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Biomedical subjects

J Larsson

Publications and source records attributed to J Larsson.

At least 127 records · Page 7Linked to original sources
PubMed1994

Diabetic foot ulcers in a multidisciplinary setting. An economic analysis of primary healing and healing with amputation.

OBJECTIVES: To perform an economic analysis of primary healing and healing with amputation in diabetic patients with foot ulcers. DESIGN: A retrospective economic analysis based on a prospective study of consecutively presenting diabetic patients admitted to the Department of Internal Medicine because of foot ulcer. SETTING: A multidisciplinary foot-care team. SUBJECTS: A total of 314 consecutively presenting diabetic patients with foot ulcers. Forty patients died before healing occurred. In those patients who healed primarily (n = 197) or after amputation (n = 77), a retrospective economic analysis was performed. INTERVENTIONS: All patients were treated by a multidisciplinary foot care team consisting of diabetologist, orthopaedic surgeon, diabetes nurse, podiatrist and orthotist both as in- and out-patients. The patients were followed by the team from admittance until final outcome, i.e. primary healing or healing with amputation or death. MAIN OUTCOME MEASURES: Data from both the prospectively collected patient material and from patient records were used to estimate the cost for hospital care, antibiotics, surgery, out-patient care, staff attendance, drugs and material for ulcer dressings, and orthopaedic appliances. RESULTS: The total costs were SEK 51,000 (3000-808,000) for patients with primary healing and SEK 344,000 (27,000-992,000) for healing with amputation. Costs for in-patient care were 37% of total average costs for primary healing and 82% for patients with amputation. The costs for topical treatment of the ulcers in out-patient care were 45% of the total average cost for primary healed and 13% for patients who healed with amputation. The costs for products used for ulcer dressings were 21% of total costs for topical treatment, i.e. 9% and 3% of total average costs for primary healing and healing with amputation, respectively. Costs for visits to the foot care team, antibiotics and orthopaedic appliances were low in relation to total costs. CONCLUSION: Treatment of diabetic patients with foot ulcers in a multidisciplinary system was associated with relatively low costs. Healing with amputation was associated with high costs mainly due to multiple and extended hospitalization. These findings indicate the potential cost savings of preventive and multidisciplinary foot care.

Aged↗
PubMed1994

Feeding dependence and nutritional status after acute stroke.

BACKGROUND AND PURPOSE: We assessed the nutritional status of patients with acute stroke and evaluated it in relation to the patients' dependence on assistance with feeding. METHODS: Fifty patients aged 70 years or older, admitted from their homes, were included. Weight index, triceps skinfold thickness, arm muscle circumference, serum proteins, delayed hypersensitivity, body composition measured by bioelectric impedance, and functional condition were determined on admission and 2 and 9 weeks after admission. Food and fluid consumption were also recorded. RESULTS: On admission, four patients were regarded as protein-energy malnourished. Those who required assistance with feeding after admission (n = 18, 36%) had lower serum albumin (P < .05), lower body cell mass (P < .01), and were more anergic than the independent patients (P < .01) on admission. The mean food consumption was 72% of the food served without significant difference between dependent and independent patients. Nine weeks after the onset of stroke symptoms, the patients who were dependent on assisted feeding showed a decrease in body cell mass. The loss of body cell mass was related to their activity and feeding dependence. CONCLUSIONS: Low serum albumin and anergy commonly occur in elderly patients with acute stroke, and they occur more prevalently among those with a severely impaired functional condition. During the recovery period, the patients use body fat to compensate for energy needs, and immobility leads to loss of body cell mass.

Activities of Daily Living↗
PubMed1994

Local signs and symptoms in relation to final amputation level in diabetic patients. A prospective study of 187 patients with foot ulcers.

Local signs and symptoms were evaluated in 187 consecutively presenting diabetic patients undergoing amputation for foot ulcers. From admission until final outcome the patients were treated by the same multidisciplinary team both as in- and out-patients. At the time of amputation, the types of lesions were superficial/deep ulcer (n 17), ulcer with deep infection, but without gangrene (n 40), and gangrene with or without infection (n 130). Healing after a minor amputation (below the ankle) occurred in 74 patients, while 88 patients healed after a major amputation (above the ankle), and 25 patients died before healing had occurred. Deep infection and presence of popliteal or pedal pulses were associated with healing after minor amputation and so were ulcers on the small toes, metatarsal head area and midfoot. Pain, progressive gangrene, intermittent claudication, and decubital and multiple ulcers were related to healing after major amputation. In a logistic regression analysis, pain, progressive gangrene and intermittent claudication remained. However, none of these factors excluded healing of a minor amputation and thus selection of amputation level in diabetic patients with foot ulcers cannot be based upon these factors exclusively.

