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Biomedical subjects

B Brismar

Publications and source records attributed to B Brismar.

At least 73 records · Page 4Linked to original sources

Suicide attempts by battered wives.

During an 8-month period a total of 117 battered wives, all seeking emergency surgical care, were identified. Twenty-two of the battered wives were found to have made 82 suicide attempts during the 16-year study period. This corresponds to an incidence more than 8 times that of an unselected population of women being treated because of attempted suicide in the same hospital. The suicide attempts were predominately passive methods. Although conflict with the husband was the most common triggering factor for the attempt, mental disorder of the woman was another main cause. It is concluded that the doctor, when confronted with a patient who has attempted suicide, always should consider the possibility of ongoing physical abuse. Although battering generally is not the only explanation, the physician should remember this possibility and the patient should, if necessary, be referred to proper care services.

Adolescent↗

Identification and characterization of alkaline phosphatase isozymes in human colorectal adenocarcinomas.

Using alkaline phosphatase isozyme-specific immunocatalytical assays, the content of isozymes was determined in normal mucosas and adenocarcinomas from human colon or rectum. Tumor levels of both the tissue (liver)-unspecific and the placental-like alkaline phosphatase (PLAP-like) were elevated compared to normal mucosas of the same patients. Such elevations have been reported previously, particularly in seminomas and ovarian tumors. In several tumors, moreover, the intestinal isozyme was expressed in lesser amounts than in the adjacent mucosa. The present results indicate that the activation of two of the phosphatase isozymes, including expression of the typical germ cell line phosphatase (the PLAP-like isozyme), may occur even in nongonadal tumors. This may reflect an induction pattern of phosphatase isozymes, with implications for malignant transformation also in other tumors.

Adenocarcinoma↗

A 5-year follow-up study of 117 battered women.

This paper reports register data concerning somatic and psychiatric hospital care on 117 battered women who were identified in a surgical emergency department and offered a treatment program. Data were collected during a period of 10 years before to 5 years after the battering in question. It was concluded that the battered woman seeks hospital care much more than the average woman of the same age. It is, however, not only traumatic injuries that bring her to the hospital, but also medical, gynecological, psychiatric, and unspecified disorders and suicide attempts. In this study it was hypothesized that this overuse of hospital care reflects the situation at home characterized by ongoing battering and other psychosocial problems. During the 5 years following the battering, the women did not show any signs of reducing their use of hospital care. It is alarming that this high use of medical care continues over years, and doctors should consider battering as one possible explanation for this phenomenon.

Adolescent↗

Soluble fecal acidic lipids and colorectal epithelial cell proliferation in normal subjects and in patients with colon cancer.

Soluble fecal acidic lipid concentrations and colonic epithelial cell proliferation rates, two biologic markers for colon cancer, were compared in a group of colon cancer patients and a group of healthy controls. No significant difference was found in the concentration of bile acids (155 (136) microM, n = 33, versus 103 (89) microM, n = 19) in the aqueous phase of feces from patients and controls or in proliferation rates between the two groups, the volume density of tritiated thymidine-labeled epithelial cells being 0.153 (0.050), n = 8, for the patients and 0.164 (0.072), n = 11, for the controls. When the dietary intake of three food components known to influence both of the above factors (that is, fat, fiber, and calcium) was ascertained for the year preceding the study, the only significant difference observed was the higher calcium intake in the female patients than in the controls. The authors conclude that it may be premature to rely too heavily on either of the above markers to predict risk for developing this disease.

Adult↗

Comparative effects of clarithromycin and erythromycin on the normal intestinal microflora.

10 healthy volunteers received 250 mg of clarithromycin orally q 12 h for 7 days and 10 other volunteers 1000 mg of erythromycin ethylsuccinate orally q 12 h for 7 days. Stool specimens were collected before, during and after antibiotic administration. In the clarithromycin group, the numbers of streptococci and enterobacteria decreased among aerobic microorganisms while in the erythromycin group streptococci, enterococci and enterobacteria decreased and staphylococci increased during antibiotic administration. The anaerobic intestinal microflora was also affected. The alterations were more pronounced in the volunteers receiving erythromycin than in those having clarithromycin.

Administration, Oral↗

Chronic obstructive pulmonary disease and anaesthesia: formation of atelectasis and gas exchange impairment.

