Biomedical subjects

C Backman

Publications and source records attributed to C Backman.

At least 19 recordsLinked to original sources

PubMed1998

Cold intolerance is not more common or disabling after digital replantation than after other treatment of compound digital injuries.

Cold intolerance is a common reason for disability after hand injury. In this study of posttraumatic cold intolerance, 20 patients with a history of digital replantation were matched with 20 control subjects who had not undergone replantation. The incidence and intensity of cold-related symptoms among patients in the two groups was investigated through the use of individual interviews and a grading scale for self-assessment of symptoms. The analysis of data indicates that although the pattern of symptoms may vary, the condition is neither more common nor more disabling among those who have undergone digital replantation. Cold intolerance after digital replantation seems, therefore, to be defined by the initial trauma and not by the subsequent reconstructive surgery.

Adult↗

PubMed1998

Personal projects: a useful approach to the study of occupation.

A comprehensive and useful understanding of human occupation requires research methods that capture its individual dimensions while permitting analyses within and across groups. In this article we describe the construct of personal projects and the research method of personal projects analysis. Both have their origins in studies of personality and have been used successfully to link individual traits and context-based, goal-directed behavior to well-being and other variables. The appropriateness and relevance of this approach for studies of occupation and occupational therapy are considered.

Goals↗

PubMed1997

Impact of autonomic neuropathy on circulatory instability during liver transplantation for familial amyloidotic polyneuropathy.

BACKGROUND: Circulatory instability with severe hypotension frequently complicates liver transplantation in patients with familial amyloidotic polyneuropathy. Autonomic dysfunction is found early in the course of the disease by analysis of beat-to-beat heart rate variability (HRV). The aim of the present study was to investigate the impact of autonomic neuropathy on intraoperative circulatory instability during liver transplantation for familial amyloidotic polyneuropathy. METHODS: Twenty-two patients were evaluated at the Department of Medicine, Umea University Hospital, by spectral analysis of HRV and later received liver transplants at Huddinge University Hospital. The low-and high-frequency bands obtained by spectral analysis of HRV in the supine and upright positions, respectively, were used as representative of sympathetic and parasympathetic activity. Circulatory instability during transplantation was defined as a fall in systolic arterial blood pressure below 70 mmHg for more than 5 min during the preanhepatic phase. RESULTS: Both arrhythmia preventing spectral analysis of HRV and a sympathetic variability peak below 2.5 mHz2 were significantly more common among patients with intraoperative circulatory instability (P=0.03 and 0. 004, respectively). A diminished increase in pulse rate when tilting the patients from the supine to the upright position was also more pronounced among patients with circulatory instability (P<0.05). CONCLUSIONS: The majority of patients who will develop circulatory instability with a pronounced fall in arterial blood pressure can be identified by Poincare plots of R-R intervals and spectral analysis of HRV. A low sympathetic peak or arrhythmia precluding spectral analysis of HRV is significantly related to operative circulatory instability.

Amyloid Neuropathies↗

PubMed1997

Echocardiographic findings, lipids and lipoprotein(a) in patients with systemic lupus erythematosus.

Cardiac involvement, evaluated by echo-doppler-cardiography, occurred in 41 of 50 (82%) patients with systemic lupus erythematosus (SLE). Valvular pathology with aortic cusp sclerosis was the most prevalent finding irrespective of age. This finding, suggestive of atherosclerotic heart disease, was supported by increased levels of cholesterol and triglycerides in these patients. There was no significant increase in Lp(a) in the whole patient group, but Lp(a) was raised in patients with proteinuria. Forty percent of the SLE patients had pericarditis. Twelve patients with hypertension and/or mitral regurgitation had increased dimensions of left ventricle, left atrium or interventricular septum while 15 of 50 patients had isolated increase of these parameters. Localized hypokinesia was found in nine patients. Reduced cardiac index was found in five patients with SLE. There was no association between valvular disease, increased pulmonary artery pressure, and anticardiolipin antibodies.

Adult↗

PubMed1997

Pattern recognition in post-traumatic cold intolerance.

