Abstract:
BACKGROUND:Splenectomy is accompanied by a life-long risk of overwhelming postsplenectomy infection (OPSI), mainly caused by polysaccharide (PS) encapsulated bacteria such as Streptococcus pneumoniae. Despite extensive prophylactic efforts the mortality and morbidity rates remain high. The present study was based on a strategy with a predefined vaccination algorithm including repeated 23-valent pneumococcal vaccinations and monitoring of pneumococcal antibody levels. The antibody levels of splenectomized Hodgkin's lymphoma (HL) patients were compared with those patients splenectomized due to immune-mediated cytopenias [autoimmune haemolytic anaemia (AIHA) and immune thrombocytopenic purpura (ITP)] and also individuals who were splenectomized because of trauma (TRAUMA). METHODS:A total of 311 splenectomized individuals were included in this prospective study (208 HL; 15 AIHA; 60 ITP; 28 TRAUMA). Depending on their individual anti-PS antibody levels measured by enzyme-linked immunosorbent assay technique the patients were revaccinated with 23-valent pneumococcal PS vaccine up to four times in accordance with the predefined algorithm. For each vaccination occasion, serum was collected at vaccination, after 1 month +/- 2 weeks (peak), and after 1 year +/- 6 months (follow-up). Patient files, a national population-based database, and microbiological databases were checked for 124 HL patients to identify OPSI. RESULTS:A significant response was recorded on primary vaccination as well as on two revaccination occasions for HL, AIHA/ITP, as well as TRAUMA patients. None of the variables age, gender, or time elapsed between splenectomy and first pneumococcal vaccination was found to be associated with mean PS antibody levels at prevaccination, peak or follow-up. No severe adverse events were reported. Amongst 124 clinically monitored HL patients, 10 OPSI were recorded in seven patients during the study period. One of these patients, a middle-aged female, died as a result of fulminant pneumococcal bacteraemia, which was her third OPSI during a 7-year period. CONCLUSIONS:A significant response to pneumococcal PS vaccination was found in all three groups (HL, AIHA/ITP and TRAUMA) of splenectomized patients. Importantly, both primary and repeated vaccinations were safe. Until further knowledge is gained regarding the protective concentration of serotype-specific antibody concentrations we believe that the value of vaccination and frequent revaccination (every 1-5 years) in combination with education of patients and health care professionals and clinical monitoring is beneficial for these patients at risk for OPSI.
journal_name
J Intern Medjournal_title
Journal of internal medicineauthors
Landgren O,Björkholm M,Konradsen HB,Söderqvist M,Nilsson B,Gustavsson A,Axdorph U,Kalin M,Grimfors Gdoi
10.1111/j.1365-2796.2004.01312.xsubject
Has Abstractpub_date
2004-06-01 00:00:00pages
664-73issue
6eissn
0954-6820issn
1365-2796pii
JIM1312journal_volume
255pub_type
杂志文章abstract::Hypertriglyceridaemia, as defined by fasting triglyceride levels of greater than 2.8 mmol l-1, is a prevalent dyslipoproteinaemia in our population. The underlying pathophysiological mechanisms that result in elevations of plasma triglycerides are heterogeneous and, in most cases, incompletely understood. However, in ...
journal_title:Journal of internal medicine
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2796.1992.tb01256.x
更新日期:1992-06-01 00:00:00
abstract::Monitoring survival of cancer patients using data collected by population-based cancer registries is an important component of cancer control. In this setting, patient survival is often summarized using net survival, that is survival from cancer if there were no other possible causes of death. Although net survival is...
