Biomedical subjects
Publications and source records attributed to S Berg.
After a review of the development of ethics committees, their relationship to forensic medicine as a university subject is illustrated. This is followed by a discussion on the structure, competence and efficiency of ethics committees on the faculties of medicine, taking into account the specific aims of internal pharmacological research projects and particularly risky operations taking place on humans for the first time.
The authors compared four different continuity-of-care measures recently suggested in the literature. First, an analytic comparison is made and useful inequalities are derived. Then the continuity indexes are applied to an extensive data material from a Swedish ambulatory care center. The four indexes give fairly similar results, and the basic finding is the substantially higher index values for elderly patients. Finally, computed index values are compared with what could be expected under a scheme of random assignment of patients to doctors.
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Patients presenting with ureteral calculi and fever were treated with antibiotics, fluids and careful monitoring. An emergency operation or ureteral manipulation was withheld until the patient became afebrile. In 14 patients so treated all became afebrile and 11 required no surgical intervention. It is suggested that carefully monitored resuscitation should precede instrumentation in patients with urinary stones and fever.
Bone samples from autopsies, recent and subfossile samples as well as skin and muscle material from non-preserved local mummies were investigated. The material was evaluated morphologically and serologically in parallel by means of the well-known absorption-test, the agglutinin-cohesion technique with deionized concentrated EDTA extracts according to Borgognini, the absorption-elution technique according to Kind with the modification proposed by Kirst & Landes, and the immunofluorescence-histology according to Lengyel. With the latter method no specific results could be obtained at all; with the absorption and the absorption-elution tests the blood-group status of autoptic compacta material could always be estimated correctly, and also with recent bone samples an acceptable phenotype distribution was found. On the contrary, with the old-historic material consisting of 39 skeletons a reverse proportionality between the morphological preservation state and the serological results was found: the more advanced the decay of the organic matrix, the more frequent was the finding of blood-group A or B; the better preserved the bony substance, the more frequent negative (= 0 ?) results were obtained. By analogy with the findings in mummy tissue, where the tracing of A and B bloodgroup substances also prevailed in cases of extensive saprophyte contamination, the postmortal infiltration of microbiological blood-group active foreign material is discussed as a possible cause of erroneous diagnoses for bones, too. The compared methods yielded different results on the same bone in some cases, and also with the, according to our experiences, most suitable absorption-elution method contradictory blood-group findings were achieved with different bones of the same skeleton occasionally. In light of these results it seems possible to detect blood-group substances of the ABO system in bone material only under protective storage conditions, as tomb funeral, ossuaries, or reliquaries after centuries and with acceptable error quote; serological findings on subfossile materials must be valued with greatest reservation, and critical restraint should be recommended especially against the method of approach.
The diagnosis and determination of the nutritional status for the evaluation of a surgical risk is achieved on the basis of a simple documentation scheme: The aim of the presented study was the characterization of this specific check-up protocol to find out the usefulness and applicability of this scheme and its value for the recognition of the nutritional status as one of the factors determining the outcome of surgical patients. The results show that this simple procedure allows an equivalent ranging of patients in different classes of nutrition related states as the highly sophisticated, time, costs and staff consuming protocols which were published to define nutritional states in the last years. When the exact and differentiated status is not necessary the simple protocol gives the same information to judge the possible risk by nutritional deficiencies as the complicated protocols.
This report on firearm tests with dead bodies deals with external marginal splinterings from entrance holes in bone, the trapping of hairs, and the stability of powder smoke deposits on bones under the influence of special postmortal conditions and preparatory treatment. The investigations were carried out in connection with an expertise in a case of murder in Africa in which the question of the distance of shooting had to be evaluated after 6 months of decomposition, action of ants, and preparation.
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Continuous infusion of a 0.2% solution of bupivacaine via a peridural catheter in a rate of 0.2 ml/kg x h is sufficient to make a patient pain-free for any time required following upper abdominal or abdomino-thoracic surgery. The zone of analgesia extends segmentally from T4 to T12/L1 so that the patient can be mobilized. If necessary an insufficient blockade can be completed by bolus injection of 10 to 15 ml of 0.2% solution. Using this technique over a period of four days after surgery, serum concentrations of bupivacaine were measured in 20 patients. The following values were found (median, range): at the end of the operation 0.85, 0.26-1.72 mg/1, after 24 h 1.70, 0.58-4.04 mg/1, after 48 h 3.46, 1.22-7.62 mg/1, after 72 h 2.80, 0.73-12.15 mg/1 and after 96 h (end of the investigation) 2.39, 0.34-9.92 mg/1. Moderate excitation was sometimes observed, while the patient was in the recovery room (shivering, restlessness) but disappeared completely within 10 h. Later on no signs of intoxication were observed, even when serum bupivacaine concentrations exceeded 6 mg/1. During continuous epidural anaesthesia, when serum bupivacaine concentrations increase gradually this level does not seem to be toxic. We consider this method to be suitable for keeping a patient pain-free following upper abdominal surgery, provided that adequate monitoring is available.
