Search PubMed⌕ Search

Biomedical subjects

B Lundell

Publications and source records attributed to B Lundell.

At least 19 recordsLinked to original sources
PubMed2004

Nicotine exposure in breastfed infants.

AIM: To study exposure to nicotine in breastfed infants in relation to parental smoking habits. MATERIAL AND METHODS: Forty mother-infant pairs were studied. Twenty non-smoking mothers, 18 smoking (2-20 cigarettes per day) and two snuff-taking mothers were included. All infants were healthy, exclusively breastfed and their postnatal age was 6 wk. During a home visit, parental smoking habits were recorded, and the time of mothers' last smoke or taking of snuff and breastfeeding were recorded. Breast milk and infant urine samples were collected. Concentrations of nicotine and cotinine were analysed with gas chromatography. The amount of milk ingested during the home visit was calculated by weighing the infants. RESULTS: Two non-smoking and non-snuff-taking women had milk containing nicotine (28 and 13 microg/l, respectively). Both had smoking spouses. In the smoking and snuff-taking group, the mean (SD) milk nicotine concentration was 44 (38) microg/l (n = 36). When milk samples taken 7 h and 0.6 h after smoking were compared, the concentration of milk nicotine increased from 21 to 51 microg/l (p < 0.01). The two snuff-taking mothers exposed their children to higher milk nicotine concentrations than all but two of the smokers. The concentrations of the metabolite cotinine in infant urine correlated with the dose of nicotine ingested during the home visit (r = 0.84, p < 0.01). CONCLUSIONS: Breastfed infants with a smoking or snuff-taking mother are exposed to nicotine in breast milk. The mean intake of nicotine via milk is 7 microg/kg/d. With a shorter time between the mothers' smoking and breastfeeding, the milk nicotine concentration will increase. Both passive smoking at home and snuff-taking were associated with measurable nicotine levels in milk. Healthcare personnel promoting breastfeeding should be aware of these factors influencing exposure to nicotine in the breastfed infant.

Cotinine↗
PubMed2001

[Rheumatic fever behind acute chorea in a young girl. A case report].

This article presents the case of a 13-year old girl who was admitted to the emergency department because of rapidly evolving, seriously disabling impairments in movement and speech. Investigation led to the conclusion that her problems were caused by Sydenham's chorea as a manifestation of rheumatic fever. A neuropsychiatric examination performed one year after the onset of disease revealed a hitherto unknown mild mental retardation. The case description is followed by a clinical update on rheumatic fever focusing on cerebral manifestations. The theories concerning the existence of PANDAS--an autoimmune neuropsychiatric disorder following streptococcal infections, distinct from rheumatic fever--are presented.

Acute Disease↗
PubMed2001

The outcome of children born with pulmonary atresia and intact ventricular septum in Sweden from 1980 to 1999.

OBJECTIVE: To study the outcome of all children born with pulmonary atresia and intact ventricular septum in Sweden between 1980 and 1999. DESIGN: Retrospective study of medical records with review of the initial, preoperative angiocardiographic and echocardiographic examinations. RESULTS: A total of 84 children were born with pulmonary atresia and intact ventricular septum, giving an incidence of 4.2 per 100,000 live births. In all, 77 were operated on with a 1-year survival rate of 75%. Thirty-six children had ventriculocoronary communications, with a 1-year survival rate of 50%. At the end of the study period, 52 children were alive, 32 with biventricular repair, and 19 with univentricular repair. Follow-up time was 14 days-20 years (median, 6 years). Statistical analysis of incremental risk factors for death showed statistical significance for low birth weight, male sex, muscular pulmonary atresia, and having a systemic-to-pulmonary shunt as the sole initial intervention. CONCLUSION: Complete national data of all patients born with pulmonary atresia and intact ventricular septum during 1980-1999 in Sweden revealed a total mortality in accordance with previous reports for results for surgery. Further improvements demand a thorough preoperative investigation of the cardiac anatomy, particularly of the ventriculocoronary communications, to enable right ventricular decompression whenever possible.

Child↗
PubMed2001

Hospital-managed advanced care of children in their homes.

