Late-onset endophthalmitis after cataract surgery caused by Propionibacterium acnes. J Hosp Infect 1994; 27:319-20. [PMID: 7963475 DOI: 10.1016/0195-6701(94)90120-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
In order to evaluate the changes in medium composition during closed system corneal organ culture at 30 degrees C, pH, pO2, glucose and lactate was measured 1 to 7, 14 and 28 days after incubation of a total of 49 human corneas. During organ culture pO2 decreased from 17.3 kPa to 8.8 kPa at day 28. The average oxygen consumption was initially 0.16 mumole/h/cm2, but decreased rapidly to an average of 0.04 mumole/h/cm2 during the first weeks of incubation. The glucose concentration fell from 5.1 mM to 0.25 mM after 28 days, and the lactate concentration rose from 2.5 mM to 11 mM. The concentration changes were for both substances highest during the first 14 days of organ culture. The pH fell from 7.36 to 6.64 after 28 days. These findings indicate that the cultured human cornea predominantly metabolizes glucose anaerobically, and that the metabolic activity decreases during incubation. The limiting metabolic factors for prolonging the culture period seem to be development of severe acidosis and glucose depletion in the medium.
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Affiliation(s)
- J O Hjortdal
- Department of Ophthalmology, Arhus University Hospital, Denmark
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24
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Abstract
The predictability of a theoretical, computer-assisted IOL calculation method and of the Sanders-Retzlaff-Kraff (SRK) method was evaluated from pre- and postoperative biometry in 110 cataractous patients subjected to a routine IOL calculation. With the theoretical method and the preoperative data the refraction was on the average 0.72 D (SD 0.78) more myopic than expected, an error which could be corrected for by (1) substituting the assumed postoperative chamber depth by the actual mean value and (2) adding 0.16 mm to the preoperative axial length. With the postoperative data the error was 0.05 D (SD 0.78) (p greater than 0.05). By the SRK method the refraction was 0.15 D (SD 0.71) and 0.37 D (SD 0.69) more hyperopic than expected with the pre- and the postoperative data respectively. These offset errors could be corrected for in either case by adjusting the assumed A constant in the SRK formula. With appropriate empirical corrections for offset errors the theoretical and the SRK method were similar in accuracy, that is, about 82% of the predictions within +/- 1 D, 99% within +/- 2 D, and 100% within +/- 3 D error. The variation in postoperative refraction after computerised IOL calculation was about one-third of the variation previously seen after implantation of standard power IOL.
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Affiliation(s)
- T Olsen
- Department of Ophthalmology, University of Aarhus, Aarhus Kommunehospital, Denmark
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25
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Andersson PG, Hinge HH, Johansen O, Andersen CU, Lademann A, Gøtzsche PC. Double-blind study of naproxen vs placebo in the treatment of acute migraine attacks. Cephalalgia 1989; 9:29-32. [PMID: 2650879 DOI: 10.1046/j.1468-2982.1989.0901029.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Naproxen was compared with placebo in a double-blind, crossover trial in classic and common migraine. The trial was terminated at a fixed date; 37 patients had entered, 5 of whom were excluded. Naproxen was given as 750 mg at the first symptom of the attack, a total of 1250 mg per 24 h was allowed. Patients were followed for six attacks or three months in each phase, whichever came first. The severity of the headache was significantly less with naproxen in the first 2 h of the attack (p = 0.047), whereas there was no difference when the whole attack was considered. Significantly more patients preferred naproxen (p = 0.042). Side effects occurred in five patients, causing withdrawal of one patient while on naproxen.
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Affiliation(s)
- P G Andersson
- Department of Neuromedicine, Hjørring Sygehus, Denmark
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Abstract
A prospective study of amaurosis fugax was carried out in a Danish community (population 481,000); case ascertainment was based on the collaboration of practicing ophthalmologists and general practitioners. Over a 3-year period we registered 131 cases; the annual incidence of "first amaurosis fugax episodes coming to medical attention" was 8.6 and 6.2 per 100,000 population for men and women, respectively. On the basis of a comparison of the age-incidence curves for cerebral and retinal ischemic attacks, the "true" incidence of amaurosis fugax is estimated to be approximately 14/100,000/yr, or 25-30% of the reported incidence of transient ischemic attacks. Clinical and/or radiologic signs of a carotid lesion on the appropriate side were present in 56% of the patients, and an additional 27% had symptoms or signs of other organic cardiovascular disorders. Forty-three (68%) of the 63 patients who underwent arteriography had an atheromatous lesion apparently amenable to carotid endarterectomy. In spite of the case-finding procedures employed in the study, cases of amaurosis fugax suitable for carotid surgery were thus ascertained at a rate of only 3/100,000/yr. This suggests that surgical treatment of patients with retinal ischemic attacks is of minor importance as a preventive measure against stroke in the community.
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Affiliation(s)
- C U Andersen
- Department of Neurology, Aalborg Hospital, Denmark
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Andersen CU, Marquardsen J, Nehen JH. [Amaurosis fugax and carotid artery stenosis. A diagnostic imperative?]. Ugeskr Laeger 1983; 145:408-12. [PMID: 6845503] [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: 01/22/2023]
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