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Biomedical subjects

A Nachemson

Publications and source records attributed to A Nachemson.

At least 19 recordsLinked to original sources
PubMed1992

Mobility, strength, and fitness after a graded activity program for patients with subacute low back pain. A randomized prospective clinical study with a behavioral therapy approach.

Patients with nonspecific mechanical low back pain (n = 103), examined by an orthopaedic surgeon and a social worker, were randomized to an activity group (n = 51) and a control group (n = 52). Patients with defined orthopaedic, medical, or psychiatric diagnoses were excluded before randomization. No patients were excluded due to place of birth or difficulties in speaking or understanding the Swedish language. The purpose of the study was to compare mobility, strength and fitness after traditional care and after traditional care plus a graded activity program with a behavioral therapy approach. A graded activity program, with a behavioral therapy approach was given under the guidance of a physical therapist. The endpoint of the graded activity program was return to work. This program significantly increased mobility, strength, and fitness more than could be explained by only a time recovery effect, especially in males. The patients in the activity group returned to work earlier than did the patients in the control group. Spinal rotation, abdominal muscle endurance time and lifting capacity were significantly correlated to rate of return to work. Traditional care plus a graded activity program were superior to only traditional care, evaluated in terms of mobility, strength and fitness. The graded activity program proved to be a successful method of restoring occupational function and facilitating return to work in subacute low back pain patients. The patients in the graded activity program learned that it is safe to move, while regaining function.

Back Pain↗
PubMed1992

Respiratory failure in scoliosis and other thoracic deformities. A survey of patients with home oxygen or ventilator therapy in Sweden.

Registers covering Swedish patients with home ventilator or long-term oxygen therapy were used to study respiratory failure caused by thoracic deformities. In all, 107 patients were studied. Postpolio scoliosis was found in 47 patients. The age of starting therapy varied between 28 and 80 years. Fourteen patients had thoracic deformities other than scoliosis. The mean scoliotic angle was 135 degrees among the patients with scoliosis, and the mean vital capacity was 26% (range, 13-54%) of predicted normal. The yearly demand for home ventilator or oxygen therapy is calculated to three per million inhabitants. No operated patients had respiratory failure, and no patients were found with idiopathic scoliosis and respiratory failure younger than 30 years of age, which may indicate a preventive effect of corrective surgery on the development of respiratory failure.

Aged↗
PubMed1992

Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms.

The mortality and causes of death in 115 patients (80 women), born 1902-1937, with untreated scoliosis were compared to the expected according to official Swedish statistics. Subgrouping for cause and onset of scoliosis was done. Fifty-five patients had died; 21 of respiratory failure and 17 of cardiovascular diseases. The mortality was significantly (P less than 0.001) increased. The increased risk was apparent at 40-50 years of age. The mortality was significantly increased in infantile (P less than 0.001) and juvenile (P less than 0.01) scoliosis but not in adolescent scoliosis. The mortality was also increased in post-polio scoliosis, scoliosis combined with rickets and scoliosis of unknown etiology indicating an increased mortality in idiopathic scoliosis. Among the surviving patients anti-hypertensive treatment was frequent (23 of 50).

Adolescent↗
PubMed1992

Survival of patients with severe thoracic spine deformities receiving domiciliary oxygen therapy.

Scoliosis can lead to respiratory failure and premature death. Alveolar hypoventilation is a dominant cause and artificial ventilation at home (AVH) is probably the treatment of choice. It has been suggested that long-term domiciliary oxygen therapy (LTO) is of little value because of the worsening of hypercapnia. We analyzed survival and predictors of death among 80 patients with scoliosis and other severe thoracic spine deformities receiving LTO for chronic hypoxia. The survival rate was higher in patients under the age of 65 (p = 0.01) and in patients without concomitant pulmonary or airways disease. Likewise, the survival rate was higher in patients with a PaCO2 of greater than 7.4 kPa than in patients with a lesser degree of hypoventilation and hypercapnia (p less than 0.05). The risk of developing life-threatening hypercapnia during well-controlled LTO appeared to be small. In younger patients without complicating disease, long-term survival was achieved with LTO, but with time, an increasing proportion of the patients changed to AVH, with or without LTO.

Aged↗
PubMed1991

Lung function in adult idiopathic scoliosis: a 20 year follow up.

