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Biomedical subjects

H Svensson

Publications and source records attributed to H Svensson.

At least 73 records · Page 4Linked to original sources
PubMed1996

Allogeneic bone marrow transplantation versus autologous stem cell transplantation in multiple myeloma: a retrospective case-matched study from the European Group for Blood and Marrow Transplantation.

A retrospective case-matched analysis was performed comparing 189 myeloma patients treated with allogeneic bone marrow transplantation (allo-BMT) with an equal number of patients who received autologous stem cell transplantation (ASCT). Matching was performed with respect to gender and number of treatment lines before transplantation. The groups were comparable with the exception of median age (43 years for allo-BMT v 49 years for ASCT, P = .0001) and median posttransplant follow-up (46 months for allo-BMT v 30 months for ASCT, P = .0003). The overall survival was significantly better for ASCT than for allo-BMT, with a median survival of 34 months and 18 months, respectively (P = .001). However, this survival advantage was only observed in men, but not in women. The statistically significant survival advantage for ASCT was seen in most subgroups, ie, chemotherapy-responsive patients, patients who had received two or more treatment lines before transplantation, patients in partial remission, patients with an IgG-subtype, patients older than 46 years of age, patients with stage II disease, and patients with a low or high serum-beta-2-microglobulin at diagnosis. The main reason for the poorer survival in allo-BMT patients was higher transplant-related mortality (41% v 13% for ASCT, P = .0001), which was not compensated for by a lower rate of relapse and progression. However, in patients alive at 1 year posttransplant, there was a trend for better long-term survival (P = .09) and significantly better progression-free survival (P = .02) for allo-BMT as compared with ASCT. We conclude that the median survival is superior for ASCT. However, allo-BMT has a lower relapse rate, which results in a similar long-term outcome for both approaches, but a longer follow-up is needed to assess the final outcome.

Acute Disease↗
PubMed1996

Quality assurance in radiotherapy: the importance of medical physics staffing levels. Recommendations from an ESTRO/EFOMP joint task group.

The safe application of ionising radiation for diagnosis and therapy requires a high level of knowledge of the underlying processes and of quality assurance. Sophisticated modern equipment can be used effectively for complicated diagnostic and therapeutic techniques only with adequate physics support. In the light of recent analyses and recommendations by national and international societies a joint working group of representatives from ESTRO (European Society for Therapeutic Radiology and Oncology) and from EFOMP (European Federation of Organisations for Medical Physics) was set up to assess the necessary staffing levels for physics support to radiotherapy. The method used to assess the staffing levels, the resulting recommendations and examples of their practical application are described.

Europe↗
PubMed1996

The cell surface phenotype of human natural interferon-alpha producing cells as determined by flow cytometry.

The relationship between the so-called natural interferon-alpha (IFN-alpha) producing cell (IPC), stimulated to produce IFN-alpha by herpes simplex virus type 1 (HSV), and of dendritic cells (DC) in peripheral blood leucocytes was investigated. The simultaneous expression of cell surface antigens and intracellular IFN-alpha in the HSV-stimulated IPC (HSV-IPC) was examined by flow cytometry (FCM). The HSV-IPC were infrequent, < 0.3% of the mononuclear leucocytes, and with homogeneous light scatter characteristics. The HSV-IPC were confirmed to lack leucocyte lineage specific markers, and to express CD4, CD36 and HLA-DR. Furthermore, they expressed high levels of CD44, CD45RA and CD45RB, and lower levels of CD40, CD45R0, CD72 and CD83. The HSV-IPC expression of CD13, CD33 and Fc epsilon RI were weak but significant, while no CD5, CD11b, CD16, CD64, CD80 or CD86 were detected. Sorted pure HSV-IPC had irregular shaped nuclei, many mitochondria and vesicles, and rugged cell membranes without veils. Sorted HSV-IPC stimulated proliferation of autologous T cells from HSV immune donors. Thus, the HSV-IPC in many respects resemble immature DC, but clearly differ from typical mature DC. However, they may also represent a specialized population of efficient IFN-alpha producing cells.

Antigens, CD↗
PubMed1996

Stimulation of natural interferon-alpha/beta-producing cells by Staphylococcus aureus.

