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Biomedical subjects

M Steen

Publications and source records attributed to M Steen.

At least 19 recordsLinked to original sources
PubMed2006

Vertical distraction of fibula transplant in a case of mandibular defect caused by shotgun injury.

This case demonstrates the successful aesthetic and functional reconstruction of a complex facial gun-shot injury with extended bone defects and soft tissue destructions using a 3-step procedure. Initially, a reconstruction plate was inserted, later a fibula transplant enabled the basic reconstruction and finally was distructed in a 3rd session. The rationale behind the sequencing of surgical sessions was the extended bony defect and soft-tissue destruction. The main problem in this type of wound is hypoxia or anoxia of the receptor bed for the transplant. A microvascular anastomosized bone transplant is necessary for sufficient oxygen tension in the recipient site. The anatomical dimensional disproportion of the transplanted free fibula graft and the shape of the mandible were corrected prior to the insertion of dental implants by means of vertical distraction.

Bone Plates↗
PubMed2006

[Post-lobectomy bronchopleural fistula -- a challenge for postoperative intensive care].

Bronchopleural fistula (BPF) and bronchial stump insufficiency (BSI) after lobectomies and pneumonectomies are dreaded complications with incidences of up to 12 % and a mortality rate of up to 51 %. Apart from the basic illness causes include complications like aspiration-pneumonia and ARDS, formation of empyema as well as histories of sepsis. Corticoid treatments, old age, diabetes mellitus, previous irradiation as well as post-operative mechanical ventilation (barotrauma) are often counted among contributing causes. Suturing the bronchus and reinforcement by tissue are still the methods of choice, but they are often counter-indicated in high-risk patients. Endoscopic treatments with partial lung occlusions, e. g. by insertion of spongiosa, coils, and/or fibrin glue have been described. However, they require the respective area to be probable. With only one third the rate of success is quite unsatisfactory. The retro-graded instillation of inflammatory-selerotizing substances, like doxycycline, via a chest tube leads to a pleurodesis caused by adhesion of the remaining lung parenchyma to the thoracic wall and a reduction in size of the residual pleural space. In an 82-year old female patient a BPF of the second upper lobe bronchus was detected after a middle lobe resection for abscess and post-radiation ulcer following a mastectomy for carcinoma. The leakage was detected on bronchoscopy by retro-graded instillation via the chest tube of methylene-blue solution into the thoracic cavity. After administering the water-soluble contrast agent amidotrizoic acid in a similar manner a CT confirmed the diagnosis. As the bronchial segment concerned could not be entered selectively, preservation of the right lung lobe's residual ventilation by endoscopic-occlusion procedures was ruled out. Employing a strictly conservative therapy (spontaneous ventilation, retro-graded doxycycline instillations) complete healing with a fully ventilated lower lobe could be achieved over a period of 78 days. BPF as well as residual intro-thoracic cavities after lobectomies pose a serious problem. Using methylene blue for a retro-graded demonstration of BPF during bronchoscopy presents a feasible and cost-efficient diagnostic method. A strictly applied conservative therapy including short-time low-pressure artificial respiration as well as obliteration by fibrous tissue of the thoracic cavity using doxycycline is a feasible procedure for inoperable high-risk patients.

Aged, 80 and over↗
PubMed2004

Establishing a baseline for organisation and outcome in burn care-basic data compiled by German burn centres, 1991-2000.

From the years 1991 to 2000, basic data from patients admitted to the intensive care unit of burn centres in Germany, Austria and Switzerland, participating in the German Speaking Association for Burn Treatment, were collected prospectively. Starting in 1991 with 7 hospitals and 618 patients included in the study; in the year 2000, 19 hospitals representing nearly 1500 patients submitted their data. Over a period of 10 years, a total number of 10,259 patients could be included in the study. The majority of patients were adult, the male/female ratio was 70/30. Most of the patients suffered from household accidents, only 25% were occupational accidents. Medium total burn surface area (TBSA) and Abbreviated Burn Severity Index (ABSI) score were quite similar in the participating hospitals, while the medium length of stay in the ICU ranged from 6 to 24 days. The overall mortality was 17.5% and showed no decrease over the period of time.

Adolescent↗
PubMed2004

Causes behind a human cheese-borne outbreak of gastrointestinal listeriosis.