The subjective symptoms called "post-traumatic cold intolerance" were analysed in a study of 40 patients with a history of digital trauma (amputation, neurovascular laceration, or comminuted fracture requiring surgical reconstruction). The patients were individually interviewed to obtain detailed information about perception of each symptom as well as the pattern of symptoms of post-traumatic cold intolerance. The study confirmed the high incidence of the condition and its potentially disabling nature. Although the individual symptoms described by the patients have a limited number of categories, the subjective expression of cold intolerance is too varied to allow an adequate definition or assessment to be based on any single symptom or group of symptoms.

Adult↗

PubMed1997

Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden.

BACKGROUND AND PURPOSE: The aim of this study was to conduct a population-based epidemiological survey among young adults aged 18 to 44 years in Northern Sweden and furthermore to gain further insight into the etiology of ischemic stroke in this age group. METHODS: Two studies were done. In the first part, epidemiological data were collected to calculate incidence and mortality from 1991 through 1994. This was based on the World Health Organization Northern Sweden MONICA register of acute stroke events. Eighty-eight first-ever ischemic stroke patients were identified during that period. In the second part, 107 consecutive patients aged 18 to 44 years with ischemic stroke referred to a university hospital were studied prospectively during a 5-year period and were extensively evaluated according to a standardized protocol. On the basis of modified Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria, the patients were classified into eight subtypes of ischemic stroke. RESULTS: The average population-based annual incidence rate for ischemic stroke (cases per 100,000 per year) was 11.3 (95% confidence interval, 6.7 to 16.1). The case-fatality rate was 5.7%. According to the modified TOAST criteria, a probable cause of ischemic stroke was identified in 36% and remained unexplained in 21% of cases. Spontaneous cervical arterial dissection was the leading probable etiology (13%). Patent foramen ovale or atrial septal aneurysm was a possible cause of stroke in 28% of cases. The percentages of ischemic stroke attributed to IgG anticardiolipin antibodies (4.7%), atherothrombotic vasculopathy (3.7%), oral contraceptive use (7%), and migraine (1%) were lower than reported in recent clinical series. CONCLUSIONS: The incidence rate for ischemic stroke was higher than previously reported from most countries in Western Europe. The higher incidence was not explained by a higher prevalence of premature atherosclerotic vasculopathy. Without the additional diagnostic information derived from advanced cardiac imaging, the proportion of indeterminate cases would have constituted 37% of the patients.

Adolescent↗

PubMed1995

Arthritis hand function test: inter-rater reliability among self-trained raters.

OBJECTIVE: The purpose of this project was to examine the inter-rater reliability of the Arthritis Hand Function Test (AHFT), a new instrument for measuring hand strength and dexterity in adults with arthritis. METHODS: Six occupational therapists (two at each of three sites) trained themselves as AHFT administrators using the test manual and training videotape. They recruited 30 adult subjects (10 at each site) with rheumatoid arthritis or osteoarthritis affecting the hands. There were 21 women and 9 men in the sample (mean age, 57.5 years; average time since diagnosis, 14.8 years). Subjects were tested twice, once by each rater from that site. RESULTS: Inter-rater reliability ranged from 0.45 to 0.99 (Pearson r). Because subjects were tested twice, AHFT scores were examined for an order effect. Although scores on all strength items declined by the second test session, and improved for all dexterity items, only the aggregate applied dexterity score showed significant change across all three sites (P = 0.002, 0.001, and 0.031, respectively). CONCLUSIONS: These results suggest the AHFT is a reliable instrument for measuring hand strength and dexterity that requires minimal training on the part of occupational therapist raters.

Arthritis↗

PubMed1995

Pulmonary venous systolic flow fraction in patients with mitral regurgitation: transoesophageal echocardiographic findings in relation to haemodynamic and angiographic evaluation.

