[Medically and emotionally safe labor in hospital].
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Analgesia, Obstetrical↗
Biomedical subjects
G Nylander
Publications and source records attributed to G Nylander.
Natural history of digital replantation: a 12-year prospective study.
UNLABELLED: The purpose of the study was to evaluate the fate of the digital arterial anastomoses, resting total digit blood flow, and cold-induced discomfort following digital replantation with two repaired arteries. The evaluation was done with a Doppler ultrasound of the anastomoses, temperature recording from the finger pulp at room temperature, and a questionnaire regarding the patient's impression of cold-induced discomfort. At the 2-year follow-up all anastomoses were patent, but in two of the six patients one anastomosis was occluded at the 12-year follow-up. The replanted digits generally showed lower skin temperatures compared with controls at the 2-year follow-up but these had normalized 10 years later, even in digits with one of the two repaired arteries occluded. The number of patients with severe cold-induced discomfort was unchanged during the observation period. CONCLUSION: The digital flow continues to increase after the first 2 years after replantation and may reach normal levels at room temperature; however, cold-induced discomfort is not normalized. Total blood flow improvement is not affected by late arterial occlusion.
Adolescent↗
Cold-induced vasospasm after digital replantation does not improve with time. A 12-year prospective study.
The incidence of cold-induced vasospasm after hand injuries has been reported to be as high as 100%, following replanted digital amputations. The exact cause of this problem is obscure, no specific treatment is available and little is known about the long-term prognosis. Further knowledge is therefore needed in order to advise patients concerning future job potential at an early stage. In a previous paper we evaluated the incidence and severity of cold intolerance 2 years after digital replantation. The incidence of cold-induced vasospasm then was high as well as the discomfort experienced by the patients. We carried out a follow-up of patients previously examined 10 years ago. Our results show that cold induced vasospasm in replanted digits does not improve with time. Patients with moderate symptoms may perceive improvement, probably due to a change of habits. Patients with severe problems did not experience improvement and should be given early advice to seek work in warm surroundings to reduce the discomfort.
Amputation, Traumatic↗
Radioprotective effect of local administration of lysine-vasopressin and triglycyl-lysine-vasopressin on the rectal mucosa in rats.
Reactions from the rectal mucosa often give rise to troublesome side-effects during and after radiotherapy in the pelvic region. Local vasoconstriction in the rectal mucosa will cause an ischemia which will decrease the sensitivity of the mucosal cells to radiation and thereby these side-effects can be reduced. Triglycyl-lysine-vasopressin applied rectally in 1% Blanose solution gave in the present study significant radioprotection of the rectal mucosa in the doses of 0.8, 1.6, and 3.2 mg. These doses are, however, very high. Triglycyl-lysine-vasopressin in 1.2% Natrosol solution in a dose of 128 micrograms did not show any certain protective effects. However lysine-vasopressin in 1.2% Natrosol solution in a dose of 16 micrograms gave significant radioprotection of the rectal mucosa. This dose level has in a previous study not given any significant effects on the systemic circulation. Lysine-vasopressin in Natrosol solution seems to be a suitable combination for further studies.
Animals↗
Hyperbaric oxygen treatment attenuates glutathione depletion and improves metabolic restitution in postischemic skeletal muscle.
Glutathione serves as an important intracellular defence against reactive oxygen metabolites and has been shown to be depleted from a number of tissues upon oxidative stress. In the present study we have investigated the levels of total glutathione (reduced + oxidized) in skeletal muscle of the rat after prolonged ischemia and reperfusion with and without treatment with hyperbaric oxygen (HBO) for the initial 45 minutes immediately following reperfusion. A tourniquet model for temporary, total ischemia was used, in which one hind leg was made ischemic for 3 or 4 hours. Muscle biopsies were taken after 5 hours of reperfusion. In postischemic muscle there was a significant decrease of total glutathione compared to control muscle, but in the 3-hour-ischemia-groups the loss of total glutathione was less in HBO treated animals than in untreated. HBO treatment also preserved ATP and PCr and decreased edema formation in the postischemic muscle following 3 hours of ischemia and reperfusion when compared to untreated animals. However, after 4 hours of ischemia, HBO treatment failed to improve any of these parameters in the postischemic muscle. Thus, our results demonstrate that HBO treatment lessens the metabolic, ischemic derangements and improves recovery in postischemic muscle after 3 hours of ischemia followed by reperfusion.
Adenosine Triphosphate↗
Hyperbaric oxygen improves wound healing in normal and ischemic skin tissue.
