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Biomedical subjects

J Pillgram-Larsen

Publications and source records attributed to J Pillgram-Larsen.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Ambulatory evaluation and treatment of blunt thoracic injuries].

307 patients with chest injuries were treated in an outpatient clinic during a three month period. Ten patients developed complications such as hemothorax, pneumothorax and lung contusion, or late complications such as atelectases and pneumonia. 21 patients were hospitalized after initial evaluation. Two patients died. Pain was a symptom in 306 of the 307 patients. Other symptoms were coughing, hempoptysis, fever, nausea. Complications increased in 40 patients, with other symptoms or signs in addition to pain. These other symptoms had a 40% positive and 95% negative predictive value as regards complications. 45 out of 114 patients had a pathological chest x-ray. Positive chest x-ray had a 40% positive and 94% negative predictive value as regards complications. In four patients (1.3%) complicating injuries were not identified initially. Five of 24 patients (21%) were hospitalized unnecessarily. Chest x-ray should be performed in patients with additional symptoms and signs. Patients with no signs in addition to chest wall tenderness can be observed at home.

Adolescent↗
PubMed1991

[Blunt thoracic injuries in Oslo].

All 327 patients treated in Oslo City Hospital for blunt chest injuries during a period of three months were registered prospectively. 274 were treated outside hospital. Traffic accidents accounted for 10% of the total number of patients, but 40% of the hospitalized patients. Accidents in the home were most numerous, with many complications and admissions to hospital. 20% of the hospitalizations, were for injuries due to violence. The registration indicates more than 1,300 patients with chest injuries per year, of whom more than 40 are severely multitraumatized. The chest injury was serious in 21 patients, moderate in 306. 13.5% of the cases were complicated by pneumo-hemothorax and lung contusion, or by late complications such as pneumonia and atelectases. Seven patients (2.1%) died. These were old, physically disabled or multitraumatized. 100 patients had extrathoracic injuries, of whom 15 had intrathoracic injuries as well. In 227 patients with thoracic injuries only, the injuries were intrathoracic in six of them. The mortality in patients with chest wall injuries only was 0.7%, as compared with 20% in patients with intrathoracic injuries.

Accidents↗
PubMed1991

[Accidental hypothermia. Risk factors in 29 patients with body temperature of 30 degrees C and below].

29 patients with a body temperature below 30 degrees C (mean 26.4 degrees C) were treated during the period 1982-88, both years inclusive. Eight patients were severely hypotensive (systolic blood pressure less than 60 mm Hg) and two had ventricular fibrillation on admission. Bradycardia (less than 60 beats per minute) was noted in ten patients. 12 patients were rewarmed by surface warming, 17 by extracorporeal circulation with femoral cannulation. 22 patients (76%) were discharged alive. Age, sex, body temperature, method and rate of rewarming, serum electrolytes, acidosis and the use of blood components did not influence the outcome. Renal failure was the only complication associated with a fatal outcome. Severe hypotension on admission tended to increase mortality, but logistic regression analysis identified the mode of cooling as the only independent risk factor for death. A patient cooled indoors had an odd risk of 10.6 of hospital mortality compared to one found outdoors. For the sake of convenience, in hospitals with the available resources rewarming by extracorporeal circulation may be used in patients with circulatory arrest, since this is the easiest way to control and support failing circulation. In all other cases carefully monitored surface rewarming should be used as this necessitates less use of hospital resources and produces equally good results.

Accidents↗
PubMed1991

Plasma kallikrein generation in endotoxemia is abolished by ultra high doses of methyl-prednisolone: in vivo studies in a pig model.

Thirty-one healthy young pigs were studied to evaluate the effects of methylprednisolone sodium succinate (MP) on cellular, proteolytic, and hemodynamic parameters in normal and endotoxin-exposed animals. Fourteen animals served as controls, whereas 17 test animals received a continuous infusion of endotoxin, 0.01 mg/kg/3hr. Seven of the test animals and seven of the control group received a total of 200 mg/kg body weight over 5 hr of MP, 100 mg/kg as pretreatment before the endotoxin infusion was started. The administration of MP to control animals did not cause changes in the plasma kallikrein-kinin system, as determined with chromogenic peptide substrate assays. Only temporary effects, which normalized during the observation period, were seen in hemodynamic parameters. The pretreatment with MP significantly counteracted the increases in plasma kallikrein activity (KK) and the decreases in functional kallikrein inhibition capacity (KKI) seen after endotoxin infusion in untreated animals. Marked reductions in the number of circulating leukocytes and platelets were observed in untreated endotoxemia, together with increases in hematocrit. Furthermore, increases in pulmonary vascular resistance (PVR) and decreases in cardiac output (CO), left ventricular stroke work (LVSW), and mixed venous oxygen saturation (SvO2) ensued. The changes in circulating cells, PVR, and SvO2 were significantly counteracted by MP treatment, whereas changes in hematocrit, CO, and LVSW were only moderately improved.

Animals↗
PubMed1990

[Abdominal injuries after blunt trauma].