Severe idiopathic scoliosis may lead to respiratory failure, which can be treated by assisted ventilation. Twenty four patients with surgically untreated idiopathic scoliosis who had been examined in 1968 were re-examined in 1988 to assess changes in lung function and risk factors for respiratory failure. The patients were aged 15-67 years in 1968 and had a scoliotic angle of 10-190 degrees and a vital capacity of 1.0-6.0 litres. Spirometric values and scoliotic angles were determined in 1968 and 1988, and arterial blood gas tensions in 1988. The decline in spirometric values over the 20 years was of the same magnitude as the predicted decline due to aging. Arterial blood gas tensions in 1988 were strongly correlated with the scoliotic angles and spirometric indices recorded in 1968. Hypoxaemia and hypercapnia was seen in four patients in 1988 (then aged 43-67 years) and these were the four patients who had a vital capacity below 43% predicted in 1968. The remaining 20 patients had blood gas values within normal limits. Two further patients had died from respiratory failure before 1988, so a total of six patients had developed respiratory failure. In a multiple logistic analysis vital capacity expressed as % predicted in 1968 was the strongest predictor of the development of respiratory failure, followed by the scoliotic angle. Respiratory failure occurred only in patients who had a vital capacity below 45% predicted in 1968 and an angle greater than 110 degrees. Thus respiratory failure develops in adults with scoliosis with a large angle and a low vital capacity when normal aging reduces the ventilatory capacity further. Such individuals merit close follow up.

Adolescent↗
PubMed1991

Chymopapain versus conventional surgery for lumbar disc herniation. 10-year results of treatment.

We reviewed two comparable groups of patients who had been treated for lumbar disc herniation by chymopapain chemonucleolysis (145) or conventional surgical discectomy (91). They were reviewed 10 years after treatment by questionnaire, followed by a personal interview by an independent observer. The results of the surgically treated groups were slightly better than those treated with chymopapain. In particular, there was significantly better early relief of leg and low back pain, and fewer patients needed a second procedure. Complications were few in both groups.

Activities of Daily Living↗
PubMed1989

Transfusion-related non-A, non-B hepatitis in elective spine deformity surgery patients in Gothenburg, Sweden.

This study presented a retrospective analysis of the incidence and clinical course of non-A, non-B hepatitis in patients after receiving homologous blood transfusion for elective spine deformity surgery, at Sahlgren Hospital. The medical records of all patients who underwent surgical procedures for scoliosis and spondylolisthesis between January 1, 1971 and December 31, 1986 were reviewed. From this group, 918 patients with negative medical histories for prior homologous blood transfusion, hepatitis, or the exposure to hepatotoxic medications were selected. All of the patients received two or more units of homologous blood and were followed for at least 1 year postoperatively. Eight hundred fifty-nine (94%) of the patients were either personally interviewed or contacted by mail. The group included 697 scoliosis patients (average age 16.2) and 162 spondylolisthesis patients (average age, 16.8). The scoliosis and spondylolisthesis patients received an average of 5.6 and 3.4 units of homologous blood, respectively. Three patients (0.35%) developed posttransfusion hepatitis, all non-A non-B. The incubation period was 9 to 12 weeks. Presenting symptoms varied widely, ranging from no symptoms to marked icterus. Two of the three patients went on to develop chronic persistent hepatitis, which was confirmed by liver biopsy. The incidence identified in this retrospective study was low when compared with an overall incidence of 4 to 15%, as presented in several larger prospective studies. Non-A, non-B hepatitis is a major risk associated with the homologous transfusion of blood and must be considered one of the more serious complications in surgery for spinal deformity.

Adolescent↗
PubMed1988

Nutrition of the intervertebral disc: acute effects of cigarette smoking. An experimental animal study.

We have in the present experimental study investigated the influence of cigarette smoking on some nutritional parameters of the porcine intervertebral disc. The results from the acute smoking tests show a significant reduction in solute transport. Diffusion of sulphate, oxygen and methyl glucose was reduced by 30-40 per cent. This effect was obtained after exposure to smoke for 20-30 minutes. A smoking period of three hours reduced the transport efficiency to about 50 per cent. The effect of smoking decreased when the exposure ceased. The concentration gradients were close to normal after 2 hours "recovery". These findings suggest that cigarette smoking not only significantly affects the circulatory system outside the intervertebral disc, where the most pronounced effect is the reduction in solute exchange capacity, but also significantly deteriorates the cellular uptake rate and metabolite production within the disc.

Animals↗
PubMed1986

Back injuries in industry: a retrospective study. I. Overview and cost analysis.