A hospital-managed project for the advanced care of children in their homes (SABH) has been established in Sweden. The aim was to provide an alternative to inpatient paediatric care by providing hospital-at-home care to stable infants and children using mobile units based on advanced information and communication technology. The Karolinska Hospital children's ward and emergency room referred children to SABH care. A medical care plan was drawn up by the physicians and nurses responsible for the patient while in hospital, in conjunction with the parents and the patient. In one year, 350 episodes of care requiring 3000 bed-days were managed by SABH in the children's homes rather than at hospital. Forty-two per cent of the patients were aged less than one year, 41% were between one and six years old, and 17% were older than six years. SABH care was at least 30% cheaper than conventional hospital care and patient satisfaction with the service was high. At the conclusion of the two-year project, the SABH became a permanent unit at the Karolinska Hospital.

Caregivers↗
PubMed2000

WHIPS--Volvo's Whiplash Protection Study.

Whiplash associated disorders (WAD) resulting from rear end car impacts are an increasing problem. WAD are usually not life threatening, but are one of the most important injury categories with regard to long-term consequences. This paper is a review of Volvo's Whiplash Protection Study (WHIPS), which is the result of more than ten years of concentrated research efforts in the area of neck injuries in car collisions, with the focus on rear end car impacts. The study follows the whole chain from accident research to the development of a seat for increased protection against WAD. Results from Volvo's accident research are summarized. Existing biomechanical knowledge regarding possible injury mechanisms are presented and discussed. Based on the interpretation of accident research and biomechanical knowledge, guidelines for improved protection against WAD in rear end impacts are presented. Requirements and test methods based on the guidelines are explained. An important part of the study is a new rear end impact dummy, BioRID. Test results using the new dummy are presented. Finally, the paper explains the design of a new seat for increased WAD protection, the WHIPS-seat. Results from the accident research and biomechanical research emphasize the importance of considering the whole spine of the occupant and, accordingly, the whole seat when addressing WAD in rear end impacts, with a particular focus on low and moderate impact severity. Low and moderate impact severity crashes should be focused. Also important to consider are the individual differences between occupants, the seating position and the variety of seating postures. All results, including sub-system testing, mathematical modeling, sled testing, as well as geometrical parameters show that the WHIPS-seat will have considerable potential for offering increased protection against WAD in rear end impacts.

Accidents, Traffic↗
PubMed2000

Magnetic resonance imaging and echocardiography in assessment of ventricular function in atrially corrected transposition of the great arteries.

OBJECTIVE: Patients with atrial correction of transposition of the great arteries (TGA) may develop right ventricular (RV) failure with time. A reliable non-invasive method for assessment of ventricular function is therefore needed. To evaluate the accuracy of echocardiography in assessment of ventricular volumes and function in these patients we compared echocardiography with magnetic resonance imaging (MRI) in 10 patients late after the Mustard and Senning procedures. DESIGN: Prospective echocardiography and MRI examinations were performed on the same day. Two different echocardiography technicians examined all patients. All echocardiography and MRI examinations were performed at the university hospital outpatient clinic and MRI department respectively. Ten patients, age 14.0+/-2.9 years, who had been operated on with atrial correction of TGA at 8 (2-60) months of age (median and range) were examined. Echocardiography RV and left ventricular (LV) end-systolic volumes (ESVs), end-diastolic volumes (EDVs), stroke volumes (SVs) and ejection fractions (EFs) were calculated, using the modified Simpson method, and compared with the same measurements obtained from MRI. RESULTS: For RV function there was good agreement between echocardiography- and MRI-derived measurements. Both echocardiography and MRI revealed reduced RV function with EFs of 42.6+/-9.1% and 46.4+/-7.2% respectively. For RV volumes there were no significant differences between echocardiography and MRI. LV function was significantly overestimated by echocardiography (EF with echocardiography = 72.7+/-4.4% vs. MRI = 50.5+/-7.6%) while all LV volumes were greatly underestimated. Echocardiography measurements of volumes in repeated examinations by different technicians showed large variations, 13-50%, for different variables in individual patients. CONCLUSION: Echocardiography can provide clinically important information concerning RV function in follow-up of patients late after atrial correction of TGA. It has limited value in assessment of LV function in these patients. Volume measurements by echocardiography are, however, highly user-dependent and interobserver variation is high. MRI may accordingly serve as an important reference method in individual patients.

