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Biomedical subjects

B Brismar

Publications and source records attributed to B Brismar.

At least 37 records · Page 2Linked to original sources
PubMed1996

Influence of age on circulation and arterial blood gases in man.

BACKGROUND: Modern data on the influence of age on hemodynamic and blood gas data in healthy subjects are sparse, especially in middle aged or older subjects. Most measurements have been done in patients during major surgery or in intensive care when the patients have one or more failing organ systems. This study reports on hemodynamics, blood gases and blood volume in healthy patients prior to anesthesia and elective surgery. METHODS: A total of 116 subjects (92 males, 24 females) were investigated prior to anesthesia and elective surgery. No one had received any premedication or was taking regular medication. All subjects were in good physical condition, except for their surgical disease, and clinical examination and history did not reveal any sign of cardiopulmonary disease. Measurements were made of systemic and pulmonary vascular pressures, cardiac output, arterial blood gases and blood volume by 131I-Albumin distribution. RESULTS: Cardiac output, stroke volume, and blood volume correlated to body surface. Relating these variables to body size eliminated almost all differences between the male and female groups. These variables, as well as both systemic and pulmonary artery systolic vascular pressures, were affected by increasing age. Pulmonary capillary wedge and right atrial pressures were not influenced by age. PaO2 decreased with age from 14.0 kPa at 20 years to 11.3 kPa at 80, whereas PaCO2 was unaltered. No effect of light smoking was found on pulmonary circulation or arterial blood gases. Significant correlations were found between blood volume on the one hand and body size and age on the other hand, but not in regard to sex.

Adult↗
PubMed1996

V/Q distribution and correlation to atelectasis in anesthetized paralyzed humans.

Regional ventilation and perfusion were studied in 10 anesthetized paralyzed supine patients by single-photon emission computerized tomography. Atelectasis was estimated from two transaxial computerized tomography scans. The ventilation-perfusion (V/Q) distribution was also evaluated by multiple inert gas elimination. While the patients were awake, inert gas V/Q ration was normal, and shunt did not exceed 1% in any patient. Computerized tomography showed no atelectasis. During anesthesia, shunt ranged from 0.4 to 12.2. Nine patients displayed atelectasis (0.6-7.2% of the intrathoracic area), and shunt correlated with the atelectasis (r = 0.91, P < 0.001). Shunt was located in dependent lung regions corresponding to the atelectatic area. There was considerable V/Q mismatch, with ventilation mainly of ventral lung regions and perfusion of dorsal regions. Little perfusion was seen in the most ventral parts (zone 1) of caudal (diaphragmatic) lung regions. In summary, shunt during anesthesia is due to atelectasis in dependent lung regions. The V/Q distributions differ from those shown earlier in awake subjects.

Adult↗
PubMed1996

Cohabiting relationships and sexual interest of male alcoholics.

This study comprises data from a consecutive series of 52 heterosexual male alcoholics. The purpose of the study was to describe sexual interest and cohabiting relationships and to analyse the influence of personality and biological factors on these phenomena. An increased sexual interest or activity and frequent changes of cohabiting partners are two common characteristics of male alcoholics but these two phenomena are not interrelated. A decreased sexual interest is reported by only a minority of male alcoholics. The alcoholics with several previous cohabiting relationships stand out as being aggressive and hard drinking. The alcoholic with an increased sexual interest makes an opposite impression. He is non-aggressive, socially adjustable and unafraid of close interpersonal relations. When decreased sexual interest or activity occurs in male alcoholics, it is mainly a result of hormonal changes. Low levels of male and high levels of female sex hormones are common in these men.

Adult↗
PubMed1996

Biapenem versus imipenem/cilastatin in the treatment of complicated intra-abdominal infections: report from a Swedish Study Group.

