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Biomedical subjects

O Jonasson

Publications and source records attributed to O Jonasson.

At least 55 records · Page 3Linked to original sources
PubMed1986

Acute subdural hematoma: direct admission to a trauma center yields improved results.

We studied 128 patients admitted over a 12 1/2-year period to the Cook County Hospital Trauma Unit with acute subdural hematoma (ASDH): 82 were admitted directly and 46 were admitted after transfer from another hospital; 59% of the entire group died and only 27% obtained a functional recovery. As a group, the transferred patients, who suffered delays of several hours before receiving definitive surgical care, fared significantly worse than the patients with equivalent trauma who were admitted directly. The mortality of the transferred patients was 76%, compared to 50% of the direct admit patients. The outcome was also worse for transfer patients who experienced a 'lucid interval' or with alcohol intoxication. We conclude that the delays associated with failure to admit patients with ASDH directly to a head trauma center cause an excessive mortality and morbidity which could potentially be avoided by proper triage.

Adolescent↗
PubMed1985

Leprosy associated with HLA-DR2 and DQw1 in the population of northern Thailand.

A study of the frequency of HLA-DR2 and DQw1 was performed in leprosy patients and controls in northern Thailand. HLA-DR2 was found in 100% (17/17) of patients with sporadic tuberculoid leprosy and in over 90% (30/32) of all tuberculoid leprosy patients, as compared to 62% (20/32) of controls (p = .02). These strong associations had relative risks of 21.4 for sporadic and 7.4 for all tuberculoid leprosy, and etiologic fractions of 1.0 and 0.84, respectively. There was also a statistically significant and strong association between tuberculoid leprosy and DQw1. These data add to the growing body of evidence that products of HLA class II determinants or closely linked genes may play a role in determining the clinical manifestations of M. leprae infection.

Adult↗
PubMed1985

The pathophysiology of experimental insulin-deficient diabetes in the monkey. Implications for pancreatic transplantation.

In an 11-year study of experimental insulin-deficient diabetes (IDDM) induced in rhesus monkeys by streptozotocin or total pancreatectomy, the authors have found that pathophysiologic changes occur in eye and kidney, which closely resemble the early stages of human insulin deficient diabetes mellitus (IDDM). In addition, morphologic changes of thickening of glomerular capillary basement membrane and expansion of mesangial matrix (by light microscopy) appear within 3 years of onset of hyperglycemia. However, progression to irreversible complications of advanced diabetic nephropathy or proliferative retinopathy, have not occurred. This animal model resembles human disease in that the animals tend to become ketotic unless maintained with exogenous insulin; C-peptide production is low to absent, and large amounts of glycosylated hemoglobin develop within a month of onset. The monkeys differ from humans in the absence of hypertension and hyperlipidemia. The authors suggest that the abnormalities in basement membrane form and function caused by hyperglycemia form the necessary background upon which other factors, such as hypertension and hyperlipidemia, then act to cause irreversible complications. The role of pancreatic transplantation is in prevention of these background changes.

Animals↗
PubMed1985

Serious wound infections in burned patients.

Wound infections are a major problem in burned patients. To determine the rate of wound infection associated with initial wound size and the amount of open full-thickness wound, we prospectively studied all patients admitted within 1 week of burn injury during a 2-year period using weekly wound cultures. Wounds were treated with topical silver sulfadiazine and occlusive dressings. Burn wound excision and immediate grafting were initiated during the first postburn week. One thousand five hundred twenty-three patient weeks (483 patients) were evaluated. Serious burn wound infections developed during 55/185 patient weeks (42.3%) when the initial total burn (ITB) was greater than 40% body surface area (BSA). This decreased to 27/304 (8.9%) when the ITB was 21% to 40% and 60/1034 (5.8%) when the ITB was less than 20% BSA. Burn wound infections developed during 57/211 patient weeks (27.0%) when the initial full-thickness burn (IFB) was greater than 20% BSA. The rate of wound infection decreased to 73/776 (9.4%) when the IFB was 1% to 20% and to 12/536 (2.2%) when no IFB was present. We further analyzed the prevalence of serious wound infections in relation to the open wound size during the hospital course. Wound infections occurred during 47 of 96 patient weeks (49.0%) when the current full-thickness wound was greater than 10% BSA. The infection rate decreased to 76 of 594 (12.8%) and 17 of 833 patient weeks (2.0%) when the remaining full-thickness wound was reduced to 1% to 10% and less than 1% BSA, respectively (p less than 0.05). Early wound closure would appear to reduce the risk of serious wound infections, especially in patients with full-thickness burns.

Adolescent↗
PubMed1985

Parathyroid allotransplantation in the treatment of complicated idiopathic primary hypoparathyroidism.

