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Biomedical subjects

L Dernevik

Publications and source records attributed to L Dernevik.

54 records · Page 3Linked to original sources
PubMed1987

Pathogenesis of shrinking pleuritis with atelectasis--"rounded atelectasis".

The pathogenesis of "shrinking pleuritis with atelectasis" or "rounded atelectasis" is discussed on the basis of 37 operated patients and on experiments on cadaver lungs. Peroperative dissections with microscopic examinations and the results of experiments with the cadaver lungs support the concept that the lesion is caused by an inflammatory reaction in the visceral layer of the pleura, caused by asbestos fibers. The inflammation occurs in stages, with deposition of connective tissue that shrinks and causes considerable atelectasis of the underlying pulmonary parenchyma. Compression of the lung due to fluid collecting in the pleural cavity involved was not noted.

Asbestos↗
PubMed1986

Treatment of benign strictures and injuries of the oesophagus with a permanent oesophageal tube introduced through a cervical oesophagostomy. II. Clinical observations.

Eighty-four patients with severe benign oesophageal strictures and/or oesophageal perforation have been managed with a permanent oesophageal tube (POT) introduced through a cervical oesophagostomy. Sixty-eight patients had severe strictures of varying etiology. In these patients, the conservative treatment by bouginage could not be continued due to a stricture unyielding for dilatation or early recurrence of the stricture after a number of dilatations. Eleven of these patients had iatrogen oesophageal perforation at the time the treatment with POT was started. In 16 patients indication for treatment with POT was a severe injury of the oesophagus and in 15 of them it was transmural. The results of the treatment are considered to be satisfactory. The mortality rate, the final results and the factors determining poor results of the treatment are discussed. The treatment with POT introduced through a cervical oesophagostomy is considered to be a valuable method which can be used in cases with stricture and injuries of the oesophagus in which conventional conservative treatment is futile or impossible and resection of the oesophagus undesirable.

Adolescent↗
PubMed1985

Exogenous particles in lymph nodes in patients with shrinking pleuritis with atelectasis.

Shrinking pleuritis with atelectasis is a disease in which a compression atelectasis of the lung is caused by shrinking of the inflamed visceral pleura. This reaction has been attributed to asbestos. By means of scanning electron microscopy, with computerised x ray spectrophotometry and x ray diffraction analysis, tissue samples from the lymph nodes of patients with the disease and control subjects were examined for other particles of possible aetiological importance. The results would suggest, however, that asbestos is the most important factor in the aetiology of shrinking pleuritis with atelectasis.

Asbestos↗
PubMed1985

Long term results of operation for shrinking pleuritis with atelectasis.

During 14 years 34 patients were operated on for shrinking pleuritis with atelectasis. They were followed up after one to 14 years (mean 6.0) by interview, chest radiography, and spirometry. Most were in good condition, but a reduction in vital capacity had occurred in eight and in FEV1 in 15 patients. Radiographs were normal in 28 patients except for small pleural or parenchymal fibrotic changes. One patient had a suspected recurrence of shrinking pleuritis with atelectasis after nine years, suggesting continuation of the disease process despite operation.

Adult↗
PubMed1985

Surgical removal of pulmonary metastases from renal cell carcinoma.

Thirty-three patients operated on for pulmonary metastases from renal cancer were followed up for a minimum of 5 years or to death. The 5-year survival was 21%. There was a tendency to better survival in patients operated by lobectomy rather than limited resection. Extended operations carried a grave prognosis. Manifest metastatic disease within one year after the primary operation showed shortened survival. Repeated operations were possible, with good results. It is concluded that operations for pulmonary metastases can be performed with good results. However, the effect is a palliative one as the ultimate cause of death in all instances was the spread of the cancer disease.

Carcinoma, Renal Cell↗
PubMed1985

Resectional operations and long-term results in carcinoma of the esophagus.

