Search PubMed⌕ Search

Biomedical subjects

M Wickman

Publications and source records attributed to M Wickman.

At least 73 records · Page 4Linked to original sources
PubMed1998

Donor-site morbidity after pedicled or free TRAM flap surgery: a prospective and objective study.

The main disadvantage when the transverse rectus abdominis musculocutaneous (TRAM) flap is used for breast reconstruction is the potential for weakening of the abdominal wall. This prospective study was initiated to objectively evaluate abdominal muscle strength after pedicled and free TRAM flap breast reconstructions over time. Twenty-three patients with pedicled TRAM flaps and 19 patients with free TRAM flaps were included. A dynamic dynamometer system, KIN-COM, was used to measure maximal voluntary trunk flexor and extensor strength preoperatively and 6 and 12 months postoperatively. The patients' subjective opinions 1 year postoperatively were recorded by means of a questionnaire. A transient decrease in abdominal strength, in both groups, occurred at 6 months but was essentially regained at 12 months. The use of a pedicled or free TRAM flap did not influence postoperative abdominal strength per se. The balance between the abdominal strength and back strength remained in the free flap group but was altered postoperatively in the pedicled flap group; back strength was increased and remained so after 12 months. The difference between the two procedures is relatively small compared with individual variations, indicating that there are more important factors than the kind of surgery influencing the restoration of muscle strength. The questionnaire revealed a greater occurrence of abdominal wall bulging in the free flap group (82 percent) versus 48 percent in the pedicled flap group. No postoperative differences regarding exercise frequency or sensitivity of the abdominal wall were found between the pedicled and free TRAM flap groups.

Abdominal Muscles↗
PubMed1998

Deposition of cat (Fel d 1), dog (Can f 1), and horse allergen over time in public environments--a model of dispersion.

BACKGROUND: The occurrence and accumulation over time in public environments of cat, dog, and horse allergens was evaluated. METHODS: Concentrations of animal danders were analyzed by ELISA and countercurrent immunoelectrophoresis (CCIE). RESULTS: Among factory-new mattresses, 15/17 contained detectable levels of cat and/or dog allergen, whereas no horse allergen was found although six of the mattresses were stuffed with horsehair. Dust from 15 used mattresses contained significantly higher concentrations of Fe1 d 1 and Can f 1 than the factory-new ones (P < 0.001). Allergen concentrations and titers correlated to the period of time that the mattresses had been tried by customers; rs = 0.52-0.77, P = 0.04-0.001 (cat), rs = 0.38-0.48, P = 0.15-0.08 (dog), and rs = 0.64-0.74, P = 0.008-0.003 (horse). The increase over time occurred rapidly in highly frequented stores and after 3 weeks reached concentrations that have been found in homes where furred pets had formerly been kept or even the lower allergen scale of homes where pets were currently kept. CONCLUSIONS: The dispersion of allergens from furred animals to pet-free public places is likely to occur by deposition from people who have been in direct or indirect contact with pets, and high levels of such allergens seem to accumulate in a short period of time.

Allergens↗
PubMed1998

Cat and dog allergen in mattresses and textile covered floors of homes which do or do not have pets, either in the past or currently.

The aim of this study was to measure the levels of cat and dog allergen in homes of families that had either never kept pets or kept or had kept cats or dogs. From a small residential area outside Stockholm consisting of 250 houses with similar exteriors 70 homes were included. Dust samples were collected from mattresses and textile-covered floors. The levels of cat and dog allergen were analysed by ELISA. Fel d1 was found in mattress dust in all 70 homes, median 0.5 micrograms/g [0.24-8.89 micrograms/g (quartiles)] and textile-covered floors 0.7 micrograms/g (0.20-2.52 micrograms/g). Can f1, was found in 98% of the collected samples, mattress dust 1.89 micrograms/g (0.70-9.20 micrograms/g) and textile-covered floor dust 2.5 micrograms/g (1.04-2.72 micrograms/g). There was a positive correlation (p < 0.001) between allergen levels in dust from mattresses and textile-covered floors for both Fel d1 (r = 0.68) and Can f1 (r = 0.78). The highest levels of cat and dog allergen were found in homes with furred pets (p < 0.001). A significant (p < 0.001) difference was seen in the levels of Fel d1 and Can f1 between the homes of former pet-owners and homes without pets. In summary; cat and dog allergens are present in homes regardless of whether such animals live in the house or not. Mattresses seem to be an underestimated reservoir for pet allergens even in homes without pets. It is important to note that the homes of former pet owners have much lower levels of allergen than current pet owners.

Allergens↗
PubMed1998

Hospitalization for lower respiratory disease during 20 yrs among under 5 yr old children in Stockholm County: a population based survey.