Parathyroid allotransplantation was performed in a 25-year-old woman with idiopathic hypoparathyroidism that had been diagnosed at age 4 years. Long-term medical management of the primary condition with vitamin D and oral calcium supplementation was complicated by multiorgan calcinosis and renal failure. At the age of 21 years she received a successful cadaver renal allograft. Four years later she developed calcinosis cutis with widespread skin necrosis. Medical control of calcium and phosphate metabolism was unsatisfactory and the skin necrosis became progressive and life threatening. A parathyroid allograft that was performed with tissue from a parathyroid adenoma resulted in normalization of the serum calcium and phosphorus levels with arrest and subsequent healing of the skin necrosis. Later failure of the parathyroid allograft was followed by successful retransplantation of normal parathyroid tissue from a cadaver organ donor.

Adult↗
PubMed1984

Peripheral glomerular basement membrane thickness in the normal and diabetic monkey.

Diabetes of varying severity was induced in a colony of rhesus monkeys by streptozotocin injection or total pancreatectomy. Peripheral glomerular basement membrane thickness was determined using a reproducible and efficient procedure. Four groups of monkeys formed on the basis of sex, age, severity, and duration of treatment were analyzed. In control animals peripheral glomerular basement membrane thickness increased with age from 3 to 7 years, whereas monkeys aged 11 to 18 years had relatively constant measurements. Mean values did not differ between control and age-matched non-insulin-dependent streptozotocin-injected animals treated up to 13 years previously. Insulin-dependent streptozotocin-treated or pancreatectomized monkeys with a treatment duration of 10 to 27 months were not different from age-matched controls, whereas insulin-dependent monkeys treated 2 to 12.5 years earlier showed significantly increased peripheral glomerular basement membrane thickness. The peripheral glomerular basement membrane thickening observed in the insulin-dependent monkey is easily measured and is similar to changes observed in human diabetes mellitus.

Analysis of Variance↗
PubMed1984

Partial splenic embolization, an alternative to splenectomy--results of a prospective, randomized study.

UNLABELLED: We conducted a prospective, randomized study comparing transcatheter partial splenic embolization (PSE) with splenectomy (SX) in 53 renal transplant candidates. An additional 112 PSE procedures were performed for various indications in 101 patients. STUDY RESULTS: A mean +/- SD of 65% +/- 16% of splenic mass was ablated in the PSE group. The early postoperative morbidity rate was similar in the two study groups, as was the duration of hospital stay. Abscess or rupture of the spleen were not encountered. Severe pancreatitis occurred only in the SX group. Renal transplantation was carried out in equivalent numbers in both groups, with a similar long-term (2.5 to 4.0 years) graft survival (60% versus 66%). No difference in long-term patient mortality was noted. Splenic "regeneration" occurred frequently after PSE. PSE experience exclusive of study: Embolization attempts failed in nine patients. Repeat PSE was performed in 11 of the 101 patients. Where hypersplenism was the primary indication, PSE resulted in significant improvement in the hematologic parameters. The incidence of serious complications was acceptably low. There were two late procedure-related deaths. Our conclusion from the study and the total experience of 137 PSE procedures is that PSE offers an acceptably safe alternative to SX in selected high-risk patients in whom both the surgical intervention and the resulting asplenic state carry a prohibitive risk.

Adolescent↗
PubMed1983

Splenic preservation in adults after blunt and penetrating trauma.

This study was carried out to evaluate the possibility and safety of splenic preservation in adults subjected to both blunt and penetrating. In an 18 month period there were a total of 36 splenic injuries studied (in 36 patients): 18 due to blunt trauma, 11 due to gunshot wounds, and 7 due to stab wounds. A total of 18 spleens were repaired: 8 (45 percent) in the blunt trauma group, 4 (36 percent) in the gunshot group, and 6 (85 percent) in the stab wound group. There were no deaths in the entire group nor were there any complications associated with splenic salvage. Splenic preservation after both blunt and penetrating trauma is both safe and feasible in the adult population, except in those instances specified herein.

Adolescent↗
PubMed1983

Correlation of spontaneous microaggregate formation with the severity of trauma in man.

Blood samples were obtained from 237 consecutive injured patients before any resuscitation. Microaggregate (MA) formation was measured by the screen filtration pressure (SFP) technique. Arterial blood gases were analyzed concomitantly and the respiratory index (RI) calculated. An Injury Severity Score (ISS) was calculated for each patient. The results show a significantly larger amount of trauma in the patients with the higher SFP results (p less than 0.001). Associated with the increase in the amount of MA formation was a significant decrease in arterial pO2 (p less than 0.05) and a significant rise in the RI (p less than 0.005), suggesting a correlation between MA formation and pulmonary impairment. Attempts to prevent or resolve MA formation may result in a decrease in the incidence or severity of post-traumatic pulmonary insufficiency.