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journal_title:Journal of internal medicine
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doi:10.1046/j.1365-2796.1997.100115000.x
更新日期:1997-03-01 00:00:00
abstract::Hip fractures in the elderly represent a global issue, associated with significant morbidity and mortality. Considering the magnitude of the problem, any substantial reduction in the hip fracture burden depends on prevention. In view of the complex pathogenesis of senile (type II) osteoporosis, preventive strategies s...
journal_title:Journal of internal medicine
pub_type: 杂志文章,评审
doi:10.1046/j.1365-2796.1996.427779000.x
更新日期:1996-05-01 00:00:00
abstract::Orthopaedic implants are highly susceptible to infection. The aims of treatment of infection associated with internal fixation devices are fracture consolidation and prevention of chronic osteomyelitis. Complete biofilm eradication is not the primary goal, as remaining adherent microorganisms can be removed with the d...
journal_title:Journal of internal medicine
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doi:10.1111/joim.12233
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abstract::The fruitless search for the cause of Crohn's disease has been conducted for more than a century. Various theories, including autoimmunity, mycobacterial infection and aberrant response to food and other ingested materials, have been abandoned for lack of robust proof. This review will provide the evidence, obtained f...
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abstract:BACKGROUND:Patients with venous thromboembolism (VTE) secondary to transient risk factors may develop VTE recurrences after discontinuing anticoagulation. Identifying at-risk patients could help to guide the duration of therapy. METHODS:We used the RIETE database to assess the prognostic value of d-dimer testing after...
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abstract::Cerebral toxoplasmosis is optimally treated with the combination of high doses of sulphadiazine and pyrimethamine. We described two patients with AIDS treated for cerebral toxoplasmosis who developed renal failure due to sulphadiazine-induced crystalluria. Symptoms and renal failure were rapidly reversed with urine al...
journal_title:Journal of internal medicine
pub_type: 杂志文章
doi:10.1111/j.1365-2796.1993.tb00685.x
更新日期:1993-04-01 00:00:00
abstract::Epilepsy affects 50 million persons worldwide, a third of whom continue to experience debilitating seizures despite optimum anti-epileptic drug (AED) treatment. Twelve-month remission from seizures is less likely in female patients, individuals aged 11-36 years and those with neurological insults and shorter time betw...
journal_title:Journal of internal medicine
pub_type: 杂志文章,评审
doi:10.1111/joim.12322
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVES:Mild hyperhomocysteinaemia (HHC), fasting or after methionine loading, is associated with an increased risk and severity of atherosclerotic vascular disease. Post-methionine and fasting HHC are responsive to treatment with vitamin B, and folic acid. We performed a prospective cohort study amongst normohomocy...
journal_title:Journal of internal medicine
pub_type: 杂志文章
doi:10.1046/j.1365-2796.1999.00541.x
更新日期:1999-07-01 00:00:00
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journal_title:Journal of internal medicine
pub_type: 杂志文章
doi:10.1046/j.1365-2796.1996.420765000.x
更新日期:1996-02-01 00:00:00
abstract:OBJECTIVES:To determine whether a first myocardial infarction leads to increased plasma homocysteine concentrations and whether the association between homocysteine and myocardial infarction was greater at follow-up compared with baseline. DESIGN:A population-based, prospective, nested case-referent study. SETTING:Sc...
journal_title:Journal of internal medicine
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doi:10.1111/j.1365-2796.2004.01415.x
更新日期:2004-12-01 00:00:00
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journal_title:Journal of internal medicine
pub_type: 杂志文章
doi:10.1046/j.1365-2796.1997.00161.x
更新日期:1997-08-01 00:00:00
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journal_title:Journal of internal medicine
pub_type: 杂志文章
doi:10.1111/j.1365-2796.2011.02465.x
更新日期:2012-05-01 00:00:00
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journal_title:Journal of internal medicine
pub_type: 杂志文章
doi:10.1046/j.1365-2796.1999.0443f.x
更新日期:1999-03-01 00:00:00
abstract:BACKGROUND:Bupropion sustained release (bupropion SR) has been shown to increase smoking cessation success rates in the US studies. OBJECTIVE:To determine whether bupropion SR, in combination with counselling, is effective for smoking cessation in a multi-country study. METHODS:This randomized, double-blind, placebo-...
journal_title:Journal of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1046/j.1365-2796.2003.01185.x
更新日期:2003-08-01 00:00:00
abstract::Studies have shown occasional evidence of increased physiological activity in patients with primary insomnia. We hypothesized that metabolic rate, as measured by overall oxygen use (VO2), might be a more general index of increased physiological activity. An initial experiment found elevated VO2 both at night and durin...
