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Biomedical subjects

M Lie

Publications and source records attributed to M Lie.

At least 19 recordsLinked to original sources
PubMed2000

Closed mitral commissurotomy in Archangel, Northern Russia, 1965-1993. Operative assessment of 367 patients operated on for rheumatic mitral stenosis.

OBJECTIVE: Preoperative and operative assessment of the 367 patients operated on for rheumatic mitral stenosis with closed mitral commissurotomy (CMC) at the regional hospital in Archangel, northwest Russia, between 1965 and 1993. DESIGN: Retrospective survey. RESULTS: Mean age at first attack of rheumatic fever was 15 years +/- 1.09 years. Mean age at time of surgery was 33.4 years +/- 0.92. Preoperatively, most patients (67%, n = 245) were in New York Heart Association stage III; 29% (n = 107) in stage IV. Digital commissurotomy alone was performed in 16% (n = 57) and a transventricular dilator was used in 84% (n = 310). Operative blood loss was average (384.4 ml +/- 34 ml); 20% (n = 73) developed wound infection, 21% (n = 77) pericarditis. In-hospital stay was above 50 days for both sexes. In-hospital mortality was 1.6% (n = 6). CONCLUSION: Rheumatic heart disease developed rapidly in these patients. CMC has a place as a low cost treatment of mitral stenosis when a heart lung machine is not available.

Adult↗
PubMed1999

[Misconceptions and tacit learning--a challenge in medical education].

Medical education has undergone several reforms and innovations both in Norway and elsewhere, and the quality of teaching and learning is, and should be, a subject of ongoing discussions and developments. As a contribution to this discussion a teaching experience and a follow-up study of misconceptions among medical students are presented. More than 10% of 48 young medical students answered that the antagonist moved the femur into abduction when asked to choose between two alternatives. According to a constructivistic theory of learning, unexpected and often incorrect understandings may be developed informally either before or parallel to formal teaching. Whereas there has been a vast number of studies into students' misconceptions in school subjects and their tendency to survive formal educational programmes, they have drawn little attention in medical education. The observations are discussed with reference to contemporary theories on learning: some implications for medical education are suggested.

Adult↗
PubMed1999

[Rheumatic fever and rheumatic heart disease in Northwest Russia].

296 patients who were operated between 1965 and 1993 with mitral commissurotomy, were included in this retrospective study of rheumatic heart disease in North-West Russia. There were 117 (39.5%) reported cases of acute rheumatic fever, with either polyarthritis (n = 88), carditis (n = 23), or Sydenham's chorea (n = 6). There were no reported cases of erythema marginatum and subcutaneous nodules. The first case of acute rheumatic fever in our patients was in 1924. More than 50% of the patients (164) did not get the diagnosis acute rheumatic fever, and became aware of their rheumatic heart disease only when symptoms of mitral stenosis appeared. 15 patients had a subclinical attack of rheumatic fever, i.e. not all of Jones' criteria were fulfilled. At onset of acute rheumatic fever, the mean age was 15 years, when valvular disease was confirmed 24 years, and 33 years at mitral surgery. Dyspnea (n = 293) was the most common symptom of mitral stenosis, followed by atrial fibrillation (n = 105). 15 patients developed cerebral stroke. The Archangel Health Region has one of the highest prevalences of rheumatic heart disease in Europe (3.7/1,000 in those above 16 years of age, 1993). There is high mortality and the disease develops rapidly.

Adolescent↗
PubMed1999

[Experiences with biological aortic valve at Ullevål hospital].

Biological valves have been used at Ullevål Hospital since 1993 in patients over the age of 70, and in younger patients when anticoagulation is contraindicated. We have used two different types of biological valves; Medtronic Freestyle, a non-stented valve made from pigs aortic root; and Carpentier-Edwards, made from calf pericardium. This valve is mounted in a metallic frame (stent), covered by dacron. Both valves are fixed in glutaraldehyde to diminish tissue antigenicity. 91 patients were operated with biological valves during the period 1993 till January 1998; 56 patients received the Carpentier-Edwards and 35 Freestyle. Postoperative complications have been few and time in the intensive care unit and total hospital stay is satisfactory despite the high age of this group of patients. The overall 30 days postoperative mortality was 4.4%. In conclusion, aortic stenosis and insufficiency can be operated with low mortality and short postoperative or intensive care stay. There was no significant difference between the two groups of patients.

Adult↗
PubMed1996

Extracorporeal membrane oxygenation (ECMO) as lung or heart assist.

Extracorporeal membrane oxygenation (ECMO) may serve as extracorporeal lung assist (ECLA) in patients with acute respiratory failure (ARF) or as extracorporeal heart assist (ECHA) in patients with low output syndrome (LOS) after open heart surgery. From 1988 to 1992 seven patients underwent ECMO in our hospital; four suffered from ARF and three from LOS. Various bypass techniques were employed. Two ARF patients, aged 58 and 18 years, had veno-venous bypass; in the latter, ECMO was reinstituted as a veno-arterial bypass one week after weaning. In a three-year-old boy, the ECMO outflow tubing was primarily connected to the pulmonary artery, and shortly afterwards relocated to the common carotid artery. In a 31-year-old man with ARF, and three LOS patients, a 56-year-old woman, and two men aged 68 and 70 years, ECMO was veno-arterial with direct access to the ascending aorta. A heparin-coated system was used, and all but one patient, who was treated with warfarin, received a daily low dose of heparin, which was withdrawn after from one to nine days. Six patients were weaned off ECMO after 4.5 to 21 days. Three ARF patients recovered completely; the child died. In one LOS patient, ECMO was withdrawn due to a poor general condition. Two others were weaned off ECMO and the intra-aortic balloon pump, and the inotropic support was significantly reduced, but both died of multiple system organ failure. Although no firm conclusions can be drawn from these few case reports, the heparin-coated system used as ECLA appears promising, whereas ECHA seems to imply a poor prognosis in patients who are not candidates for cardiac transplantation.