Gas exchange impairment and the development of atelectasis during enflurane anaesthesia were studied in 10 patients (mean age 70 yrs) with chronic obstructive pulmonary disease (COPD). Awake, no patient displayed atelectasis as assessed by computed X-ray tomography. The ventilation/perfusion distribution (VA/Q), studied by the multiple inert gas elimination technique, displayed an increased dispersion of VA/Q ratios (the logarithmic standard deviation of the perfusion distribution, mean log Q SD 0.99; upper 95% confidence limit of normal subject: 0.60), and increased perfusion of regions with low VA/Q ratios (0.005 less than VA/Q less than 0.1: 5.4% of cardiac output). Shunt was negligible (mean 0.6%). Computed chest tomography showed significantly larger cross-sectional thoracic areas than previously seen in subjects with healthy lungs (p less than 0.01). No atelectasis was seen in any patient. During anaesthesia there was a further worsening of the VA/Q mismatch with significantly increased log Q SD (1.29, p less than 0.05) but no increase in shunt (mean 1%). Minor atelectatic areas were noted in three patients, the others displayed no atelectasis at all. Chest dimensions were reduced by no more than 3% during anaesthesia, suggesting an unchanged or only minimally affected functional residual capacity. These findings contrast with those seen in patients with healthy lungs in whom atelectasis and shunt regularly develop during anaesthesia.

Aged↗

DNA distribution pattern in colorectal carcinoma. A methodologic study comparing two different biopsy techniques.

DNA content was measured in 59 samples from 20 colorectal adenocarcinomas and 5 adenomas by single cell microspectrophotometry. Samples were obtained simultaneously by fine needle aspiration (FNA) and touch imprints of punch (IMP) biopsies. The results showed that specimens obtained by the two biopsy methods displayed similar DNA ploidy patterns in 46 of 59 samples (78%). The DNA patterns in six samples were aneuploid in IMP and nonaneuploid in FNA and vice versa in seven samples. When DNA patterns of the individual tumors were classified according to the most aggressive one, the two biopsy methods showed 88% concordance, with similar DNA patterns in 22 of 25 patients. The DNA patterns in three patients were classified as aneuploid in FNA specimens and nonaneuploid in IMP. The results indicate that imprints of punch tissue biopsies can be used for a reliable evaluation of the DNA pattern in colorectal tumors.

Adenocarcinoma↗

Effect of lomefloxacin on the normal oral and intestinal microflora.

Ten healthy volunteers received 400 mg of lomefloxacin orally once daily for seven days. Saliva and faecal samples were collected on days 0, 2, 4, 7, 9, 11, 14 and 21 to investigate the effect of lomefloxacin on the normal oral and intestinal microflora. The mean concentration of lomefloxacin in faeces on day 7 was 203 mg/kg, while saliva levels were low, less than 0.6 mg/l in nine of ten volunteers. Aerobic gram-negative microorganisms were almost completely eradicated, while aerobic gram-positive and anaerobic microorganisms were virtually unaffected by the lomefloxacin administration. Two weeks after lomefloxacin was discontinued, the oral and intestinal microflora had returned to normal levels.

4-Quinolones↗

The influence of body position and differential ventilation on lung dimensions and atelectasis formation in anaesthetized man.

The effects of body position and anaesthesia with mechanical ventilation on thoracic dimensions and atelectasis formation were studied by means of computerized tomography in 14 patients. Induction of anaesthesia in the supine position reduced the cross-sectional area for both lungs and caused atelectasis formation in dependent lung regions in 4/5 patients. Conventional ventilation with positive end-expiratory pressure (PEEP) increased thoracic dimensions and reduced, but did not eliminate, the atelectatic areas. The vertical diameters of both lungs were smaller in the lateral position as compared to the supine position (16.7 vs 10.4 cm in the left lung and 17.3 vs 12.8 cm in the right lung). The lateral positioning also caused a large reduction of the atelectatic area in the non-dependent lung. Differential ventilation with selective PEEP to the dependent lung eliminated (3/8 patients) or reduced (5/8 patients) dependent lung atelectasis. It can be concluded that lung geometry is altered in the lateral position: the shape of the lung makes the vertical diameter of each lung less in the lateral position, compared to the supine position. The atelectatic areas are mainly located in the dependent lung in the lateral position, and these atelectatic areas could be further reduced by selective PEEP to this lung.