In patients with mitral regurgitation (MR), pulmonary venous systolic flow fraction (PVSFfr) recorded using pulsed Doppler transoesophageal echocardiography (TEE) was compared with PVSFfr in normal subjects, to angiographic grading and to haemodynamic parameters. PVSfr was calculated as the systolic flow velocity integral divided by total inflow integral. PVSfr is negative when systolic flow is reversed. Forty patients with MR were studied. PVSFfr < 0 was 100% sensitive for angiographic severe MR (specificity 83%). In 35 patents heart rate differed by 10 bpm or less between TEE and cath, either at rest or during stress. PVSFfr was correlated with angiographic grade (r = -0.69, P < 0.0001), with mean PCW (r = -0.61, P < 0.0001), with the v-wave (r = -0.72, P < 0.0001), with systolic blood pressure (r = 0.48, P < 0.005) and with left atrial diameter (r = -0.52, P < 0.005). Stepwise forward multiple linear regression analysis revealed the v-wave, angiographic grading and systolic blood pressure to be independent predictors of PVSFfr. PVSFfr differed in normal subjects, patients with 0-2+ and patients with 3-4+ regurgitation. PVSFfr is a valuable index in assessing mitral regurgitation. This index may be less dependent on equipment and operator than colour flow imaging.

Adult↗

PubMed1995

Comparison of some criteria for diagnosing a myocardial infarction after aorto-coronary bypass grafting (CABG).

The incidence of myocardial infarction during a 1-year follow-up period after coronary bypass surgery (CABG), i.e. a recent myocardial infarction (RMI), was studied in 86 patients. Different criteria for the diagnosis of a RMI were compared. Clinical observation, including ECG and serum enzyme analysis, diagnosed RMI in 8% of patients. Specific ECG changes indicating RMI (ECGsp) occurred in 12% of cases, and if less specific ECG changes were also taken into account (ECGsp+nonsp) RMI was found in 30% of cases. Asynergy, detected by two-plane ventriculography, indicated RMI in 24% of the patients, and was probably the most valid of the criteria examined. The differences in diagnostic accuracy of the various criteria highlight the importance of defining diagnostic criteria.

Adult↗

PubMed1995

Cold induced vasospasm in replanted digits: a comparison between different methods of arterial reconstruction.

Nineteen patients each of whom had had a single digit replanted were examined after replantation. The arterial reconstruction had been done with long grafts (n = 10) or short grafts or no graft (n = 9). The effect of local or whole body cooling on the replanted and uninjured opposite digits was monitored (9-46 months after the replantation), and the patients were given a questionnaire (9-95 months after replantation) designed to explore the development of their cold related symptoms in relation to time. All patients were troubled by cold intolerance, and improvement occurred in only 60% of the cases. Pathological (vasospastic) arterial reactions to cold measured as finger systolic pressure, were less common after replantation with long grafts. Perceived cold intolerance was significantly more pronounced in the group of patients (60%) who had evidence of cold induced arterial spasm in the replanted finger.

Adult↗

PubMed1994

Contaminated collection media as a cause of pseudoinfection.

Following the appearance of positive Gram's stains from sterile surgical cases, an investigation was begun. Nonviable but stainable bacteria were found in the gel-based transport media. The use of a cause-and-effect diagram helped to show the numerous items that affected the problem.

Bacteria↗

PubMed1994

Anaesthesia for abdominal vascular surgery in patients with coronary artery disease (CAD), Part I: Isoflurane produces dose-dependent coronary vasodilation.

