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Biomedical subjects

S Larsson

Publications and source records attributed to S Larsson.

At least 235 records · Page 13Linked to original sources
PubMed1989

Eleven years' experience with Carpentier-Edwards biological valves in relation to survival and complications.

The Carpentier-Edwards porcine valve bioprosthesis was implanted in 299 patients (325 prostheses) from April 1976 to April 1982. The series consisted of aortic valve replacement in 150 patients, mitral valve replacement in 120, multiple valve replacement in 26, pulmonary valve replacement in 2 and tricuspid valve replacement in 1 patient. The postoperative follow-up was 100% complete. The total accumulated follow-up was 1956 patient-years. The early mortality was 6.4% (20 patients) and the late mortality was 22% (62 patients). Valve-related mortality was seen in 8 patients (2.7%): 1 paravalvular leak during the 1st 30 postoperative days and 7 late mortalities (1 endocarditis, 2 paravalvular leaks and 4 deaths during reoperation). Three operative deaths (1.5%) occurred. The overall patient survival including operative deaths was 78.5% +/- 5% at 5 years and 66% +/- 4% at 10 years. The incidence of the different complications were: thromboembolism in 5 patients (1.7%) with a risk of 0.3%, haemorrhage in 1 (0.3%) with a risk of 0.05%, endocarditis in 2 (0.7%) with a risk of 0.1%, and paravalvular leak in 11 patients (3.7%) with a risk of 0.6%. There was a high incidence of tissue failure during the last 6 years which occurred in 54 patients (18%) with a risk of 2.7%. Sixty-seven patients (22.5%) were reoperated upon during the 11 years with an annual risk of 3.4% and the main cause of reoperation was primary tissue failure. The Carpentier-Edwards biological valve was shown to be efficient during the first 5 years of implantation after which the incidence of tissue failure increased.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Functional evaluation of the spinal cord by magnetic resonance imaging in patients with rheumatoid arthritis and instability of upper cervical spine.

Thirty-four patients with atlanto-axial instability due to rheumatoid arthritis were examined with plain x-ray views and functional magnetic resonance imaging (MR), and were neurologically evaluated. Transcranial brain stimulation was performed in 25 patients. In 22 cases, the authors observed inflammatory tissue thicker than 3 mm behind the odontoid peg. The spinal canal diameter was significantly decreased in the flexed position. Nine patients showed signs of cranial migration of the axis. The diameter of the spinal cord was measured to be 7.4 mm in the neutral position, and 6.5 mm in flexion. The difference between the diameter of the neutral and flexed positions was highly significant. Twelve of the 34 patients displayed clinical signs of cervical myelopathy, and 13 showed a significant delay of central motor latency, as calculated from the motor evoked potentials. Surgical intervention, either by a posterior approach only or combined with a transoral dens and inflammatory tissue resection, is recommended in patients with progressive atlanto-axial instability, pathologic clinical and neurophysiologic findings, and a spinal cord diameter of less than 6 mm in flexion. Severe pain and cranial migration of the axis, as measured by the MRI, also justify a surgical intervention.

Adult↗
PubMed1989

Class inequality in health. A methodological study of two measures of social class in relation to sickness insurance diagnoses.

Measures of social class, if related to different class concepts, should differ in external consistency. External consistency depends on the character of the dependent variable. Two measures of social class are here used for independent variables, the socio-economic classification, the official index of Sweden, and a structural class concept. For dependent variables, ICD diagnose chapters, directly and in a simple grouping, are used on a material from health insurance authorities. Class inequality is measured both as to size and direction, by Gini-index and rank-order correlation, respectively. Separate analyses are made for the whole material, men and women, and doctor certified absence days. Results show clear differences between the class measures for diagnoses more closely associated to work conditions, while the measures coincide in other cases.

Absenteeism↗
PubMed1989

Reconstruction for lateral ligament injuries of the ankle.