In a previous paper, we reported an outbreak of gastrointestinal listeriosis due to consumption of fresh cheese made from raw milk and manufactured on a summer farm. The aim of the present study was to investigate why the cheese harbored Listeria monocytogenes. To our knowledge, this is the first documented outbreak of listeriosis caused by raw milk cheese where the human epidemic strain has been cultured from a dairy animal, whose milk has been used for cheese production. The conditions on a summer farm can hardly fulfil the requirements for hygienic and strictly controlled conditions necessary for safe processing of fresh cheese.

Animals↗
PubMed2003

Febrile gastroenteritis after eating on-farm manufactured fresh cheese--an outbreak of listeriosis?

An outbreak of febrile gastroenteritis affected consumers of on-farm manufactured dairy products from a summer farm in Sweden. Symptoms included diarrhoea, fever, stomach cramps and vomiting in 88, 60, 54 and 21% of cases identified. The median incubation period was 31 h. A cohort study with 33 consumers showed an attack rate of 52% and an association between the total amount of product eaten and illness (P=0.07). Twenty-seven of 32 (84%) stool samples cultured for Listeria monocytogenes tested positive, although there was no association between clinical disease and the isolation of L. monocytogenes. In addition, gene sequences for VTEC and ETEC were detected in 6 and 1 subjects, respectively. Bacteriological analysis of cheese samples revealed heavy contamination with L. monocytogenes and coagulase positive staphylococci in all of them and gene markers for VTEC in one of them. Molecular profiles for L. monocytogenes isolated from dairy products, stool samples and an abscess from 1 patient who developed septic arthritis were identical. Results of both microbiological and epidemiological analyses point to L. monocytogenes as the most likely cause of this outbreak. The finding of markers for VTEC in some humans and cheese samples means that a mixed aetiology at least in some cases cannot be conclusively ruled out.

Adolescent↗
PubMed2003

Factor V I359T: a novel mutation associated with thrombosis and resistance to activated protein C.

We report a kindred in which two siblings suffered spontaneous venous thromboses in the second decade of life. Further investigation showed reduced coagulation factor V (FV) activity and activated protein C resistance (APCR) ratio but no other thrombophilic abnormalities. The reduction in APCR ratio persisted in a modified APCR assay in which FV activity was normalized between test and control plasmas. Analysis of the FV gene showed that the thrombotic individuals had a complex genotype that included two novel point mutations c.529G>T and c.1250T>C resulting in FV E119X and FV I359T substitutions inherited on different alleles. Individuals in the kindred with FV E119X or FV I359T substitutions alone were asymptomatic. We suggest that the FV I359T substitution confers pro-thrombotic risk and APCR, but that this is only clinically manifest when co-inherited with the FV E119X allele. The FV I359T substitution creates a new consensus sequence for N-linked glycosylation within the FV heavy chain and we speculate that this abnormal glycosylation may disrupt activated protein C-mediated proteolysis of the variant FV and FVa.

Activated Protein C Resistance↗
PubMed2002

Factor Va-factor Xa interactions: molecular sites involved in enzyme:cofactor assembly.

The generation of thrombin by the prothrombinase complex is a key event in coagulation. In this complex, the activated form of coagulation factor V (FVa) serves as an essential cofactor to factor Xa (FXa) in the activation of prothrombin to thrombin. The enzyme FXa is virtually ineffective in the absence of its cofactor. The assembly of FXa with its cofactor FVa on negatively charged phospholipid membranes enhances its catalytic efficiency by several orders of magnitude. The non-activated procofactor factor V (FV) circulates in plasma with a domain organization of A1-A2-B-A3-C1-C2 expressing little procoagulant activity. Upon activation through limited proteolysis by either thrombin or FXa, the B-domain dissociates from FVa. After activation, the procoagulant activity of FVa is greatly enhanced. This report provides insight into the interaction of FV and FXa and the molecular events important in enzyme:cofactor assembly of the FXa:FVa complex. Furthermore, light is shed on the molecular events associated with the activation process, i.e. the release of the B-domain and exposure of binding sites for FXa. The assembly of FVa and FXa was studied using a set of recombinant FV mutants. The interaction between FVa and FXa on phospholipid was investigated with a functional prothrombin activation assay as well as in a novel direct binding assay in the absence of prothrombin. We found that all three thrombin cleavages in FV contribute to increasing the FXa affinity and that the B-domain in intact FV has an inhibitory effect on the FV-FXa interaction, which is important in prohibiting premature coagulation.

