Biomedical subjects

K Axelsson

Publications and source records attributed to K Axelsson.

At least 37 records · Page 2Linked to original sources

PubMed1997

Nutrient intake and weight development in children during chemotherapy for malignant disease.

The aim of the study was to assess the actual daily oral intake of energy, protein, fat and carbohydrate in relation to current recommendations in children with malignant disease during chemotherapy and to follow their weight development. Dietary information was collected for 21 consecutive days via 7-day recording in 14 children, aged 5-16 years. The number of days with loss of appetite, vomiting, and the number of days on anti-emetic drugs were also recorded. The average daily energy intake decreased from 91% of the recommendation of the Swedish Nutrition Recommendations (SNR), before chemotherapy to 69% after start of chemotherapy. During days spent at home, the energy intake increased to 77% of SNR. Twenty-two per cent of the total energy intake during the hospital days came from sucrose. On average, the children experienced loss of appetite on 50% of the days, vomiting on 12%, and received anti-emetic drugs on 38%. On admission, the average SD score for body weight for the whole group was -0.09. The mean weight reduction after 1 week was 0.19 SD (P = 0.05) compared to the admission weight. The weight reduction 6 weeks (n = 10) and 3 months (n = 13) after the start of chemotherapy was 0.10 SD and 0.37 SD (P = 0.04), respectively.

Adolescent↗

PubMed1997

Patients' satisfaction with surgical care impaired by cuts in expenditure and after interventions to improve nursing care at a surgical clinic.

Between 1991 and 1994 the number of beds in the surgical clinic at a central hospital in Southern Sweden was cut back by almost 50%. To develop the nursing care and to control the effects of the budgetary cuts, an intervention, including nursing care development, of an organization that would secure continuity in the nurse-patient relationship, individually planned care and quality assurance for aspects believed to be crucial to the quality of nursing care was implemented. The aim of this study was to analyse patients' satisfaction with surgical nursing care between, under and after the last cut in expenditure and the concluded intervention. A patient satisfaction questionnaire covering such areas as: patient satisfaction with information and decision-making; patient satisfaction with contact and the staff-patient relationship; patient satisfaction with ward facilities and the physical treatment or examination and patient satisfaction with various other aspects of care, was administered (1993 n = 131; 1994 n = 128). Subsample analysis showed lower scores for patient satisfaction if the respondents were women, young, or acutely ill when admitted. While surveys carried out between 1991 and 1993 showed an overall improvement in the quality of care, as measured by patient satisfaction, it remained at the same level in 1994 as in 1993, or decreased, regarding patient contacts with staff and physicians, involvement in decision-making, anxiety before examination/treatment, anxiety regarding professional secrecy, opportunity to influence the solution to their physical problems, chance to get sleep without being disturbed, physical nursing care and preparations before discharge. Thus a deterioration in quality seemed to take place in 1994 indicating that the cuts in expenditure may have been too hard and had been made at the expense of patient satisfaction.

Adult↗

PubMed1997

Outcomes of individualized interventions in patients with severe eating difficulties.

The aim of this case study is to describe the outcomes of individualized interventions for patients with severe eating difficulties. The participants were 15 patients who had severe eating difficulties following a stroke or brain tumor and were receiving oral feeding or tube feeding. Interventions focused on training functions needed for eating, activities in eating, and discussions with the patient. Improvements were especially noted in eating activities, and some improvements were noted in oral movements and nutritional status. Before the interventions, none of the patients ate regular food; afterward, six did, and in four patients, the feeding tube was removed. The patients said eating was easier, and they could eat in a safe way. Furthermore, they appreciated the attention to their experience during meals. Although the impairments were not always alleviated, the patients found means to cope with their eating difficulties.

Activities of Daily Living↗

PubMed1996

Oxidation of human insulin-like growth factor I in formulation studies: kinetics of methionine oxidation in aqueous solution and in solid state.