118 patients with complicated intra-abdominal infections participated in an open randomized comparative multicenter trial in order to compare the clinical and microbiological efficacy and safety of biapenem with imipenem/cilastatin (Tienam). 31 men and 27 women (mean age 52.3 years) were enrolled in the biapenem group, and 43 men and 17 women (mean age 52.3 years) in the imipenem/cilastatin group. The patients received either biapenem 500 mg every 8 h or imipenem/cilastatin 500 mg/500 mg every 6 h by intravenous infusion for up to 13 days (mean 6.5 days). 28/43 evaluable patients (65.1%) receiving biapenem and 27/40 evaluable patients (67.5%) in the imipenem/cilastatin group were clinically cured. The microbiological response was satisfactory in 28/43 evaluable patients (65.1%) receiving biapenem and in 27/40 evaluable patients (67.5%) receiving imipenem/cilastatin. No significant differences in clinical or microbiological efficacy between the two treatment groups were found. The present study shows that biapenem may be useful in the treatment of intra-abdominal infections.

APACHE↗
PubMed1995

Meropenem versus imipenem/cilastatin in the treatment of intra-abdominal infections.

In order to compare the clinical and microbiological efficacy and safety of meropenem with imipenem/cilastatin, 249 patients with intra-abdominal infections participated in an open randomised comparative multicentre trial. Seventy-five men and 57 women (mean age 51 years) were enrolled in the meropenem group and 67 men and 50 women (mean age 52 years) in the imipenem/cilastatin group. The patients received either meropenem, 500 mg q 8 h, or imipenem/cilastatin, 500 mg/500 mg q 8 h by intravenous infusion for up to 17 days (mean 5 days). Ninety-seven of 99 patients (98%) receiving meropenem were clinically cured while 86 of 90 patients (96%) in the imipenem/cilastatin group were clinically cured. The microbiological response was satisfactory in 89 of 94 evaluable patients (95%) receiving meropenem and in 78 of 81 evaluable patients (96%) receiving imipenem/cilastatin. There was no significant difference in clinical and microbiological efficacy between the two treatment groups. Adverse reactions were noted in 26 patients receiving meropenem and in 36 patients receiving imipenem/cilastatin. The present study shows that meropenem is effective and well tolerated in the treatment of intra-abdominal infections.

APACHE↗
PubMed1995

Sociodemographic characteristics and criminality in victims of firearm injuries.

This study is based on all victims of firearm injuries (n = 820) treated in public hospitals in Stockholm, Sweden, between 1972 and 1992. The aim of the study was to determine the sociodemographic characteristics, criminality, and mortality in victims of firearm injuries. The diagnosis was accident in 56.0%, suicide/attempted suicide in 11.7%, murder/attempted murder in 20.6%, and undetermined in 11.7%. Information was procured from the Swedish National Population Register, the Swedish National Board of Health and Welfare's register on causes of death, and the Swedish National Police Board's register on sentences passed. The average victim of a firearm injury was a young man, single, and often divorced. The proportion of immigrants was larger than expected, involvement in criminality was massive, and the mortality rate was high. The risk of being killed by the gunshot if brought to the hospital alive was relatively low, except in the cases of attempted suicide. The recurrent rate in violent trauma was high. It is suggested that secondary prevention could make an important contribution to the reduction of firearm injuries and fatalities. If the necessary surgical care is supplemented with a psychosocial intervention program to help the patient change his or her current situation, the number of "chronic" victims of violence could be reduced.

Adolescent↗
PubMed1995

Management of splenic trauma--changing concepts.

During the last two decades the reported risk of overwhelming postsplenectomy infection (OPSI) has resulted in a conservative approach to splenic trauma, with the aim of splenic salvage. The appropriateness of this strategy is now questioned. The risk of OPSI varies with age and indication for splenectomy from less than 1% in adults to more than 4% in children. Pneumococcus is the causative agent in about 60% of cases. A prerequisite for splenic preservation procedures should be a haemodynamically stable patient without other intraabdominal injuries. The benefits derived from non-operative treatment of splenic salvage procedures may be overshadowed by the potential risk of transfusion-related bacterial and viral diseases. Polyvalent pneumococcal vaccines given early after splenectomy appear to reduce the incidence of OPSI substantially.