The 5 year survival rate after resectional operations for carcinoma of the esophagus is still very low. Many factors have been identified as contributing to these poor long-term results. The main factor found in this study, comprising 102 patients undergoing resection out of 125 patients operated upon during a 10 year period, was nonradical resection. The main cause of nonradical resection was invasion of the tumor into the mediastinum, which was observed in 80% of the patients. In 43 of the 102 patients undergoing resection, the penetration of the carcinoma into the tissue surrounding the esophagus was observed only histologically. Thirty-three of the 38 hospital survivors in this group died within 2 years of the operation of recurrence of carcinoma. Fourteen of 17 survivors after resectional operations in whom the tumor growth was still limited to the esophagus were alive from 2 to 9 years (mean 6 years) after the operation, without evidence of recurrence.

Adult↗
PubMed1985

Immunological abnormalities in shrinking pleuritis with atelectasis.

The immunological status of 14 patients with shrinking pleuritis with atelectasis (SPA) was assessed by skin testing for delayed hypersensitivity reactions and in vitro tests of peripheral blood lymphocyte reactivity. The results were compared with those of 3 control groups, one consisting of healthy men, one of workers exposed to asbestos and one of workers exposed to quartz dust. Only 2 of 14 SPA patients showed a positive skin reaction to 2.4-dinitrochlorobenzene (DNCB). The cutaneous reactions to candida and varidase were significantly increased in the SPA group compared with the other groups (p less than 0.05). The response of the blood lymphocytes to stimulation with phytohaemagglutinin was significantly decreased in the SPA group (p less than 0.01), as was unstimulated lymphocyte proliferation (p less than 0.05). The results suggest a primary or secondary immune abnormality in the SPA group. The exact nature of the defect requires further elucidation.

Adult↗
PubMed1984

Foreign bodies in the mediastinum perforating the oesophagus.

A patient attempting suicide put four unsterile objects into a stab wound in his neck. These objects remained in the tissues unnoticed for about three months before they were removed from the upper mediastinum by operation. Owing to penicillin treatment, no diffuse mediastinitis developed but the oesophagus was perforated by the objects. In spite of severe damage to the gullet by the perforation and by operative incision, the oesophagus could be repaired without development of stenosis. The method of preventing stenosis is presented.

Adult↗
PubMed1983

Changes in plasma zinc and urinary excretion of zinc after operation with extracorporeal circulation.

Sixteen adults undergoing cardiac surgery were studied with respect to postoperative levels of zinc in plasma and urinary excretion of zinc. The preoperative plasma concentrations of zinc were normal. On the first postoperative day the mean for the series had fallen from 15 to 7.2 mumol/l. A gradual rise followed, and on the fifth day all patients had plasma zinc above the lower limit of normal range. The urinary excretion of zinc was significantly increased on the first, second and fifth days after surgery. The mean total of zinc in the urine during five days was 67 mumol. The short-term fall in plasma zinc level had no discernible effect on wound healing. It was therefore apparently harmless and did not indicate a need for zinc supplementation.

Aged↗
PubMed1982

Shrinking pleuritis with atelectasis.

During a 10-year period 28 patients with shrinking pleuritis with atelectasis (SPA) were observed and operated upon. This lesion has been given different names in the literature, for instance rounded atelectasis, pleuroma, pulmonary pseudotumour, and lung folding. All patients except two were operated upon because of a diagnosis of pulmonary tumour. However, at operation no tumour was found. The aetiology and pathogenesis of SPA are discussed on the basis of X-ray, operative, and histopathological findings.

Diagnosis, Differential↗
PubMed1982

Oesophagocardiomyotomy and antireflux procedures.

Although oesophagocardiomyotomy has been the method of choice for surgical treatment of achalasia cardiae for several decades, there are still great discrepancies in the technical details of the procedure as performed in different centres. This is one of the main explanations for the diverging results reported, particularly with regard to the incidence of postoperative gastro-oesophageal reflux. Sixty-three patients underwent primary oesophagocardiomyotomy with a total length of 12 cm, including incision of about 2 cm onto the stomach. Forty-one patients were not examined preoperatively for conditions now recognized as predisposing to reflux and were managed with oesophagocardiomyotomy only, except one patient. Eight patients developed severe reflux complications from 1 to 5 years (mean 2 years) after the operation. In 11 out of 22 patients examined preoperatively for such conditions, Heller's operation was combined with an antireflux procedure. The results were good in all patients and pathological gastro-oesophageal reflux was not detected in any of the 22 patients during a follow-up period of 2 to 7 years (mean 4 years). It is concluded that oesophagocardiomyotomy should be combined with an antireflux procedure in selected patients. The indications for an antireflux procedure are discussed.

