Biomedical subjects

L Blomqvist

Publications and source records attributed to L Blomqvist.

At least 37 records · Page 2Linked to original sources

PubMed1999

A prospective randomised study (named SVEA) of three methods of delayed breast reconstruction. Study design, patients' preoperative problems and expectations.

A randomised study named SVEA to compare three methods for delayed breast reconstruction was initiated in 1994. The methods were: the lateral thoracodorsal flap, the latissimus dorsi flap, and the pedicled transverse rectus abdominis muscle flap. In the present paper we describe the study design, primary endpoints, and inclusion and exclusion criteria. Results from preoperative questionnaires about problems after mastectomy and expectations of the reconstruction are presented. The preoperative questionnaires, completed before randomisation, included a health related quality of life questionnaire, the SF-36, and a questionnaire concerning the impact of breast loss and expectations of the reconstruction. A total of 87 patients have been randomised in SVEA and 30 patients have been followed up outside the randomised study, comprising a reference group. The results from preoperative questionnaires, completed by 106 of the total 117 women, showed that they encountered many problems after mastectomy, primarily about feeling mutilated and being bothered socially. They held high expectations on the breast reconstruction in these areas. The women in the present study did not differ from Swedish women in general regarding health related quality of life, with two exceptions: the study sample scored lower on physical functioning and mental health.

Attitude to Health↗

PubMed1999

Clinical experience with the lateral thoracodorsal flap in breast reconstruction.

The lateral thoracodorsal flap is a local fasciocutaneous flap used for breast reconstruction. From 1986 to 1994 the authors used this flap in 157 breast reconstructions in 152 patients. The patients who had been treated with postmastectomy radiotherapy (N = 40) had significantly more (p < 0.01) early complications, such as necrosis and infection. Irradiated patients also required more operations due to secondary complications, such as capsular contracture (p < 0.05). A patient questionnaire (response rate, 91%) was sent to 121 patients and showed that, although a majority of patients felt the reconstructed breast was less sensitive to touch and harder than the contralateral breast, they still regarded the reconstructed breast as a natural part of themselves. More than 90% of patients did not regret the reconstruction and 80% would recommend it to a friend.

Adult↗

PubMed1999

Rectal adenocarcinoma: assessment of tumour involvement of the lateral resection margin by MRI of resected specimen.

The aim of the present study was to investigate whether MRI could predict tumour involvement of the lateral resection margin on resected rectal cancer specimens. 26 specimens obtained after total mesorectal excision were examined in the sagittal and axial plane on a clinical 1.5 T MR system using phased-array surface coils. The shortest distance between the deepest point of tumour penetration and the lateral resection margin was measured. This distance is referred to as LRM. The results were correlated to measurements on digital images of giant histopathological sections. The total number of lymph nodes and lymph node metastases was also counted. LRM was less than or equal to 1 mm (a distance considered for non-radically excised tumours) in eight of the histopathological specimens. On MR images of the resected specimen, LRM was less than or equal to 1 mm in seven of these specimens. LRM was shorter in MR examinations than in histopathological giant sections in 11 specimens. The sensitivity, specificity, positive and negative predictive values for prediction of tumour involvement of the lateral resection margin (LRM < or = 1 mm) by MR of the resected specimen were 88%, 78%, 64% and 93%, respectively. Presence of lymph node metastases could not accurately be predicted by MR. However, it is concluded that the presence of a tumour free lateral resection margin can be predicted by MRI of resected rectal specimens when this exceeds 1 mm.

Adenocarcinoma↗

PubMed1998

The pelvis after surgery and radio-chemotherapy for rectal cancer studied with Gd-DTPA-enhanced fast dynamic MR imaging.

The aim of this work was to study the gadolinium-enhancement of malignant and benign pathology in the pelvis after surgery for rectal cancer. Thirty patients with either local recurrence (n = 17) or benign changes related to treatment for rectal cancer (n = 13) were studied with pelvic MR imaging. T2-weighted fast spin-echo as well as T1-weighted spin- or gradient-echo imaging before and after intravenous contrast was performed and referred to as contrast-enhanced MRI (CEMRI). In addition, between the pre- and postcontrast images, dynamic contrast-enhanced MRI (DCEMRI) was performed using a single-slice, multi-phase, contrast-enhanced T1-weighted fast spoiled gradient-echo sequence. The time between the start of contrast injection to the beginning of enhancement, the duration and rate of enhancement as well as enhancement amplitude were recorded. The data were compared with the clinical diagnosis according to biopsy in 8 patients and surgery in 6 patients. In the remaining 16 patients, the clinical diagnosis was obtained by clinical or radiological follow-up. DCEMRI did not improve the diagnostic information compared with CEMRI. None of the examined parameters were found to help discriminating malignant from benign changes. Characterisation of lesions in the pelvis after rectal cancer surgery was not improved by a dynamic gadolinium-enhanced sequence.