Adolescent↗
PubMed1999

Mortality in Down's syndrome in relation to congenital malformations.

Down's syndrome (DS) is the most common form of intellectual disability. The syndrome is characterized by congenital malformations, especially of the heart and gastrointestinal tract, which can result in high mortality rates in the affected population. Many improvements have been made in the medical treatment of this syndrome during the past few decades and the survival of individuals with DS has increased in the industrial world. The aim of the present study was to investigate mortality in relation to congenital malformations. Medical records from all liveborn children with DS delivered between 1973 and 1980 in northern Sweden were studied, and malformations and causes of death were recorded. Out of the 219 children included in the study, a congenital heart defect was reported in 47.5% of subjects, 42.1% of whom had complete atrioventricular septal defect. Gastrointestinal tract malformations were present in 7.3% of subjects, and was frequently associated with a cardiac malformation and a very high mortality rate. Other major and minor congenital anomalies were present in 5.5% and 5.5% of subjects, respectively. In the 14.5-year follow-up of 213 children, the rate of survival was 75.6%. Mortality rates within one and 10 years after birth were 14.6% and 23.5%, respectively. Mortality within 10 years differed significantly between children with (44.1%) and without (4.5%) a congenital heart defect. A very high mortality rate was observed among children with a congenital heart defect, especially when it was combined with a gastrointestinal malformation.

Adolescent↗
PubMed1994

Inhaled nitric oxide in neonates and children with pulmonary hypertension.

Fourteen critically ill neonatal and paediatric intensive care patients with various primary diagnoses and signs of associated pulmonary hypertension received inhaled nitric oxide (NO), 20-80 ppm, after failure of conventional therapy to improve oxygenation. NO administration was found to be associated with a significant improvement in postductal arterial oxygen tension (pre-NO: 3.75 (SD 1.39) kPa; post-NO: 6.05 (SD 1.70) kPa; p = 0.004). In 10 patients, NO was found to increase arterial oxygen tension with more than 1 kPa. In 2 of these patients, ECMO treatment could be avoided due to the pronounced improvement in gas exchange seen after the initiation of NO administration. The remaining 4 patients failed to respond to NO administration. One patient developed methaemoglobinaemia (13.9%) which required treatment with methylthionine. Since we were unable to produce any beneficial effect of NO in the late phase of the pulmonary disease process, we believe that, in order to be successful, inhaled NO should be instituted when conventional treatment has failed and the administration of an iv vasodilator is usually considered.

Administration, Inhalation↗
PubMed1990

Nicotine and cotinine concentrations in the nursing mother and her infant.

Twenty-two smoking mothers and their healthy newborn infants (mean postnatal age of 3.7 days) were studied in the maternity ward. A close correlation was found (r = 0.94) between nicotine concentrations in the mothers' plasma and milk after smoking, the milk: plasma ratio being 2.9. The amount of nicotine transferred to the infant increased from 0.09 to 1.03 micrograms/kg infant body weight when mothers smoked before breast-feeding. The daily dose of nicotine via the mothers' milk was 6 micrograms per kg infant body weight. Cotinine but not nicotine concentrations in the plasma and milk of the mothers and the urine of the infants reflected the smoking habits of the mothers during pregnancy. There was no correlation between nicotine and cotinine concentrations in the infant's urine and the amount of nicotine given to the infant via the mother's milk.

Breast Feeding↗
PubMed1988

Intrauterine cranial gunshot wound in a 32-week fetus.

Intrauterine cranial gunshot wounds are rare and usually associated with a fatal outcome for the fetus. We present a case where preterm delivery, neonatal intensive care, and later removal of the bullet resulted in a normal child without any untoward sequelae.

Adult↗
PubMed1988

Cardiac function and sympathoadrenal activity in the newborn after cesarean section under spinal and epidural anesthesia.

