[Urgent need for a Swedish registry for active uremia care units].
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Humans↗
Biomedical subjects
M Lundberg
Publications and source records attributed to M Lundberg.
In vivo comparative evaluation of hemodialysis tubing plasticized with DEHP and TEHTM.
The migration of plasticizers from blood lines was studied in 11 patients with chronic renal failure on hemodialysis for a period of six months. Di-2-ethylhexylphthalate (DEHP), the conventional plasticizer, was compared with tri-2-ethylhexyltrimellitate (TEHTM). A liquid chromatography method for quantitative determination of DEHP and TEHTM in human blood plasma is described. During treatment with tubing containing DEHP, the plasma level of DEHP rose from 0.10 micrograms/ml (less than 0.05-0.17 n = 11) to 0.70 micrograms/ml (0.30-1.6 n = 11). When the patients were changed to tubing containing TEHTM, the concentration of DEHP was below or close to the detection limit and TEHTM could not be detected. No adverse events of either tubing were found as regards acute toxic effects, performance or applicability.
Aged↗
HIV prevention among injecting drug users: three years of experience from a syringe exchange program in Sweden.
Exchange of syringes and needles has for the last 3 years been offered to injecting drug users as part of an HIV prevention project in a small university town in south Sweden. The program at the local hospital has been visited by 979 drug users, of which 182 have participated on a more regular basis. The typical participant is a 30-year-old male who has injected amphetamine or heroin for at least 10 years. The seroprevalence for HIV among drug users in south Sweden has been maintained at approximately 1% in contrast to up to 60% in subpopulations from other Scandinavian regions with a comparable drug problem. No project participant has become HIV infected during the study period and a reduction in risk behavior has been noted among local drug injectors. The HIV prevention project has attracted many individuals with no previous contact with drug rehabilitation programs; for a number of drug users, the syringe exchange has served as an introduction to such treatment efforts.
Adult↗
Urea kinetics and clinical evaluation of the haemodialysis patient.
Urea kinetic modelling (UKM) was performed on 62 patients in a haemodialysis unit not normally using kinetic methods. Without knowledge of the results, four nephrologists, four nurses and the patients themselves evaluated adequacy of dialysis (eAD) and daily protein intake (eDPI). Thirty-two patients had Kt/V less than 1.0, and 17 patients had Kt/V less than 0.9. Estimated improvement of the efficacy of treatment after the intervention of a physician was minor. Seven patients had a protein catabolic rate (pcr) at less than 0.8 g/kg per day. On average physicians identified five of these. Both nurses and doctors exhibited highly significant correlations between Kt/V and eAD, and between pcr and eDPI, but the correlation coefficients were generally modest (typically below 0.4). When patients evaluated themselves, no significant correlations were found. Examined individually, all four physicians' decisions about eAD correlated better with model-generated decisions than with eAD stated by their colleagues. It is concluded that UKM should be used to secure adequate and more uniform treatment prescription. There is no 'clinical standard' competing with UKM. Nurses make satisfactory evaluations compared to doctors, but the patients are unable to assess the adequacy of their dialysis or diet.
Adult↗
Secondary effects of erythropoietin treatment on metabolism and dialysis efficiency in stable hemodialysis patients.
To test the possible effect of erythropoietin (EPO) induced higher hematocrit on dialysis efficacy and metabolism, 14 metabolically stable hemodialysis patients were evaluated with various kinetic methods, including total dialysate collection. Tests were performed twice before EPO treatment and twice when hemoglobin had stabilized in the targeted range. Samples were frozen and batch analyzed for each patient after completion of the study. During this period, dialysis regimens were fixed. EPO treatment caused several significant changes. Hematocrit increased from 21.5% to 34.3%. Pre- and postdialysis serum potassium increased 0.3-0.4 mmol/l, and 56% more potassium binder was given. Serum phosphate concentrations were unchanged, but the aluminum hydroxide dose had been raised 44%. Dialyzer clearance decreased for urea (4.8%), creatinine (14.7%), phosphate (16.5%) and potassium (8.6%). The ratio of postdialysis/predialysis measurements changed for calcium, creatinine and uric acid. Five patients experienced enhanced appetite, but average dry weight did not change, nor could changes be demonstrated for protein catabolism, generation rate of urea and creatinine, or their distribution volumes. Estimated sodium intake remained unchanged. The findings indicate that EPO treatment reduces dialysis efficiency slightly for a number of substances, but in the metabolically stable patient there are no impressive dietary changes. Problems can be overcome by appropriate changes of dialysis regimen and medication.