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abstract::To determine the effect of prednisolone on severe hypercalcaemia in women with metastatic breast cancer, 30 patients with serum ionized calcium above 1.60 mmol l-1 (reference range 1.15-1.35 mmol l-1) entered a randomized trial. Performance status before entry to the trial and survival time after hypercalcaemia were a...
journal_title:Journal of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1111/j.1365-2796.1992.tb00578.x
更新日期:1992-09-01 00:00:00
abstract::In Sweden, prophylactic treatment of boys with severe haemophilia has been practised since 1958 in an attempt to convert the disease from a severe to a milder form. The present study population consisted of 60 severe haemophiliacs (52 A, 8 B), aged 3-32 years. Treatment is started when the boys are 1-2 years of age, t...
journal_title:Journal of internal medicine
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doi:10.1111/j.1365-2796.1992.tb00546.x
更新日期:1992-07-01 00:00:00
abstract:OBJECTIVES:To describe types of diabetes treatment in a total, adult population, including those on no antidiabetic medication, and to evaluate use of the defined daily doses in estimation of diabetes prevalence. DESIGN:Cross-sectional epidemiologic survey applying patient-based questionnaires and clinical examination...
journal_title:Journal of internal medicine
pub_type: 杂志文章
doi:10.1111/j.1365-2796.1994.tb00793.x
更新日期:1994-09-01 00:00:00
abstract::Ten adult patients with a severe nephrotic syndrome resistant to conventional immunosuppression were treated with cyclosporin A (CyA) for a mean period of 11 months. CyA was effective in all but two patients, as evaluated by 24-h urine protein excretion and clinical appearance. In general the best effect of CyA was se...
journal_title:Journal of internal medicine
pub_type: 杂志文章
doi:10.1111/j.1365-2796.1990.tb00120.x
更新日期:1990-01-01 00:00:00
abstract::Conventional nonsteroidal anti-inflammatory drugs (NSAIDs), i.e. nonselective cyclooxygenase COX inhibitors have well-documented nephrotoxicity. Adverse renal effects occur because of inhibition of the synthesis of cyclooxygenase-derived prostaglandins which act to modulate pathologic processes that would normally imp...
journal_title:Journal of internal medicine
pub_type: 杂志文章,评审
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更新日期:2003-06-01 00:00:00
abstract:BACKGROUND:The X-linked Fabry disease (FD) is a multiorgan disorder due to alpha-galactosidase A (α-GAL) deficiency with consequent lysosomal accumulation of globotriaosylceramide (Gb3). We established the immunocytochemical detection of Gb3 in blood cells of FD patients as a new method for FD diagnostics, follow-up an...
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更新日期:2018-10-01 00:00:00
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journal_title:Journal of internal medicine
pub_type: 临床试验,杂志文章
doi:10.1111/j.1365-2796.1994.tb00841.x
更新日期:1994-11-01 00:00:00
abstract::A major challenge in the growing field of bioelectronic medicine is the development of tissue interface technologies promoting device integration with biological tissues. Materials based on organic bioelectronics show great promise due to a unique combination of electronic and ionic conductivity properties. In this re...
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更新日期:2017-07-01 00:00:00
abstract::Developing new pharmacotherapies for autism spectrum disorder (ASD) is a challenge. ASD has a complex genetic architecture, several neurobiological phenotypes and multiple symptom domains. However, new opportunities are emerging that could lead to the development of 'targeted' and individualized pharmacological interv...
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pub_type: 杂志文章,评审
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更新日期:2013-10-01 00:00:00
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pub_type: 杂志文章
doi:10.1046/j.1365-2796.2000.00600.x
更新日期:2000-02-01 00:00:00