Acute Disease↗
PubMed1995

[Aortic dissection. A 8-year material from health region 5].

At the University Clinic Tromsø 27 and 16 patients with aortic dissection of Stanford type A and B have been admitted during the last eight years. The treatment strategy has been immediate surgery for type A and a conservative strategy consisting of blood pressure reduction and observation for type B. Nine (33%) of the patients with type A dissections were diagnosed either too late for surgery or at autopsy. Two were deemed too ill for operative treatment. One patient with a chronic type A dissection has been followed up without surgery. The remaining 15 were operated on. Four of these (26%) died within 30 days. Apart from a temporary hemiparesis, no sequelae related to the surgical treatment were observed in the remaining 11 patients. Six of the 16 patients with type B dissections were operated on because of organ ischemia or rupture/threatening rupture. Two died within 30 days. One patient had a prolonged postoperative course owing to multiple organ failure and muscle necrosis. Two of the ten patients with type B dissections who were followed up without surgery died during the observation period. These observations indicate a need for a more aggressive approach to the diagnosis and follow-up of aortic dissections.

Adult↗
PubMed1995

[Aortic root reconstruction with homograft in bacterial endocarditis].

We describe successful use of respectively an aortic and a pulmonary homograft as total root replacement in two patients with extensive aortic valve endocarditis. At follow-up 18 months after operation both patients were doing well and echocardiography demonstrated excellent graft function with only trivial aortic regurgitation.

Adult↗
PubMed1995

The effects of 'in-use' surgical handwashing on the pre- and postoperative fingertip flora during cardiothoracic and orthopaedic surgery.

Two operating teams (25 persons) were followed for two months with fingerprint samples taken preoperatively; before and after 'in-use' surgical handwashing; and immediately postoperatively, with and without surgical gloves. The mean time for handwashing for the cardiothoracic team (CT) was 2 min and for the orthopaedic team (OT) was 3.5 min. A closer observation of 10 persons revealed a great individual variation in washing techniques, in spite of standard guidelines. The CT team performed eight, and the OT team nine sterile operations with an average duration of 3 h and 20 min and 2 h and 40 min, respectively. Surgical handwashing resulted in fingertip sterility in 111/118 (94.1%) cases; in 61/66 (92.4%) samples from the surgeons and in 50/52 (96.2%) samples from the assistants. Postoperative fingerprinting with gloves on showed sterile conditions in 85/91 (93.4%) samples; 57/59 (96.6%) from the surgeons and 28/32 (87.5%) from the assistants. Immediately after removal of the gloves, 43/67 (64.2%) of fingerprint samples from the surgeons and 13/48 (27.1%) from the assistants were still sterile. Coagulase-negative staphylococci (CNS) and Bacillus species predominated in fingerprint samples. Of the 105 CNS strains tested, 11.4% were methicillin resistant. Only five strains of Staphylococcus aureus were isolated; in 4/5 cases from the OT. This study illustrates that in spite of standard guidelines, there is great individual variation in surgical handwashing. However, in most instances, the bacteria are eradicated from the fingertips. Even after surgery for 2-3 h, there may still be a residual effect of the hand disinfecting agent in half of the cases.

Bacteria↗
PubMed1995

Pulmonary function 3-13 months after pneumonectomy, lobectomy or bilobectomy for lung cancer.

Pulmonary function was studied 3 and 12 months after pulmonary resection for lung cancer in 37 patients, ten of whom had undergone pneumonectomy, 17 lobectomy and eight bilobectomy. The resection was right-sided in 25 cases and left-sided in 12. Tumour site and diameter were registered, arterial blood gases measured and spirometry performed Three months after all types resection there was significant decrease in forced vital capacity (FVC), and forced expiratory volume/1 second (FEV1), but not in FEV1/FVC%. At 12 months pneumonectomy had reduced FVC to 58% of predicted values, FEV1 to 50% and FEV1/FVC% to 70%. After lobectomy the corresponding figures were 86%, 73% and 67% and after bilobectomy they were 88%, 78% and 70%. Between 3 and 12 months postoperatively, FVC increased in all groups, significantly in those with lobectomy or bilobectomy (p<0.01 and 0.05, respectively).

Adult↗
PubMed1995

Survival in thoracic or thoracoabdominal aortic aneurysm. Comparison between patients with or without surgical treatment.

The surgical mortality among 22 patients treated for thoracic or thoracoabdominal aneurysm was compared with the mortality in 47 patients managed without surgery. Surgical mortality ( < 30 days) was low (1/13) in ascending aortic aneurysm, but higher (3/8) in aneurysm of the descending or thoracoabdominal aorta (including both acute and elective operations). Of the 20 non-surgically managed patients in the latter group, 15 died after a mean of 1.1 year. The only patient operated on for aortic arch aneurysm died of cerebral ischaemia 2 days postoperatively. Most of the 19 non-operated patients with aneurysm of the arch or total aorta (mean age 76 years) were never considered for surgical treatment. The analysis supports aggressive management of patients with aneurysm of the ascending, descending or thoracoabdominal aorta. Many of our patients with aneurysm of the arch or involving most of the aorta were old and had other, concomitant diseases, and in such cases an aggressive treatment strategy does not seem justified.

Adult↗