PURPOSE: The aim of this work was to study the kinetics of oxidation of methionine in human Insulin-like Growth Factor I (hIGF-I)1 in aqueous solution and in the solid state by the aid of quantification of oxygen. METHODS: The oxidized from of hIGF-I was characterized by tryptic peptide analysis, RP-HPLC and FAB-MS and quantified by RP-HPLC. The oxygen content was quantified polarographically by a Clark-type electrode. RESULTS: Second-order kinetics with respect to amount of protein and dissolved oxygen was found to be appropriate for the oxidation of methionine in hIGF-I. The rate constants ranged from 1 to 280 M-1 month-1 and had an activation energy of 95 (+/-4) kl/mole. Light exposure, storage temperature and oxygen content were found to have a considerable impact on the oxidation rates. No significant difference in reaction rates was found for the oxidation of hIGF-I in aqueous solution or in the solid state. A method for decreasing the oxygen content in aqueous solution without purging is described. CONCLUSIONS: Polarographic quantification of dissolved oxygen makes it possible to establish the kinetics for oxidation of proteins. The oxidation of methionine in hIGF-I appears to follow second-order kinetics.

Amino Acid Sequence↗

PubMed1996

Eating despite severe difficulties: assessment of poststroke eating.

A programme for the assessment and nursing diagnoses of eating difficulties among stroke patients was tested. The patients' experiences regarding eating were expressed in interviews and dialogues. Eating was observed during both a test meal and regular meals. The assessments included the prerequisites for eating as well as oral, pharyngeal and oesophageal functions. General and specific nursing diagnoses as well as life consequences (handicap) were established, based on assessment of disabilities and impairments, and interviewing the patients and their families, respectively. The general nursing diagnoses were formulated on admission after the test meal and these were reformulated to form specific nursing diagnoses after assessments of the functions. The programme presented proved to be useful in clinical practice. It is emphasized that many assessments must be co-ordinated for each individual.

Adult↗

PubMed1996

The effect of continuous epidural infusion of ropivacaine (0.1%, 0.2% and 0.3%) on nerve conduction velocity and postural control in volunteers.

BACKGROUND: Continuous epidural infusions of local anaesthetics have become increasingly popular in postoperative pain treatment, especially as they permit early mobilisation. Ropivacaine is a promising new agent which induces more pronounced sensory than motor blockade. This study was focused on the influence of continuous epidural infusion of ropivacaine on impulse conduction in large nerves (by measurement of F and H latencies), and on the subjects' ability to maintain postural control during mobilisation. METHODS: Healthy male volunteers received 0.1%, 0.2% or 0.3% ropivacaine, and bupivacaine 0.25% was used as reference. A bolus epidural injection of 10 ml of the drug, at L2/3 level, was followed by continuous infusion at 10 ml/h for 21 h. Motor blockade was assessed by mechanical measurements of force during big toe flexion and by recording of F latency. Sensory blockade was monitored by pin-prick and Thermotest methods, and by H latency recording. The subjects' ability to perform a postural test was evaluated by posturography. RESULTS: The F and H latencies became prolonged/abolished dose-dependently. With ropivacaine, F latency recovered significantly later than motor function (P = 0.0002), and H latency recovered later than normal pin-prick perception (P = 0.0006). However, the duration of partial blockade of thermoperception was comparable to that of H latency prolongation. Posturographically, the subjects receiving 0.1% ropivacaine differed significantly from all others (P < 0.001) in that they were able to maintain postural control during the infusion. The recovery period after termination of infusion was significantly shorter with ropivacaine than with bupivacaine for all measured variables. CONCLUSION: Recovery of postural control with 0.2% and 0.3% ropivacaine is significantly faster than with bupivacaine 0.25%. H latency recording allows detection of epidural blockade intensity that does not prevent subjects from performing postural tests.

Adult↗

PubMed1995

Tumor angiogenesis as a prognostic assay for invasive ductal breast carcinoma.