Seventy-six patients (83 ankles) with chronic lateral instability of the ankle were treated by a simple reconstructive operation, namely, a subperiosteal release on the distal part of the lateral malleolus. The released flap, including the insertion of both the anterior talofibular and the calcaneofibular ligaments, was reattached to the malleolus more proximally. Seventy-five patients (82 ankles) were examined at a mean of 24 months (range 12 to 70) after operation. In 78 ankles (95%) the result was excellent or good. Forty-four of the 51 patients (86%) whose sporting activities were restricted before operation had no restriction at follow-up. Recurrence of instability occurred in one ankle, following a further injury two years after operation.

Adolescent↗
PubMed1989

Primary tracheal rhabdomyosarcoma. Case report.

A case of primary tracheal rhabdomyosarcoma is presented--the second in the English-language literature. The treatment policy is discussed on the basis of this case and the literature is reviewed.

Adolescent↗
PubMed1989

Hip fractures in northern Sweden 1973-1984. A comparison of rural and urban populations.

The hip-fracture incidence in persons aged 50 years and older in the two northernmost counties of Sweden was studied during three periods between 1973 and 1984. The mean age rose from 75 to 78 years, and the annual number of fractures increased from 511 to 754. Half of this increase could be attributed to demographic aging. For persons 80 years and older, the fracture incidence in 1983/84 was higher (P less than 0.01) than the fracture incidence in 1973/74. The women/men ratio was approximately 2:1 during the survey, while the ratio cervical/trochanteric fracture type changed from 1.7:1 to 1.8:1. The crude fracture incidence rate rose from 4.4 to 5.8 fractures per 1,000 women 50 years and older; the corresponding figures for men were 2.3 and 3.4. Comparison of a rural mountain population with an urban population revealed a lower age-adjusted hip-fracture incidence rate in the rural area during the final part of the study (P less than 0.001). In the rural population, there was no change in age-specific incidence during the survey, while in the urban area the age-specific incidence in person 75 years and older was higher in 1983/84 compared with 1973/74.

Aged↗
PubMed1989

Atrial myxomas: results of 25 years' experience and review of the literature.

Twenty patients with atrial myxoma from a 25-year period were reviewed. Sixteen patients had a tumor in the left atrium, three in the right, and one had a biatrial myxoma. The main clinical presentations were dyspnea and tachyarrhythmias seen in 11 patients. Nineteen patients had a correct preoperative diagnosis. Echocardiography confirmed the diagnosis in eight patients, angiocardiography in four, and both these techniques in seven. The diagnosis was established at the operative table in one case in which the preoperative diagnosis was mitral stenosis. All tumors were successfully removed with cardiopulmonary bypass. There were no operative deaths. Excision of the tumor resulted in marked symptomatic improvement. No recurrences have been observed. A differential approach to preoperative investigation, surgical treatment, and follow-up is suggested according to the clinical behavior of the tumor. Excision of the tumor appears to be curative, with no recurrences at long-term follow-up in cases of "sporadic" myxoma. The risk of recurrences is much higher when a "complex" or a "familial" myxoma is faced. For these types, our recommendations are presented.

Adult↗
PubMed1989

Formoterol, a new long-acting bronchodilator for inhalation.

The aim of this study was to evaluate if treatment with inhaled formoterol is appreciated by asthmatics and whether it causes tachyphylaxis. Twenty stable asthmatics were included in a randomized, double-blind, crossover study. They were treated for two weeks either with formoterol or salbutamol, with one week washout inbetween. They were given 12 micrograms formoterol or 200 micrograms salbutamol twice daily and instructed to use additional spray doses on demand. On a diary card they recorded the number of doses, asthma symptoms and peak expiratory flow rate (PEFR) before every dose. Forced expiratory volume in one second (FEV1) dose-response curves for salbutamol (total dose 1.3 mg) were performed before and after each treatment period to evaluate development of tachyphylaxis. There was a significant difference in favour of formoterol concerning symptoms, PEFR recordings, spray consumption, and preference. Fifteen patients preferred formoterol and two salbutamol. The dose-response curves before formoterol and before, as well as after salbutamol were almost identical. After formoterol the curve had changed; both basal and maximum values were higher than before. Thus, no evidence of tachyphylaxis was found, compared to the ordinary beta-stimulant treatment.

