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Biomedical subjects

B Zederfeldt

Publications and source records attributed to B Zederfeldt.

At least 37 records · Page 2Linked to original sources
PubMed1992

A demographic survey of leg and foot ulcer patients in a defined population.

By means of a questionnaire sent to all medical units in Malmö, including primary care, homes for the elderly, and industrial health clinics, 275 patients with leg and foot ulcers were identified. With a population of 232,908 in Malmö, this corresponds to a prevalence of 0.12%, which is lower than reported by others. Since the response rate was high (88% total, Primary Care: 100%), the prevalence of 0.12% is, however, believed to be real and might be explained by the urban area investigated, with easy access to care and proximity to one somatic hospital. 50% of the patients with leg and foot ulcers were treated in Primary Care, and 30% of the leg ulcer patients were treated at the Department of Dermatology. 88% of leg and foot ulcer patients were over 75 years of age. Median age was 79.5 years, with 80 for women and 76.5 for men. In Primary Care the median age was 82. There was a predominance of women in the study population with an overall sex ratio of 3:1. A higher proportion of patients living alone was found in Primary Care. The etiology of the ulcers was considered to be "unknown" or "other" or else no statement was given in 36% of the leg ulcer- and 22% of the foot ulcer patients. This might reflect an overall uncertainty about the underlying etiological cause. Medially and laterally located leg ulcers were reported equally often, but there was also a great proportion of wholly or partially circumferential ulcers. 76% of the foot ulcers were located on the toes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Importance of dehydration in anastomotic and subcutaneous wound healing: an experimental study in rats.

OBJECTIVE: To find out if preoperative and postoperative dehydration adversely affect anastomotic and subcutaneous healing. DESIGN: Randomized study. MATERIAL: 18 Wistar rats. INTERVENTIONS: Dehydration established in nine rats by withdrawal of food and water for 24 hours before operation, and by injections of frusemide twice daily. Laparotomy and division of intestine 5-8 cm from the ileocaecal valve. Implantation of expanded polytetrafluoroethylene (ePTFE) tubes in the backs of the necks. All rats killed after five days. MAIN OUTCOME MEASURES: Measurements of weight loss and of hydroxyproline per centimetre in the ePTFE tubes and standardized biopsy specimens of the intestine. Presence of anastomotic dehiscence at necropsy. RESULTS: Preoperative and postoperative dehydration caused a 24% weight loss in the experimental group on day 5 compared with 8% in the control group. Dehydrated animals accumulated less collagen in the ePTFE tubes than control animals (p less than 0.05). There were three anastomotic breakdowns in the dehydrated group compared with one in the control group. There was a loose but significant correlation between collagen accumulation in the anastomoses and the weight of the animal (r = 0.5, p less than 0.05). CONCLUSION: Preoperative and postoperative dehydration has a deleterious effect on subcutaneous, and to a lesser extent on anastomotic healing in rats.

Anastomosis, Surgical↗
PubMed1992

Effect of tissue perfusion and oxygenation on accumulation of collagen in healing wounds. Randomized study in patients after major abdominal operations.

OBJECTIVE: To compare the accumulation of collagen in standardised wounds in patients who had abdominal operations and whose postoperative fluid replacement was decided either clinically or by measurements of subcutaneous oxygen tension (PscO2). DESIGN: Prospective randomised trial. SETTING: University Hospital. SUBJECTS: Twenty-nine patients with cancer or inflammatory bowel disease who were undergoing abdominal operations. INTERVENTIONS: Silicone rubber catheter placed in the upper arm to measure PscO2. Two tubes of expanded polytetrafluoroethylene (ePTFE) implanted subcutaneously parallel to the silicone rubber catheter to measure the amount of collagen accumulated. MAIN OUTCOME MEASURES: Amount of postoperative fluid replacement required in each group, and measurements of hydroxyproline/cm of the ePTFE tubes. RESULTS: The group treated according to PscO2 measurements received more fluid on the day of operation than the group treated according to clinical criteria (p < 0.05). They had accumulated more collagen in their ePTFE tubes by day 7 (p < 0.05). CONCLUSION: Replacement of fluid according to measurements of PscO2 rather than by clinical criteria results in improved accumulation of collagen in healing wounds.

Adult↗
PubMed1991

Bacterial load and inflammatory reaction in the bowel wall after colonic obstruction. An experimental study in rats.