BACKGROUND: Tumor angiogenesis, as assayed by microvessel density, has been proposed as an independent prognostic marker for clinical outcome in breast cancer patients. PURPOSE: The present study evaluated the microvessel density assay and assessed its utility, alone and together with the evaluation of other tumor characteristics, in predicting outcome in patients with invasive ductal carcinomas. METHODS: In a blinded design, cases of invasive ductal carcinoma were selected from a registry containing the records of and tumor specimens from 386 breast cancer patients treated at the Massachusetts General Hospital from 1977 through 1982. After the exclusion of ineligible patients and inadequate specimens, 220 patients were included in the study; their median time of follow-up was 11.5 years. Half of these patients (n = 110) were positive for axillary lymph node metastases. Histologic sections of the tumors were stained immunocytochemically for factor VIII, a coagulation protein expressed by blood vessel endothelium, and for p53 protein. Independently, two analysts counted microvessels in three microscope fields selected from separate vascular regions of the tumor. Variability in microvessel scores between analysts and among different fields of the same tumor was summarized by the coefficient of variation. The kappa statistic tested for agreement between the analysts while correcting for chance agreement. The effects of tumor characteristics on metastasis-free survival and overall survival were tested univariately by the Harrington-Fleming rank test procedure. The effect of multiple factors on survival was tested under a Cox multivariate proportional hazards model. RESULTS: Microvessel count showed considerable variability between the two analysts and among regions within each tumor, with an overall concordance for tumor classification of 73%. Univariate analysis revealed no association between microvessel count and any other tumor or patient characteristic. Multivariate analysis indicated, for these patients, that nodal status and p53 staining predicted metastasis-free survival and that nodal status, estrogen receptor (ER) status and tumor grade predicted overall survival. CONCLUSIONS: Microvessel count showed much variation among different regions of each tumor. It did not predict metastasis-free survival or overall survival. Nodal status was the most powerful criterion to stratify these patients with invasive ductal carcinoma of the breast into different survival groups. Only ER status, tumor grade, and p53 staining had additional prognostic utility for these patients after they had been stratified by nodal status.

Analysis of Variance↗

PubMed1995

Risk of catheter migration during combined spinal epidural block: percutaneous epiduroscopy study.

Combined spinal epidural (CSE) block with the needle-through-needle technique has become increasingly popular during recent years. However, the risk of epidural catheter penetrating dura mater through the hole made by the spinal needle (migration) is a major concern. In 15 fresh cadavers a percutaneous epiduroscopy technique with a rigid epiduroscope and video recording was used to assess the risk of catheter migration when a CSE block is performed. The experimental sequence included (a) one dural hole made by the spinal needle, (b) multiple (five) dural holes made by the spinal needle, and (c) a dural hole made by Tuohy needle. Twenty-four experimental sequences were performed in the lumbar region. Four sequences were failures due to technical problems. In the remaining 20 cases, the anatomic structures in the epidural space were recognized easily. The epidural space appears to be only a potential space, kept open either by epiduroscope or by repeated injections of air or saline. The dural holes made by Tuohy and spinal needles, and the ease of difficulty of catheter penetration through these holes, were clearly visible. Extensive tenting of the dura was seen in all subjects. It was impossible to force an 18-gauge epidural catheter through the dural hole after a single dural puncture made by a 25-gauge spinal needle. After multiple (five) dural punctures with the spinal needle, the epidural catheter penetrated the perforated dura in 1 of 20 cases. The epidural catheter penetrated the dural hole made by the Tuohy needle in 9 of 20 cases. The distribution of fat, rather than any dorso median connective tissue band, influences the course of epidural catheter in epidural space.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Nurses' satisfaction with nursing care and work at three care units for severely demented people.

The aim of this study is to investigate the degree of job satisfaction, burnout and strain among nurses (n = 134) working in three care units for demented people in southern Sweden. Three questionnaires were used: the Maslach burnout inventory (MBI), the work-related strain inventory (WRSI), and a recently developed measure for assessing job satisfaction. Based on principal component analysis, an eight-factor job satisfaction scale was chosen. Nurses in general were found to be satisfied, with registered nurses (RNs) being most satisfied with their work and the nursing care provided. The nurses in one of the care units were more satisfied than the nurses on the other two. The MBI and WRSI results showed a low degree of burnout and work-related strain and there was little difference between the care units or the categories of nurses. Job satisfaction scores were relatively independent from the MBI and WRSI scores. However, scores from these two inventories of burnout and strain at work were positively correlated. The results of the questionnaires seem to indicate that positive work experience and negative experience are not opposites. This particular method of evaluating job satisfaction needs further development. However, it seems important to include one specific measure for job satisfaction when action is taken in connection with the working situation of nurses.