Administration, Inhalation↗
PubMed1988

A microelectrophoretic method for the evaluation of GABA transaminase activity.

The reduction to the micro-scale of a recently described electrophoretic method for the evaluation of GABA catabolism by GABA-T is presented. The micromethod involves the electrophoresis, in 1 mm diam. capillaries, of small samples of mixtures of [14C]GABA and its metabolites. By coupling this procedure to previously devised micromethods, it was possible to evaluate GABA-T attack to 14C labeled GABA diffusing across a single microdissected neuronal membrane.

4-Aminobutyrate Transaminase↗
PubMed1988

Torsion of a lung lobe: diagnosis and treatment.

Intraoperative lobar torsion occurred in 4 of about 2000 patients subjected to thoracotomy. Two of the patients died. Early diagnosis and proper management are of great importance to the outcome. Temporary deflation of the diseased lung by using double lumen endobronchial tube is a potential risk. Early progressive lobar opacity without signs of atelectasis on conventional chest radiograph is indicative of this serious complication. Computerized tomography and bronchoscopy are of diagnostic value. Exploratory thoracotomy must be performed without delay. The injured parenchyma should be sacrificed unless the diagnosis is obtained very early. When the injured lobe or lung is rotated back into normal position the airways may be flooded with serosanguinous fluid which promptly has to be removed. If an attempt is made to save the lobe or the lung, tracheostomy for frequent suction of the airways is indicated in order to prevent "spill-over" and dangerous postoperative hypoxia.

Adult↗
PubMed1988

Premedication with intramuscular dixyrazine: (Esucos). A controlled double-blind comparison with morphine-scopolamine and placebo.

Ninety patients scheduled for general or orthopaedic surgical procedures were randomly assigned to receive one of three i.m. premedications: dixyrazine 0.5 mg kg-1; morphine 0.15 mg kg-1 and scopolamine 0.0065 mg kg-1; or placebo. The premedication was administered and evaluated in a double-blind fashion. The patients were anaesthetized with thiopentone, fentanyl, pancuronium, and ventilated with nitrous oxide in oxygen. The three premedications had no noticeable anxiolytic effect. Although there was no difference in the frequency of observed postoperative nausea and vomiting between the three groups, premedication with dixyrazine nonetheless reduced the patients' experience of postoperative nausea as well as their need for postoperative antiemetics. Although patients in the two treatment groups were significantly more sedated immediately before induction of anaesthesia than patients receiving placebo, the degree of postoperative sedation was similar in all three groups. Morphine-scopolamine caused more postoperative dizziness than dixyrazine and placebo. Lack of recall was produced by both morphine-scopolamine and dixyrazine. It is concluded that premedication with dixyrazine is a useful alternative, especially in patients who have previously experienced postoperative nausea and vomiting.

Adult↗
PubMed1988

Use of experimental models to study the development of renal function.

By use of animal experiments it has been demonstrated that renal cells are immature at birth. Membrane transport is quantitatively and qualitatively different. The control of fluid and electrolyte balance is therefore different in infancy. The increased filtered load at birth as well as hormones will induce tubule maturation. The use of animal experiments will in the future give an insight into how external factors influence growth and maturation.

Animals↗
PubMed1988

Income redistribution effect of the Swedish sickness allowance insurance in a comparison of two concepts of social class.

Social insurances effect income distributions between social strata. Here, insurance returns in relation to income are studied on the Swedish sickness allowance insurance, which is intended to redistribute from higher to lower social strata. Two measures of social class are used, the socio-economic classification, the official index of Sweden, and a structural class concept, which in earlier results discriminates better for material factors such as income and work conditions. The material consists of all sickness cases of 1983 for 3,161 persons, sampled from insurance registers and cross-classified with registers at taxation authorities. Data on insurance returns, incomes, and occupation are used. Results clearly confirm the intended redistribution effect, but considerably clearer with the structural class concept. The effect is even stronger than intended for some strata, where the system seems to lack in implementation. The consequences for choice of class measure are finally discussed.

