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Biomedical subjects

S Holmberg

Publications and source records attributed to S Holmberg.

At least 145 records · Page 8Linked to original sources
PubMed1987

Predictors of tardive dyskinesia: results of a cross-sectional study in an outpatient population.

A cross-sectional study was conducted to identify predictors of tardive dyskinesia (TD) in a group of 180 psychiatric outpatients maintained on neuroleptic medications. The estimated prevalence of this involuntary movement disorder was 33% in the total study population. Using multiple logistic regression, we found that TD was independently related to five factors: being 55 yr of age and older; being male; using depot (injectable) neuroleptics; having 6 or more years of neuroleptic exposure; and having less than 6 months of psychiatric hospitalization. In addition, the effect of depot medication was much greater in white males than it was in other race-sex groups. We observed no other interaction effects between pairs of predictor variables, nor did we find significant independent effects of race, denture use, DSM III diagnosis, current neuroleptic dose and potency, percent time on neuroleptics, and recent use of antiparkinsonian drugs or lithium. This study is serving as a pilot investigation for a large prospective incidence study that has already begun among patients at risk of developing TD in the same source population.

Adult↗
PubMed1987

Mortality and morbidity in suspected acute myocardial infarction in relation to ambulance transport.

In 681 patients admitted to the coronary care unit (CCU) at Sahlgrenska hospital between 1 May 1983 and 31 May 1984, due to suspected acute myocardial infarction (MI), the hospital mortality and morbidity were related to whether the patients were transferred to hospital by ambulance or not. In the ambulance group acute MI developed in 48% (during the first 3 days in hospital) compared with 41% in the non-ambulance group (P = 0.10). The overall mortality rate was 10.4% in the ambulance group versus 3.8% in the non-ambulance group (P = 0.001). Corresponding figures for MI patients were 19.3% versus 9.1% (P = 0.02). In all, patients referred by ambulance had larger infarcts according to maximum serum enzyme activity and a higher incidence of congestive heart failure. Similar findings were observed when MI patients were analysed separately. On the other hand, the incidence of ventricular fibrillation, requirement for lidocaine, and the course of pain was fairly similar in the two groups. In a multivariate analysis, infarct size was the major independent predictor for early mortality rate. We conclude that patients who call for an ambulance due to suspected acute MI appear to have a different early mortality and morbidity pattern compared to those who do not. The most obvious observation was a higher early mortality. These patients therefore might be the most suitable candidates for early intervention studies.

Adult↗
PubMed1987

Pain assessment by patients and nurses in the early phase of acute myocardial infarction.

In 47 patients admitted to the coronary care unit (CCU) at Sahlgren's Hospital in Göteborg, Sweden, due to acute myocardial infarction (MI) the intensity of pain independently assessed by the patient and by the nurse on duty was evaluated during the first 24 hours in CCU. Pain was assessed according to a modified numerical rating scale graded from 0-10, where 0 meant no pain and 10 meant the most severe pain. A positive correlation between the patients' and nurses' assessments was found (r = 0.76; P less than 0.001). However, the nurses under-estimated the patients' pain in 23% of the situations and over-estimated it in 20%. Over-estimation was particularly found when heart rate and blood pressure increased. Many patients scoring their pain to fairly high degrees were not given pain-relieving treatment. Treatment with morphine did not cause substantial pain relief in a substantial number of patients. A significantly positive correlation was found between the patients' and nurses' assessments of pain, although under-estimation as well as over-estimation occurred. A few patients with severe pain were not treated and when treatment was given it was often ineffective.

Aged↗
PubMed1987

Early weight bearing of displaced ankle fractures.

A prospective randomized study was performed comparing immediate and late weight bearing in 53 dislocated bimalleolar and trimalleolar fractures. Using cerlage, staples, and pins (Cedell 1967), an exact reconstruction of the ankle mortise was achieved in 41/53 ankles. At follow-up after 3 and 6 months, the two groups were equal regarding clinical results. Evaluation radiographically and by roentgen stereophotogrammetric analysis (Selvik 1974) indicated that the stability of the ankle mortise was sufficient to allow early postoperative weight bearing.

Ankle Injuries↗
PubMed1987

Intracapsular pressure and caput circulation in nondisplaced femoral neck fractures.

