Jens Møller-Petersen

Assessment of the Diagnoses of Crohn's Disease and Ulcerative Colitis in a Danish Hospital Information System

BACKGROUND Our aim was to estimate the completeness-that is, whether all patients were included in the system-and the validity-that is, whether the diagnostic criteria were fulfilled for the patients registered-of the diagnoses of Crohns disease and ulcerative colitis in a Danish hospital system. METHODS Information in a regional hospital system, in the County of North Jutland, Denmark, was compared with hospital records and information in a pathology system. RESULTS The analysis of the completeness included 143 patients with Crohns disease and 285 patients with ulcerative colitis. The completeness of the regional hospital system using the pathology system as a reference standard was 94% for both diseases. The analysis of the validity included 281 patients registered as having Crohns disease and 506 patients registered as having ulcerative colitis. The validity of the two diagnoses was 97% and 90%, respectively. CONCLUSIONS The regional hospital system showed few misclassifications of the diagnoses of Crohns disease and ulcerative colitis. Thus the nationwide hospital system (based on the regional hospital systems) may provide a unique study base for future research.

Renal haemodynamics and extracellular homeostasis during the menstrual cycle

Renal haemodynamics and extracellular homeostasis during the menstrual cycle were studied in 14 healthy women (age 21-41 years) who were not taking oral contraceptives in the follicular (Period I) and luteal phase (Period II). The glomerular filtration rate [( 51Cr] EDTA clearance) and the effective renal plasma flow ([125I] hippuran clearance) increased from Period I to II by a median of 6.3% (95% confidence interval (CI): 0.6-9.2%) and 7.3% (95% CI: -0.4-22%) respectively. Serum sodium decreased from period I to II (p less than 0.01) by a median of 1 mmol/l (95% CI: -2.0 to -0.5 mmol/l) and the urinary excretion rate of potassium increased (p less than 0.02) from a median value of 35 mumol/min in Period I to 45 mumol/min in Period II. The extracellular fluid volume did not change between the two periods but the concentration of water in serum increased (p less than 0.05) from a median value of 91.7-92.0 g/100 g in Period II. Serum total protein and serum albumin both showed a borderline statistically significant decrease from Period I to II. The investigation demonstrated a number of physiological and biochemical changes from the follicular to the luteal phase, most of which in a lower scale mimic well known changes that occur during pregnancy.

Evaluation and comparison of cathodic trypsin-like immunoreactivity, pancreatic lipase and pancreatic isoamylase in the diagnosis of acute pancreatitis in 849 consecutive patients with acute abdominal pain

In 849 patients (417 men, 432 women) consecutively hospitalized with acute abdominal pain we compared the value of serum cathodic trypsin-like immunoreactivity, pancreatic lipase (EC 3.2.1.3) and pancreatic isoamylase (EC 3.2.1.1) as diagnostic tests for acute pancreatitis. The diagnoses of acute pancreatitis (in 49 patients, 5.8%) and other diseases were made without knowledge of these enzyme values. When evaluated by means of receiver operating characteristic curves no differences were found in diagnostic performance of the three enzymes. Use of combinations of different enzymes had no advantage over single enzyme determination using discrimination analysis for evaluation. The highest efficiency was for all three enzymes 0.991 (95% confidence limits: 0.983-0.995) and for all three enzymes the discrimination value giving this efficiency was several times the upper limit of reference range: 1 779 micrograms/l for cathodic trypsin-like immunoreactivity, 831 U/l for pancreatic isoamylase and 316 micrograms/l for pancreatic lipase. None of the enzymes had any prognostic value at admission in predicting a mild or severe attack of acute pancreatitis. In conclusion, no single enzyme or combination of enzymes had any diagnostic advantage for acute pancreatitis in patients with acute abdominal pain. Thus selection of one of the three enzymes as diagnostic test of acute pancreatitis is to be based on considerations such as economy, methodological simplicity, possibility of automated assay and the time-consumption at the assay.

Lowered serum ionized calcium in insulin treated diabetic subjects

The concentration of ionized calcium at pH 7.40, [Ca2+]7.4, in serum from 43 insulin dependent diabetic patients was lowered in comparison with 47 healthy controls (p less than 0.001), and the difference was biggest in children under sixteen. Serum total calcium, phosphate, and parathyroid hormone were normal, and it is inexplicable why the parathyroid glands did not react by raising serum total calcium. The lowered serum ionized calcium may contribute to the development of diabetic bone loss.