Lower respiratory disease (LRD) is a common cause of hospitalization in infants, and episodes of obstructive LRD increase the risk for asthma later in life. The purpose of this study was to assess time trends and geographical variation of first time hospitalization for LRD among children in Stockholm County, Sweden. Data on first time admittance for LRD among children aged up to 5 yrs from 1973 through 1992 were obtained from the Stockholm County Council hospital discharge register, and population register data were used for estimation of the population at risk. Municipal data were available for 1982-1992 on outbreaks of respiratory syncytial virus (RSV) infections and socio-economic factors. A total of 12,450 children had been hospitalized for the first time with LRD. For children aged <2 yrs a 100% increase in the rate of first time hospitalization for LRD was observed during the study period and children aged up to 1 yr predominated (50%). The average yearly increase in the population based first time hospital admission rate for LRD was 1.82%. Males constituted 65% of the cases. Of the diagnoses, 89.6% were consistent with obstructive LRD, e.g. asthma and obstructive bronchitis. In children aged up to 1 yr, peaks in the rate of hospitalization tended to coincide with outbreaks of RSV infections. Differences in hospitalization between municipalities seemed to be partly explained by differences in the admission practices of the four paediatric hospitals in the area. We conclude that the increased rate of hospitalization for lower respiratory disease in infants of Stockholm County may reflect a true increase in the incidence of obstructive respiratory disease. However, several factors determine admittance to hospital and the results need to be interpreted with caution.

Age Distribution↗
PubMed1998

17Beta-hydroxysteroid dehydrogenase type 1 in normal breast tissue during the menstrual cycle and hormonal contraception.

Our purpose was to assess 17beta-hydroxysteroid dehydrogenase (17HSD) type 1 protein expression in normal breast tissue during the menstrual cycle and hormonal contraception. We analyzed 17HSD type 1 protein expression by immunohistochemistry during the regular menstrual cycle (n = 12) and hormonal contraception (n = 7) in women undergoing reduction mammoplasty. 17HSD type 1 protein was detected in normal breast epithelial cells throughout the menstrual cycle and in all women using hormonal contraception. Mean 17HSD type 1 staining intensity was higher in alveolar epithelial cells in women using hormonal contraception (2.14) than in untreated women (1.25; P < 0.04). For ducts, this difference approached significance (2.29 vs. 1.41; P = 0.06). There was a negative correlation between serum estradiol (E2) levels and 17HSD type 1 protein expression for both alveolar (r(s) = -0.68; P = 0.004) and ductal (r(s) = -0.75; P = 0.002) breast epithelial cells. Enhanced 17HSD type 1 protein expression might increase the conversion to E2 in normal breast tissue during hormonal contraception. The negative correlation between serum E2 levels and 17HSD type 1 suggests this enzyme to be one of the regulatory mechanisms of intratissue E2 concentration in normal breast tissue.

17-Hydroxysteroid Dehydrogenases↗
PubMed1997

Low capsular contraction rate after primary and secondary breast reconstruction with a textured expander prosthesis.

The expander prosthesis has the advantage over the temporary expander of being permanent and thus does not require an operation when the implant has to be exchanged for a permanent prosthesis. Forty-nine women who had had either primary or secondary breast reconstruction performed with a permanent textured expander prosthesis were included in the study. No patient in either group had received radiotherapy. Breast softness was evaluated by an objective method, applanation tonometry, when saline was extracted from the implant to the desired breast volume after 3 months of slight overexpansion. Follow-up examinations were done 6 and 12 months later. In both groups the breasts became harder between the extraction of saline and the 6-month follow-up but then remained unchanged at the 12-month checkup. The capsular contracture rate after 6 months was 11 percent in the primary breast reconstruction group (n = 37) and 0 percent in the secondary breast reconstruction group (n = 11). After 12 months, the results were constant. There was no statistically significant difference between the two groups at any time. The low capsular contracture rate in both groups shows the suitability of the expander prosthesis for achieving good results in both primary and secondary breast reconstruction. Objective evaluation of the results in order to compare different materials and methods of breast reconstruction should be mandatory.

Breast Implants↗
PubMed1997

Reduction of the mite-allergen reservoir within mattresses by vacuum-cleaning. A comparison of three vacuum-cleaning systems.