Adult↗

PubMed1998

Metabolism in myocutaneous flaps studied by in situ microdialysis.

The aim of this investigation was to follow the metabolism of myocutaneous flaps using microdialysis. After subcutaneous implantation of a microdialysis catheter into the flap tissue, serial samples were collected and changes in composition of the extracellular fluid assessed. Ten women underwent reconstructions with transverse rectus abdominis myocutaneous (TRAM) or latissimus dorsi flaps. Glucose, glycerol, and lactate concentrations were measured in the flaps and compared with those in adipose control tissue located over the hip. A transient rise in glucose was observed initially in the flaps. The glycerol concentration also increased significantly, and remained increased for approximately 12 hours after the operation. The lactate concentration changed in the same direction, but stayed elevated in the flap tissue during the entire investigation (24 hours). Neither of these parameters changed to the same extent in the control tissue. In one of the patients a haematoma developed postoperatively in the flap. This incident was accompanied by a sharp decline in glucose, and marked additional increases in glycerol and lactate concentrations. It may well be that this "metabolic pattern" in flap tissue signals threatening flap ischaemia. If so, this new microdialysis technique may be useful as a postoperative surveillance tool in myocutaneous flap surgery.

Adult↗

PubMed1998

The inflammatory reaction in elective flap surgery.

The inflammatory response in three different flap procedures was investigated by measuring the preoperative and postoperative levels of C-reactive protein, leukocyte count, and body temperature. Patients scheduled for delayed breast reconstruction were operated on with the lateral thoracodorsal flap, the latissimus dorsi flap, or the pedicled TRAM flap. All patients received 2 gm of intravenous cloxacillin for antibiotic prophylaxis and 1 gm of paracetamol four times a day as basic treatment for postoperative pain. Within each treatment group, significant postoperative changes in C-reactive protein levels, leukocyte count, and body temperature were noted when compared with preoperative values. The highest C-reactive protein level (130 mg/ml) was found in the TRAM group on the third postoperative day. The kinetic pattern of C-reactive protein was similar for the latissimus dorsi flap and lateral thoracodorsal flap procedures, but the maximum C-reactive protein levels were significantly lower, 74 and 44 mg/ml respectively. Small (0.5 to 0.9 degrees C) but significant differences in body temperature were also noted on the second and third postoperative day. The TRAM flap group had the highest, the latissimus dorsi flap group intermediate, and the lateral thoracodorsal flap group the lowest value. The postoperative C-reactive protein levels seem to reflect the extent of the surgical trauma.

Acute-Phase Reaction↗

PubMed1998

Antibody response in Staphylococcus aureus septicaemia--a prospective study.

Formation of serum antibodies against alpha-toxin, teichoic acid and lipase was followed in 63 patients with Staphylococcus aureus septicaemia in 240 consecutive serum samples. Control subjects comprised 23 patients with septicaemia due to other causes and 21 febrile patients without septicaemia. An antibody response against alpha-toxin, measured by ELISA, was most common (40%) in the initial serum, but antibody to teichoic acid was present in the highest number of positive patients (60%) when samples were drawn between 0 and 30 days: 74% of the patients showed a positive antibody response to at least one of the three antigens. When complicated versus uncomplicated septicaemia was compared (samples taken 8-14 days), 14 (45%) of 31 patients had a positive response against alpha-toxin versus 12 (75%) of 16, against teichoic acid 16 (51%) of 31 versus 12 (75%) of 16 and against lipase 15 (48%) of 31 versus 8 (50%) of 16. Patients with low initial antibody levels displayed a poorer antibody response than those with higher initial antibody levels. This phenomenon was observed with all three antigens, but was most pronounced with alpha-toxin. The initial antibody levels may predict the antibody response during the course of the disease. ELISA titres against alpha-toxin correlated (r=0.87) with biological neutralising activity of the antisera. The results may indicate a biological role of serum antibodies in staphylococcal septicaemia.