To quantify the inflammatory reaction to obstruction, alkaline phosphatase and myeloperoxidase activities were measured in specimens of colonic wall from 60 rats. Twenty rats had undergone laparotomy and band obstruction, 20 laparotomy without obstruction and 20 had no operation. The mean activities of both enzymes were increased proximal but not distal to the obstruction, that of alkaline phosphatase significantly so. Despite increase in the number of bacteria, both proximal and distal to the obstruction, no signs of bacterial invasion of the bowel wall were seen either on histological examination or culture. These findings indicate that mechanical factors may be more important than bacteria in causing the increased inflammatory reaction in bowel wall proximal to an obstruction.

Alkaline Phosphatase↗
PubMed1990

Peroperative contamination and anastomotic leakage after resection for left colon stenosis. An experimental study in the rat.

In this experimental study the effect of peroperative faecal soiling on immediate postoperative anastomotic leakage after resection and primary anastomosis of a left colon obstruction was evaluated. Faecal soiling was quantified by a standardized irrigation of the abdominal cavity and then culturing of the fluid. An increased peroperative soiling was found after resection of a stenosis compared to resection of a non-stenotic bowel. Anastomotic complications were correlated to the degree of bacterial contamination and a breakpoint of 10(4) CFU/ml was found. Immediate postoperative leakage, tested with the bacteria Serratia marcescens, was not increased in the stenosis group. Thus, peroperative bacterial contamination seems to be one important factor in developing anastomotic complications after resection of colonic obstruction while an immediate leakage of bacteria through the anastomosis seems to be less important.

Anastomosis, Surgical↗
PubMed1990

The effect of diverting colostomy on anastomotic healing after resection of left colon obstruction. An experimental study in the rat.

A standardized stenosis of the left colon was created in the rat model. After four days the stenosis was resected and a primary anastomosis made. Half of the animals (n = 21) were randomized to a proximal diverting colostomy and the other half to a non-colostomy control group. On postoperative days two and seven anastomotic complications were recorded and anastomotic strength was determined. Collagen content in the anastomotic area was measured. In the colostomy group no anastomotic complications occurred, while 6/21 (29%) animals in the non-colostomy group had complications. On day two there was no difference between the groups as regards anastomotic strength and collagen content. After a week, however, the control group showed a significant increase in both anastomotic strength and collagen content which was not observed in the colostomy group. The absence of increase in anastomotic strength in the colostomy group had no adverse effect on anastomotic healing, as judged by complications. Thus, a diverting colostomy may be of value in reducing anastomotic complications after resection of a left colon obstruction.

Anastomosis, Surgical↗
PubMed1990

Anastomotic healing after resection of left-colon stenosis: effect on collagen metabolism and anastomotic strength. An experimental study in the rat.

Anastomotic breaking strength and collagen metabolism in the colonic wall were studied after resection of a standardized left-colon stenosis in the rat. An increased complication rate was found in the stenosis group compared with the control group (27 percent vs. 2 percent) and the complications arise soon after surgery. The collagen turnover in the anastomotic area, as well as the changes of breaking strength, were equal between the groups in the early healing course, implying that the stenosis group, as an entity, did not show impairment in the studied parameters predisposing for complications. Other factors such as mechanical strain by the increased fecal bulk and increased bacterial load may contribute to occurrence of the anastomotic complications.

Anastomosis, Surgical↗
PubMed1990

Preoperative localization in unilateral parathyroid surgery. A cost-benefit study on ultrasound, computed tomography and scintigraphy.

In 50 patients with primary hyperparathyroidism, investigation before initial neck exploration included ultrasonography, computed tomography and 99technetium-201thallium subtraction scintigraphy. The sensitivity for correct preoperative localization was 50%, 54% and 56%, respectively. There was marked inter-observer variation in assessment of ultrasonography and computed tomography, while scintigrams were evaluated by only one person. The scintigraphic sensitivity increased with size of the glands. In cases where correct preoperative localization permitted unilateral parathyroidectomy, the time for surgery and anesthesia was significantly reduced. A cost-benefit analysis, however, revealed that the financial saving from this time reduction was outweighed by the cost of the localization procedures. The authors conclude that investigations for definition of enlarged parathyroid glands are not indicated prior to unilateral parathyroidectomy.