Mattresses are considered to be the main source of house-dust-mite (HDM) allergen. This study aimed to investigate different types of vacuum cleaners for their ability to reduce this allergen reservoir. Three types of vacuum cleaners were examined: a conventional vacuum cleaner, a water-trap cleaner, and a central vacuum cleaner. Cut out pieces of mattresses were analyzed for content of mite allergen after vacuum-cleaning. Three polyester mattresses from the homes of three children were selected for the study. These three mattresses had earlier been found to be contaminated by group 1 HDM allergen (8-15 micrograms/g of dust). Each mattress was divided into three main sections, separated by a safety zone, and each main section was subdivided into four parts. The three main sections were cleaned by each vacuum-cleaning system. Pieces 2-cm-thick of the surface of the mattresses were cut out, and extracts were made to assess the amount of mite allergen still present after different intensities of vacuum-cleaning. A considerable reduction in the level of mite allergen was found after using all three of the vacuum-cleaning systems. Only 22% of the original mite-allergen reservoir remained after intense vacuum-cleaning. Since the number of mattresses in the investigation was low, and niche formations of group 1 HDM allergen within the mattresses were observed, the results must be interpreted with caution. Furthermore, allergen-producing living dust mites were not affected by this method. However, intense vacuum-cleaning seems to reduce considerably the level of the mattress-bound mite-allergen reservoir, a fact which may be important in mite-allergic and mite-exposed families.

Allergens↗
PubMed1996

Patients' psychological and cosmetic experience after immediate breast reconstruction.

Immediate breast reconstruction was introduced in 1990 at the Karolinska Hospital. A semistructured interview with 20 patients operated on between 1991 and 1994 was undertaken to evaluate patients' degrees of satisfaction regarding pre-operative information, the need for psychological support and the opinion about the cosmetic outcome. During the pre-operative period, 18 patients felt that they were engaged in the decision-making whereas two patients felt that the surgeon alone was responsible for the decision. Regarding pre-operative information given, 7/20 were satisfied, 5/20 were mostly satisfied, 5/20 were unsatisfied and 3/20 had no opinion. During the early post-operative period (<3 months), five patients felt anxiety or depression and 10 patients felt a need of additional psychological support. Within 6 weeks 19/20 patients returned to their occupational level. During the late post-operative period (>3 months), 19/20 patients were generally satisfied with the reconstructive procedure. Eight patients thought the final result exceeded their initial expectations and 11/17 accepted the new breast as an integrated part of their body. The results confirm that immediate breast reconstruction plays an important role in the surgical management of breast cancer. The need for pre-operative information and continuous psychological support in terms of an empathetic behaviour cannot be underestimated.

Adult↗
PubMed1996

Transient sensitization to house-dust mites: a study on the influence of mite exposure and sex.

This study aimed to evaluate the prognosis of a previous positive skin test to house-dust mites (HDM) in relation to environmental exposure. A total of 115 children, 50 from Stockholm and 65 from northern Sweden, all with a previous (average 2.5 years) positive Phazet (Pharmacia AB, Uppsala, Sweden) skin prick test (SPT) to extracts of Dermatophagoides pteronyssinus (Dpt) and/or D. farinae (Df) were included. Dust samples were collected from the children's mattresses, and the total (Dpt, Df, and D. microceras [Dm]) amount of major mite allergen was measured by ELISA (50 children) and expressed as microgram allergen per gram of dust, or was measured by microscopy (65 children). The results of microscopic mite counts were transformed to approximate allergen levels as 2 micrograms equals 100 mites per gram of dust. Of 115 originally SPT-positive children, only 48 (48%) remained positive at retest, while the majority (58%) were SPT negative after 2 years. Among the 67 converted children, 11 were still exposed to mite allergen, but only to low concentrations (only one converted child being exposed above the suggested threshold level [TLV] of 2 micrograms/g), compared to 15/48 children still SPT positive who were exposed above the TLV. This shows that continued mite exposure is a major risk factor (OR = 30, CI 4.8-184) for continued positive SPT to HDM. A minor risk factor for continued sensitization was sex, boys having a higher risk than girls (OR = 2.2, CI 1.0-4.8). In conclusion, a surprisingly high rate of SPT conversion occurred, mainly as a result of a favorable indoor environment with low exposure to HDM and, to a lesser degree, as a result of sex. The present results support the view that the risk level of exposure is 2 micrograms mite allergen per gram of dust.

Allergens↗
PubMed1996

Measurement of breast volume with thermoplastic casts.

A pilot study was carried through to assess the reproducibility of a new method of measuring breast volume. Twenty healthy female volunteers participated. A negative replica of the breast was made with thermoplastic cast material. The volume was measured by filling the cast with water until it reached two opposite points of the boundaries of the breast delineated on the cast. Three measurements were made of every cast and the mean was calculated. The range of the three measurements expressed as a percentage of the mean volume was 2.9 (SD 1.6)%. Each volunteer's breasts were measured twice with a brief intervening pause. The coefficient of variation between the two corresponding measurements was 6%.

Adult↗
PubMed1995

Peroperative adenosine infusion reduces the requirements for isoflurane and postoperative analgesics.