Binding Sites↗
PubMed2001

[Tuberculosis among immigrants in Scandinavian medical journals].

BACKGROUND: The decline in incidence of tuberculosis in Scandinavia has stagnated in the last decades because of a growing number of immigrants from high incidence countries. The aim of this study was to find out what has been published on tuberculosis among immigrants in Denmark, Norway and Sweden in the main medical journals in these countries from 1995 to 2000. MATERIAL AND METHODS: 23 papers on the topic were identified through PubMed searches. Eight papers were selected for a more detailed description of their content. RESULTS: The main medical journals in Denmark, Norway and Sweden have published papers on epidemiological aspects and clinical traits as well as the challenge for the health services of controlling tuberculosis in immigrants. The majority of patients are under the age of 40 and of African origin. They seldom infect the population of the host country. Extrapulmonary tuberculosis is relatively common. Control on arrival could be improved in all three countries. Considerable doctor's and patient's delay is not uncommon. INTERPRETATION: Medical journals are an important source for knowledge on tuberculosis among immigrants from high incidence countries.

Adult↗
PubMed2001

Hematogenous cervical spondylodiscitis after severe burn injury.

A 47-year-old man sustained a 31% TBSA burn injury. In spite of early escharectomy and mesh-graft-transplantation the patient suffered a septicaemic phase in the first week, which was treated by a specific antibiotic. Five weeks after the burn injury a cervical spondylodiscitis was diagnosed. Immediate wound debridement, ventral and dorsal spondylodesis with a tricortical bone-graft from the left iliac crest and titanium plates and specific antibiotic therapy led to the stabilization and healing of the cervical spinal column. The spondylodiscitis was microbiologically proved to be hematogenous after spread of Staphylococcus aureus from the blood in the early septicaemic phase. Swab culture from the burn surface wound, infected vertebrae and blood during the septicaemic phase revealed coagulase positive S. aureus. The aetiology, predisposing factors and management of this rare, but recognized, complication of major burns are discussed. Case features of this patient are compared with the single site's reported case of hematogenous cervical spondylodiscitis after severe burn injury.

Anti-Bacterial Agents↗
PubMed2000

A randomised controlled trial to compare the effectiveness of ice-packs and Epifoam with cooling maternity gel pads at alleviating postnatal perineal trauma.

OBJECTIVE: To evaluate the effectiveness of standard regimes (ice packs and Epifoam) at relieving perineal trauma and compare these with a new cooling device (maternity gel pad). DESIGN: A randomised controlled trial involving three treatment groups. The women were free to choose the time of initial application (within four hours after delivery) in all treatment groups and the number of subsequent treatments up to 48 hours after suturing. SETTING: A midwifery unit in the north of England and then continued in the women's own homes. PARTICIPANTS: 120 women who had undergone an instrumental delivery and had a 48 hours post-delivery stay in a postnatal ward. MEASUREMENTS AND FINDINGS: The ordinal scale of none, mild, moderate and severe was used to determine the levels of perineal oedema and bruising at initial assessment (less than 4 hours), 24 hours and at 48 hours, by use of a newly developed visual evaluating tool. Self-assessed pain was recorded using a 10-point visual analogue scale within four hours, at 24 hours, 48 hours, and finally at five days after suturing. Women's opinions as to the effectiveness of their treatment was rated by use of a 5-point scale describing the categories; poor, fair, good, very good and excellent. A high proportion of women had some perineal oedema at initial assessment. A statistically significant difference in the proportion of women with oedema was found between treatment groups at 48 hours (p = 0.01), which was in favour of the maternity gel pad group. This was particularly noticeable for women with initial levels of mild oedema (p = 0.017). Localised treatment with the gel pad caused a significant decrease in reported pain at 48 hours in women who initially demonstrated moderate or severe pain (p = 0.048). A significant increase in the proportion of women with some bruising was seen across all treatment groups from initial assessment, through 24 hours to 48 hours (p < 0.0005). The bruising was significantly less in the gel-pad group in women who initially had no bruising (p = 0.021). There was no statistically significant effect of treatment at other initial levels of severity for oedema, bruising or pain at 24 hours, 48 hours and five days (for pain). Women in the gel-pad group rated the effectiveness of their localised treatment to be significantly higher than women in the other two treatment groups (p < 0.0005). KEY CONCLUSIONS: This trial demonstrated that a high proportion of women experience perineal oedema, bruising and pain following an instrumental delivery, which continues for at least five days for perineal pain, despite oral analgesia. Maternity gel pads, which were specially designed to cool the perineal region, were more effective in alleviating perineal trauma when compared with hospital standard regimens and were more highly rated by women.