Adult↗

PubMed1995

Perioperative autotransfusion and functional coagulation analysis in total hip replacement.

Functional coagulation analyses like Sonoclot and thromboelastography have not been evaluated during perioperative autotransfusion. We have prospectively studied three different transfusion regimes in 45 patients undergoing total hip arthroplasty. Blood losses were replaced either with heterologous erythrocyte concentrate (group I), intra- and postoperative autotransfusion of blood salvaged with cellsaver technique (group II) or predonated autologous erythrocyte concentrates together with salvaged blood (group III). Routine and functional coagulation analyses with a Sonoclot were performed preoperatively, 6 hours postoperatively (6 h), day 1-5 and 10. An early postoperative hypo- and late postoperative hypercoagulative phase could be detected with Sonoclot signs of platelet function and fibrin deposition in all groups. Sonoclot coagulation analyses better correlated to both blood loss and dextran dosage than APTT and platelet count in the routine coagulation analyses. Functional coagulation analysis has a potential use in individualizing plasmasubstitution and thromboprophylaxis regimes during autotransfusion in THR.

Blood Coagulation↗

PubMed1995

Desmopressin acetate does not reduce blood loss during total hip replacement in patients receiving dextran.

The blood loss-reducing effect of desmopressin during dextran therapy was studied in a double-blind fashion in 79 elderly but otherwise healthy patients with preoperative normal bleeding time undergoing total hip replacement for primary coxarthrosis. An infusion of desmopressin (0.3 microgram/kg body weight) or placebo was randomly administered immediately after administration of spinal anaesthesia and six hours later. Haemostasis was evaluated on the basis of vWF: ristocetin cofactor activity, FVIII: C activity, human tissue plasminogen activator (tPA) plasminogen activator inhibitor type (PAI), beta-thromboglobuline (beta TG) and a clot impedance test (Sonoclot). There were no statistically significant differences (P > 0.05) in mean blood loss or transfusion requirements between the placebo and the desmopressin group. There was a significantly increase (P < 0.01) both in vWF: ristocetin cofactor and in FVIII: C activity after both infusions of desmopressin compared with placebo. There was no significant difference in beta TG, tPA, PAI or Sonoclot analysis between the groups. In conclusion, desmopressin did not reduce blood loss in patients undergoing total hip replacement.

Aged↗

PubMed1994

F response and H reflex for monitoring nerve block during epidural analgesia with ropivacaine.

The effect of a single epidural injection of ropivacaine on the motor and sensory function controlled from the L5/S1 level was investigated in 28 male volunteers. Concentrations of 1%, 0.75%, or 0.5% ropivacaine, 20 mL, administered at the L2/3 level were studied. Motor function was assessed quantitatively (measurement of muscle force by mechano-transducers), and sensory function by the pinprick method. In addition, F response and H reflex, tests which measure the conduction velocity in the central parts of peripheral nerves, were used. Epidural ropivacaine caused dose-dependent prolongation of the latencies of both these variables. F response latency recovered significantly later than motor function measured by mechano-transducers in the two lower concentration groups. H reflex latency recovered significantly later than sensory function assessed by the pinprick method in all three concentration groups. The time needed for recovery of F and H latencies was not significantly longer than the time from epidural injection to mobilization. At the time when the subjects could go through the mobilization procedure, 12 of 28 subjects were not completely recovered. In 5 of these 12 subjects, the H reflex latency was persistently prolonged at the end of the investigation, long after the subjects felt "normal" again. On follow-up recordings 5 mo later, the baseline latency had been regained in all five subjects. We conclude that F response and H reflex latencies are good indicators of the inhibition of nerve impulse conduction induced by epidural analgesia.