The aims of this study were to investigate the influence of adenosine infusion, firstly, on postoperative analgesic requirements, and secondly, on peroperative isoflurane requirements. Seventy-five women, aged 18-70 yrs, ASA grades I and II, scheduled for breast surgery, were randomly assigned to peroperatively receive a double-blind intravenous infusion of either adenosine, 80 micrograms.kg-1.min-1, or placebo, during surgery under isoflurane/N2O/O2 anesthesia. The peroperative isoflurane requirements were significantly reduced at 30 and 90 min of surgery during adenosine treatment. The number of patients reporting pain when regaining consciousness after surgery was reduced by 57% in the adenosine group, 8/31 vs 19/32 (P < 0.02). Further, the postoperative 24-h opioid requirements were reduced by 27% in the adenosine group (P < 0.03). In conclusion, we found that a peroperative infusion of a small dose of adenosine during breast surgery, reduces the peroperative anesthetic requirements, and the demand for post-operative analgesics.

Adenosine↗
PubMed1995

Rapid versus slow tissue expansion for breast reconstruction: a three-year follow-up.

Twenty-eight women scheduled for a breast reconstruction with tissue expansion were randomly divided into two groups. In the first group, the breast tissue was expanded rapidly, i.e., starting 1 week postoperatively on a daily basis; in the other group the breasts were expanded slowly, i.e., starting after 2 weeks, once each week. The expansion periods were 14 and 37 days, respectively. In both groups, the expansion volume was about 200 percent of the final breast prosthesis. The expanders were replaced by textured, gel-filled implants after 3 months. Follow-up examinations were performed after 1 year and 3 years to evaluate breast softness. An objective method, applantation tonometry, was used, and relative breast compressibility was calculated. The capsular contraction rate after 1 year was 45 percent in the rapid expansion patients and 23 percent in the slow expansion patients; after 3 years, it was 31 percent in the rapid expansion group and 33 percent in the slow expansion group. There was no statistically significant difference between the two groups at any time. Irradiated patients included in the study did not achieve poorer results. The results already obtained after 6 months remained stable up to 3 years after the implantation of the permanent prosthesis.

Adult↗
PubMed1995

Ventilation in homes infested by house-dust mites.

Thirty single-family homes with either high (> or = 2000 ng/g) or low (< or = 1000 ng/g) house-dust mite (HDM) allergen levels in mattress dust were examined for ventilation, thermal climate, and air quality (formaldehyde and total volatile organic compounds (TVOC). Elevated concentrations of HDM allergen in mattress and floor dust were associated with the difference in absolute humidity between indoor and outdoor air, as well as with low air-change rates of the home, particularly the bedroom. No correlation was found between concentration of TVOC or formaldehyde in bedroom air and HDM allergen concentration. In regions with a cold winter climate, the air-change rate of the home and the infiltration of outdoor air into the bedroom appear to be important for the infestation of HDM.

Air Pollution, Indoor↗
PubMed1995

Indoor environmental risk factors in young asthmatics: a case-control study.

One hundred and ninety three children with asthma and 318 controls aged 1-4 years were evaluated for atopic heredity and exposure to possible indoor risk factors for asthma-for example exposure to furred pets, tobacco smoke, and home dampness. A subgroup of cases were classified as cat and/or dog allergic on the basis of skin prick tests. Heredity for asthma was a significant risk factor (odds ratio (OR) 3.0, confidence interval (CI) 2.1 to 4.6). Environmental tobacco smoke was associated with an excess risk for asthma (OR 1.7, CI 1.1 to 2.3) and signs of home dampness tended to increase this risk (OR 1.3, CI 0.9 to 2.0). High dose exposure to cat and/or dog resulted in an increased risk only in asthma cases sensitised to cat and/or dog (OR 2.7, CI 1.0 to 7.3). A combination of high dose exposure to cat and/or dog, environmental tobacco smoke and damp housing was associated with an OR of 8.0 (CI 1.9 to 34.1). Raised indoor humidity has been shown to reflect low air exchange, which may also lead to increased doses of inhaled aeroallergens and tobacco smoke, and contribute to the interaction between the three risk factors.

Allergens↗
PubMed1995

Breast reconstruction--past achievements, current status and future goals.

Breast cancer is the most common malignant tumour in women, and more than 5000 new cases are discovered each year in Sweden, this means that one woman in nine will be treated for breast cancer during her lifetime. For unknown reasons, the incidence increases by 1% each year. Partial mastectomy is the most common surgical treatment today, but a large number of women undergo mastectomy--that is, excision of all breast tissue including the nipple-areola complex with or without an axillary biopsy. Radical mastectomy--that is the Halsted mastectomy with excision of the pectoral muscles (51)--is almost never done today, so chest wall defects are smaller than in the early days of breast reconstruction. There is, however, still a demand from patients for good, natural-looking, and longlasting breast reconstructions, and reconstructive surgeons have to search for perfection both in existing methods and also in new methods of breast reconstruction. The purpose of this article is to review this complex subject.

Breast Implants↗