Adult↗
PubMed1995

[Hospital without borders--visions of telemedicine].

Transfer the expertise rather than the patient! With the help of a screen and a videocamera the general practitioner requiring expert help in diagnosis is able to consult the specialists directly via the broadband ISDN (Integrated Services Digital Network), and referrals complemented with audio-visual material can also be transmitted via the network. Modern telemedicine technology enables hospitals to be linked up, advanced information to be transmitted, interpreter services to be enlisted, and continuous postgraduate training to be developed. Thus, time and money can be saved, the patients given better and faster service, and the quality of health care enhanced.

Audiovisual Aids↗
PubMed1995

CT-assessment of dependent lung densities in man during general anaesthesia.

PURPOSE: We aimed to describe the frequency of atelectasis occurring during anaesthesia, to describe the size and pattern of the atelectasis, and to standardise the method of identifying the atelectasis and calculate its area. MATERIAL AND METHODS: Patients (n = 109) scheduled for elective abdominal surgery were examined with CT of the thorax during anaesthesia. RESULTS: In 95 patients (87%) dependent pulmonary densities were seen, interpreted as atelectasis. Two different types of atelectasis were found-homogeneous (78%) and non-homogeneous (9%). Attenuation values in histograms of the lung and atelectasis were studied using 2 methods of calculating the atelectatic area. CONCLUSION: On the basis of the present findings, we defined atelectasis as pulmonary dependent densities with attenuation values of -100 to +100 HU.

Adolescent↗
PubMed1994

Characteristics of imprisoned wife-beaters.

The aim of this study is to present the authors' recent findings concerning the wife-beater and to discuss the existing state of knowledge as well as practical implications concerning the treatment of these men. The study presents interview and register data as well as some endocrinological findings in 18 wife-beaters sentenced to prison. These men generally lived under unfavourable socio-economic conditions, half of them were immigrants and most of them had been maltreated as children. Drug and alcohol abuse was common. The men showed an overconsumption of both somatic in-patient and out-patient care but had virtually no previous psychiatric history. Depressive symptoms were common, however, as were anti-social personality traits, reflected in a marked involvement in both violent and non-violent offences. The levels of testosterone were generally high. It is argued that the most efficient therapeutic approach would be to treat alcohol and drug addiction, an aspect of rehabilitation that has often been underestimated or overlooked in previous treatment programmes. The period of imprisonment could be utilized for these purposes, as an alcoholic who becomes sober is probably less prone to abuse his wife.

Adult↗
PubMed1994

Phrenic nerve stimulation during halothane anesthesia. Effects of atelectasis.

BACKGROUND: Atelectasis formation during anesthesia may be due to loss of respiratory muscle tone, in particular that of the diaphragm. This was tested by tensing the diaphragm by phrenic nerve stimulation (PNS) and observing the effect on atelectasis. METHODS: Twelve patients (mean age 48 yr) without preexisting lung disease were studied during halothane anesthesia. PNS was executed with an external electrode on the right side of the neck. Chest dimensions and area of atelectasis were studied by computed tomography of the chest. RESULTS: Right-sided PNS against an occluded airway at functional residual capacity reduced the atelectatic area in the right lung from 5.1 to 3.8 cm2. The atelectasis was reduced to 1.1 cm2 after application of positive end-expiratory pressure (PEEP) of 10 cmH2O and large tidal volumes but increased to 2.5 cm2 within 1 min after discontinuation of PEEP. Commencement of PNS immediately after PEEP prevented the atelectasis from increasing, the mean area being 0.9 cm2. In seven patients, in whom the trachea was intubated with a double-lumen endobronchial catheter the atelectatic area was smaller during PNS with an open airway than during positive pressure inflation of the lung with the same volume as inspired during PNS (3.5 and 5.2 cm2, respectively. CONCLUSIONS: The findings indicate that contracting the diaphragm in the anesthetized subject reduces the size of atelectasis.

