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Biomedical subjects

P Christensson

Publications and source records attributed to P Christensson.

15 recordsLinked to original sources
PubMed1998

Can preoperative psychological defensive strategies, mood and type of lower urinary tract reconstruction predict psychosocial adjustment after cystectomy in patients with bladder cancer?

OBJECTIVES: To assess if there is relationship between: (i) preoperative psychological defensive strategies, mood and type of lower urinary tract reconstruction, and (ii) psychosocial adaptation after radical cystectomy for bladder cancer. PATIENTS AND METHODS: Fifty-seven consecutive patients (44 men and 13 women, mean age 62 years, range 34-81) undergoing radical cystectomy (ileal conduit urinary diversion in 17, continent cutaneous diversion in 22 and orthotopic bladder replacement in 18) were assessed preoperatively using the meta-contrast technique (MCT), a projective test to reveal individual defensive strategies. From the results the patients were classified as hypothetical 'at risk' or 'no risk' patients for postoperative psychosocial complications. An 'at risk' patient was designated as one who showed neurotic defensive strategies in coping with threats, i.e. primitive, immature or regressive strategies or even lack of defence in connection with pronounced anxiety. All patients completed a questionnaire and were interviewed; 10 questions dealt with mood, five reflecting anxiety and five the depressive states. The questionnaire and the interview were repeated 3 and 12 months, and 5 years after surgery. RESULTS: The remembered difficulties during the first month after discharge from hospital differed between the 'risk' and 'no risk' groups after 1 and 5 years. On a visual analogue scale (VAS) the 'risk' patients had very low scores (less difficulty) or very high, while the 'no risk' patients had intermediate scores. VAS score were also higher, although not significantly so, in patients using primitive defence strategies. The psychosocial situation did not differ between the groups in the first year, but at 5 years there were differences in self-esteem and interpersonal contact-seeking. High depression scores before surgery were associated with high VAS scores at 3 months when recalling the first month after discharge, but the anxiety score was not predictive. Men with orthotopic bladder replacement adapted less well throughout the 5 year follow-up. Elderly patients with stereotypy (the commonest defensive strategy at these ages) adapted relatively well to ileal conduit diversion. About 20% of patients had difficulty in accepting the postoperative situation, regardless of urinary diversion modes. CONCLUSION: The combination of defensive strategies assessed using the MCT and selected on hypothetical grounds was less discriminatory than expected for those at risk of postoperative psychosocial problems. However, those with primitive strategies apparently had a long-term risk of poor adaptation. The search for an optimal instrument for the identification of patients at risk is warranted. In this study, patients with a 'wet' stoma did not seem to fare less well than those with a continent reconstruction.

Adaptation, Psychological↗
PubMed1986

Changes of volume of trapped gas after bronchodilation in subjects with suspected subclinical emphysema.

We studied the volume of trapped gas (VTG), using a nitrogen washout method, before and after bronchodilation in four groups with theoretically increasing risk of developing pulmonary emphysema: (1) nonsmoking healthy controls (PiMn), (2) nonsmoking subjects with an intermediate alpha 1-antitrypsin deficiency (PiMZn), (3) smoking subjects with normal concentration of alpha 1-antitrypsin, and (4) smoking PiMZ subjects. VTG was the only lung function variable that showed a significant difference between PiMZn and PiMn subjects but only after bronchodilation. Some conventional lung function tests also distinguished smokers from nonsmokers of both genotypes but VTG was the most sensitive test. VTG decreased after salbutamol inhalation in the control group but showed a consecutively larger increase with more risk factors of developing emphysema. An increase in VTG after bronchodilation may be a sign of alveolar abnormality preceding development of clinical lung emphysema.

Albuterol↗
PubMed1981

Volume of trapped gas in lungs of healthy humans.

The volume of trapped gas (Vtg) that could be mobilized by maximal breaths at the end of a nitrogen washout to 2% N2 was measured in 70 healthy women and 62 healthy men while seated. The average Vtg was found to be 102 +/- 21 (SD) ml in men and 73 +/- 18 ml in women. The Vtg was positively related to total lung capacity (TLC) (r = 0.67; P less than 0.001). An average percent Vtg/TLC of 1.4 +/- 0.31 (DS) % was applicable to both sexes. Vtg/TLC (%) was positively related to age (4 = 0.45; P less than 0.001). The error of a single determination was 8 ml, i.e., the reproducibility was very high. The existence of lung compartments that are unventilated or extremely underventilated may explain part of the physiological alveolararterial O2 difference. An increase in Vt has been found to be a very sensitive sign of subclinical bronchospasm.