Adolescent↗

PubMed1997

[Magnetic resonance tomography of the lesser pelvis. Clinical application in disparity with technology].

Technological innovations which change diagnostic routines are continually being introduced in medical care, as exemplified by magnetic resonance imaging (MRI) with its advanced diagnostic capacity, now considered indispensible for the investigation of many disorders of the central nervous system. The article consists in an outline of applications of MRI in the investigation of the lower abdomen, a field characterised by substantial technical improvements in recent years, and a brief review of subject literature. Based on their experience of pelvic MRI, the authors advocate its more frequent use in investigating disorders of the lesser pelvis.

Female↗

PubMed1997

Rectal tumours--MR imaging with endorectal and/or phased-array coils, and histopathological staging on giant sections. A comparative study.

OBJECTIVE: To investigate the accuracy of MR imaging in the preoperative staging of patients with clinically resectable rectal tumours. MATERIAL AND METHODS: Forty-eight consecutive patients with rectal tumours were examined, 29 with a pelvic phased-array coil and 19 with a multi-coil arrangement including a pelvic phased-array coil and an endorectal coil. MR images and histopathological specimens and sections were reviewed independently and tumours were staged according to the TNM classification. RESULTS: A more complete visualisation of the various layers of the rectal wall was achieved on the endorectal MR images than on the pelvic phased-array images. The sensitivity of MR in correctly staging T3 tumours compared with histopathology was 81% with a specificity of 82%. Penetration of the rectal wall was predicted with a sensitivity of 82% and a specificity of 87%. Sensitivity and specificity in predicting lymph node metastases was 83% and 74% respectively. CONCLUSION: MR imaging with both pelvic phased-array and endorectal coils allowed the preoperative staging of rectal tumours with a high degree of accuracy.

Adult↗

PubMed1997

Serum creatine kinase in fasciocutaneous and musculocutaneous flap surgery.

The pre- and postoperative serum levels of creatine kinase (CK) were analyzed in 56 patients operated with three different breast reconstructive procedures. Thirteen patients were operated with the lateral thoracodorsal flap (LTD), 23 by the latissimus dorsi flap (LD), and 20 by the pedicled transverse rectus abdominis musculocutaneous (TRAM) flap. Nineteen patients in the LD and TRAM groups had received postmastectomy radiotherapy. The operations caused a significant rise in the serum levels of CK, and the highest levels were found on the first postoperative day: LTD, 5.4 microkat per liter; LD, 8.1 microkat per liter; and TRAM, 7.3 microkat per liter. There was no significant difference in CK levels between the groups. The irradiated patients did not show increased CK levels when compared with nonirradiated patients.

Adult↗

PubMed1997

Hamartoma of the breast: surgical treatment and reconstruction. Case report.

Hamartoma of the breast is a rare and usually benign tumour with a variable growth pattern. Slowly increasing breast asymmetry is the most common clinical finding. Smaller hamartomas are often diagnosed on mammography. Simple enucleation and secondary expansion of the breast tissue are often sufficient to restore breast symmetry but sometimes, as in the two cases presented, reconstruction is necessary.

Adolescent↗

PubMed1997

Toxic shock syndrome after burn injuries in children.

Toxic shock syndrome is a life-threatening exotoxin mediated disease caused by Staphylococcus aureus, which was originally described as affecting menstruating women, but has lately been reported after surgical procedures and burns. The high mortality emphasises the importance of early diagnosis. In most cases there is a prodromal period with fever (> 38.9 degrees C), myalgia, headache, and vomiting before the onset of hypotension and multiorgan failure. We present two cases in children with minor burns, and review current recommendations for treatment.

Bandages↗

PubMed1996

Pancreas size and insulin secretion: lack of association in non-diabetic subjects.

Both type 1 and type 2 diabetes mellitus are associated with reduced pancreatic size. This could be caused by insulinopenia with loss of a trophic insulin effect and/or other factors associated with a diabetic state. To investigate the role of long-term moderate insulinemia per se, we compared the pancreatic size in healthy subjects with documented low (n = 5) and high (n = 5) insulin secretion. Insulin responses to a glucose clamp (11 mM) procedure were threefold higher in the high insulin responders (HIR) than low insulin responders (LIR). Age, body mass index (BMI), and blood glucose were similar between groups. Computed tomography showed no difference in total pancreatic size (total pancreas volume 84.8 +/- 29.4 ml in LIR, 79.8 +/- 8.4 ml in HIR; NS) nor in the size of various parts (caput, corpus, or cauda). We conclude that moderate hypoinsulinemia of long duration does not affect the pancreatic size.