Adolescent↗
PubMed1983

The importance of burn wound size in determining the optimal calorie:nitrogen ratio.

Calorie requirements in hypermetabolic burned patients have been established based on burn size and patient weight. However, the requirement for nitrogen (N), especially with variable open wound sizes, is not clear. Thirty-six adult burned patients were fed with diets containing two different calorie to N (kcal:N) ratios--150:1 (group 1) and 100:1 (group 2)--and N balance was studied with wounds of different sizes. Calorie requirements were calculated with the Curreri formula (25 cal X weight (kg) + 40 Cal X % body surface area [BSA] burned). Daily N balance was calculated from total N intake less total N output (estimated by adding 4 gm to the measured 24-hour urea N production). The data were selected on 233 patient-days when actual calorie intakes were 100% to 150% of the calculated requirement. For a wound size of 1% to 10% BSA, group 1 patients had an N balance of +2.33 gm/day and group 2, +5.54 gm/day. For a wound size of 11% to 30% BSA, N balance was +0.13 and +3.49 gm/day, respectively. For a wound size of 31% to 60% BSA, N balance was -3.38 and +3.88 gm/day, respectively. The traditional 150:1 kcal:N ratio may be adequate for patients with open wounds of less than 10% BSA. Patients with greater than 10% BSA open wounds require a dietary regimen containing a nonprotein kcal: N ratio of 100:1 in order to achieve positive N balance.

Adult↗
PubMed1983

Immunogenetic studies of juvenile dermatomyositis. HLA antigens in patients and their families.

Typing for HLA-A and -B antigens was performed on 87 children with definite juvenile dermatomyositis (JDMS). A significantly increased frequency of HLA-B8 (estimated relative risk = 2.8, Pc less than 0.01) was observed among White patients, but not among Blacks or Latin Americans with JDMS. No abnormality of HLA haplotype segregation was observed among 38 healthy siblings of the JDMS probands.

Adolescent↗
PubMed1983

Cardiovascular lymphoscintigraphy.

The technique of lymphoscintigraphy when applied to the heart and blood vessels correlates well with results of anatomic investigations of arterial and cardiac lymphatic vessels reported in the literature. Five dogs and eight rabbits underwent lymphoscintigraphy of the heart and aorta, as well as the iliac, femoral, and tibial arteries. After surgical exposure, approximately 500 microCi of 99mTc-labelled antimony sulfide was injected into the myocardium or the adventitial-medial plane of an artery. The colloid particle size of 4 to 12 m mu causes resorption and transport only via the lymphatic vessels. Twenty-one preparations were imaged from 2 to 48 hours after administration. This method provides a functional demonstration that the tibial and femoral arteries of both species are invested with lymphatics. The first echelon of lymph nodes which drain muscular arteries are imaged within 2 hours. Regional lymph nodes could not be seen to drain the aorta or iliac arteries. Anterior left ventricular myocardial injection in the dog showed a single cardiac lymph node. This drainage pattern has been described previously by other investigators. In the rabbit a similarly placed injection visualized a group of regional cardiac nodes. Ligation of the collecting ducts afferent to the cardiac node in the dog prevented removal of the isotope from the heart at 3, 6, and 9 hours. At 24 hours the liver and spleen were imaged, the radiocolloid gaining entrance to the blood vascular system presumably via myocardial lymphaticovenous anastomoses. Lymphoscintigraphy reflects physiologic processes such as lymph transport, filtration, and reticuloendothelial function. It defines regional patterns of cardiac and arterial lymph drainage. It can confirm experimentally produced impairment of lymph drainage from a defined area of tissue. Lymphoscintigraphy should be useful in the investigation of the significance of lymph drainage to diseases of the heart and blood vessels.

Animals↗
PubMed1982

Amebic liver abscess.

Amebic liver abscess was seen in 35 patients over a ten-year period at Cook County and the University of Illinois hospitals, Chicago; 32 had immigrated from an area of endemic amebiasis, but three were natives of Chicago. Typically they had right upper-quadrant abdominal pain and fever of short duration (nine days); on physical examination, upper abdominal tenderness and hepatomegaly were usually present. The diagnosis was confirmed by liver scan, serologic studies, aspiration of "anchovy paste" from the abscess, and/or a favorable response to specific antiamebic therapy. Most were solitary abscesses in the right lobe of the liver. Metronidazole treatment alone was adequate in 24 of 29 patients (83%). Nine patients underwent percutaneous or surgical drainage of the abscess owing to incorrect diagnosis (three), persistent pain and fever after medical treatment (three), expanding left lobe abscess (two), and for diagnosis (one). Mortality was 5.7% (two patients). Owing to current immigration patterns amebic liver abscess should be considered in the differential diagnosis of patients with right upper-quadrant pain and fever. The diagnosis should be confirmed with a liver scan and serologic study for amebiasis.

Adolescent↗