Research in the Danish health service system: completeness and validity of prescription data, illustrated by analysis of utilization of oral anticoagulants

We studied the utilization of oral anticoagulants and the degree of completeness and validity of some key research variables from the Danish health service in the county of North Jutland (482 000 inhabitants), studying the records of 12 855 prescriptions of oral anticoagulants during 1991 and 1992. The utilization of oral anticoagulants showed an increase of 16% from 1991 to 1992, when 0.3% of all women and 0.4% of all men were treated during one year. The increase was less than expected based on newly introduced indications for treatment of atrial fibrillation. The following variables were studied: the name (ATC commodity number) and amount of the prescribed drug, the defined daily dose, the personal registration number of the patient, type of prescription (e.g. in writing or by telephone), number of repeat prescriptions, date of prescription issued by the doctor, the registration number of the GP or hospital department (if the prescription is made by a hospital doctor) and date of expedition from the pharmacy. The number of wrong and missing data was less than 1%. The study suggests that Danish prescription information is of such quality that it can be used for pharmacoepidemiological studies.

Cathodic trypsin-like immunoreactivity in serum: influence of sex, age, renal function, food and diurnal variation

Radioimmunologically determined cathodic trypsin-like immunoreactivity (TLI) in serum was positively correlated with age (Spearmans rho = 0.40, p less than 0.001) and negatively correlated with estimated creatinine clearance (Spearmans rho = -0.31, p less than 0.01) in healthy adults (37 women, 27 men) under standard conditions. Women had higher TLI concentrations than men (median value 358 micrograms trypsin standard/l compared with 283 micrograms trypsin standard/l, p less than 0.02). A clinically significant uptake of cathodic trypsin from the intestine to the blood is not likely because no change was found in serum concentrations of TLI and the two major protease inhibitors (alpha 1-antitrypsin and alpha 2-macroglobulin) one hour after a standard meal. No diurnal variation of TLI in serum was found in a group of 12 healthy subjects. The results indicate that due consideration must be given to sex, age and renal function of the persons used in reference groups for TLI determination.

Campylobacter pylori in esophagus

5. Roediger WEW: The colonic epithelium in ulcerative colitis: An energy-deficiency disease. Lancet 2:712-715, 1980 6. Dirksen G: Acidosis. In Physiology of Digestion and Metabolism in the Ruminant. AT Phillipson (ed). Newcastleupon-Tyne, England, Oriel Press, 1970, pp 612-625 7. Essig HW, Huntington GB, Emerick RJ, Carlson JR: Nutritional problems related to the gastro-intestinal tract. In The Ruminant Animal--Digestive Physiology and Nutrition. DC Church (ed). Englewood Cliffs, New Jersey, Prentice Hall, 1988, pp 474-480

Monoclonal Gammopathy in General Practice Associated Clinical Conditions

The clinical diagnoses in all 88 cases of monoclonal gammopathy, detected by general practitioners in Northern Jutland during a 3-year period, were investigated: 15% had malignant monoclonal gammopathy, 5% had non-haematologic cancers, and in 80% a benign disorder was found. These results indicate that the finding of a monoclonal gammopathy in general practice deserves attention, but it is rarely accompanied by a grave prognosis. Malignant monoclonal gammopathy should be suspected, but search for another type of cancer is not indicated.

The use and mechanism of urinary clearance of cathodic trypsin-like immunoreactivity to creatinine clearance ratio in the diagnosis of pancreatic cancer

The ratio between urinary clearance of cathodic trypsin-like immunoreactivity and creatinine clearance (CTr/CCr ratio) was evaluated as a test for pancreatic cancer in patients with chronic pancreatic diseases and gastrointestinal diseases clinically mistakable for pancreatic cancer. The efficiency of the CTr/CCr ratio in the diagnosis of pancreatic cancer was no better than the urinary clearances of albumin and beta2-microglobulin to creatinine clearance (CA1b/CCr ratio and C beta 2m/CCr ratio). An overall positive association was found between the three ratios. Furthermore, there was a positive relationship between proteinuria and elevation of any of the ratios--as well as between proteinuria and the degree of cancer dissemination. The latter was positively associated with elevation of any of the three ratios. The results point to a changed renal handling of proteins due to cancer disease per se as the mechanism causing elevated CTr/CCr ratios in pancreatic cancer.

One-year follow-up after the first prescription of strong analgesics outside hospital

To evaluate the risk of addiction after prescription of a strong analgesic, we followed 90 patients during the year after they had received a prescription for a strong analgesic for the first time in September 1989 in North Jutland County, Denmark. The study was based on copies of all prescriptions of strong analgesics; these are sent to the National Health Service, which is responsible for the control of the prescribing of strong analgesics. Seven patients were excluded because the data registration was incomplete, while there was valid data on the remaining 83 patients, 12 of whom had cancer. All the cancer patients and 14 other patients died during the follow-up period. Of the remaining 57 patients, seven were still being treated (12.3%; 95 confidence limits: 5.1-23.7%) with strong analgesics. Addiction was not suspected by their general practitioners in any of these seven as the main reason for continued treatment with strong analgesics. We therefore conclude that addiction is rare after a first prescription of strong analgesics.