[Guidelines for increased safety in anesthesiology].
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Accident Prevention↗
Biomedical subjects
S Lindahl
Publications and source records attributed to S Lindahl.
Dynamic changes in the dimensions of the lumbar spinal canal: an experimental study in vitro.
The variation in the dimensions of the lumbar spinal canal under both flexion-extension and axial compression-distraction was studied using computerized tomography (CT) scans in human cadaver lumbar spine specimens. In 3-mm-thick CT slices through the disk at L3-L4, the cross-sectional area of the spinal canal was reduced by around 40 mm2, corresponding to a 16% reduction of the initial area when the lumbar spines were moved both from flexion to extension and from distraction to compression. A corresponding reduction in the midsagittal diameter of the canal of 2 mm was found. During these motions, the ligamentum flavum did not appear to be a significant factor for the dynamic changes affecting the dimensions of the canal. This held true even after the disk had been excised in order to produce a total collapse of the disk space.
Humans↗
Management of quintuplet pregnancy by selective embryocide.
Selective embryocide was performed as a two-stage procedure in a patient with a quintuplet pregnancy in the first trimester. No complications occurred, and the patient was delivered of healthy twins at term. This procedure may be offered to selected patients with pregnancies with greater than five embryos.
Abortion, Induced↗
Intrinsic disc pressure as a measure of integrity of the lumbar spine.
Intradiscal pressure and volume measurements were made in 84 fresh cadaveric lumbar spine disc spaces. The nucleus was injected with a roentgenographic contrast agent under fluoroscopic examination. The intrinsic pressure, the pressure at which the agent entered the disc, and the maximum pressure that the disc could hold were measured. The discs were graded for degeneration. The intrinsic and maximum pressures were found to be inversely related to disc degeneration grade, and directly related to each other. Relatively greater degeneration was found at lower levels of the lumbar spine as compared to the upper levels. The intrinsic disc pressure may prove to be a useful clinical tool in the evaluation of spinal integrity.
Biomechanical Phenomena↗
The psychological impact of diagnostic ultrasound.
The psychological impact of ultrasound scanning in pregnancy was examined in low- and high-risk pregnancies. Women in each category were assigned consecutively to a condition of either low or high feedback. In the latter condition, the women received extensive verbal and visual feedback, whereas in the former, subjects were denied visual access to the monitor. Psychological changes were measured using the State Anxiety Inventory and the Subjective Stress Scale. When a male partner attended, he was included in the assessment. The emotional impact of ultrasound was influenced by the level of feedback provided, with those in the high-feedback condition indicating significantly less anxiety and more positive emotional experiences during the scan, compared with those who received less feedback.
Adult↗
Congenital generalized multicentric myofibromatosis with orbital involvement.
We studied a rare case of congenital myofibromatosis of the orbit as part of a generalized multicentric disease in a 5-month-old boy. The ultrasonographic and computed tomographic findings were those of a low-reflective, firm, vascularized, lesion with heterogeneous internal structure. The histopathologic findings showed vascular channels with large polygonal cells and transition toward myofibroblasts with interwoven collagen fiber bundles.
Follow-Up Studies↗
Vascularization of peripheral neurilemomas: angiographic, computed tomographic, and histologic studies.
The vascularization of peripheral neurilemoma was studied in 17 patients, in eight by angiography and in 16 by computed tomography (CT) using contrast enhancement. Angiographically the degree of vascularity varied from scarcity to abundance of vessels. In two patients, arteries connected to the proximal and distal poles of the tumor could be identified as nutrient arteries of the affected nerve, and in three patients some of the veins draining the tumor followed the course of the nerve. All 16 tumors examined by CT showed lower density than skeletal muscle. They were well delineated and at least partially surrounded by adipose tissue. With contrast enhancement the density increased focally, reflecting the distribution of vessels in the tumors. Histologic examination showed that Antoni-A tissue was rich in small (below 15 micron) and medium-sized vessels, whereas large vessels (above 100 micron) were more frequently seen in Antoni-B tissue. Medium-sized and large vessels often tended to be arranged along the border between Antoni-A and Antoni-B tissues.
Adult↗
Early posttraumatic pulmonary platelet trapping and its potentiation by oral pretreatment with alcohol.