Nine patients with nondisplaced femoral neck fracture were evaluated with preoperative Tc-MDP-scintimetry, ultrasonography, and measurement of the intracapsular pressure. The intracapsular pressure in straight neutral position of the hip exceeded normal hip pressure in all cases. Patients with an intracapsular pressure greater than 80 mm Hg had a low scintimetric rate, indicating a risk for segmental collapse of the femoral head. Intracapsular tamponade may contribute to the development of segmental collapse in some patients with nondisplaced femoral neck fracture, but further investigations are needed to determine whether evacuation of the hemarthrosis should be recommended.

Aged↗
PubMed1987

Statistical analysis of femoral neck fractures based on 3053 cases.

Femoral neck fractures in 2289 women and 764 men (total 3053) from the years 1975-1977 in Stockholm County Council were retrospectively analyzed regarding social and demographic classification. Seventy-nine percent of the patients (2418 of 3053) were admitted directly from their homes, more commonly in central city areas (82%) than in rural areas (74%). Direct return home was possible in 36%, and 47% could return home after some weeks of institutionalized rehabilitation. There was no increase in fracture incidence found during the three-year period. More fractures occurred on Mondays and less on Sundays than during the rest of the week. The period of December through March showed the highest fracture rate. Diseases other than hip fractures were seen in approximately one-half (1492) of the patients. Internal fixation was performed in 2937 fractures, mainly with the von Bahr screws (1465 cases), Hessel/Nyström multiple pins (674 cases), Thornton nails (380 cases), or Rydell nails (224 cases). Primary hemiarthroplasties were performed in only 102 cases. The detailed analysis of this consecutive population-based femoral neck fracture material is intended as a base for more uniform treatment and rehabilitation of this group of resource-consuming patients.

Age Factors↗
PubMed1987

Treatment and outcome of femoral neck fractures. An analysis of 2418 patients admitted from their own homes.

All patients admitted from their own homes with a femoral neck fracture to 12 hospitals in Stockholm County Council during a three-year period were reviewed six years after the fracture. The outcome of the fractures was related to different types of treatment centers (orthopedic and surgical) and primary treatments (conservative, internal fixation, and hemiarthroplasty [HAP]). The treatment results of the four most common types of internal fixation (von Bahr, Hessel/Nyström, Thornton, and Rydell nails), the experience of the surgeons, and the operative delay were also compared. Of 2418 patients, the majority (93%) were treated with internal fixation. Thirty-three percent of patients sustained complications after conservative treatment, 37% after primary internal fixation, and 15% after primary HAP. Early redisplacement of the fracture was most common when the Thornton nail was used and when less experienced surgeons treated the fractures. Early complications such as redisplacement and nonunion occurred most often in surgical departments, but the total frequency of complications including segmental collapse was equal for different treatment centers. In surgical departments these fractures were operatively treated most often by less experienced surgeons and the Thornton nail was used more frequently than in orthopedic departments. An operative delay of up to one week did not result in more complications. Seventy percent of the complications after primary treatment were reoperated. Only 11% were not reoperated, either because of the presence of only minor symptoms, or because of the patient's poor general condition, which made reoperation too risky. The results of the present study stress the importance of stable fixation of this fracture and of the experience of the surgeon for optimal treatment results.

Adult↗
PubMed1986

The ILV5 gene of Saccharomyces cerevisiae is highly expressed.

The nucleotide sequence of the yeast ILV5 gene, which codes for the branched-chain amino acid biosynthesis enzyme acetohydroxyacid reductoisomerase, has been determined. The ILV5 coding region is 1,185 nucleotides, corresponding to a polypeptide with a molecular weight of 44,280. Transcription of the ILV5 mRNA initiates at position -81 upstream from the ATG translation start codon and terminates between 218 and 222 bases downstream from the stop codon. Consensus sequences have been identified for initiation and termination of transcription, and for general control of amino acid biosynthesis, as well as repression by leucine. The ILV5 gene is regulated slightly by general amino acid control. Codon usage of the ILV5 gene has the strong bias observed in yeast genes that are highly expressed. In agreement with this, the reductoisomerase monomer, with an apparent molecular weight of 40,000, has been identified in an SDS polyacrylamide gel pattern of total soluble yeast proteins as a gene dosage dependent band.

2-Acetolactate Mutase↗
PubMed1986

Chest pain in acute myocardial infarction: a descriptive study according to subjective assessment and morphine requirement.