Adult↗
PubMed1990

Tension leads to increased neutrophil accumulation and decreased laparotomy wound strength.

Wound margin strength was measured immediately after and at 72 hours after median laparotomy in rats. The laparotomy wound was sutured with or without tension, and wound margin strength was measured as breaking strength with the sutures in situ. In wounds sutured without tension, no decrease in breaking strength was observed at 72 hours; in rats sutured with tension, breaking strength decreased by 77%, and in almost half of the animals the sutures cut through. There was markedly increased accumulation of neutrophil leukocytes around the sutures in the tension group, as indicated by increased tissue myeloperoxidase activity. The decrease in breaking strength was abolished by treatment with an inhibitor of the collagen-degrading proteinases of the neutrophils (the soybean trypsin inhibitor). Although the decrease in breaking strength should be due to collagenolysis, there were no changes in collagen content or solubility around the sutures, indicating that the changes in collagen were too delicate to be revealed by the methods used. We conclude that the decrease in breaking strength was caused by the neutrophils.

Abdominal Muscles↗
PubMed1990

Impact of bacteria on metabolism of collagen in colonic obstruction in rats.

The influence of bacteria on metabolism of collagen in the colonic wall under normal conditions and after obstruction was evaluated by using germ-free and conventionally bred rats. Under normal conditions, no differences in synthesis and content of collagen or tissue dry weight in the colonic wall were found between germ-free and conventionally bred rats. After obstruction, both groups reacted similarly with an equally increased collagen synthesis. The findings imply that bacteria do not play any major role in the regulation of collagen metabolism in the colonic wall, neither under normal conditions nor in the strained situation with colonic obstruction and fecal impaction.

Animals↗
PubMed1989

Sutureless large bowel anastomosis: European experience with the biofragmentable anastomosis ring.

Sutureless colonic anastomosis using a biofragmentable anastomosis ring (BAR) has been evaluated in a prospective randomized comparison with sutures and staples for elective colorectal surgery. One hundred and one patients underwent BAR anastomosis, 85 a sutured anastomosis, and 16 a stapled anastomosis. There were two anastomotic leaks in the patients undergoing BAR anastomosis, seven in patients having a sutured anastomosis, and one in a patient who had a stapled anastomosis. Wound infection occurred in ten BAR patients, ten sutured patients and no stapled patient. There was no statistically significant difference in these or in other postoperative complications between the groups. The BAR was easy to use and is a safe alternative to sutures and staples for large bowel anastomosis.

Adolescent↗
PubMed1988

Influence of proximal colostomy on the healing of a left colon anastomosis: an experimental study in the rat.

The healing of an experimental left colon anastomosis protected by a proximal diverting colostomy was studied in the rat. Collagen synthesis in the anastomotic area was measured by incorporation of [3H]proline. With a defunctioning proximal colostomy, the synthesis and accumulation of collagen in the anastomosis was diminished, and the anastomotic strength development delayed and reduced. The development of anastomotic strength seems to proceed according to the level of strain from intraluminal bulk. As the healing of the anastomosis protected by a diverting colostomy was uncomplicated, these findings should not contra-indicate the use of diverting colostomy.

Anastomosis, Surgical↗
PubMed1988

Healing of a left colon anastomosis after early colostomy closure. An experimental study in the rat.

The healing of a standardized left colon anastomosis after early (7 days) closure of a concomitant proximal diverting colostomy was studied experimentally. Early closure of the diverting colostomy could be conducted safely by an intraperitoneal technique and the healing of the primary anastomosis was uncomplicated. Colostomy closure in the proliferative phase of wound healing resulted in development of anastomotic strength similar to colonic healing without faecal diversion. The anastomotic strength had doubled after three weeks. As compared to colostomy closure in the remodelling phase of anastomotic healing development of anastomotic strength was more rapid and without serious local complications.

Anastomosis, Surgical↗
PubMed1988

Influence of long-term relative bowel rest on the healing of a left colon anastomosis.

The influence of long-term relative bowel rest, using a low residue diet, on healing of a left colon anastomosis was experimentally studied. Retarded and diminished gain of postoperative anastomotic collagen and strength was found. The healing of the anastomosis was uncomplicated, however, and it is concluded that anastomotic integrity after surgery in this condition is safe.

Albumins↗