Adolescent↗
PubMed1981

Salbutamol inhalation in chronic asthma bronchiale: dose aerosol vs jet nebulizer.

The effect of inhalation of 5 mg of salbutamol by a jet nebulizer and 0.3 mg from a metered aerosol was compared in 20 patients with chronic asthma. Half the patients, randomly selected, received one treatment method on day one and the other on day two. A battery of lung function tests suitable for detecting large and small airways obstruction showed only insignificantly more pronounced bronchodilatation after the use of the jet nebulizer. Neither was a better dilation of small airways with this method obvious. It is concluded that the higher dose by jet-nebulizer is only clinically motivated when the patients cannot perform the deep inhalations and breathholding necessary for efficient use of the dose aerosol.

Adult↗
PubMed1979

Netilmicin: clinical evaluation of efficacy and toxicity of a new aminoglycoside.

The efficacy and toxicity of netilmicin, a new semisynthetic aminoglycoside, was clinically evaluated in fifty-two patients with moderate to severe infections with Gram-negative rods or Staph. aureus. Average duration of treatment was 14 days and mean total dose 2,960 mg. One-hour mean value of netilmicin serum concentration was 6.4 microgram/ml and mean trough value 1.2 microgram/ml. Forty-four patients were cured or improved. In twenty-one of them the effect could be attributed to netilmicin alone; the other twenty-three had a combined therapy. No improvement took place in five, but four of them could not be regarded as netilmicin failure. One patient with Pseudomonas aeruginosa infection was possible failure. The sensitivity of the causative bacteria to netilmicin was studied and compared with amikacin, gentamicin, sisomicin and tobramycin. Vestibular function and hearing acuity was thoroughly examined by electronystagmography and audiography. Drug-related VIIIth nerve damage could not be confirmed in any of our patients. Five patients showed a rise of serum creatinine of 30 mumol/l. This shows that netilmicin, similar to other aminoglycosides, is a potential nephrotoxic drug. Netilmicin appears to be an efficacious aminoglycoside and the oto- and nephrotoxicity is low, if careful attention is paid to the renal function and the serum concentrations of the drug.

Adolescent↗
PubMed1979

Early and late results of controlled ventilation in flail chest.

From 1967 through 1974, a consecutive series of 35 patients with flail chest were treated with intermittent positive-pressure breathing (IPPB). The controlled ventilation contributed to stabilization of the thoracic cage in a favorable position for healing of the fractures. Surgical stabilization of the chest was not attempted in any of the cases. During treatment with IPPB, one patient died from profuse bleeding due to a generalized coagulation disorder, but the remaining 34 were discharged in a satisfactory respiratory condition. A late follow-up study of the pulmonary function one to eight years after the trauma included x-ray films of the trachea and lungs, kymographic studies of the diaphragm, spirometric and radiospirometric testing, and arterial blood gas levels. Eighteen patients were examined. Spirometric testing revealed astonishingly little impairment of the total pulmonary function. The radiospirometric studies with 133xenon showed a significant reduction of the regional perfusion only in five patients (2 to 4.5 pulmonary segments). Kymographic study of the diaphragm gave no further information and was less selective compared with the other tests of pulmonary function. Owing to the encouraging early and late results in this study, early treatment with IPPB is considered to be the method of choice in flail chest with paradoxic respiratory movements.

Adolescent↗
PubMed1978

Changes in volume of trapped gas in the lungs during provoked asthma followed by beta-2 receptor stimulation.

The volume of trapped gas (VTG) that could be mobilized by maximal breaths at the end of a nitrogen washout to 2% N2 was measured in 11 subjects with a history of asthma before and after provocation with specific allergens. The change after salbutamol was also measured. VTG was found to be more specific and sensitive for demonstrating early bronchospasm than changes in FEV1, VC or nitrogen washout. Salbutamol relieved all symptoms of bronchospasm.

Adult↗