To evaluate the impact off back injury on industry, the authors conducted a retrospective analysis of injuries among hourly employees of a large industrial manufacturer in western Washington. The Boeing Company provided injury information on 31,200 employees for a 15-month period from July 1, 1979 to September 30, 1980. Of the 4,645 injuries reported, 900 were back injuries. Claims related to back injuries constituted 19% of all workers' compensation claims but were responsible for 41% of the total injury costs, or approximately $1,800,000. The 90 most expensive back injury claims (10% of all back injury claims) were responsible for 79% of the total back injury costs. The percentage of back injury claimants with claims having a total incurred cost exceeding $10,000 (6.5%) was significantly higher than the corresponding percentage of claimants (1.5%) with claims for other than back injuries (P = 0.000). A similar significant difference was found concerning the tendency of back injury claimants to have multiple claims compared with the non-back injury claimants. This retrospective study reaffirms the significant economic impact of back injuries on industry, and specifically high-cost back injuries. In addition, it provides insight into factors associated with back injury and points to positive measures that may be taken to reduce back pain and economic loss. Characteristics of the back injury and employee-related factors associated with back injury are presented in two subsequent articles.

Back Injuries↗
PubMed1986

Back injuries in industry: a retrospective study. II. Injury factors.

To evaluate the impact of back injury on industry, the authors conducted an extensive retrospective analysis of injuries among hourly employees of The Boeing Company, the largest industrial manufacturer in western Washington. The Boeing Company provided injury information on 31,200 employees for a 15-month period from July 1, 1979 to September 30, 1980. From this information, we analyzed 4,645 injury claims filed as of February 28, 1981 by 3,958 different employees. There were 900 back injuries in this group. Claims were categorized according to total incurred cost (TIC), made up of the medical costs and indemnity costs. High-cost claims were defined as those with a TIC greater than $10,000, and low-cost claims were those with a TIC less than $10,000. Among 857 claimants with 900 back injuries, lifting or material handling was much more commonly considered the cause of injury than accidents such as slips or falls. Accidents, however, had a much greater tendency to result in an expensive claim. The authors could not make reliable conclusions regarding injuries and 32 job skill classifications. The rate of injury did not vary according to day of the week or month, but a significantly higher rate of high-cost back injuries was noted on the day shift than on the evening or night shifts.

Absenteeism↗
PubMed1986

Back injuries in industry: a retrospective study. III. Employee-related factors.

To evaluate the impact of back injuries on industry, the authors conducted a retrospective analysis of injuries occurring among a group of 31,200 employees of The Boeing Company, a large industrial manufacturer in Western Washington. They analyzed 4,645 injury claims (including 900 back injuries) made by 3,958 different employees. Two previous articles give an overview of the study, provide a detailed analysis of the costs associated with these back injuries, and analyze the characteristics of the injury. This article focuses on employee-related factors associated with back injuries. Claims were categorized according to severity, as indicated by total incurred cost (TIC), the sum of the medical costs, and indemnity costs. High-cost claims were defined as those with a TIC greater than $10,000 and low-cost claims as those with a TIC less than $10,000. Employees younger than 25 years of age had a statistically significant increased risk of back injury, although their claims tended to be low-cost ones. This finding tends to discredit the premise that back problems are related to aging of the lumbar spine. While older employees had a lower injury rate, they did have a significantly increased risk of incurring high-cost back injury claims. The 31-40-year age group was the most susceptible to high-cost back injuries. Newer employees tended to have a significantly increased risk of back injury. The data show that women had fewer injuries than men but a statistically significant increased risk of becoming a high-cost injury claim.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Long-term effects on personality development in patients with adolescent idiopathic scoliosis. Influence of type of treatment.

In a series of 157 patients treated surgically and/or with Milwaukee braces, constituting 83% of the original criterion patients with adolescent idiopathic scoliosis, treated in the Department of Orthopaedics in Gothenburg, Sweden, from 1969 to 1974, a specific psychologic interview was carried out an average of 9 years after treatment. The 92 surgical patients all wore a Milwaukee brace postoperatively for 6-9 months and were gradually weaned over the next year (17 +/- 2 months). The brace-treated patients wore their braces full time for 18 months and part time for another 8 months (26 +/- 3 months). The psychologic portion of the study was a semistructured interview aimed at evaluating reactions in connection with the diagnostic phase, attitudes and reactions to the treatment, attitudes to the hospital staff, and body image concepts at follow-up. The brace-treated patients more often said that they experienced more fear and anxiety when informed about the diagnosis than did the surgical patients (53% and 38%, respectively). In both groups, nearly all patients initially had negative attitudes to the brace treatment. Most of the surgically treated patients gradually accepted the brace, whereas very few of the other group did so. Forty percent in the brace group had negative experiences with the hospital staff, but only 15% in the other group reported negative experience. Several years after completed treatment, one-half of the brace group had definite signs of negative body image concept, whereas this emotional disturbance was found in 33% of the surgically treated patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