Adult↗

PubMed1994

[Morning care of patients with Alzheimer's dementia: a theoretical model based on direct observation].

Five hospitalized patients in different stages of Alzheimer-type dementia were monitored by unstructured, direct observations during morning care. Orem's model of nursing as a compensation for the patient's lack of self-care capabilities was used as a frame of reference for an analysis of the behaviours of patients and nurses during morning care. A 12-step classification system was developed to be used as a guide to understand and determine abilities essential for performance of morning care for demented patients. The quantitative assessment showed that none of the patients was able to manage morning care independently, but there was a wide variation in their highest level of performance.

Alzheimer Disease↗

PubMed1993

Blockade of the abdominal muscles measured by EMG during lumbar epidural analgesia with ropivacaine--a double-blind study.

A single shot of 20 ml of 1%, 0.75% or 0.5% ropivacaine was administered epidurally (at L2/3 level) to 30 volunteers, in a double-blind manner. The blockade of the rectus abdominis muscle was measured quantitatively by registration of the average rectified electromyographic signal (AREMG) at the T7, T9 and T11 motor segmental levels and with a qualitative test for blockade of the rectus abdominis muscle (the so-called RAM test). The maximal cranial spread of analgesia, evaluated by the pin-prick method, was not significantly different for the three concentrations (T8-T10 dermatome; median value). The intensity of motor blockade, measured by the AREMG method, increased progressively from the T7 segment and caudally with all three concentrations. The blockade was partial (i.e. 85-25% of baseline AREMG activity was present at its maximum) in all subjects. When the effect of the three concentrations of ropivacaine was compared at the same segmental level, the intensity and duration of maximal motor blockade seemed to be dose-dependent, but the difference was not statistically significant. The total duration of motor blockade was shorter with the 0.5% solution than with the higher concentrations. The AREMG method gave a more exact and graded picture of blockade of the rectus abdominis muscle than the RAM test. The duration of sensory blockade did not outlast motor blockade at any level. In half of our subjects the maximal spread of sensory blockade was either equal to or higher than the spread of partial motor block. In the other half, this relationship was reversed--the maximal cranial level of partial motor block was 1-4 segments higher than the maximal level of analgesia.

Abdominal Muscles↗

PubMed1992

Disulfide arrangement of human insulin-like growth factor I derived from yeast and plasma.

The disulfide arrangement of yeast derived human insulin-like growth factor I (yIGF-I) was determined using a combination of Staphylococcus aureus V8 protease mapping, fast-atom-bombardment mass spectrometry as well as amino acid sequence and composition analysis. Three disulfide bridges were found between the following cysteine residues: Cys6-Cys48, Cys47-Cys52 and Cys18-Cys61. IGF-I isolated from human plasma (pIGF-I) was found to have an identical disulfide configuration. A yeast-derived isomeric form of IGF-I (yisoIGF-I) exhibited an altered disulfide arrangement: Cys6-Cys47, Cys48-Cys52 and Cys18-Cys61. Radioreceptor analysis of pIGF-I and yIGF-I showed high specific activity, 20,000 U/mg. However, yisoIGF-I demonstrated a severely reduced ability to bind to the IGF-I receptor (19%) and was less potent in provoking a mitogenic response in Balb/C 3T3 fibroblasts (50% at doses 10-100 ng/ml). The data demonstrate the importance of correct disulfide arrangement in IGF-I for full biological activity.

Amino Acid Sequence↗

PubMed1991

Sensory and motor blockade during epidural analgesia with 1%, 0.75%, and 0.5% ropivacaine--a double-blind study.