Left ventricular systolic time intervals, bupivacaine concentrations, adrenaline and noradrenaline levels were determined in 19 neonates delivered by elective cesarean section. Ten of the cesarean sections were performed under spinal and nine under epidural anesthesia. Plain bupivacaine 0.5% was used for the epidural anesthesia and bupivacaine 0.5% in glucose 8% for the spinals. The noradrenaline and adrenaline levels were higher in the neonates whose mothers received epidural anesthesia. The differences in catecholamine and bupivacaine concentrations were not associated with differences in left ventricular dynamics, or the timing of postnatal circulatory changes. The significant exposure of the neonate to bupivacaine, at maternal epidural anesthesia, seems to have no negative effect on early neonatal circulation in the healthy term infant.

Anesthesia, Epidural↗
PubMed1987

Pulmonary lesions mimicking pericardial effusion on ultrasonography.

Two children with right middle lobe lesions mimicking pericardial effusion on ultrasonography are presented. They were admitted with fever and chest radiographs showed atelectasis or consolidation of the middle lobe of the right lung along the right heart border. A low-echogenic layer suggesting pericardial fluid was seen on ultrasonography, but with a spatial distribution closely corresponding to the lesions seen on the chest radiographs. If the possibility that a lung lesion adjacent to the heart can simulate pericardial fluid on ultrasonography is kept in mind, the correct diagnosis should not be difficult to make.

Child, Preschool↗
PubMed1986

Reproducibility of intracranial Doppler flow velocimetry.

Doppler velocimetry for assessment of flow in deep cerebral arteries was investigated in 9 term and 11 preterm healthy infants. A combined range gated and continuous wave Doppler instrument was used. A satisfactory reproducibility was found with a variation coefficient of 8-10% between repeated measurements. No systematic difference between examiners or head positions was recorded. The term infants had significantly higher mean flow velocities, 21.1 (3.1) cm/s (mean and 1 SD), compared to the preterm infants', 15.1 (3.6) cm/s (p less than 0.01). Both systolic and diastolic flow velocities were higher in the term infants, whereas the pulsatility index was higher in the preterm infants. Recordings from the intracranial part of the internal carotid arteries were found to be easy to obtain with a satisfactory reproducibility.

Blood Flow Velocity↗
PubMed1984

Catecholamine surge and metabolic adaptation in the newborn after vaginal delivery and caesarean section.

The immediate postnatal metabolic adaptation and sympatho-adrenal activation were studied in infants delivered vaginally or by elective caesarean section. Vaginally delivered infants showed high catecholamine levels at birth compared to infants born by caesarean section under epidural or general anaesthesia. Umbilical arterial glucose levels were significantly higher in the vaginal group than in both caesarean section groups. At 30 min, all groups showed a marked decrease with several infants showing asymptomatic hypoglycaemia in the caesarean section group. C-peptide levels showed no difference at birth but later became significantly higher in the vaginal group. Although the levels of free fatty acids and glycerol were low at birth, they were significantly higher in the vaginal group. In all groups they increased substantially with time. Considering the marked differences in catecholamine levels, the differences in metabolic adaptation were unexpectedly small. This implies an attenuated metabolic response to sympatho-adrenal stimulation in the newborn.

Adaptation, Physiological↗
PubMed1983

Catecholamine surge and lung function after delivery.

Lung function was measured at 30 minutes and again at 2 hours after birth in 12 infants delivered vaginally, in 15 infants delivered by elective caesarean section under general anaesthesia (GA), and in 15 delivered under epidural anesthesia (EDA). Umbilical arterial blood was analysed for pH and for concentrations of catecholamines and cortisol. No important differences in gestational age, birthweight, Apgar scores, or haematocrit were found among the three groups. Tidal volume and minute ventilation measured 30 minutes after birth were lower in infants delivered by caesarean section than in those delivered vaginally and at 2 hours the tidal volume was still lower in the babies delivered by caesarean section than in those delivered vaginally. Dynamic compliance was lower at 30 minutes in the group that had a caesarean section than in the vaginal group, and this difference was significant at two hours. Tidal volume, minute ventilation, and dynamic compliance in the GA and EDA groups did not differ. The catecholamine and cortisol concentrations at birth were higher in the vaginal group than in the group delivered by caesarean section. Two hours after birth there was a significant correlation (r = 0.84) between the catecholamine concentrations of the infants born vaginally and lung compliance. The lower dynamic lung compliance in infants delivered by elective caesarean section might be explained by delayed absorption of liquid in the lung due to lack of catecholamine surge.

Anesthesia, Epidural↗