Human peripheral blood mononuclear cells (PBMCs) produced high levels of antiviral activity, as determined by bioassay, when stimulated by Staphylococcus aureus Cowan I (SAC) and E. coli. Specific immunoassays demonstrated the presence of both IFN-alpha and gamma and, for SAC, also low levels of IFN-beta. The frequencies of SAC-induced IF N-alpha-producing cells (IPCs) were up to 1-2 per 10(3) PBMCs. These IPCs expressed the HLA-DR and CD4 antigens but not CD3, CD14, or CD19, thus resembling the natural IFN-alpha-producing cells (NIPC). The SAC was more efficient as IFN inducer when heat killed than when streptomycin inhibited. The SAC was inhibitory to virally induced IFN-alpha responses, in particular when streptomycin inhibited. Both pronase treatment and mechanical disruption of SAC cells abolished their capacity to induce IFN-alpha production. Staphylococcal strains lacking or expressing low levels of protein A (SpA) showed a decreased ability to induce IFN-alpha production. However, purified SpA did not itself induce IFN-alpha. Possibly, SpA together with other bacterial surface proteins is important for the capacity of SAC to induce IFN-alpha production in NIPC.

Cell Division↗
PubMed1996

A new device combining laser Doppler perfusion imaging and digital photography.

We describe a new method for acquisition and analysis of skin perfusion images acquired by laser Doppler scanning and digital photographs of the area scanned. Photographs are obtained with a commercial digital still video camera. A commercial software package is used to handle the perfusion image file and the digital photo. We describe software developed to assess blood flow distribution in detail in relation to the visual appearance of the skin, palpatory findings and other clinical signs. Possible clinical applications of the method described by case reports are post-operative evaluation of vascularized grafts and monitoring of treatment of chronic skin ulcers.

Blood Flow Velocity↗
PubMed1995

Cost-effectiveness analysis in early detection of prostate cancer: an evaluation of six screening strategies in a randomly selected population of 2,400 men.

Based on the findings in an early detection study for prostate cancer [Gustafsson et al.: J Urol 148:1827-1831, 1992] using digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate-specific antigen (PSA), a cost-effectiveness analysis was performed based on 6 screening strategies, namely: 1) DRE of all individuals; 2) TRUS of all individuals; 3) DRE, TRUS, and PSA analysis followed by reexamination of individuals with PSAs > or = 7 ng/ml; 4) DRE of individuals with PSAs of > or = 4 ng/ml; 5) TRUS of individuals with PSAs of > or = 4 ng/ml; 6) DRE and PSA analysis followed by TRUS on individuals with PSAs > or = 4 ng/ml. The detection rates of prostate cancer using these 6 strategies were 2.4%, 3.3%, 3.6%, 2.0%, 2.6%, and 3.2%, respectively. Except for costs per detected cancer, costs were also calculated per detected small cancer (< or = 1.5 cm) and per detected cancer treated for cure. The cost calculations were based on total costs, i.e., direct plus indirect costs. When the 6 strategies were compared, taking into account the detection rate of cancers treated for cure and cost-effectiveness with respect to cancers treated for cure, strategies 1), 2), 3), and 4) were ruled out as less favorable than the remaining 2 strategies. TRUS of individuals with PSAs > or = 4 ng/ml (strategy 5) was the most cost-effective strategy and detected 80% of the cancers actually treated for cure. Screening with DRE and PSA analysis followed by TRUS of individuals with PSAs > or = 4 ng/ml (strategy 6) had a somewhat lower cost-effectiveness, but detected 90% of the cancers treated for cure.

Aged↗
PubMed1995

Microsurgical replantation of partial avulsion of the scalp. Case report.

An 8-year-old girl was bitten by a dog and, as well as minor wounds, had a complete avulsion of the central part of the scalp covering an area of 8 x 10 cm. By rotating the replant 180 degrees and by using 5 cm long vein grafts, two sleeve anastomoses, and two end-to-end anastomoses the blood supply was restored. The operation lasted nine hours, and she stayed in hospital for 12 days. Her clinical course was uneventful. At follow-up 23 months later the cosmetic and functional results were good.

Anastomosis, Surgical↗
PubMed1995

Casting the implant for reconstruction of pectus excavatum.

