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Biomedical subjects

D Sørlie

Publications and source records attributed to D Sørlie.

At least 19 recordsLinked to original sources
PubMed2000

Predictors of satisfaction with surgical treatment.

OBJECTIVE: To investigate prospectively which medical, psychosocial or treatment-related factors predicted treatment satisfaction and to evaluate the adequacy of a preceding retrospective study which had examined the same factors. Furthermore, to examine the predictors and the stability of the major determinants of patient treatment satisfaction. DESIGN: Assessments made before admission, at discharge and 2 and 4 months after discharge were used to predict both the level and the rate of change in satisfaction with different aspects of treatment. SETTING: Three surgical departments at a University Hospital. STUDY PARTICIPANTS: Four-hundred and eighty-two patients electively admitted for several surgical conditions. RESULTS: The central treatment-related measures were the same in the retrospective and prospective studies: global satisfaction with treatment (GS), perceived quality of contact with the nursing (QCN) and medical staff (QCM) and provision of adequate treatment information (INF). More of the variance in GS was explained in the prospective study (48.7% versus 36.3%). GS was most influenced by treatment-related factors with QCN as the strongest predictor in both studies. Only a small portion of the variance in QCN and QCM could be accounted for by the characteristics of the patients. INF was predicted by characteristics of the patients, their illness and life situation and by treatment-related factors. QCN was the strongest predictor of INF. The relationships with the nursing and medical personnel appear to be the major determinants of both patient treatment satisfaction and patients' reception of adequate information about their condition and its treatment.

Adult↗
PubMed1999

Endothelial injury and trapping of blood cells in human myocardium following coronary bypass surgery.

To investigate the focal myocytic and microvascular injury that develops during the first hour of reperfusion after hypothermic cardioplegic cardiac arrest, and to compare the influence of gentle versus more abrupt reperfusion, serial atrial biopsies were obtained from 14 patients undergoing uneventful coronary bypass surgery. The biopsies were taken before cardioplegia, at the start of reperfusion, and after 20 and 60 min of reperfusion. Transmission electron micrographs of biopsies examined by stereological techniques revealed endothelial injury. Following 20 min reperfusion there was accumulation of both red blood cells (p = 0.03) and polymorphonuclear leucocytes (p = 0.0004) were found. There was also intravascular accumulation of platelets (p = 0.008) and extravasation of red blood cells (p = 0.02), which increased throughout the observation period. If reperfusion was started with a gradual rise in temperature and pressure, the numbers of platelets in the microvessels were lower than following ordinary, abrupt reperfusion (p = 0.06). It is concluded that reperfusion injury is associated with microcirculatory disturbances with trapping of blood cells, changes which may be favourably modified by a gentle reperfusion technique.

Adult↗
PubMed1998

[Satisfaction and dissatisfaction with surgical treatment].

Using two different methods simultaneously, a surgical department assessed how former patients experienced the treatment they received. One method was based on a specifically designed questionnaire, while the other studied the patients negative experiences with regard to their treatment. The two approaches were compared in 610 respondents. The questionnaire yielded a more differentiated response pattern than did the other approach. While most of the respondents (88%) expressed overall satisfaction, the degree of satisfaction with information and supervision was not so high. The importance of the doctor's role was strongly emphasized, especially in the "negative experiences" approach. The use of this approach is dependent on the questions covering aspects of treatment actually experienced by the patient. The simultaneous use of both approaches will not only provide information about how patients experience essential aspects of their treatment but also what they consider to be the most problematic practical issues. This will encourage greater motivation among the staff to become involved in evaluation and improvement of treatment.

Adolescent↗
PubMed1997

[To what degree can patient satisfaction be explained? An analysis of a retrospective study].

A retrospective survey comprising 1198 randomly chosen former surgical patients was carried out on average ten months after treatment. The goal of the research project was to investigate the associations between global satisfaction with treatment and issues that might influence how the treatment was experienced. There were no significant differences between the 610 responders and the sample of 1198 patients with respect to age, sex, length of treatment and diagnosis. The following five variables explained together 36.2% of the variance in global treatment satisfaction: Subjective health at time of investigation, the personality dimension conscientiousness, the "degree of severity of the illness", "contact with doctors and nurses" and "conveyed information and supervision". "Contact with doctors and nurses" alone explained 25.1% of the variance.