In 722 patients with suspected acute myocardial infarction (MI) we have tried to describe the course of chest pain according to their own assessment and morphine requirement. Patients were asked to score pain from 0-10 every second hour after arrival in the coronary care unit (CCU) and also to score their maximal pain at home. A very high intensity of chest pain was observed at home (mean score 7.1). At arrival in the CCU the mean pain score already had declined to 1.8, although 51% still had chest pain. Pain score declined successively during the first 12 hours in the CCU. At 24 hours after arrival, 20% still had some chest discomfort. In one quarter of the series a score of more than 0 was observed later than 24 hours after arrival in CCU. Patients developing definite MI had, as expected, a longer duration of pain and a much higher requirement of morphine compared with those with no MI. The difference between MI and no MI patients regarding subjective assessment of the initial intensity of pain at home and in hospital was, however, surprisingly low.

Adult↗
PubMed1986

Variability of chest pain in suspected acute myocardial infarction according to subjective assessment and requirement of narcotic analgesics.

In 653 patients with suspected acute myocardial infarction the course of pain according to subjective assessment and morphine requirement is described. Patients were asked to score pain from 0-10 until a pain-free interval of 12 hours appeared. Different categories of patients constructed from clinical aspects were compared. Although the variability between groups was fairly small, subgroups were found in which the initial intensity of pain was more marked and the duration of pain was longer. Thus patients with larger infarcts according to maximum serum enzyme activity and patients with Q-wave infarction had more severe pain initially and also a longer duration and a higher morphine requirement compared with patients with a lower serum enzyme activity or a non-Q-wave infarction. Other groups with a more severe course of chest pain were those with more intensive pain at home, electrocardiographic signs of acute myocardial infarction on admission to hospital, and finally those with a high systolic blood pressure or a high rate-pressure product on admission to the Coronary Care Unit. We thus conclude that there is a variability of chest pain in suspected acute myocardial infarction and that there are defined groups of patients in which a more severe course of chest pain could be expected.

Adult↗
PubMed1986

Variability, prediction and prognostic significance of chest pain in acute myocardial infarction.

The variability of chest pain is described in 389 patients with acute myocardial infarction. Whereas 17% were free from severe pain after arrival in hospital, 11% required more than 10 analgesic injections. In 27% of the series analgesics were given more than 24 h after arrival in hospital. Predictors for the severity of chest pain were the rate-pressure product and degree of chest pain soon after arrival in hospital as well as electrocardiographic signs of myocardial infarction at entry. Patients with more severe chest pain had a higher 2-year mortality rate and a higher incidence of ventricular fibrillation and congestive heart failure during hospitalization.

Analgesia↗
PubMed1986

Moderate normovolaemic haemodilution increases regional myocardial blood flow but has no effect on experimental infarct size.

Regional myocardial blood flow was measured with radioactive microspheres before and 1, 3, 6, and 12 h after occlusion of the left anterior descending coronary artery (LAD) in anaesthetized cats. In one group of cats, 1 h after LAD occlusion, moderate normovolaemic haemodilution was started with a dextran 40 solution, which reduced the haematocrit by 20-25% throughout the rest of the experiment. In the other group, the haematocrit was kept at the original level. Infarct size was measured planimetrically 12 h after the coronary ligation, using the tetrazolium staining technique for disclosing the ischaemic myocardium. Haemodilution increased blood flow in the non-ischaemic myocardium and in the so-called 'border zone' comprising both normal, and ischaemic tissue. However, in the severely ischaemic myocardium dependent on collateral blood flow, where there was no admixture of non-ischaemic myocardium, the blood perfusion was not significantly affected by the haemodilution. After 12 h of ischaemia the infarct size in the control group was fully comparable with that in the haemodiluted group: 28 +/- 3 and 27 +/- 4 (percentage of the left ventricle, mean +/- SEM), respectively.

Animals↗
PubMed1986

Mortality after cervical hip fracture. 3002 patients followed for 6 years.

In 3002 patients with a femoral intracapsular neck fracture occurring during a 3-year period in the Stockholm area, 79 per cent were admitted from home and the remainder from different types of institutions. The mortality among these fracture patients was higher than in the general population. Patients admitted from institutions had a three to four times higher mortality rate than those coming from home. After 6 years, 54 per cent of the patients admitted from home were still alive compared with only 16 per cent of those admitted from institutions.

Adult↗
PubMed1986

Early weight bearing of malleolar fractures.

A prospective randomized investigation of early versus late weight bearing in 46 patients with fracture of the lateral malleolus was performed. In 43/46 patients an exact operative reconstruction of the ankle mortise could be achieved using pins, staples and cerclage (Cedell, 1967). Radiographic and stereophotogrammetric analysis of the ankles after 3 months showed no significant differences, nor did the clinical follow-up.

Adult↗