The influence of hyperbaric oxygen on reepithelialization and on microvascular perfusion of wounds in normal and ischemic skin tissue was investigated by using a standardized model, in ears of hairless mice. Animals were treated within 2 hours of wound creation and then twice daily with 100% oxygen at 2 atmospheres of absolute pressure. Ischemia was induced by ligating two of the three major vessels of the ear 2.5 days before wound creation. Wound surface area was measured every third day after wound creation. In addition, microvascular blood flow before and during the wound healing process was measured by scanning the ear with a new laser Doppler perfusion imager. In normal tissue (n = 13), hyperbaric oxygen therapy significantly accelerated wound healing by 2 days (p < 0.01) as compared with controls (n = 16). In ischemic tissue (n = 16), treatment with hyperbaric oxygen reduced time for reepithelialization in control animals (n = 16) from 14.3 to 9.9 days (p < 0.001). Laser Doppler data showed no difference in tissue blood flow between treated and untreated animals. In comparison with normal tissue, wound healing in ischemic tissue was characterized by a reduced and less intense hyperemic response. These data suggest that hyperbaric oxygen therapy improves reepithelialization in normal and ischemic skin tissue. The beneficial effect is not associated with changes in microvascular perfusion and therefore is probably due to high arteriolar oxygen content and oxygen diffusion.
Animals↗
Myotonic dystrophy revealed at videoradiography of deglutition and speech in adult patients with velopharyngeal insufficiency: presentation of four cases.
Patients with velopharyngeal insufficiency (VPI) without cleft palate, who appear for the first time in adulthood for treatment, will probably reveal a high percentage of undiagnosed myotonic dystrophy (MD). Videoradiography of deglutition and speech reveals the diagnosis. Eleven adult noncleft palate patients with VPI were studied with videoradiography of the pharynx and esophagus. Three exhibited functional radiographic manifestations of MD during deglutition and speech. The diagnosis confirmed by neurologic examination was not known or suspected prior to videoradiography. An additional patient with VPI and suspected MD displayed the same constellation of radiographic findings. Follow-up examinations confirmed the diagnosis of MD. Three of the four patients had had symptoms of VPI since childhood, but none had complaints of deglutition problems except for accidental nasal regurgitations.
Adult↗
Smoking cessation in pregnancy. Intervention among heavy smokers.
OBJECTIVE: To investigate the effects of a low cost multicomponent intervention program among pregnant heavy smokers. DESIGN: A randomized controlled experimental trial. SETTING: The National Hospital, Oslo, Norway. SUBJECTS: 104 pregnant women smoking 10 cigarettes or more daily at the time of routine ultrasound screening around the 18th week of pregnancy. INTERVENTION: Around the 18th week of gestation the women received information about the dangers of smoking in pregnancy together with a self-help manual. The manual was developed especially for pregnant women to aid smoking cessation during a 10 day program. A control ultrasound was performed around the 32nd week of pregnancy. Two encouraging reminders were mailed to them before and after the control ultrasound. MAIN OUTCOME MEASURES: Changes in smoking pattern were investigated at delivery time. Smoking cessation, reduction, increase and no change in smoking consumption was registered. RESULTS: 20% stopped smoking and 65% reduced their smoking in the intervention group compared to 4% and 38% respectively in the control group. 11% in the intervention group did not change their smoking habit and 4% increased their consumption compared to 36% and 22% respectively in the control group. The differences were highly significant. CONCLUSION: This low cost multiple intervention model seems more effective than other intervention models investigated in Norway. The resources invested are probably within the limits of the common pregnancy health care.
Adult↗
[Breast milk as elixir of life].
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Breast Feeding↗
Improved results in zone 2 flexor tendon injuries with a modified technique of immediate controlled mobilization.
The results following primary and delayed primary repair in zone 2 flexor tendon injuries were evaluated in 85 fingers of 79 patients using immediate controlled mobilization post-operatively. In 31 patients a conventional Kleinert technique was used. In the remaining 48 patients a modified technique was used with rubber band traction to all fingers instead of only to the injured one. Also a shorter dorsal splint was used in order to secure extension of the PIP and DIP joints. The results were improved and the time of treatment was reduced.
Adult↗
Arthroscopic synovectomy of the rheumatoid wrist.
18 wrists in 16 patients with synovitis due to rheumatoid arthritis were treated with arthroscopic synovectomy. The surgical procedure and the results after surgery are described. Range of motion, grip strength, subjective experience of pain and level of activity were registered pre- and post-operatively. The operations were found to give good pain relief, increased grip strength, no post-operative stiffness and a short period of rehabilitation.
Arthritis, Rheumatoid↗
Comments on reason for conflicting results of venography.
Conflicting results of phlebography in the diagnosis of thrombosis in different investigations are discussed. The following factors may explain different results: phlebography is a subjective method, not based on measurable parameters; insufficient phlebographic technique may result in unsafe diagnosis; the selection of patient material may vary in different investigations; variations in thrombosis incidence may vary with the age of the patient and with the season; the incidence of thrombosis varies within the postoperative period.
Artifacts↗
Hyperbaric oxygen treatment enhances the recovery of blood flow and functional capillary density in postischemic striated muscle.