We present a series of 331 patients admitted to hospital in 1980-87 with abdominal injuries after blunt trauma. The patients included 230 males and 101 females. The median age was 29 years. More than half of the patients were injured in traffic accidents. 11% were transferred to our Trauma Center from other hospitals, median five hours after the accident. A doctor-manned helicopter transported 52 patients (18%) directly to our hospital. 70% had extra-abdominal injuries as well. A minimum of 20% were intoxicated by alcohol and/or drugs. Severe injuries (AIS greater than 3) were present in 46%. 168 patients underwent laparotomy, in 56% within two hours of admission. In 27 of the 168 laparotomized patients (16%) no intraabdominal injury was encountered that needed repair.

Abdominal Injuries↗
PubMed1990

[Reconstructive surge of blunt renal trauma].

The most usual causes of blunt renal injuries are motor vehicle accidents, falls and participation in contact sports. Severe injuries are rare and a conservative approach in the treatment of such injuries is advocated by most authors. In this article we present a patient who suffered a major injury to the right kidney which was treated successfully by reconstructive surgery. We discuss the diagnosis of renal injuries, indications for surgery and surgical technique.

Adult↗
PubMed1990

[Acute pulmonary dysfunction in adults. Adult respiratory distress syndrome--ARDS].

During a 3-year period 0.1% of all patients undergoing surgery and 0.3% of the patients submitted for trauma developed ARDS. The diagnosis was based on strict criteria. Mortality among the 42 patients was 45.2%. Abdominal sepsis was associated with high mortality, trauma with a much better prognosis. Swan-Ganz catheters were used in 81% of the patients. The measurements were characterized by high pulmonary vascular resistance and increased intrapulmonary shunting. However, the initial recordings showed only small differences between survivors and fatal cases as regards haemodynamics and blood gas parameters. Mortality was associated with low diuresis, heart failure, need of inotropic support and on age of over 50 years. The significance of invasive central monitoring is discussed.

Adult↗
PubMed1990

[Fluid therapy changes in surgical treatment of abdominal aortic aneurysm].

The use of blood components and blood substitutes was studied in 25 patients undergoing surgical treatment for abdominal aortic aneurysm in 1983, and was compared with the use of such components in 44 patients operated in 1988. The use of blood components had decreased by 49% from 1983 to 1988. In 1988, erythrocytes were administered only when the hemoglobin concentration fell under 9 g/100 ml. The use of plasma postoperatively was reduced to a minimum. Normovolemia was maintained with polygeline, dextran, electrolytes and autotransfusion. The change in transfusion praxis did not lead to any reduction in postoperative hemoglobin values. The stay in hospital and the number of hours spent in a respirator were both reduced, and there was a general improvement in results.

Aorta, Abdominal↗
PubMed1990

[Triage. Initial diagnosis of life-threatening injuries based on functional state and mechanism of injury].

Functional status expressed as Trauma Score (TS) and mechanism of injury were evaluated as criteria for diagnosing severe trauma in 253 traffic accident victims. An Injury Severity Score (ISS) of greater than or equal to 16 was considered a severe, potentially life-threatening injury. In 67 patients with ISS greater than or equal to 16, either TS was less than or equal to 13 or the history suggested risk of high energy trauma in 72%. When one or both of these criteria were met, ISS was greater than or equal to 16 in 54%. In addition, five patients (3%) with ISS less than 16 had potentially life-threatening injuries in the abdomen or in the thorax. Of these, two had a history indicating high energy trauma. Identifying severely injured patients by assessment of function and mechanism of injury gave an overtriage of 46%, which is acceptable, and an undertriage of 12%. Caution should be exercised in excluding severe trauma on these criteria. Considered together, decreased TS and a history indicating high energy injury, gave high sensitivity (72%) and specificity (78%) for diagnosing severe trauma, ISS greater than or equal to 16.

Accidents, Traffic↗
PubMed1990

[Grading and prognosis of blunt abdominal injuries].

From 1 January 1980 to 31 December 1987, 297 patients were admitted to Ullevål Hospital, Dept. of Surgery, with abdominal injury after blunt trauma. The Injury Severity Score (ISS) was determined in retrospect, and correlated to mortality, morbidity and use of resources. 50 patients (16.8%) died. Mortality increased with increasing ISS, until ISS was above 34. In this group, mortality was 75%. In the survivors, hospital costs (days in the hospital, in the intensive care unit, on mechanical respiration, and number of blood units transfused) increased with increasing ISS. The likelihood of developing septicaemia adult respiratory distress syndrome (ARDS) or multiple organ failure also increased with increasing ISS. Those who died were older and had a higher ISS than the survivors. In patients over 55 years old, the mortality increased significantly. The ISS is well suited for identification of seriously injured patients after blunt abdominal trauma. The ISS can be used to predict mortality, morbidity and cost of treatment in groups of patients.

Abdominal Injuries↗
PubMed1990

[Prognosis for patients involved in traffic injuries].