Anemia↗
Acute renal failure caused by low-osmolar radiographic contrast media in patients with diabetic nephropathy.
Four patients reacting with acute renal failure despite using low osmolar contrast media are reported. They all had diabetic nephropathy and renal insufficiency. A retrospective study of 75 consecutive patients examined with angiography showed that 13% had both of these two risk factors.
Acute Kidney Injury↗
Non-operative treatment of meniscal tears.
In a retrospective review of the results of 3,612 arthroscopic procedures that were performed for the treatment of an acute or a chronic meniscal lesion, with or without an associated ligamentous lesion, we identified eighty meniscal tears (in seventy-five patients) that had been assumed to be stable. Seventy were vertical longitudinal tears and ten were vertical radial tears. The seventy longitudinal tears included fifty-two lateral and eighteen medial meniscal lesions. All of the radial tears were in the lateral meniscus. Of the seventy-five patients, fifty-two had been followed for two to ten years. At the time of follow-up, only six of these fifty-two patients had needed additional intervention because of symptoms that were related to the meniscal tear. Four of them had the intervention after a sports-related traumatic extension of a stable tear, and two, because persistent symptoms were caused by the original meniscal lesion. A repeat arthroscopy was performed on thirty-two patients (twenty-six of whom had a longitudinal tear and six of whom had a radial tear), at an average of twenty-six months after the original arthroscopy. Seventeen of the twenty-six longitudinal tears had completely healed. Five of the six radial tears had no evidence of healing and one had extended. Neither ligamentous laxity nor a meniscal tear that was chronic at the time when it was discovered appeared to preclude healing of the stable longitudinal tears. No localized degenerative changes in the adjacent articular cartilage were found in association with any of the stable vertical longitudinal or radial meniscal lesions. Excluding the six patients who had had additional surgical treatment, none of the fifty-two patients who filled out a questionnaire reported that they had symptoms of a meniscal lesion, and none of the forty-two patients who were re-examined two years or more after the operation had signs of a meniscal lesion. Stable vertical longitudinal tears, which tend to occur in the peripheral vascular portions of the menisci, have great potential for healing. The tear should be left alone unless it is the only abnormality that is found and it is causing symptoms that warrant treatment. Stable radial tears, which tend to occur in the avascular inner one-third of the meniscus, have little potential for healing. Whether it is best to leave these lesions alone or to fashion an intact rim by contouring the meniscus was not established by this study.
Adolescent↗
Development of gingiva following surgical exposure of a facially positioned unerupted incisor.
A case with a facially positioned, unerupted maxillary incisor is presented as an illustration of the potential of the periodontal tissues to establish a zone of gingiva following surgical intervention. Despite the fact that the tooth had an erupting position entirely within the area of the alveolar mucosa, a zone of keratinized gingiva developed following surgical exposure of the crown of the tooth. This healing potential should be considered when selecting the treatment for facially positioned, unerupted teeth.
Child↗
Dentinogenesis imperfecta in a six-generation family. A clinical, radiographic and histologic comparison of two branches through three generations.
Dentinogenesis imperfecta type II through 2 branches of a 6-generation family was presented focusing on individual differences in clinical, radiographic and histological appearances. These differences lead to different treatment approaches emphasizing prevention of attrition in order to avoid loss of vertical height and development of periapical lesions.
Adolescent↗
[He ended his fasting with wine and paracetamol. The patient's liver and kidney were damaged].
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Acetaminophen↗
Kinetics of glycosylated haemoglobin in uraemia determined on ion-exchange and affinity chromatography: no increase in the rate of glycosylation.