Adult↗
PubMed1994

The effect of mannitol on reperfusion after severe induced subtotal ischemia of the leg. A hemodynamic, biochemical and metabolic study in a pig hind limb model.

Revascularization of acutely ischemic muscle tissue is followed by edema, decreased oxygen utilization, increased vascular resistance and massive efflux of intracellular compounds indicating loss of cellular integrity, with resultant irreversible damage. In this pig hindlimb study, 8 pigs were submitted to standardized subtotal ischemia of one leg and mannitol was administered i.v. prior to and during 2.5 hours of reperfusion. Compared to 9 controls, the mannitol treated pigs had increased blood flow to the legs, increased oxygen consumption and decreased release of intracellular compounds (CK). This indicates that mannitol attenuates the ischemia/reperfusion syndrome. Muscle energy metabolic parameters showed a similar response to ischemia for both mannitol-treated pigs and controls and no differences in recovery were detected during 2.5 hours of reperfusion between the groups.

Animals↗
PubMed1994

Surgical management of pure pancreatic fistulas.

This paper reports on 13 patients with pure pancreatic fistulas defined as persistent lesions originating directly from the gland tissue and not from a pancreatico-intestinal or pancreatico-gastric anastomosis. Six fistulas were external and seven internal. All external fistulas were postoperative whereas all the internal ones were due to chronic pancreatitis. Conservative treatment of 2 to 36 months duration was unsuccessful, so that all patients underwent surgery. To establish a proper surgical strategy, preoperative mapping of the fistula by endoscopic retrograde cholangiopancreaticography (ERCP), fistulography and/or computerized tomography proved of value. In eleven patients, pancreatic fistula flow was surgically redirected into the gastrointestinal tract, while the remaining two were submitted to a pancreatic left resection. There were no hospital deaths and the complication rate was low. During the follow-up time of 6 to 96 months no recurrent fistulas were seen.

Adult↗
PubMed1994

[Malnutrition common in Swedish hospitals. Risk of complications and prolonged care increases].

The occurrence of malnutrition has been investigated at four hospitals and the underlaying factors evaluated. The results suggest that malnutrition is still a manifest clinical problem at Swedish hospitals, and that it is associated with an increased risk of complications and prolonged care. During hospitalisation a negative nitrogen and energy balance is observed. It is important to identify patients at risk, as the prevention of undernourishment would appear to be a more effective approach than the treatment of established malnutrition.

Activities of Daily Living↗
PubMed1993

Improved glucose metabolism after subtotal pancreatectomy for pancreatic cancer.

Diabetes occurs frequently in patients with pancreatic cancer. To investigate the impact to tumour removal, seven patients were studied before and after 85 per cent subtotal pancreatectomy for adenocarcinoma of the pancreas. The frequency of diabetes was determined by the oral glucose tolerance test. Fasting levels of C peptide and insulin were measured in plasma, and insulin secretion was investigated by hyperglycaemic glucose clamp and glucagon stimulation. Six of the seven patients were diabetic before surgery and four required insulin treatment. Improvements in diabetic status and glucose metabolism were found in all seven patients after operation, as demonstrated by increased glucose metabolic capacity during hyperglycaemia. This occurred despite a postoperative reduction in insulin secretion and is explained by the observed augmentation of whole-body insulin sensitivity after surgery. A diabetogenic factor may be produced by pancreatic adenocarcinoma that may be responsible, directly or indirectly, for the high frequency of diabetes in patients with pancreatic cancer.

Adenocarcinoma↗
PubMed1993

Islet amyloid polypeptide: demonstration of mRNA in human pancreatic islets by in situ hybridization in islets with and without amyloid deposits.

Islet amyloid polypeptide which is normally coexpressed with insulin in beta cells, forms amyloid deposits especially in islets of Type 2 (non-insulin-dependent) diabetic subjects. Occurrence of islet amyloid is paradoxically associated with loss of islet amyloid polypeptide immunoreactivity in beta cells. The present study was undertaken to examine whether the islet amyloid polypeptide gene is expressed in islets with decreased islet amyloid polypeptide immunoreactivity. Pancreatic tissue from 14 patients, 7 with Type 2 diabetes and 7 non-diabetic, were obtained at autopsy or surgery and studied for islet amyloid polypeptide expression by in situ hybridization and for presence of insulin and islet amyloid polypeptide by immunohistochemistry. Six of the specimens from the diabetic and three of those from the non-diabetic patients had varying degrees of islet amyloid polypeptide-derived islet amyloid. Amyloid deposits were associated with decreased numbers of beta cells with islet amyloid polypeptide immunoreactivity despite an apparent normal frequency of insulin-containing cells. This discrepancy might reflect an alteration in islet amyloid polypeptide production or processing at a transcriptional or post-transcriptional level. In contrast to the varying immunohistochemical patterns, islets of all categories showed strong labelling using an islet amyloid polypeptide probe for in situ hybridization. It is concluded that islet amyloid polypeptide production is not altered at the transcriptional level. The following possibilities remain: (1) islet amyloid polypeptide production may be altered at a post-transcriptional level or (2) that islet amyloid polypeptide production is normal but the reduced immunoreactivity of the cells reflects a reduced storage of IAPP in secretory granules.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Models for predicting accidents at junctions where pedestrians and cyclists are involved. How well do they fit?