Adult↗
PubMed1999

[Do computerized reminders to the patients affect the preventive work in general practice?].

Norwegian general practitioners have the opportunity to perform preventive medicine on many levels. There are uncertainties as to the effect of this activity. A systematic approach is one of the prerequisites for obtaining significant results. We have made a study of the review literature concerning computerised patient-specific reminders used in preventive health care. Electronic literature search was supplemented by expert-guided manual search. We found that a conclusion from the literature is that such computerised reminders have a lasting effect regarding doctors' handling of preventive care issues. The effect of reminders in a general practice setting will be determined by the way they are implemented. In this process it will be necessary to address motivating issues, technical solutions and administrative adjustments.

Decision Making, Computer-Assisted↗
PubMed1997

A tool for assessing perineal trauma.

The initial aim of this study was to develop a reliable visual tool to assist in the assessment of the severity of oedema and bruising in perineal trauma, using a categorical scale of 'none', 'mild', 'moderate' and 'severe'. A standardised set of photographs was selected by 10 clinically experienced midwives to represent these categories. The tool was tested in a clinical trial involving 77 women, recording and monitoring changes in the level of oedema and bruising during the first 48 hours following suturing of an episiotomy. The results demonstrated a statistically significant change for both oedema and bruising. However, the less experienced assessors reported some uncertainties in assessing a small proportion of women. A combined method, using this tool with a categorical scoring scale, was used to minimise difficulties in the assessment. Two pairs of midwives, one pair very experienced in assessing perineal trauma and the other less experienced, evaluated the combined method. The results showed a high level of agreement. The standard set of photographs and categorical scoring scale together resulted in a reliable and sensitive assessment tool to evaluate severity of perineal trauma.

Adult↗
PubMed1994

Association of a retrovirus with a wasting condition in the Swedish moose.

A wasting disease in moose (Alces alces) has killed more than one thousand animals in a densely populated, limited geographical area in Sweden. To investigate the cause, local environmental conditions were studied and infectious agents, mainly viruses, were looked for. A virus, identified as a retrovirus, has repeatedly been isolated from diseased animals by cocultivation of their leukocytes with fetal moose kidney cells. The virus has the characteristics of a member of the Oncovirinae subfamily, as deduced from its morphology from EM studies, reverse transcriptase activity, cell transforming properties, and serological cross-reactivity with other oncoviruses. Striking features of the disease are the poor and transient capacity of affected moose to respond serologically in addition to the frequent presence of high levels of reverse transcriptase activity in their sera.

Animal Diseases↗
PubMed1993

Review of the use of povidone-iodine (PVP-I) in the treatment of burns.

Local infection and burn wound sepsis are one of the most severe problems in the treatment of thermally injured patients. Early surgical treatment and the use of topical antiseptics led to a decrease in the infection rate and significantly improved the survival rate of burns patients within the last twenty-five years. Many antiseptics are used in the treatment of burns. Silver nitrate, silver sulphadiazine, sulfamylon and povidone-iodine (PVP-I) are the most common substances used worldwide in burn care facilities. Clinical studies demonstrate that treatment with PVP-I is the most effective against bacterial and fungal infection. Several methodological problems however arise from direct comparison between these antiseptics, and local and systemic adverse effects can make the right choice difficult. Some case reports documented possible side effects in the treatment of patients with PVP-I, leading to general concerns about this treatment. Absorption of iodine and possible changes in thyroid hormones are well known, but evaluation of the clinical consequences is controversial. Reports of severe metabolic acidosis and renal insufficiency with lethal results have condemned the use of PVP-I in the treatment of extensive burns. The case reports, however, dealt with patients suffering from general morbidity and sepsis and therefore these single reports may not be generally valid. Local treatment of burns may cause further problems. The beneficial effect of a decrease of bacterial counts in deeper tissue may be confounded by other effects delaying wound healing, as shown in some experimental studies. Controlled clinical investigations on burn patients however are still missing. The paper will discuss these topics in detail referring to the treatment of burns with PVP-I. It is based on a critical review of the literature and the author's own experience in burns therapy.

Acid-Base Imbalance↗