Fourteen patients with pectus excavatum underwent a total of 17 operations for the insertion of subcutaneous implants aimed at camouflaging their defects. A silicone prosthesis in one patient early in the series caused severe capsular formation. Although a block of Proplast may occasionally be used with success, the rational solution to the problem is to produce a custom made Silastic implant that adheres optimally to the defect in each individual case. This retrospective study shows that a subcutaneous implant clearly improves the appearance of the chest wall in most of the patients.

Adolescent↗
PubMed1995

Wound healing after total elbow replacement in rheumatoid arthritis. Wound complications in 50 cases and laser-Doppler imaging of skin microcirculation.

Wound healing complications, predisposing to deep infection, are common following prosthetic surgery of the elbow. 50 capitellocondylar elbow prostheses were inserted, using a lateral approach, in 42 patients with rheumatoid arthritis. The first 5 elbows were immobilized postoperatively for 5 days and the following 45 elbows for 12 days, because of delayed wound healing in 2 of the first 5 elbows. No wound healing complications were recorded in elbows immobilized for 12 days and elbow motion was not compromised. 5 elbows were investigated with laser-Doppler imaging (LDI) technique, both pre- and postoperatively. Postoperative LDI values were considerably higher than preoperative ones, indicating no impairment of local skin microcirculation. The authors conclude that the lateral approach is safe to use in prosthetic surgery on the elbow. Early mobilization can delay wound healing, but this can be prevented by 2 weeks of postoperative immobilization.

Adult↗
PubMed1994

Laser Doppler imaging of finger skin blood flow in patients after microvascular repair of the ulnar artery at the wrist.

Laser Doppler imaging is a new, non-invasive technique allowing the spatial distribution and the temporal variation of the skin blood flow to be monitored. A mean blood flow value over an area, such as the finger-tip in the present study, can also be calculated. Recordings from 12 patients with a sutured ulnar artery following trauma did not significantly differ from those obtained in 14 controls. Four patients with a ligated ulnar artery, however, showed a slower restitution of blood flow values after cold provocation. All sutured ulnar arteries were found to be patent, which confirms that microvascular reconstruction of an injury to the ulnar artery at the wrist is worthwhile.

Adolescent↗
PubMed1994

Neutron therapy--the historical background.

Neutron therapy was first introduced by Stone et al. in 1938, i.e. more than 10 years earlier than electron beam therapy and only 6 years after the discovery of neutrons. In spite of the impressive accomplishment in generating an adequate therapy beam, time was also found for careful radiobiological studies of neutron beams. However, it was not considered that for a certain early reaction the late effects were much greater with neutrons than with x-rays. The severe late sequelae in proportion to the few good results motivated the closure of this therapy. Neutron therapy was again introduced in Hammersmith hospital at the end of the 1960's. The major reason seems to have been to overcome the oxygen effect. Encouraging results were reported. It was argued that the very favourable statistics on local tumour control were obtained at the expense of more frequent and more severe complications. A clinical trial in Edinburgh seemed to indicate this, but it was not proved in the end as the two trials differed regarding fractionation. Today about 16,000 patients have been treated with neutrons. The neutron beams now used differ significantly, both regarding dose distributions and microdosimetrical properties, from those utilized earlier. The advantage of neutrons is still, however, controversial. There are indications that neutron treatment may be favourable for some tumours. A careful cost-benefit study ought to be performed before the creation of a neutron therapy centre in Sweden as the group of patients suitable for neutrons is limited, and there may be new possibilities for improvement of photon and electron treatment with much smaller resources.

Cyclotrons↗
PubMed1994

Efficacy of a topical anesthetic on pain and unpleasantness during scaling of gingival pockets.

The efficacy of a topical anesthetic on pain and unpleasantness provoked by scaling of gingival pockets was investigated in 20 patients with mild chronic periodontitis. A eutectic mixture of local anesthetics (EMLA) and a placebo cream, both occluded by Orahesive Oral Bandages, were applied in a balanced, randomized, double-blind, split-mouth design, which enabled within-subject comparison of the anesthetic and the placebo in the upper and the lower jaw. Pretreatment interviews showed that approximately two-thirds of the patients considered gingival scaling to be associated with some degree of pain and unpleasantness. Pain intensity and unpleasantness were evaluated on 100-mm visual analog scales (VAS). Application of EMLA reduced both pain intensity and unpleasantness significantly compared to placebo cream. Median reductions in VAS pain intensity in the upper and lower jaw were 58.9% and 61.9%, and corresponding reductions in VAS unpleasantness were 31.9% and 25.6%, respectively. Generally, the patients accepted the anesthetic procedure well. The residual perception of pain and unpleasantness following topical anesthesia may be dependent on activation of nonanesthetized nociceptive fibers in the tooth pulp. However, the present study clearly demonstrates the efficacy of a topical anesthetic in a clinical situation, which may be recommended as a simple pharmacologic strategy to reduce pain and unpleasantness during scaling procedures.