The effects of anaesthesia for major abdominal vascular surgery on coronary flow regulation and mechanisms of myocardial ischaemia were studied in 56 patients with CAD, using a randomized, partly double-blinded protocol. After induction with fentanyl (3 micrograms.kg-1) and thiopentone (2-4 mg.kg-1) and tracheal intubation, principal anaesthetics were nitrous oxide/oxygen (60/40) with isoflurane (n = 20), halothane (n = 19) or fentanyl (15-20 micrograms.kg-1) (n = 17). Conventional invasive techniques and coronary venous retrograde thermodilution were used to assess systemic and coronary haemodynamics. Coronary vascular resistance was estimated from myocardial oxygen extraction. Myocardial ischaemia was diagnosed by 12-lead ECG and/or anterior wall motion abnormalities by cardiokymography and/or myocardial lactate production. When adjustment of anaesthetic dose was insufficient for haemodynamic control, i.v. phenylephrine and nitroglycerine were administered to treat hypotension and hypertension or cardiac failure respectively. Measurements were performed at four specific intervals; awake, before surgery and 10 and 30 min after abdominal incision. Comparable changes of systemic haemodynamics and myocardial oxygen consumption were observed in the three groups. Coronary vasodilation was evidenced in isoflurane patients only and was linearly dose-dependent (P < 0.001). Partial Least Squares Projections to Latent Structures modelling with cross validation confirmed this dose-dependency and ruled out a clinically measurable influence by intervention drugs or simultaneous systemic haemodynamic abnormalities. The incidence of myocardial ischaemia during anaesthesia and surgery was comparable in the three groups (35, 37 and 24%, respectively) and there was an association with systemic haemodynamic aberrations in 19 of the 27 ischaemic episodes. In contrast to ischaemic halothane and fentanyl patients, isoflurane patients with ischaemia had significantly lower myocardial oxygen extraction (P = 0.008 and P = 0.001, respectively), indicating that the oxygen extraction reserve was not utilized in a normal way during ischaemia.

Abdomen↗

PubMed1994

Anaesthesia for abdominal aortic surgery in patients with coronary artery disease, Part II: Effects of nitrous oxide on systemic and coronary haemodynamics, regional ventricular function and incidence of myocardial ischaemia.

This study examines the effects of nitrous oxide on haemodynamics, anterior left ventricular (LV) function and incidence of myocardial ischaemia in abdominal vascular surgical patients with coronary artery disease. Forty-seven patients were randomly assigned to isoflurane-fentanyl anaesthesia with nitrous oxide-oxygen vs air-oxygen (control). Systemic and coronary haemodynamics, 12-lead ECG, LV anterior wall motion by cardiokymography (CKG) and myocardial lactate balance were recorded at four intervals: before and during anaesthesia and 10 and 30 minutes into surgery. Systemic haemodynamics were controlled by anaesthetic dose, and, when insufficient, by i.v. nitroglycerine (NG) in case of LV failure (PCWP > 18 mmHg) and by phenylephrine during hypotension. We found that nitrous oxide was associated with greater need for i.v. nitroglycerin (patients: P = 0.031, episodes P = 0.005) and more myocardial ischaemia (patients P = 0.012, episodes P = 0.001) despite systemic and coronary haemodynamics comparable to the control group. We conclude that nitrous oxide, known to have both sympathomimetic and cardiodepressive actions, produced cardiodepression in the face of sympathetic stimulation. Our study design did not allow to conclude if myocardial ischaemia was the consequence of increased wall stress or a reason for the observed LV dysfunction. The higher incidence of introperative myocardial ischaemia and need for NG did not cause increased cardiac morbidity.

Abdomen↗

PubMed1994

Effects of digitalis, anti-anginal drugs and arterial hypertension on the relationships between exercise ECG and angiocardiographic variables and on the diagnostic accuracy of exercise ECG in patients with coronary heart disease.

We have previously found a statistically significant correlation between some exercise ECG variables and angiocardiographic scores used to evaluate the extent and type of coronary heart disease (CHD). In the present study we examined the effects of digitalis, beta-adrenergic blockers, slow release nitrates, calcium channel blockers, presence of arterial hypertension (AHT), and angiocardiographic changes on the exercise ECG variables. The effects of drugs and AHT were small as compared to the effects of the angiocardiographically detected pathological changes caused by the CHD. Sensitivity and specificity of the exercise ECG ST criteria in identifying patients with an angiocardiographic criterion indicating coronary insufficiency were not much different in the whole group and in the subsets with AHT or medication with digitalis and anti-anginal drugs.

Adrenergic beta-Antagonists↗

PubMed1993

Echocardiographic findings in patients with primary Sjögren's syndrome.