Adult↗
PubMed1994

Hormone levels and personality traits in abusive and suicidal male alcoholics.

This study presents personality and biochemical correlates to abusive and suicidal behavior in 49 male alcoholics. Our hypothesis was that neuroendocrine and personality characteristics reflect a postulated regulatory mechanism that determines the direction of aggression either outward (abusive) or inward (suicidal). Eleven patients (22%) had physically abused someone on one occasion and 15 (31%) constituted a more violent subgroup with repeated instances of abuse. Thirteen (27%) had attempted suicide at least once. There was a significant positive correlation between the number of abusive and suicidal events (r = 0.33). The violent subgroup with repeated episodes of physical abuse had elevated levels of serum testosterone and low levels of cortisol when compared with the rest of the sample. Aggressive, antisocial, and impulsive personality traits were common. Suicidal alcoholics did not differ from the rest regarding hormone levels, but exhibited high impulsivity and muscular tension on the personality test. It is suggested that the high impulsivity without aggressive traits makes them exhibit autoagressive rather than abusive behavior. Both the abusive and suicidal alcoholics partly had a history typical of the type 2 alcoholic. We propose that these two categories constitute subgroups of the type 2 alcoholic determined by a combination of genetic predisposition to alcoholism, certain personality traits, and, with regard to the violent group, also hormone disturbances. We find it highly justified to identify and treat these subgroups because of their harmful acting-out behavior.

Adult↗
PubMed1994

Immune response in patients with intra-abdominal infections treated with carbapenems.

The immune responses against isolated microorganisms in patients with intraabdominal infections treated with meropenem or imipenem/cilastatin were investigated. Fifty-nine patients received meropenem 500 mg t.i.d. intravenously for 3-21 days (mean 5.4 days) and 50 patients imipenem/cilastatin 500 mg/500 mg t.i.d. intravenously for 3-17 days (mean 5.1 days). Three serum samples were taken from each patient, the first sample at admission, the second sample between three and seven days after start of antibiotic treatment, and the third sample between 14 and 28 days later. Ninety-eight per cent of the patients in the meropenem group and 95% of the patients in the imipenem/cilastatin group were cured. There was no difference in the clinical outcome between the two treatment groups. Escherichia coli, Bacteroides fragilis group, anaerobic cocci, Staphylococcus epidermidis, and Klebsiella spp. predominated among the isolated microorganisms. Thirty-nine patients in the meropenem group had significant immune responses against one or more of the isolated microorganisms while 31 patients in the imipenem/group had significant responses. E. coli and B. fragilis gave rise in antibody titres in most patients indicating that these species are the most important pathogens in intraabdominal infections.

Abdominal Abscess↗
PubMed1994

Characteristics of violent alcoholics.

This study is based on interviews with 53 male alcoholics. Its purpose was to study the relationship between childhood conditions, history of alcohol and drug misuse and assaultive and suicidal behaviour. Fifty-seven per cent of the alcoholics reported a history of violent behaviour. Hidden violence, often towards women, was common. One-third of the violent patients had a history of attempted suicide compared to 17% in the non-violent group. The assaultive alcoholics also had a more violent childhood, a higher proportion of fathers with alcohol problems and had started drinking earlier in life. Drug addiction was much more common in this group too. We find support for our hypothesis that there is a positive correlation between violence in the parental home and assaultive and suicidal behaviour and drug misuse later in life. When violent and non-violent alcoholics are compared many of the same characteristics appear as when suicidal and non-suicidal and type 2 and type 1 alcoholics are compared. This study raises the question of adding attempted suicide as a characteristic of the type 2 alcoholic.

Adult↗