The coefficient of determination, R2, i.e. the squared correlation coefficient between observed and fitted values, is often used as a measure of how well a model predicts the number of accidents at road junctions, for instance. The purpose of this article is to show that the R2 values obtained in different studies are rarely comparable with each other and that a prediction model can be "nearly perfect" even if the coefficient of determination is small. Another purpose of the article is to present some results of interest from a practical viewpoint in regard to accidents where pedestrians and cyclists are involved. Empirical R2 values for models predicting accidents at junctions where pedestrians or cyclists are involved are compared with the maximal R2 values that could possibly be obtained. The latter can be calculated both theoretically and with the aid of simulation. How the maximal R2 value depends on the average accident level and the relative dispersion of the expected values for the studied junctions is also shown theoretically. The results obtained show how difficult it can be to determine whether and how far the number of accidents is influenced by additional factors, over and above the traffic flows, which describe the design in greater detail.

Accidents, Traffic↗
PubMed1993

Is profound peripheral insulin resistance in patients with pancreatic cancer caused by a tumor-associated factor?

Diabetes in patients with pancreatic cancer occurs in 70% to 80% of the patients and is characterized by high plasma levels of insulin. In type II diabetes that is not associated with pancreatic cancer, peripheral insulin resistance and impaired muscle glycogen synthesis are major pathogenic factors. We investigated peripheral insulin sensitivity in patients with pancreatic cancer before and after tumor removal. The effects of pancreatic tumor extracts on glycogen synthesis in skeletal muscle in vitro and the tumor content of pancreatic islet hormones were also investigated. Marked peripheral insulin resistance was found in the patients with pancreatic cancer and was more pronounced in the diabetic patients than in the nondiabetic patients. Insulin sensitivity was not correlated with weight loss, tumor size, or bilirubin levels but improved after surgery. Tumor extracts from diabetic patients with pancreatic cancer caused a marked reduction of glycogen synthesis in skeletal muscle in vitro. All tumors contained islet hormones but not in concentrations sufficient to explain the effect on glycogen synthesis. These findings indicate that a diabetogenic factor associated with pancreatic adenocarcinomas could be involved in the development of the profound peripheral insulin resistance and thereby could contribute to the high incidence of diabetes observed in patients with pancreatic cancer.

Aged↗
PubMed1993

Growth hormone after abdominal surgery attenuated forearm glutamine, alanine, 3-methylhistidine, and total amino acid efflux in patients receiving total parenteral nutrition.

OBJECTIVE: The study clarified the effects of growth hormone treatment on forearm amino acid efflux in patients with full nutritional support after gastrointestinal surgery. SUMMARY BACKGROUND DATA: Growth hormone attenuates net nitrogen loss after surgical trauma. An increase in net protein synthesis has been described, whereas the results regarding protein breakdown have been conflicting. METHODS: Elective patients undergoing abdominal surgery were double blindly randomized to treatment with recombinant human growth hormone (GH, n = 9) 24 IU or placebo (PL, n = 10) the first 5 postoperative days. All received parenteral nutrition (nitrogen = 5.7 +/- .1 g/m2, energy = 1018 +/- 12 kcal/m2 (125 +/- .7% of BMR) and epidural analgesia. Amino acid plasma levels and forearm fluxes were measured. RESULTS: The second postoperative day, growth hormone abolished forearm efflux of total amino acid nitrogen (GH: 170 +/- 117, PL: -785 +/- 192 nmol/100 mL/min, p = .0007) due to reduced losses of both essential and nonessential amino acids. Glutamine release was abolished (13 +/- 15 vs. -137 +/- 43 nmol/100 mL/min, p = .007) and alanine release attenuated (-61 +/- 17 vs. -211 +/- 51 nmol/100 mL/min, p = .01). 3-Methyl-histidine release was attenuated (-.20 +/- .11 vs. -.62 +/- .09 nmol/100 mL/min, p = .04). Growth hormone also induced decreased venous plasma amino acid levels. CONCLUSIONS: When given after gastrointestinal surgery in patients treated with total parenteral nutrition, growth hormone treatment abolished glutamine, 3-methylhistidine, and total amino acid nitrogen loss from forearm tissue. Alanine loss from forearm tissue was attenuated.