Levels of sensory (pinprick) and somatic motor blockade were measured in a double-blind study of 30 volunteers given single epidural injections of 1%, 0.75%, and 0.5% ropivacaine. Onset of analgesia was rapid with all concentrations (7-10 min). Maximal levels of analgesia were established 60 min after injection, with no significant differences in the maximal median cephalad spread. Duration of analgesia at the T-12 level and total duration were significantly longer with 1% and 0.75% than with 0.5% ropivacaine. Motor blockade was assessed by a quantitative method (measurements of isometric muscle force) and a qualitative method (modified Bromage scale). Onset of motor blockade measured by the quantitative method was significantly slower with 0.5% ropivacaine than with the higher concentrations. Maximal muscle weakness occurred 1-1.5 h after injection with all three concentrations. With increase in ropivacaine dose from 100 to 200 mg, the intensity and duration of motor blockade increased. Muscles involved in knee extension were blocked most, those of plantar flexion least. Recovery of motor function, assessed by the above-mentioned quantitative method, occurred simultaneously with the recovery of pinprick perception. Motor blockade registered by Bromage scale showed a slower onset for 0.5% ropivacaine than for the higher concentrations. Mean durations of grade 1 and 2 block were longest for the 1% solution. Motor blockade described by the Bromage scale showed only the first part of the regression phase. Full recovery of muscle strength (Bromage scale = 0) was attained 1.5-2.5 h earlier than assessed by the quantitative method. No adverse effects were registered.

Adult↗

PubMed1991

Epidural anesthesia with 0.5% bupivacaine: influence of age on sensory and motor blockade.

To determine the influence of age on epidural blockade, 10 elderly male patients (mean age, 73 yr) and 11 young male volunteers (mean age, 25 yr) received epidural anesthesia with 20 mL of 0.5% bupivacaine with epinephrine at the L2-3 interspace. Median cephalad analgesia level (pinprick) was T-4 in the elderly and T-10 in the young subjects (P less than 0.01). The duration of analgesia at the L-1 to S-3 segments was about 60 min shorter in the older patients than in the young volunteers (P less than 0.05). Motor blockade was evaluated quantitatively by isometric muscle force measurements in the lower extremities and by electromyographic recordings from the abdominal and quadriceps muscles. Motor blockade in the lower extremities was also assessed qualitatively by the Bromage scale. The intensity of motor blockade was not influenced by age. The mean duration of maximal motor blockade of the lower abdominal muscles was 69 min in elderly patients and 140 min in young subjects (P less than 0.05). The corresponding mean duration in the lower extremities was approximately 1.5 h in the older patients and 3 h in the young subjects (P less than 0.01). The elderly patients could be mobilized 2 h earlier than the young volunteers. Duration of Bromage grade 1 was about 1.5 h shorter in the elderly than in the young subjects (P less than 0.01). Not until 1.5-2 h after attainment of Bromage grade 0 was the muscle force in the lower extremities restored to 90% of baseline value. The authors conclude that cephalad spread was more extensive and duration of epidural blockade was shorter in elderly patients versus younger volunteers.

Adult↗

PubMed1990

Protein kinase C and casein kinase II activities in two human colon carcinoma cell lines, HT-29 and CaCo-2: possible correlation with differentiation.

Protein kinase C (PK-C) and casein kinase II (CK-II) activities were studied in two human colon carcinoma cell lines (HT-29 and CaCO-2) undergoing differentiation in vitro resulting, in small-intestine-like cells. CaCo-2 cells, when grown under standard conditions, appear to undergo spontaneous differentiation. In these cells PK-C and CK-II activities were determined on day 5, 10 and 15. No significant differences in activities were seen either in PK-C or CK-II activity. HT-29 cells, when grown in glucose-free medium can be stimulated to undergo differentiation which is completed within 20 days. PK-C and CK-II activities were determined after 5, 10, 15, 20 and 25 days, respectively. PK-C activity rose from 7.9 +/- 3.5 pmole 32P/mg protein/min at day 5 to 37.5 +/- 14.8 pmole 32P/mg protein/min at day 20. After 25 days the activity was reduced to 20.0 +/- 7.8 pmole 32P/mg protein/min. CK-II activity did not change significantly during day 5 to 20, but on day 25 there was a significant decrease in CK-II activity from 94.9 +/- 6.4 pmole 32P/mg protein/min (day 20) to 62.6 +/- 3.9 pmole 32P/mg protein/min (day 25) p = 0.003. The results in this study indicate a role for PK-C and CK-II in cell growth and differentiation.

Casein Kinases↗