Adult↗

PubMed1996

MR imaging, CT and CEA scintigraphy in the diagnosis of local recurrence of rectal carcinoma.

PURPOSE: To compare advanced imaging techniques in the diagnosis of recurrent rectal cancer. MATERIAL AND METHODS: Twenty-five consecutive patients with either suspected or verified recurrence were examined by CT (n = 25), MR with phased-array capabilities (n = 24) and CEA scintigraphy (n = 16). Three experienced radiologists (who were blinded to results obtained at surgery and histopathology) independently evaluated the films, one observer for each modality. RESULTS: The MR radiologist arrived at a correct diagnosis in 87.5% of the examinations, the CT radiologist in 76% and the CEA radiologist in 75%. The MR radiologist's results correlated more often with reported pathology than did those of the CT radiologist with regard to the relation of recurrent tumor to surrounding structures in the pelvis. CONCLUSION: MR imaging is the most effective of the 3 modalities in the diagnosis of recurrent rectal cancer.

Aged↗

PubMed1996

Reduction mammaplasty: analysis of patients' weight, resection weights, and late complications.

The medical records of 291 patients who had undergone reduction mammaplasty were analysed. A total of 216 (74%) of the women were overweight and 67 (23%) to such a degree that according to our policy they should not have been candidates for operation. Most of the patients were young-199 (68%) were less than 40 years old and 110 (38%) were less than 25 years old. Total bilateral resection weights in many younger women were quite low. Of the 199 patients less than 40 years old 64 (32%) had less than 500 g total bilateral resection weight whereas 85 (92%) of the women 40 years old or more had resections of more than 500 g. Late complications were few-the rate of infection was similar in all weight groups. Fat and nipple necrosis-although rare-were more likely to occur in the obese and in patients over 30 years old.

Adolescent↗

PubMed1996

Evaluation of a priority grouping system for patients undergoing reduction mammaplasty.

The consequences of an earlier published priority grouping system for reduction mammaplasty are described. The system is based on breast volume but gives priority to certain age groups (25 years or less and 60 years or more), asymmetry, and ptosis, whereas overweight is considered as a negative factor. Additional points are given for psychological or somatic symptoms, or both. A total of 210 patients, who had been operated on were evaluated, and based on their total priority score, patients were assigned to one of five priority groups. Only five of the patients operated on belonged to the two groups with the lowest priority which indicates that the grouping system is a useful tool for sorting waiting lists and making decisions about priorities. The impact of the age related score and the subjective extra score for somatic and psychological distress is, however, considerable and questionable. Most of the patients (57%) less than 21 years old were in the group with the highest priority. The mean time period between acceptance for operation and the actual operation is 14 months in this age and priority group, which is far less than any other group. We think that the main focus should be the actual size of the breast and we have therefore recently modified the grouping system and reduced the impact of age and variables based on subjective scoring.

Adolescent↗

PubMed1996

Reduction mammaplasty with adrenaline infiltration: effects on perioperative bleeding.

We present a retrospective comparison of two groups of patients who underwent reduction mammaplasty with (n = 200) and without (n = 44) infiltration of a combination of a local anaesthetic and adrenaline. The vasoconstrictive effect of adrenaline reduced the intraoperative bleeding from 0.5 ml to 0.1 ml/g resected tissue. Postoperative bleeding was also reduced. Drains were omitted in 104 of the patients who had received adrenaline. In spite of this, these patients had no increases in the rates of infection, haematoma formation, or need for reoperation compared with the group that had been given drains. The practical implication is that after local infiltration of a vasoconstrictor agent post-operative drains can be omitted, at least in the Strömbeck reduction mammaplasty procedure.

Adult↗

PubMed1995

MR imaging of adult colo-rectal intussusception. A case report.

MR imaging of an intussuscepted sigmoid cancer misinterpreted as a rectal carcinoma is described. High-resolution technique with pelvic-phased array coils and fast spin-echo was used. The diagnosis is discussed in relation to the MR findings.

Colonic Diseases↗