Adult↗

Ventilation-perfusion relationships and atelectasis formation in the supine and lateral positions during conventional mechanical and differential ventilation.

Patients without respiratory symptoms were studied awake and during general anesthesia with mechanical ventilation prior to elective surgery. Ventilation-perfusion (VA/Q) relationships, gas exchange and atelectasis formation were studied during five different conditions: 1) supine, awake; 2) supine during anesthesia with conventional mechanical ventilation (CV); 3) in the left lateral position during CV; 4) as 3) but with 10 cm of positive end-expiratory pressure (PEEP) and 5) as 3) but using differential ventilation with selective PEEP (DV + SPEEP) to the dependent lung. Atelectatic areas and increases of shunt blood flow and blood flow to regions with low VA/Q ratios appeared after induction of anesthesia and CV. With the patients in the lateral position, further VA/Q mismatch with a fall in PaO2 and increased dead space ventilation was observed. Atelectatic lung areas were still present, although the total atelectatic area was slightly decreased. Some of the effects caused by the lateral position could be counteracted by adding PEEP. Perfusion of regions with low VA/Q ratios and venous admixture were then diminished, while PaO2 was slightly increased; shunt blood flow and dead space ventilation were essentially unchanged. During CV + PEEP, there was a decrease in cardiac output, compared to CV in the lateral position. DV + SPEEP was more effective than CV + PEEP in decreasing shunt flow and increasing PaO2 in the lateral position; in addition to this, cardiac output was not affected.

Adult↗

Atelectasis causes gas exchange impairment in the anaesthetised horse.

The anatomical basis of gas exchange impairment in the anaesthetised horse was studied by computerised tomography (CT; three shetland ponies) and morphological analysis (one pony and three horses). By means of CT, densities were seen in dependent lung regions early during anaesthesia, both with spontaneous breathing and with mechanical ventilation. The densities remained for some time where they had initially been created when the animal was turned from dorsal to sternal recumbency. Deep insufflation of the lungs reduced the dense area. Gas exchange was impaired roughly in proportion to the dense area. On histological analysis, the densities were atelectatic and congested with blood. Gravimetry showed no more extravascular water per unit lung tissue in the atelectatic than in the 'normal' regions, and the blood content was increased only slightly. It is concluded that the horse develops atelectasis in dependent lung regions early during anaesthesia in dorsal recumbency, and that atelectasis is the most likely explanation for the large shunt and impaired arterial oxygenation regularly seen during anaesthesia.

Anesthesia↗

Ciprofloxacin concentrations and impact of the colon microflora in patients undergoing colorectal surgery.

Ciprofloxacin was given perorally in two doses of 750 mg each with a 12-h interval starting 24 h prior to surgery, 400 mg of ciprofloxacin was given intravenously at the induction of anesthesia, and 400 mg of ciprofloxacin was given 12 h later to 21 patients undergoing elective colorectal surgery. The maximum concentrations in serum (mean value +/- standard deviation, 11.1 +/- 7.8 mg/liter) during surgery were reached 30 min after ciprofloxacin was administered. The ciprofloxacin concentrations in the intestinal mucosa samples were 2.7 to 37.8 mg/kg of tissue weight, and the concentrations in the fecal samples were less than 0.1 to 858 mg/kg. The aerobic and anaerobic bacteria in the fecal flora were suppressed markedly during the prophylaxis period. No postoperative infections occurred.

Adult↗

Battered wives--measures by the social and medical services.

The social files and medical records of 98 acutely battered wives who attended a surgical emergency department were studied. Although all women had been hospitalized during the decade preceding the present incident, wife battering was documented in the records in only 18%. The majority of the women (73%) were also known to the social services, but battering was documented in less than half of the cases in the social service files. The measures taken by the social services to help the battered women consisted mainly of economic support and psychotherapy. The cooperation between the medical and social services and the police in cases of wife battering was very limited or non-existent. It is concluded that support given to battered women by the formal sources of aid is insufficient. The documentation of the cases is poor, there is a lack of practical measures and the cooperation between the authorities is limited. This study indicates that the social and medical services underestimate the importance of informal help sources like women's groups or shelters which often are the most valued resources by the battered women themselves. With improved cooperation between authorities and between formal and informal sources of aid the battered wives could be helped more effectively.