Female↗
PubMed1997

High cardioplegic perfusion pressure entails reduced myocardial recovery.

OBJECTIVE: The cardioplegic solution is often given at high flow and pressure following aortic clamping clamping to ensure rapid diastolic arrest. With standard setup in clinical practice, it is easy to exceed 200 mmHg in the aortic root. To investigate whether cardioplegic solution delivery pressure has an influence on myocardial protection, intermittent infusions of crystalloid cardioplegia were given at two different pressures using an in vivo pig model. METHODS: Fourteen pigs (48-57 kg) were put on cardiopulmonary bypass, aorta-clamped (2 h) and 500 ml St. Thomas' cardioplegia (4 degrees C) was delivered antegradely at either 75 mmHg (group 1, n = 7) or 175 mmHg (group 2, n = 7) pressure via 9-F aortic root cardioplegic needle. Every 20 min, 100 ml cardioplegic were delivered at either one of the two pressures. After 2 h, the aorta was unclamped and the hearts reperfused. Attempts were made to wean pigs from bypass following 20 min reperfusion or, if they were failing, after 40 min. If failing once again, the pigs were reperfused for the last 20 min on the heart-lung machine. RESULTS: Hearts in group 1 (n = 7) needed significantly longer time to stop after aortic clamping (38 +/- 9 s) than did group 2 hearts (n = 7) (21 +/- 5 s) (P = 0.043). In group 1, all pigs were weaned from bypass, whereas in group 2 only 2 out of 7 pigs were able to sustain circulation without cardiopulmonary bypass (P = 0.01), and then with lower hemodynamic performances. At the end of cardiac arrest, group 1 had significantly higher adenosine triphosphate (19.4 +/- 1.1 mumol/g dry weight and 15.05 +/- 1.8 mumol/g dry weight, respectively) (P = 0.05) and significantly lesser fall in energy charge than group 2 (0.02 +/- 0.01 and 0.05 +/- 0.02, respectively) (P = 0.05). Also at the end of reperfusion, group 1 had significantly higher adenosine triphosphate (16.54 +/- 1.4 mumol/g dry weight and 12.53 +/- 0.95 mumol/g dry weight, respectively) (P = 0.016) than group 2. CONCLUSIONS: Despite a swifter diastolic cardiac arrest, the high cardioplegic solution delivery pressure caused significantly poorer postischemic recovery than a moderate pressure with the same amount of cardioplegic solution.

Adenosine Triphosphate↗
PubMed1996

Myocardial substrate oxidation during warm continuous blood cardioplegia.

BACKGROUND: Although long-chain fatty acids are a major energy substrate utilized by the myocardium, changes in the substrate balance toward a predominating fatty acid utilization could jeopardize the myocardium during cardiac operative procedures. METHODS: In the present study myocardial substrate utilization was examined during warm continuous blood cardioplegia (4 hours, 37 degrees C), using pigs undergoing cardiopulmonary bypass. Hearts were perfused antegradely in a closed extracorporeal circuit in which cardioplegic donor blood (hematocrit, 22%) containing 14C-glucose and 3H-oleate was delivered to the heart. Arterial and coronary sinus blood samples were taken at intervals for determination of plasma concentrations of energy substrates, as well as glucose and oleate oxidation rates (14CO2 and 3HOH production). RESULTS: The concentration of fatty acids in the cardioplegic perfusate did not change significantly during the cardiac arrest period. The mean concentration of glucose showed a 30% decline (not significant), whereas the lactate concentration increased from a starting value of 3.12 +/- 0.27 to 6.31 +/- 0.72 mmol/L at the end (mean +/- standard error of the mean; n = 8; p < 0.05). Only fatty acid levels showed a significant (positive) arterial-coronary sinus difference. Myocardial oxidation of oleate varied between 302 +/- 71 and 650 +/- 66 nmol.min-1.heart-1, whereas the range of variation for glucose oxidation was 144 +/- 64 to 355 +/- 107 nmol.min-1.heart-1. However, the changes in fatty acid levels and glucose oxidation rates during the cardiac arrest period were not statistically significant. We calculated that overall glucose oxidation accounted for less than 5% of the total aerobic energy production. CONCLUSIONS: The present results demonstrate overreliance on fatty acids as a source of energy during warm continuous blood cardioplegia, consistent with a condition of myocardial insulin resistance.