Cardiac involvement in 27 consecutive patients fulfilling the criteria for primary Sjögren's syndrome was evaluated using echo-doppler-cardiography. A clinical physical examination showed that the heart was normal in all patients. Nine (33%) had signs of present or previous pericarditis with effusion and/or fibrin deposition, four of them had chest symptoms. The pericarditis patients were slightly older, had significantly shorter disease duration, had significantly increased levels of orosomucoid and haptoglobin, and were significantly more often antinuclear-antibody positive than those without pericarditis. Of the echocardiographic measurements, the left ventricular systolic dimension was significantly smaller and the fractional shortening of the left ventricle significantly higher in the pericarditis patients. However, four of the nine pericarditis patients had localized hypokinesia of the left ventricle, all with unspecific ECG changes, while only one without pericarditis showed this symptom. No patient had low voltage, ST-T elevation or conduction abnormalities. Mitral valvular thickening was found in one patient and age-related sclerosis of the aortic cusps appeared in some.

Adult↗

PubMed1993

Arterial spasticity and cold intolerance in relation to time after digital replantation.

Cold induced arterial vasospasm was studied in ten patients with single digit replantation, by measuring finger systolic pressure at different finger temperatures. Each patient was examined three times; within 2 weeks of surgery, after 1 year and after 3 years. The replantations were performed using long arterial and venous grafts. Cold-related vasospasm is established during the first year after trauma, and thereafter seems to be persistent. It is concluded that the subjective cold tolerance, which affects all patients after digital amputation regardless of whether replantation is performed or not, is partly due to vasospasm. It is less pronounced in patients without pathological vasospasm in the replanted digit. Cold intolerance is likely to decrease during the first 2 years after replantation, but not to disappear completely.

Adult↗

PubMed1993

Relationships between exercise ECG and angiocardiographic indices of coronary insufficiency and myocardial fibrosis in coronary heart disease.

Patients with coronary heart disease were examined with exercise ECG and angiocardiography. Maximum work capacity expressed as a percentage of the predicted normal exercise tolerance (Wmax%) was significantly associated with the angiocardiographic score of the myocardial mass subserved by obstructed coronary arteries (MCOS). Variables related to myocardial fibrosis (MF) such as post infarction ECG signs, the left ventricular wall motion score (LVMS) and the ejection fraction of the left ventricle (LVEF) correlated significantly as did variables related to reversible myocardial ischaemia or coronary insufficiency (CI), such as ST depression during exercise (STdepr), ST/W and ST/HR indices, effort angina (EA/W) index, the extent of collaterals (CollS), and 'MCOS-LVMS'. MF variables correlated weakly with CI variables. Wmax% covariated with the variables related to both CI and MF, and most closely with MCOS. Discrepancies between results of exercise ECG and angiocardiography have to some extent been overcome by comparing appropriate parameters.

Adult↗

PubMed1992

Effects of ethanol on development of dorsal raphe transplants in oculo: a morphological and electrophysiological study.

The purpose of this project was to investigate ethanol influence on the development of serotonin-containing (5-HT) neurons of the dorsal raphe nucleus in rat. Fetal tissue of embryonic day 17 from the dorsal brainstem was grafted to the anterior chamber of the eye of adult albino rats. The experimental group was exposed to 16% ethanol in the drinking water, and the control group received water ad libitum. After 4 weeks, morphological and electrophysiological evaluations were performed. Immunohistochemical analysis showed that 5-HT-immunoreactive fibers from ethanol-treated transplants had a disturbed outgrowth pattern into the host iris as compared to the control group. Furthermore, the outgrowth area and axon bundle formation was significantly greater in the control group than in the ethanol group. Electrophysiological recordings revealed a dose-dependent biphasic effect of locally applied ethanol on transplanted monoaminergic neurons. Low doses of ethanol (0.5-3 mM) induced an increase in basal firing rate of control neurons, while higher doses (10-100 mM) caused inhibition. However, monoaminergic neurons in the ethanol group showed a decreased neuronal sensitivity to locally applied ethanol. The same dose of locally applied ethanol which produced an excitation of neuronal activity in the ethanol transplants produced an inhibition in the control grafts. The dose-response curve was shifted to the right. The present results suggest that chronic ethanol exposure during early development leads to altered axonal outgrowth from brainstem 5-HT neurons, as well as decreased sensitivity of these neurons to locally applied ethanol.

Animals↗