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The isozymes of the PGMa1-system can be determined more or less distinctly in stored blood samples up to 1.5 years in approximately half of all samples. However, in several cases shifting of the isoelectric points and splitting can be noticed, especially in the c-bands range and, as a result of this, the primary type PGM1 a1 can simulate a PGM1 a2-a1 type, or more rarely a PGM1 a2 type. By a small cathodic shift of the a-band even PGM1 a3-a2 type can be found under special circumstances. Dried traces may simulate the PGM1 a2-a1 type through the appearance of conversion-bands in the b-range and on definite trace carriers even the PGM1 a4-a1 type may be simulated. The presentation of the Gc-subtypes is nearly always possible parallel to the Tf-subtypes even in alcohol blood samples stored for up to 3 months and in most of those stored for up to 7 months. Later, it often comes to a widening and splitting of the 1-band so that a discrimination of the S- and F-homo- and heterozygotes, respectively, is not possible anymore. Altogether, Gc-basic types may be more easily determined by isoelectric focusing in aged blood samples than with the electrophoretic methods including immunofixation.
Six newly observed Gc variants are described. The variants Gc 1A10, 1A11, 1A12, 1A13, and 1C11 have double band patterns. The anodal bands of these variants are susceptible to neuraminidase treatment. Gc 2A7 is a single band variant which is not altered by neuraminidase incubation. Polyacrylamide gel isoelectrofocusing with immunofixation and polyarcylamide gel electrophoresis appear to be efficient methods for the analysis of the Gc system.
A family was described recently in which renal carcinoma developed in 10 members in 3 consecutive generations. The cancer tended to develop in patients at an early age, and to occur in both kidneys and at multiple sites more frequently than in nonfamilial renal cancer. The finding of a balanced reciprocal translocation between chromosomes 3 and 8 in affected family members suggest that an inherited genetic defect predisposes to the development of this cancer in middle-aged patients and offers a marker for screening individuals at risk. We herein discuss the surgical management of 4 family members, the proband and 3 relatives, who were discovered on screening to have bilateral, multifocal renal cancer. Certain compromises in the principles of radical tumor surgery have proved effective in these 4 patients. Partial nephrectomy has resulted in total extirpation of the bilateral tumors with survivals of 2 to 4 years without need for chronic dialysis. The sequential order of surgical procedures is important since partial nephrectomy of the least affected side first allows a total nephrectomy on the more affected side to be done later, when necessary, without transient renal failure.
Feelings of loneliness in relation to disease, handicaps, social network and social background were studied in a representative sample of 1,007 70-year-old people living in Göteborg, Sweden. The results showed that loneliness was a problem to 24% of the women and 12% of the men. The study allowed a detailed analysis of the association between feelings of loneliness and health, disabilities due to other than medical reasons, consumption of social and medical service, social contacts, cognitive functioning and personality traits. The most important factors related to the feeling of loneliness were the loss of spouse, depression of mood and lack of friends. The lonely had a negative self-assessment of health and consumed more out-patient care, social welfare help and sedatives. The higher consumption of medical service and/or social care was, however, not associated with a higher prevalence of definable somatic disease or handicaps.
The effect of physical training and ergonomic counselling on the psychological perception of work and the frequency and severity of low-back symptoms was studied in a group of female nursing aides with low-back insufficiency symptoms. The nursing aides were divided into three groups. One group (the training group) was given conditioning exercises twice a week for eight weeks. A second group (ergonomics group) was given ergonomic counselling during the same period, and a third group served as a control group. The subjects' psychological perception of their work, low-back symptoms and physical working capacity were measured before and after the study. At the end of the study the training group had improved their psychological perception of their work in two of seven variables compared with the control group. The ergonomics group did not show any change in their psychological perception of their work. The physical capacity of the training group had increased somewhat compared with the control group but not compared with the ergonomics group. The perceived exertion during work on a bicycle ergometer had decreased in the training group compared with the control group as well as with the ergonomics group. The influence of either training or ergonomic counselling on the low-back symptoms was negligible.
Little information is available on suicidal attempts using air guns. In this paper we report an unusual suicide of a 85-year-old pensioner. We also report on additional experiments regarding the power of bullets to penetrate various materials. These experiments are designed to contribute to the understanding of the details of contact gunshots. The results are discussed and compared with those from other authors.
An assessment scale consisting of 10 questions was constructed from an initial 20 questions. The scale encompassed orientation to time, place and person and was intended for geriatric patients and patients suffering from psychogeriatric disorders who had been institutionalized for at least 14 days. The reliability according to the Kuder-Richardson formula number KR20 was 0.83 and the test-retest reliability was 0.84. The scale differentiated between patients with senile dementia and/or cerebral arteriosclerosis and patients without such disorders.