Abdomen↗
PubMed1993

Long-term prognosis for diabetic patients with foot ulcers.

OBJECTIVE: To evaluate the recurrence of foot ulcers as well as the cumulative amputation and mortality rates in diabetic patients with previous foot ulcers. DESIGN: A prospective study of consecutively presenting diabetic patients admitted to the Department of Internal Medicine because of foot ulcer with a median follow-up of 4 years. SETTING: A multidisciplinary foot-care team. POPULATION: Five-hundred-and-fifty-eight consecutive diabetic patients with foot ulcers treated between 1 July 1983 and 31 December 1990 were followed to final outcome. Out of these patients, 468 healed either primarily (n = 345) or after minor or major amputations (n = 123) and 90 died before healing had occurred. Those 468 patients who healed were included in this prospective study from the time of healing. MAIN OUTCOME MEASURES: Patients were followed according to a standardized protocol with registration of foot lesions, amputation, morbidity and mortality. Clinical examination was performed twice yearly. RESULTS: After 1, 3 and 5 years of observation 34%, 61% and 70% of the patients, respectively, had developed a new foot ulcer. The recurrence rate of foot lesions was slightly higher among patients who previously had had an amputation (P < 0.05, P < 0.01 and non-significant, respectively). Among patients with previous primary healing the cumulative amputation rates were 3%, 10% and 12% after 1, 3 and 5 years of follow-up compared with 13%, 35% and 48% among those who previously healed after amputation, irrespective of previous amputation level (P < 0.001 at all time-points). All amputations except three were initiated by a foot ulcer deteriorating to deep infection or progressive gangrene. The long-term survival ratio was lower among patients healed after previous amputation (80%, 59%, 27%) compared with patients with previously primary healing (92%, 73%, 58%) after 1, 3 and 5 years of observation, respectively (P < 0.001, P < 0.01 and P < 0.001 respectively). The mortality rate was twice as high among primarily healed and four times as high among patients with amputation compared to an age- and sex-matched Swedish population. CONCLUSION: These findings stress the need for life-long surveillance of the diabetic foot at risk and the necessity of preventive foot care among diabetic patients with previous foot lesions, and particularly among those who had had a previous amputation.

Aged↗
PubMed1993

Position-effect variegation and z1 mediated white repression in the In(1)wis system in Drosophila melanogaster.

We have characterized a new X-chromosomal inversion in Drosophila melanogaster, extending from just distal of white to just proximal of the bb locus. The inversion places the w-isoxanthopterinless (wis) allele close to heterochromatin and under the influence of position-effect variegation (PEV). The wis gene activity is also regulated by chromosome pairing-dependent z1-mediated repression. By changing the environment, using specific second site modifiers, altering the amount of heterochromatin, and disturbing the chromosome pairing, we have been able to separately affect the two regulatory phenomena and analyse their respective impact on the wis regulation. We provide evidence that under normal conditions PEV and z1 mediated white repression are additive. However, at extreme levels of wis repression by PEV, changes in the z1-mediated interactions are not observable. This indicates that PEV is epistatic to z1-mediated regulation of wis. We also show that deficiencies in the short arm of Y act as suppressors of the z1-mediated white repression. This suppression does not influence PEV and is thus not due to the lower amount of heterochromatin. We propose that nonhomologous chromosome pairing between X and Y is important for the synapsis-dependent z1-mediated repression of white transcription activity in this system.

Animals↗
PubMed1993

Distal blood pressure as a predictor for the level of amputation in diabetic patients with foot ulcer.

The predictive value of distal blood pressure measurements for the level of amputation was studied prospectively in 161 consecutive diabetic patients with foot ulcers. The patients were treated as outpatients except for periods of surgery and when complications requiring hospital care occurred. All patients were treated pre- and postoperatively by the same multidisciplinary foot care team. Either ankle or toe blood pressure measurement was available in 86% of the patients. Incompressible arteries, ulcer or gangrene at the measuring site, previous amputation, poor general condition, and an emergency situation were factors that excluded standardized ankle and toe blood pressure measurements in 24% and 27% of the patients, respectively. An absolute lower ankle pressure level of 50 mm Hg was found, below which a minor amputation was never sufficient to achieve healing. An ankle pressure below 75 mm Hg was seldom sufficient, and at or above that pressure level, the ankle pressure had no predictive value in this respect. At a toe pressure below 15 mm Hg, a minor amputation was seldom sufficient. Ankle and toe pressure indices gave no further information.

Adult↗