The effect of hyperbaric oxygen (HBO) at 2.5 atmospheres of absolute pressure (ATA) on postischemic reperfusion injury in striated muscle was studied using two different animal models. One used complete tourniquet ischemia (4 hr) in the rat hindlimb, measuring blood flow in the tibialis anterior muscle by the xenon washout method at 1-1.5 and 4.5-5 hr after the start of reperfusion. The other used 4 hr of pressure-induced ischemia in the fine striated skin muscle, contained within a dorsal skinfold chamber in hamsters. Vital fluorescence microscopy was employed to measure the functional capillary density using fluorescein isothiocyanate-dextran (mw 150,000) as a plasma marker. After 1-1.5 hr of reperfusion following 4 hr of total ischemia, postischemic blood flow was severely depressed, with no significant difference between the HBO-treated and the untreated rats. However, after 4.5-5 hr of reperfusion, blood flow rates in the postischemic muscle in the HBO-treated animals did not differ significantly from those in nonischemic muscle, compared to a persistent, significant depression in the untreated animals. No significant difference was seen in functional capillary density between HBO-treated and untreated hamsters following 1 hr of reperfusion. After 5 hr of reperfusion, capillary density was significantly improved in HBO-treated animals compared to untreated animals. These results suggest that HBO treatment enhances the recovery of blood flow and functional capillary density in postischemic muscle tissue, indicating attenuation of the microvascular dysfunction or damage in the postischemic period.
Animals↗
[A survey in Malmö. The frequency of venous thromboembolism has not changed during the last 30 years].
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Humans↗
[Treatment of gynecologic bleeding disorders].
Conclusions reached at an expert meeting arranged by the Medical Products Agency (Läkemedelsverket) in Sweden on the treatment of gynaecological bleeding disorders are presented. An active approach to endometrial diagnosis is recommended when bleeding is protracted and does not respond to medication, and when bleeding occurs more than one year after menopause. A period of expectation is permissible in women younger than 45 years. Exfoliative endometrial diagnosis is highly sensitive and specific and, in recent years, the traditional curettage has been reappraised as the first method of choice. Bleeding during anovulatory cycles is usually managed by treatment with progestagens. Menorrhagia may be diminished by oral contraception, tranexamic acid or NSAID. Endometrial resection offers a promising alternative to hysterectomy. Genital infection is another common cause of irregular bleeding in sexually active women and must be treated before invasive procedures are undertaken. Abnormal bleeding in patients with endometriosis often improves as a result of the treatment given to alleviate other symptoms such as pain. Bleeding irregularities caused by gynaecological malignancy, particularly contact bleeding in cancer of the cervix, are seen during the reproductive years and are accessible for diagnosis. The authors also discuss irregular bleeding caused by coagulopathia or treatment with hormones, as well as the effect of antifibrinolytic drugs.
Adult↗
[Smoking-free pregnancy--smoking-free hospitals].
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Female↗
Mutagenicity study of urine from smoking and non-smoking road tanker drivers.
Urine from 32 road tanker drivers handling petrol, diesel, paraffin and white spirit was tested in the Salmonella/microsome mutagenicity system using tester strains TA98 anbd TA100. Urine samples were collected before and after tanking and were concentrated 250-fold on XAD-2 columns before testing. Controls were 33 office employees from the same plant. No effect on urinary mutagenicity of occupational exposure to petroleum products was found. Significant differences in mutagenic effect were demonstrated between smokers and non-smokers. Methodological experiments demonstrated a dose/response effect of smoking on urinary mutagenicity. A modified test using a preincubation period and an increased concentration of bacteria was more sensitive than the standard Ames test to mutagens from tobacco smoking.
Dose-Response Relationship, Drug↗
Unsupplemented breastfeeding in the maternity ward. Positive long-term effects.
Feeding routines in the maternity ward were investigated in 204 mother-infant pairs before and in 203 after a change towards earlier, more frequent breastfeeding and elimination of routine substitute feeds. In the intervention group, the volume of breast-milk increased, while the use of formula and sugar solution decreased correspondingly. The infants in the intervention group lost more weight during the first 2-3 days (6.4% versus 4.6%), but regained their birth weight faster than the supplemented control group. The incidence of hyperbilirubinemia was not significantly different in the two groups. No cases of hypoglycemia were diagnosed. At 6 months, 87% of the infants in the intervention group were still fed at the breast, compared with 66% in the control group. The weight curves were comparable up to 9 months, when intervention group infants were found to weigh slightly less. These follow-up results must be interpreted with some caution due to the low but comparable response rate of the two groups. Thus the intervention study demonstrated that healthy, full-term infants usually have no need for supplements to their mothers' milk provided they have had a satisfactory start in life with early and frequent feeds at the breast. The follow-up study indicated that a more "physiological" start of breastfeeding may have had a positive long term effect on the overall duration of the lactational period.
Breast Feeding↗