The outcome in trauma is influenced by the anatomical severity of the injuries as expressed in the Injury Severity Score (ISS), the physiological function as expressed in the Trauma Score (TS) and the patient's age. Based on a statistical analysis, it is possible to estimate the probability of survival. All 202 patients admitted urgently to Ullevål Hospital, Oslo, after traffic accidents in 1987 were assessed. ISS averaged 15 (one to 75). Mean ISS for the dead was 44 (25 to 75). 17 patients (8%) died. When ISS greater than or equal to 16 ('severe injury') mortality was 25%. Patients with TS less than 5 had 100% mortality. Probability of survival was mean 0.95 in survivors and 0.23 for dead. ISS, TS and probability of survival were significantly correlated to death in hospital (p less than 0.0001). Three of 181 patients with probability of survival greater than 0.5 ('avoidable deaths') died, one from an undiscovered aortic rupture, and another from a head/face injury. The third was 83 years old with thoracic injury and died from pneumonia. Two out of three patients with probability of survival between 0.5 and 0.25 ('possibly avoidable deaths') died, while six of 18 patients with probability of survival less than 0.25 ('unavoidable deaths') survived. Risk of dying in hospital was higher in patients with systolic blood pressure below 90 mmHg upon admission. In this case the odd ratio was 40.5, as compared with persons with a systolic blood pressure of 90 mmHg or above. The routines in initial trauma care can be further improved and must include rapid reversal of any hypoperfusion, parallel with quick and complete diagnostic workup.

Accidents, Traffic↗
PubMed1990

[Delayed surgery in blunt abdominal trauma].

Abdominal organ injuries caused by blunt trauma are notoriously difficult to diagnose, and for this reason an operation may be dangerously delayed. 426 abdominal organ injuries were registered in a series of 331 patients admitted after blunt abdominal trauma. 151 of these patients had 199 abdominal organ injuries which required surgical repair. In 31 patients (20%) with 44 organ injuries, operation was delayed for more than six hours after admission, in most cases because of missed diagnosis. One of these patients died as a result. Hollow viscus injuries were the most commonly missed. In addition to repeated clinical evaluation, peritoneal lavage, repeated if necessary, and diagnostic imaging must be used as valuable tools of diagnosis, especially in comatous patients, in patients with multiple injuries, and in intoxicated patients.

Abdominal Injuries↗
PubMed1990

[Penetrating abdominal injuries].

We have reviewed the medical records of 111 patients treated for abdominal stab wounds during the period 1980-87. Our two hospitals serve a catchment area of about 450,000 people. Exploratory laparotomy was performed in 89 patients with suspected peritoneal penetration. In 16 patients the laparotomy was negative, and in 15 patients only minor injuries were noted. There were no serious complications in these 31 patients. Twenty-seven patients had thoracic wounds below the fourth intercostal space, 15 with intraabdominal injuries. The most common injuries were lacerations of the liver, the small bowel and the diaphragm. The mortality in the series was 2%. Stab wounds are infrequent in Norway, and most surgeons have limited experience of such injuries. We discuss whether to employ immediate exploratory laparotomy or selective management when the peritoneum has been penetrated. When there is no evidence of evisceration or omental protrusion, local exploration of the wound should be performed in order to confirm or exclude peritoneal penetration. Injury to the diaphragm and intraabdominal viscera should always be suspected in thoracic stab wounds below the fourth intercostal space.

Abdominal Injuries↗
PubMed1990

[Diagnostic peritoneal lavage in blunt abdominal trauma].

Peritoneal lavage was performed in 142 of 331 patients submitted to hospital after blunt abdominal trauma. The lavage catheter was introduced through a short infra-umbilical longitudinal incision with surgically controlled access to the peritoneal cavity. First time lavage was positive in 58 out of 68 patients in demand of laparotomy, and after repeated lavages in 66 of 68. In 12 patients there was a false positive lavage. The sensitivity was 97% and the specificity 84%. Negative lavage strongly indicates that laparotomy is not necessary. A positive test as an indication for laparotomy should be regarded with reservation. The method is simple to perform and represents a valuable supplement to clinical evaluation in patients with blunt abdominal trauma.

Abdominal Injuries↗
PubMed1990

Hemodynamic effects of interpleural analgesia in pigs.

Six anesthetized pigs received bupivacaine 2 mg/kg with epinephrine 2 micrograms/kg interpleurally while six saline injected animals served as controls. The animals were monitored hemodynamically for 120 min after injection. There were no significant changes in hemodynamic variables in the control group. In the group receiving bupivacaine with epihephrine there was a pattern of increase in mean arterial blood pressure, systemic vascular resistance and mean pulmonary arterial blood pressure after 60 min of observation. There were no other significant changes in pulmonary or systemic hemodynamics or gas exchange as evaluated by blood gases or whole body oxygen consumption. It is speculated that the increased systemic vascular resistance was an effect of the epinephrine added to the anesthetic. Interpleural analgesia may be a safe pain-relieving method even in slightly hypovolemic individuals.

Analgesia↗