[Reversal of sick-leave certificates issued by physicians].
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Biomedical subjects
Publications and source records attributed to I Lund.
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Mitochondrial myopathy can be caused by several metabolic defects in the mitochondria. Cells with high levels of oxidative metabolism, such as skeletal muscle, myocardium and brain cells, are particularly vulnerable to these defects. We describe the structural changes in muscle biopsies from 49 patients with mitochondrial myopathy. The younger patients were often symptom-free, but the possibility of a genetic defect was suggested by the family history. "Ragged-red fibres" were found in 10% of the biopsies. Typical paracrystalline inclusions were seen in the mitochondria of the oldest patients. Electron-lucent matrix and increased thickness of the inner membranes of the mitochondria in particular were found in the younger patients. Disorganization of cristae, with cristolysis and unfolding of the cristae was also found. We suggest that structural mitochondrial changes in mitochondrial myopathy constitute a stepwise process and that the mitochondrial alterations of the cristae may represent an early stage in the morphogenesis of mitochondrial disease.
Morphologic consequences of prolonged global hypothermic (15 degrees C), cardioplegic ischemia and two reperfusion techniques were studied in Langendorff-perfused rat hearts. A 'gentle' reperfusion technique, with gradual rise in perfusate temperature and pressure to physiologic levels over 30 min, was used for 12 hearts following 2-hour or 3 1/2-hour (6 in each group) ischemia. Abrupt reperfusion, with perfusate at 37 degrees C and 70 mmHg, was performed on 13 hearts (6 ischemic for 2 hours and 7 for 3 1/2 hours). Six nonischemic, perfused hearts served as controls. Randomly selected specimens from the left ventricle after 45-60 min reperfusion were prepared for transmission electron microscopy. Volume fractions of myocardial structural components were calculated from stereologic point-counting on the electron micrographs. Two-way analysis of variance revealed that interstitial edema developed with increasing ischemic time and was not influenced by reperfusion technique. The degree of endothelial damage was independent of ischemic time, but was lessened by 'gentle' reperfusion. Both mitochondrial injury and myocyte edema were less when perfusate temperature and pressure were slowly raised after 3 1/2-hour ischemia.
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The survival-rate in 75 of 631 patients with cardiac arrest in whom resuscitation was started outside hospital by lay people was 36%. Only 8% survived when attempts at resuscitation were delayed until the arrival of an ambulance team which included an anaesthetist and a specially trained nurse. These data show the importance of anoxia-time (time from cessation of circulation to initiation of resuscitation) to the chances of survival after resuscitation) to the chances of survival after resuscitation, and support the idea that lay people should be taught and encourage to perform cardiopulmonary resuscitation.
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A system for disposing of expiratory air containing volatile anaesthetic gases during anaesthesia is described. It consists of a reservoir bag and an adjustable suction connected to the outlet port of the anaesthesia machine or the nonbreathing valvel. A valve is incorporated which opens to the atmosphere if the reservoir bag should collaps completely, thus creating a slight vacumn in the system. Another valve, opens if the bag should become fully expanded and a slifht positive pressure develop in the system. Halothane concentrations in the "anaesthetists breathing zone" were negligible when this system was being used.
Intraoperative blood loss was measured during abdominal prostatectomies in 213 patients anesthetized with neurolept anesthesia, halothane anesthesia and epidural anesthesia. In 55 of these patients, postoperative bleeding was also measured. The average intraoperative blood loss with neurolept anesthesia was 8.2 +/- 5 ml/min, with halothane anesthesia 6.6 +/- 6.3 ml/min and with epidural anesthesia 3.8 +/- 2.3 ml/min. The difference of blood loss in the epidural group and in the groups receiving general anesthesia is highly significant. Average systolic and diastolic blood pressures were lower during operation in the epidural group than in the other two groups. Statistical analyses failed, however, to show a significant correlation between blood pressures and blood loss in the individual patient. Thus, the ultimate explanation for the diminished bleeding associated with epidural anesthesia is not definitely ascertained. The average postoperative bleeding was not significantly different among the three anesthetic groups.
148 chronic schizophrenics admitted between 1938 and 1961 had previously been followed up. In 1972, they were re-examined, on the average 10 years after the first follow-up. 44 belonged to a series of patients studied between 1955 and 1957 with a battery of conditional reflex tests. The patients belonging to the experimental series were retested with word associations. From an experimental point of view the patients performed better over the prolonged observation period. The clinical state also showed improvement. A comparison of the chronic hospital population during 1955-57 and 1972-74 suggests that the new chronics present much less of the severe schizophrenic deterioration than the old ones. They also have remarkably better verbal functions these changes are assumed to be mainly due to drug treatment. The beneficial effects of drugs appear to come mainly within the first 2 years.
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