Adenosine Triphosphate↗
PubMed1996

Normotherm continuous blood cardioplegia for 4 hours in an in vivo pig model.

Warm, continuous blood cardioplegia should theoretically maintain cardiac arrest for hours without ischaemic or hypothermic injury. In the absence of in vivo studies of myocardial metabolism and ultrastructural and/or functional preservation during and after more than 2 hours of cardiac arrest and after weaning from bypass, we devised a porcine model with a closed extracorporeal circuit for the heart alone. Normothermic blood cardioplegia was administered antegrade and recirculated for 2 or 4 hours, each in seven pigs. After aortic declamping all were successfully weaned from bypass and reperfused for 1 hour. Thereafter we found no significant intergroup difference in haemodynamic characteristics (average fall in mean arterial pressure 31.7 +/- 3.2% and 26.9 +/- 2.6%) or blood analyses. After 5 and 60 minutes of cardiac arrest there was minimal lactate production (5.7 +/- 10.7 and 0.5 +/- 10.5 nmol/l, respectively), whereas in the remainder of the arrest period there was lactate uptake, indicating aerobic heart metabolism. Our setup avoids systemic hyperkalaemia, gives good cardiac protection with no deterioration between 2 and 4 hours and is well suited for studies on the quiescent, blood-perfused oxygenated heart.

Animals↗
PubMed1995

[Aortic root reconstruction with homograft in bacterial endocarditis].

We describe successful use of respectively an aortic and a pulmonary homograft as total root replacement in two patients with extensive aortic valve endocarditis. At follow-up 18 months after operation both patients were doing well and echocardiography demonstrated excellent graft function with only trivial aortic regurgitation.

Adult↗
PubMed1995

Myocardial and microvascular injury following coronary surgery and its attenuation by mode of reperfusion.

In 14 patients undergoing coronary surgery, repeated atrial biopsies were obtained before and at the end of ischemia, and at 20 and 60 min of reperfusion. In half of the patients reperfusion was initiated with an abrupt rise in blood temperature and pressure, in the other half with a gradual rise. The biopsies were prepared for transmission electron microscopy and analyzed by stereological technique. In all biopsies, myocytic injury, as revealed by mitochondrial changes and intracellular edema, occurred following ischemia (P = 0.0003 and 0.007, respectively). The intracellular edema regressed following 20 min of reperfusion (P = 0.008). The myocytic mitochondrial changes persisted during reperfusion towards the end of the observation period (P = 0.0001). Interstitial edema increased following ischemia (P = 0.007) and persisted following 60 min of reperfusion (P = 0.009). The capillary part was significantly reduced after 20 min of reperfusion (P = 0.003), probably reflecting interstitial edema. Most changes were reversible in nature, although foci of irreversible changes were shown. In patients with a gradual start of reperfusion there was a significant regression of interstitial edema (P = 0.005) at 60 min reperfusion compared to the patients with an abrupt start, where the same changes seemed to persist or even increase. The study demonstrates that "reperfusion injury" occurs in human myocardium. It can be discerned from "ischemic" injury, and it may be reduced by a gentle mode of reperfusion.

Adult↗
PubMed1995

Survival in thoracic or thoracoabdominal aortic aneurysm. Comparison between patients with or without surgical treatment.