Adolescent↗

Heterogeneity of DNA distribution pattern in colorectal carcinoma. A microspectrophotometric study of fine needle aspirates.

For 50 consecutive patients with colorectal carcinoma, the nuclear DNA content in four separate fine needle aspiration samples taken from the resected tumors was analyzed using single-cell Feulgen cytometry. The DNA distribution patterns were divided into four classes according to their degree of euploidy/aneuploidy. Twenty tumors (40%) displayed a similar DNA pattern in all four samples while 30 tumors (60%) were heterogeneous, with a different DNA pattern within one or more of the four samples. None of the tumors were homogeneously diploid. These results illustrate the importance of multiple biopsy samples in the evaluation of the DNA pattern in colorectal tumors.

Adult↗

Ecological impact of antimicrobial prophylaxis on intestinal microflora in patients undergoing colorectal surgery.

During recent years the impact of different antimicrobial agents on the intestinal microflora in patients undergoing colorectal surgery has been investigated by our research group. Thus the effects on the microflora by parenteral administration of piperacillin, cefoxitin, cefbuperazone, moxalactam, aztreonam, imipenem, ampicillin + sulbactam, clindamycin, tinidazole, ciprofloxacin and ofloxacin have been studied. Pronounced changes were observed in the aerobic microflora in patients receiving ciprofloxacin and ofloxacin, in the anaerobic microflora in patients receiving clindamycin and tinidazole and in both the aerobic and anaerobic microflora in those patients receiving piperacillin, cefoxitin, cefbuperazone, moxalactam, aztreonam, imipenem and ampicillin + sulbactam. Postoperative infections were observed in patients receiving piperacillin (2), ampicillin + sulbactam (1), cefoxitin (1), aztreonam (3), tinidazole (6), clindamycin (5) and ofloxacin (5). In the patient groups receiving cefbuperazone, moxalactam, imipenem and ciprofloxacin, no postoperative infections occurred.

4-Quinolones↗

Battered wives and female alcoholics: a comparative social and psychiatric study.

In this study 49 women seeking hospital treatment for wife battering injuries were compared with 49 female alcoholics and a control group consisting of 49 women treated in hospital for accidents. At one time or another two-thirds of the female alcoholics had been battered and the majority of these women showed the same pattern of severe, prolonged abuse as the 49 women seeking hospital treatment for wife battering injuries. The women in these groups were also similar in that many of them had experienced violence in their own childhood environment, in that they had cohabited with more men than the women in the control group and in that the frequency of depressive symptoms was high. An analysis restricted to the battered women in each of the three groups revealed similarities between them. The battered women in the control group did not, however, show any signs of more severe psychopathology or alcoholism. It is concluded that mental health is of crucial importance for the woman's ability to break away from an abusive male.

Adolescent↗

Atelectasis and gas exchange impairment during enflurane/nitrous oxide anaesthesia.

The development of atelectasis and effects on gas exchange during enflurane anaesthesia in nitrogen/oxygen or nitrous oxide/oxygen (inspired oxygen fraction 0.4) were studied in 16 lung-healthy patients (mean age 49 years). Awake, no subject displayed atelectasis as assessed by computed x-ray tomography of the thorax. Pulmonary gas exchange, studied by multiple inert gas elimination technique, and blood gases were normal. After 10 min of enflurane anaesthesia in nitrogen/oxygen, 14 of 16 subjects had developed atelectasis. After 30 min of enflurane anaesthesia in nitrogen/oxygen or nitrous oxide/oxygen, all patients had developed atelectasis, and a further increase was observed after 90 min of anaesthesia to approximately 5% of the intrathoracic area. There was no difference between the two anaesthesia groups. In the nitrogen group, shunt rose to a maximum of 5.8% at 30 min of enflurane anaesthesia, with a significant reduction to the initial anaesthesia level after 90 min of anaesthesia (3.4%). Perfusion of poorly ventilated lung regions (low VA/Q) averaged 4-5% and did not vary significantly during the anaesthesia. In the nitrous oxide group, shunt increased to 6.3% after 90 min of anaesthesia, and there was a parallel decrease in perfusion of low VA/Q regions. The findings suggest that besides prompt collapse of lung tissue during induction of anaesthesia, absorption of gas from closed-off or poorly ventilated regions takes place and further increases the atelectatic area.

Adult↗