Adolescent↗
PubMed1988

A method for surgical exposure of intramyocardial coronary arteries for bypass grafting.

A method is described for locating deep stenotic intramyocardial coronary arteries. A metal probe is passed through the aortic wall into the coronary ostium and advanced to the stenosis, where the tip of the probe is palpated. The diseased artery is then dissected free and grafted distal to the obstructive lesion. The method was used in one patient whose heart was surrounded by a thick rind of fibrous scar tissue following two previous operations for coronary artery disease, and was highly successful when other methods had failed. The technique was also used in two patients undergoing both aortic valve replacement and coronary artery bypass grafting, in whom the stenotic arteries lay deep in the myocardium and were difficult to find. The described procedure is particularly useful in reoperations on a heart with a covering rind of fibrous scar tissue.

Aorta↗
PubMed1988

Clinicopathologic studies on mesothelioma of the pleura. Differentiated approach to treatment.

A surgical series of 23 patients with pleural mesothelioma is reviewed. Three who had benign localized mesothelioma of fibrous type are alive and well at least 10 years postoperatively. In two others, radically extirpated localized mesothelioma was histologically classified as benign, but later proved to be malignant, causing death from recurrent disease 27 and 79 months postoperatively. Four patients with diffuse malignant mesothelioma underwent pleurectomy or open biopsy and survived for 2-9 months. Radical en-bloc pleuropneumonectomy was performed on 14 patients with diffuse malignant mesothelioma. One patient died postoperatively and the others succumbed to the disease after 3-51 (mean 20) months. The survival time was greater than or equal to 1 year in 62% of the patients and greater than 3 years in 23%. Patient age, histologic tumour type and extent of disease seemed to be important prognostic factors. Despite the generally poor prognosis, the results of radical surgery in this study appear to warrant an aggressive approach to treatment of benign or localized malignant pleural mesothelioma, and possibly also to stage I diffuse malignant mesothelioma of epithelial type.

Adult↗
PubMed1988

Stability of osteosynthesis in trochanteric fractures. Comparison of three fixation devices in cadavers.

Stable trochanteric fractures were produced in 12 pairs of human cadaver femora, which were fixed by either a 135 degree Jewett nail plate, a 135 degree NoLok sliding screw/plate, or a 140 degree Hansson pin/plate. The bone-implant preparations were then subjected to 20,000 load cycles simulating full weight bearing, measuring the elastic and permanent fracture displacement. In each case, elastic displacement occurred during loading. For the Jewett-stabilized fractures, a steady increased elastic displacement, as well as permanent displacement, was seen throughout the test, causing 2/8 failures when the implant penetrated the femoral head. In the NoLok- and Hansson-stabilized fractures, there were no failures, both giving better overall stability than the Jewett device with sufficient fracture stability throughout the test.

Aged↗
PubMed1988

Fixation of unstable trochanteric hip fractures. A cadaver study comparing three different devices.

A four-fragment trochanteric fracture was produced in 24 human cadaver femora. After reduction to anatomic position, the fractures were stabilized by either a Jewett 135 degree nail-plate, a 135 degree Nolok sliding screw-plate without a key, or a 140 degree Hansson pin-plate with an additional trochanteric plate. Using a hip-force simulator, the preparations were subjected to 10,000 loading cycles simulating partial weight bearing, followed by another 10,000 cycles with full weight bearing, while measuring the elastic and permanent fracture displacements. Failure occurred in 3/8 of the Jewett stabilized fractures and in 1/8 each of the Nolok and Hansson stabilized specimens. Each failure was preceded by an increase in elastic tilt and rotation followed by a permanent rotation after which failure occurred as varus angulation of the fracture. Further, two Jewett nails, one Nolok screw, and three Hansson pins showed bending. Due to the controlled telescopic action in the Nolok and Hansson dynamic devices, the resistance to fatigue when subjected to repetitive loadings was increased and thereby a better overall result was achieved when compared with the rigid Jewett nail-plate. To maintain the dynamic function, the strength of the dynamic screw-pin must be sufficient to withstand physiologic loadings without bending; otherwise, the telescopic action will be obstructed.

Aged↗