Administration, Topical↗
PubMed1993

Upper airway obstruction--an unusual complication following a minor scalding injury.

A 14-month-old girl suffered a 10 per cent scalding injury from hot water of the type sometimes recognized as 'the teapot syndrome'. The hot water also reached the hypopharynx where it caused marked swelling of the mucosa and hence obstruction of the airway. Increasing respiratory distress made endotracheal intubation necessary 4.5 h after the accident. The girl was extubated 26 h later, and breathing was normal. The external burns were initially treated with baths and dressing changes. They healed mostly spontaneously, but four areas had to be grafted. This case report shows that thermal burns of the mouth and pharynx, followed by oedema and upper airway obstruction, can occur also in a minor scalding injury involving the face. Respiratory distress makes intubation necessary.

Airway Obstruction↗
PubMed1993

Laser Doppler flowmetry of blood perfusion in mucoperiosteal flaps covering membranes in bone augmentation and implant procedures. A pilot study in dogs.

In guided tissue regeneration (GTR) procedures, flap recession or sloughing may occur as an unwanted sequel to the placement of a membrane. This study was designed to assess the applicability of laser Doppler flowmetry (LDF) in the evaluation of blood perfusion in the mucoperiosteal flap covering the membrane. Five Labrador dogs were initially used in the study, but one animal was later excluded due to post-operative problems. Maxillary premolar teeth were extracted and full thickness mucoperiosteal flaps were raised. Following removal of the buccal bone plate, 4 titanium implants were placed on each side. An experimental biodegradable polylactic-acid membrane was placed over the fixtures on one side to allow for GTR. The mucoperiosteal flap was repositioned and secured with sutures. The contralateral side served as control with no membrane. Blood perfusion was measured in the flaps before surgery, immediately after suturing and at 24, 48 and 72 h postoperatively. A laser Doppler flowmeter was used to assess the blood perfusion. In 3 animals the membrane was exposed within 2 weeks post-operatively, and in these 3 animals the LDF values were lower on the membrane side than on the control side. The mean LDF value was lower on the membrane side for each of the 4 periods studied. The findings suggest that LDF can be a valuable method to study blood perfusion of oral mucosal flaps and that there may be a relationship between a reduced relative LDF value and subsequent exposure of the membrane to the oral environment.

Alveolar Ridge Augmentation↗
PubMed1993

Interpreting laser Doppler recordings from free flaps.

Although the transfer of free flaps is nowadays accomplished with an increasing degree of safety, thrombosis of the microvascular anastomoses is still a problem. In order to avoid delay in re-operating, various methods for objective blood flow monitoring have been tried, among them Laser Doppler Flowmetry (LDF). When one reviews the literature, it is apparent that opinions differ about whether or not LDF is a reliable technique for this purpose. To focus on the need to interpret continuous recordings, this paper reports our findings in six latissimus dorsi free flaps chosen from our series of LDF monitoring procedures. One uneventful flap, no. 1, had an immediate postoperative LDF value of 4.5 perfusion units (PU). LDF values improved during the recovery period and the graphic recording showed fluctuations due to normal physiological variations of the blood flow in the flap. Another uneventful flap, no. 4, showed the same pattern, though at an appreciably lower level, 2 PU, on average. Flap no. 2 had an acceptably high value of 3.5 PU despite suffering a venous thrombosis. However, the LDF recording showed no fluctuations and the value declined gradually. Another flap, no. 3, showed fluctuations and blood flow was normal although the value decreased to 2.5 PU. In flap no. 5, any value between 2 and 3.5 PU could be obtained merely by adjusting the position of the probe in the holder. In no. 6, the LDF value suddenly dropped, accompanied by a decrease in the total amount of backscattered light, indicating venous obstruction which was confirmed at re-operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