Soft tissue trauma is associated with platelet aggregation and sequestration in the lungs. This is believed to be an early step in the later development of adult respiratory distress syndrome. In the present experiment using a new method for in vivo dynamic studies of platelet sequestration, we wanted to evaluate the effect of soft tissue trauma on pulmonary platelet trapping in pigs and the influence of acute alcohol intoxication. The results show that significant pulmonary platelet trapping is registered within minutes of trauma and that alcohol significantly increases platelet sequestration in the lungs. This indicates an increased risk for posttraumatic pulmonary problems in alcohol-intoxicated trauma victims.
Administration, Oral↗
Quality assurance activity in radiology.
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Appointments and Schedules↗
Accessory soleus muscle. A clinical and radiographic presentation of eleven cases.
When an accessory soleus muscle is present, it consists of a soft-tissue mass bulging medially between the distal part of the tibia and the Achilles tendon. It usually inserts with a separate tendon on the calcaneus anteromedial to the Achilles insertion, and may be a cause of pain on exercise. One may suspect a soft-tissue tumor, such as lipoma, hemangioma, and even sarcoma, but the anomalous muscle has a typical appearance on plain radiographs, and the appearance on computed tomography is diagnostic. If the patient is asymptomatic, no therapy is required, but if pain or other discomfort is provoked by exercise, exploration with fasciotomy or excision of the accessory muscle is recommended, as was done in six of our eleven patients who were seen between 1968 and 1985.
Adolescent↗
Unstable thoracolumbar fractures. A comparative clinical study of conservative treatment and Harrington instrumentation.
Fifty patients (14-55 years of age) with unstable thoracolumbar fractures were studied: 24 patients treated conservatively 1971-1977 and 26 patients treated surgically with Harrington instrumentation 1977-1981. The treatment groups were comparable in all respects. Radiologic evaluation showed that Harrington distraction rods restored the fractured vertebra almost to its original shape, and the gibbus and scoliosis were significantly reduced. However, at the follow-up examination at least 2 years after the injury, the gibbus angle had recurred almost to the value at admission in patients with the rods removed. The conservatively treated patients showed a continuous increase of the gibbus angle and of the anterior and central vertebral compression. At the follow-up evaluation, all fractures in both treatment groups were healed. There was no difference between the treatment groups regarding neurologic improvement. Thirteen of 14 patients with severe or moderate paraparesis considerably improved their neurological status. A rehabilitation index with special reference to paraparetic patients showed no difference between the treatment groups already three months after the injury. Thoracolumbar fatigue, thoracolumbar pain and stiffness, skin problems, and pain at direct pressure at the fracture site occurred equally in the conservative and Harrington groups. The overall complications were few. The aseptic intermittent catheterization method introduced in 1977 considerably diminished the frequency of upper urinary tract infections. The treatment with open reduction, fusion, and stabilization with Harrington rods considerably reduced the immobilization and hospitalization times. The average immobilization time was reduced from 67 to 18 days. The hospitalization time in neurologically intact patients was reduced from 80 to 30 days.
Adolescent↗
Unstable thoracolumbar fractures. A study by CT and conventional roentgenology of the reduction effect of Harrington instrumentation.
Fourteen patients with unstable thoracolumbar fractures were examined with conventional roentgenologic technique and CT before and after operation with Harrington instrumentation. CT was superior in evaluating posterior elements, bone fragments in the spinal canal, and degree of narrowing of the spinal canal. Harrington rods restored the general spinal alignment. However, even after surgery, the midsagittal diameter, as well as the cross-sectional area of the spinal canal were still diminished by 26%. The reduction of the spinal canal improved significantly by early surgical intervention. Open reduction and stabilization with Harrington rods and fusion within three days after injury is recommended.
Adolescent↗
The thoracolumbar crush fracture. An experimental study on instant axial dynamic loading: the resulting fracture type and its stability.
Seven vertebral preparations of L1, with surrounding discs, facet joints, and ligaments were exposed to an instant axial dynamic force in order to produce a burst or crush fracture. The resulting fractures were similar to fractures observed clinically and showed a comminuted vertebral body with fractured vertebral end-plates, dislocated disc nucleus, bone fragments severely encroaching upon the spinal canal, and facet joint laxity. The flexion-extension range was increased considerably. This implies that this fracture type should be regarded as unstable with a risk of progressive flexion deformity, neurologic deterioration and pain. The fracture could be reduced by an axial distraction force of 400 N simulating the effect of Harrington distraction rods. However, the distraction resulted in an "empty" vertebral body with small areas of spongious bone mixed with fragments of the disc nucleus and fragments of the vertebral end-plate.