The surgical mortality among 22 patients treated for thoracic or thoracoabdominal aneurysm was compared with the mortality in 47 patients managed without surgery. Surgical mortality ( < 30 days) was low (1/13) in ascending aortic aneurysm, but higher (3/8) in aneurysm of the descending or thoracoabdominal aorta (including both acute and elective operations). Of the 20 non-surgically managed patients in the latter group, 15 died after a mean of 1.1 year. The only patient operated on for aortic arch aneurysm died of cerebral ischaemia 2 days postoperatively. Most of the 19 non-operated patients with aneurysm of the arch or total aorta (mean age 76 years) were never considered for surgical treatment. The analysis supports aggressive management of patients with aneurysm of the ascending, descending or thoracoabdominal aorta. Many of our patients with aneurysm of the arch or involving most of the aorta were old and had other, concomitant diseases, and in such cases an aggressive treatment strategy does not seem justified.

Adult↗
PubMed1992

A new protective solution for hypothermic storage of free vein grafts in cardiovascular surgery.

In order to reduce the operative injury of the endothelium in free reversed vein grafts, cultured human endothelial cells were used to test the optimal concentration of the constituents of a flushing solution for improved protection of the endothelium. The following solution proved to be the most suitable when tested at 20 degrees C; mannitol 160 mmol l-1, glucose 15 mmol l-1, NaCl 30 mmol l-1, KHCO3 5 mmol l-1, K2SO4 10 mmol l-1, KH2PO4 4 mmol l-1, MgSO4 20 mmol l-1, CaCl2 1.5 mmol l-1, potassium citrate 1.0 mmol l-1, Pluronic F-68 20 mg l-1, HEPES 4 mmol l-1, HEPES-Na 6 mmol l-1, pH 7.25, osmolality 325 mosmol kg-1 H2O. When endothelial cell injury was measured by a 51Cr-release assay, the new solution protected human endothelial cells in culture during hypothermic incubation better than isotonic NaCl, St Thomas' cardioplegic solution or Krebs-Henseleit's buffer. Transmission and scanning electron microscopy showed that the endothelium of human saphenous vein grafts was well preserved following 6 h of incubation at 20 degrees C with the new solution. As determined by morphometry using scanning electron microscopy, the endothelium of free porcine vein grafts was better preserved after incubation for 2 h at 20 degrees C with the new solution than with either isotonic NaCl (p = 0.02) or diluted, heparinized blood (p = 0.02) as the incubation medium, all cases observed following 2 h of subsequent arterial flow. The present study indicates that the endothelium of free vein grafts can be well protected against hypothermia when the flushing and irrigation fluid has a composition favouring endothelial protection. It appears likely that such treatment of vein grafts will reduce the frequency of vein graft narrowing and occlusion, post-operatively.

Animals↗
PubMed1991

[Carotid endarterectomy. Surgical complications and long-term prognosis].

227 patients underwent 259 carotid endarterectomies because of transitory ischemic attacks (TIA). All had a 50% or more carotid lumen reduction as revealed by angiography, and symptoms from the arteriosclerotic lesion. Surgical mortality/morbidity at 30 days was 2.6%. 5.3 years after the operation (1 month-13 years) the probability of stroke was 4.9%, which corresponds to a postendarerectomy stroke rate of 1% per year. The procedure may be of value if the rate of surgical complication is very low, but the net effect still depends upon the occurrence of other vascular complications during the follow-up period. The incidence of vascular diseases in this series of seriously affected arteriosclerotics was higher than in a matched normal population, and mortality was much higher. At present a somewhat restrictive indication for surgery seems justified.

Adult↗
PubMed1990

[Improved treatment of abdominal aortic aneurysms. Progress over 17 years].

During the period 1970-86, 155 men and 24 women were operated on for abdominal aortic aneurysms at the University Hospital in Tromsø. Elective operations were performed in 76 patients with an operative mortality of 5 (7%), impending rupture in 49, of whom 14 died (29%) and ruptured aneurysms in 54 patients, of whom 33 (61%) died. There has been a substantial increase in the number of patients per year admitted with abdominal aneurysms, from an average of 4.5 during the years 1970-76 inclusive, to over 20 during the years 1984-86. Operative and early postoperative mortality have been reduced and there has been no death following elective operations during the last three years of the reported period. Mortality was 8% for impending rupture and 45% for ruptured aneurysms. Electively abdominal aortic aneurysms can be operated safely even in patients over the age of 80. Ruptured aneurysms, however, still carry a high operative mortality in patients over the age of 70.