The haemoglobin glycosylation in uraemia was studied by determination of labile and stable HbA1 in patients and by kinetical experiments in vitro. The influence of uraemia on stable and labile HbA1 was investigated in a clinical study of 32 non-diabetic and 20 diabetic patients with uraemia compared with controls. Glycosylated haemoglobin (GHb) was determined with ion-exchange chromatography (IEC). A highly significant elevation of stable as well as labile HbA1 was found in uraemic non-diabetics and of stable HbA1 in uraemic diabetics. This elevation was not related to blood glucose level. Labile HbA1 does not significantly affect the increased total level of GHb. An in vitro study using IEC and affinity gel chromatography on erythrocytes sequentially incubated in glucose and saline showed identical kinetics of GHb formation and elimination in uraemic and in non-uraemic patients. No indication of changed glycosylation by the uraemia was found.
Adult↗
Surgical treatment of ankylosed and infrapositioned reimplanted incisors in adolescents.
A method for preserving the alveolar ridge of ankylosed and infrapositioned incisors and improving conditions for a subsequent prosthetic therapy is described and evaluated clinically and radiographically. The method involves removal of the crown and root filling from the root, which is retained and covered with a mucoperiosteal flap. Clinically, there were no postoperative complications and after the follow-up a satisfactory prosthetic restoration was performed in all cases, regardless of the degree of infraposition before treatment. Radiographically, no pathologic changes were observed apart from a continuous resorption and replacement of lost root substance by bone. Alveolar bone level shifted only slightly between postoperative and 12-month follow-up radiographs, in a majority of cases in a coronal direction.
Adolescent↗
[The traditional birth attendant--a resource?].
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Culture↗
Instruments for routine arthroscopic surgery of the knee.
The use of operating instruments for routine arthroscopic operations was analysed on 2397 arthroscopies with 986 operations. The biggest group was meniscectomy (n = 358). The most common instrument combination was knife, a straight 4 mm grasper, a 3-4 mm basket forceps and a suction device, which was used in 53% of the cases. Instrument breakage rates were analysed and found to be rather high especially for straight basket forceps (2/100 operations) and grasping forceps (3.6/100 operations). In two cases arthrotomy had to be done to retrieve a broken piece of grasping forceps. 30 degree telescopes used together with a TV-system had to be replaced at a rate of 0.8/100 operations and 70 degree telescopes at 0.2/100 operations.
Arthroscopes↗
Histological appearance of pulps after exposure by a crown fracture, partial pulpotomy, and clinical diagnosis of healing.
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Dental Pulp↗
Failure to demonstrate an effect of in vivo diagnostic ultrasound on sister chromatid exchange frequency in amniotic fluid cells.
Antepartum use of diagnostic ultrasound has markedly reduced radiation exposure of the fetus. Previous investigations have documented the safety of ultrasound, but concern persists regarding its long-term effects. As new methods become available to study possible subtle effects of ultrasound, it is important to reevaluate this technique continually because of its universal use in obstetrics and elsewhere. We report results of in vivo studies of effect of diagnostic ultrasound on the sister chromatid exchange (SCE) frequency in amniotic fluid cells. SCE is a cytogenetic phenomenon believed to be a sensitive indicator of environmental perturbations and chromosome stability. In amniotic fluid cells from six pregnancies without ultrasound exposure and in 34 pregnancies that received varying amount of ultrasound immediately before amniocentesis, there was no difference in SCE frequency in exposed verus nonexposed cells. These data, which appear to confirm again the safety of ultrasound, are reassuring to both patients and clinicians.
Amniotic Fluid↗
Root resorption after orthodontic treatment of traumatized teeth.
This study concerns the frequency and degree of root resorption in traumatized incisors that have been treated orthodontically. The subjects were twenty-seven patients (fifteen boys and twelve girls) with fifty-five traumatized incisors; fifty-five consecutive patients without traumatized teeth served as controls. All the control patients were treated with extraction of four first premolars and a fixed appliance (thirty-three with an edgewise and twenty-two with a Begg appliance). Signs of root resorption were registered with index scores from 0 to 4 (Fig. 1). The degree of root resorption in traumatized teeth was compared to that in the uninjured control teeth in the same patient and in the patients without trauma. Neither the intraindividual nor the interindividual comparisons support the hypothesis that traumatized teeth have a greater tendency toward root resorption than uninjured teeth. Root resorption (scores 2 to 4) was found in 51 percent of the traumatized incisors, in 43 percent of the incisors treated with edgewise appliances, and in 48 percent of those treated with Begg appliances. Traumatized teeth with signs of root resorption prior to orthodontic treatment may be more prone to root resorption during treatment.
Adolescent↗