Biomechanical Phenomena↗
Bacterial contamination of blood transfusion: an unusual cause of sepsis.
Severe septicaemia resulted from transfusion of blood contaminated with Serratia liquefaciens. Although only a small volume of contaminated blood was administered, the patient reacted with severe hypotension, followed by renal, pulmonary, circulatory and hepatic failure together with protracted thrombocytopenia. The causal gram-negative rod, S. liquefaciens, frequently occurs in the oral cavity and is generally considered to be harmless. The source of the contamination was not detected, however. Early recognition of septicaemia and institution of intensive supporting treatment contributed to the rapid resolution in this case of multiple system failure.
Female↗
Influence of premedication on the sympathetic and endocrine responses and cardiac arrhythmias during halothane anaesthesia in children undergoing adenoidectomy.
The occurrence of cardiac arrhythmia was investigated in 80 children during halothane anaesthesia for adenoidectomy. Two different premedications were studied. Forty children (group A) were premedicated with diazepam 5 mg rectally and atropine 0.3-0.4 mg sublingually and 40 (group B) received a rectal solution including diazepam 0.5 mg kg-1, morphine 0.15 mg kg-1 and hyoscine 0.01 mg kg-1. In 17 of these children (nine in group A and eight in group B) plasma concentrations of catecholamines, ACTH and corticosteroids were measured. In group A the mean plasma concentration of catecholamines increased more than 300% during surgery, while it was virtually unchanged in group B (P less than 0.01). Plasma concentrations of ACTH, cortisol and 17-alpha-hydroxyprogesterone were also greater in group A than in group B. The occurrence of ventricular arrhythmias in group A was significantly more frequent (20.0%) than in group B (2.5%) (P less than 0.05). It was concluded that in these two comparable groups of patients ventricular arrhythmia during halothane anaesthesia was almost eliminated by the use of more effective premedication, as a result of decreases in the sympathetic and endocrine responses to surgery.
Adenoidectomy↗
The crush-cleavage fracture. A "new" thoracolumbar unstable fracture.
Among 14 patients with unstable thoracolumbar fractures examined by both conventional radiography and CT, we found seven patients with a "new" common fracture pattern. This fracture pattern consisted of (1) superior disc injury, (2) crush fracture of the upper half of the vertebral body, (3) sagittal fracture (cleavage fracture) of the lower half of the vertebral body, (4) bone fragments in the spinal canal, and (5) laminar fracture. Five of the seven patients had sustained their injuries in vertical falls; all five had primary neurological deficit symptoms. We consider this fracture to be unstable.
Adolescent↗
Endocrine stress response during general and epidural anaesthesia for elective caesarean sections.
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Adrenocorticotropic Hormone↗
Cardiac arrhythmias in non-intubated children during adenoidectomy. A comparison between enflurane and halothane anaesthesia.
The incidence of cardiac arrhythmias, heart rate, blood pressure, capillary perfusion and end-tidal CO2 tension were studied in 167 healthy children 1-12 years of age undergoing adenoidectomy (n = 82) and myringotomy (n = 85) during enflurane and halothane anaesthesia. The incidence of cardiac arrhythmias was significantly lower during myringotomy than during adenoidectomy. In children undergoing adenoidectomy the incidence of arrhythmias was 38.9% during enflurane anaesthesia and 86.6% during halothane anaesthesia (P less than 0.001). In the halothane group ventricular arrhythmias were observed in 19 patients (41.3%) but only in one child (2.8%) in the enflurane group. The ventricular arrhythmias seen during halothane anaesthesia were unifocal in six patients and multifocal in five and classified as ventricular tachycardia in eight children. Heart rate was increased by about 40% at the onset of ventricular arrhythmias. The heart rate remained unchanged with enflurane anaesthesia during surgery, which may reflect a decreased sympathomimetic activity. It is suggested that the low incidence of ventricular arrhythmias during enflurane anaesthesia may be explained by the combination of a reduced sympathomimetic activity and a lowered susceptibility of the myocardium to the actions of endogenous catecholamines.
Adenoidectomy↗