Age Factors↗
PubMed1990

[Arteria gastroepiploica dextra in coronary surgery. Complete revascularization in angina pectoris].

We have used the right gastroepiploic artery as a viable jump graft to the distal right coronary artery in two patients. The first patient was a 37 year-old man with recurrent angina after coronary bypass surgery with three vein grafts eight years previously. The second patient was a man aged 45 with angina in New York Heart Association Class III to IV. In both cases coronary angiography revealed severe triple vessel disease with multiple proximal and distal occlusions or stenosis. Both internal mammary arteries were also used in the two patients to revascularize the LAD and circumflex systems. Thus, a complete revascularization was achieved by use of only viable arteries as conduits. Both patients recovered well and were free from angina. At present only the first patient has had a postoperative angiogram, which showed good patency of the gastroepiploic artery jump graft. If the long-term patency of this type of graft is similar to that of the internal mammary arteries, it is another suitable arterial conduit for revascularization of the ischemic myocardium.

Adult↗
PubMed1990

[Enterobacter cloacae infections at the Regional Hospital in Tromsø].

Enterobacter cloacae was isolated from 69 patients hospitalized at the University Hospital of Tromsø, Norway, during a period of 18 months. The total lethality was 11.6% (8/69) and death occurred most often in patients with a serious underlying condition. Death due to septicaemia occurred in 4/10 patients. Multiple beta-lactam resistant strains were present in 15 patients and were associated with septicaemiae (7/10, p less than 0.0005). Cephalosporin treatment had been given to every third patient (24/69), and nearly half of them (10/24) were infected by multiple beta-lactam resistant E cloacae. E cloacae occurred mainly as a nosocomial infection, since more than 70% of all patients infected had been treated by an invasive procedure prior to isolation of the bacterium. A high number of E cloacae strains were from operation wounds, especially among patients at the Department of Surgery (22/30). At this Department, the total number of E cloacae, and especially the number of multiresistant strains, was markedly reduced during restricted use of cefalosporins.

Adolescent↗
PubMed1990

Amelioration of reperfusion injury following hypothermic, ischemic cardioplegia in isolated, infarcted rat hearts.

The left coronary artery was ligated and myocardial infarction developed in 28 rats. Three weeks later, the hearts were excised and mounted in an apparatus for perfusion of non-working isolated hearts (Langendorff). Hypothermic (15 degrees C), ischemic cardioplegia was induced for either 2 or 3 1/2 h followed by reperfusion for 45 min. Half of the hearts were reperfused with an initially gradual rise in temperature and pressure of the perfusion fluid, whereas the other half was reperfused directly with the perfusate at 37 degrees C and 100 cm H2O pressure. The hearts were examined by transmission electron microscopy and randomized for stereological analysis based on point counting on electron micrographs. Cardioplegia of 2 h duration was tolerated better than cardioplegia for 3 1/2 h (interstitial edema; P = 0.03, fraction of altered mitochondria; P = 0.001). Particularly in the hearts undergoing the longest cardioplegia, myocardial injury was less severe following a gentle reperfusion as compared with those exposed to the clinically common abrupt technique (fraction of mitochondria in the myocyte; P = 0.03, fraction of altered mitochondria; P = 0.008). In the interstitium, the luminal area of capillaries was significantly increased and the endothelial swelling less pronounced in the groups undergoing the gentle reperfusion technique, (luminal/endothelial fraction; P = 0.01). The study shows that previously infarcted hearts are susceptible to ischemic damage even after 2 h of regular hypothermic, ischemic cardioplegia and that a gentle reperfusion technique significantly ameliorates reperfusion injury.

Animals↗