Adult↗
PubMed1977

An approach to the surgical treatment of carcinoma of the oesophagus and cardia.

No method of surgical treatment of carcinoma of the oesophagus and cardia is universally accepted. An approach to the problems of the choice of the side for thoracotomy, the organ for reconstruction of the continuity of the oesophagus and the combination of the abdominal and thoracic stages of the surgical procedure is presented. It is based on the following principles: (1) Selecting the side for the thoracotomy on the basis of the distance from the upper incisors to the upper margin of the tumour, determined by oesophagoscopy. (2) Separation of the laparotomy and the thoracotomy. (3) Starting the operative procedure with the laparotomy. The operative mortality in a series of 44 patients operated upon according to these principles is compared with that in a previous series of 77 patients and the advantages and disadvantages of this approach are discussed.

Aged↗
PubMedDate not supplied

Shrinking pleuritis with atelectasis. Specificity of abnormalities present at conventional radiography of the lung.

Radiographic appearances claimed to be typical of shrinking pleuritis with atelectasis (SPA) were tested by mingling chest films from 6 SPA patients with those from 56 cancer cases. Two radiologists were asked to interpret the films independently, make a diagnosis, and state what abnormalities could be distinguished. No single abnormality or combination of abnormalities was found to be pathognomonic and the wish to diagnose the SPA cases led to misdiagnosis of cancer in one of 56 cases by each radiologist. To prevent underdiagnosis of cancer, further examinations are required. Careful follow-up of SPA cases, if they are not operated upon, is recommended.

Diagnosis, Differential↗
PubMedDate not supplied

Reduced per- and postoperative mortality following the use of urea during elective cardiopulmonary bypass. A proposed treatment for the prevention of reduced red cell deformability during open heart surgery.

The vital micro-rheological function of the red cells to deform was monitored during extracorporeal circulation in 75 patients undergoing open heart surgery. Red cell deformability was assessed in vitro by estimating red cell filtration rate (RFR). Urea was given to 32 patients during surgery and the remaining 43 acted as controls. After one hour on cardiopulmonary bypass (CPB) all patients showed a significant reduction of red cell filtration rate which continually worsened. In control patients where the RFR was severely altered there appeared to be more morbidity and mortality (11.6%). Using this simple method it is possible for the perfusionist to assess blood damage rapidly and possibly anticipate a difficult postoperative recovery. Urea administered during CPB reduced the decrease in RFR by a significant extent and in these patients the postoperative course was relatively uneventful and all survived.

Coronary Artery Bypass↗
PubMedDate not supplied

Cerebral perfusion in dogs during pulsatile and non pulsatile extracorporeal circulation.

Eight dogs were cannulated for left heart bypass. Conventional roller pumps were used for bypass with one of the pump console modified to deliver pulsatile bypass. The experiments were performed at normothermia. Each dog was used as its own control. For measurement of cerebral blood flow (CBF) Xe133 was injected into vertebral artery and the gamma activity elimination over the skull was registered. In addition blood samples were withdrawn from the axillary artery and the sagittal sinus for measurement of blood gases. The CBF to the gray matter of the brain was significantly higher during the periods with pulsatile perfusion (P less than 0.01). This was probably due to decreased total cerebral vascular resistance (P less than 0.001). Mean aortic pressure also decreased when the mode of perfusion was changed from non pulsatile to pulsatile (P less than 0.05), indicating a general decrease of the peripheral vascular resistance. A good correlation was noted between the arteriovenous oxygen saturation difference (AV-O2 diff) across the brain and the CBF (R = -0.77, P less than 0.01).

Animals↗