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Biomedical subjects

A Alveryd

Publications and source records attributed to A Alveryd.

At least 19 recordsLinked to original sources
PubMed1990

Lightscanning versus mammography for the detection of breast cancer in screening and clinical practice. A Swedish multicenter study.

State of the art lightscanning of the breast was tested against mammography in 2568 women in a Swedish multicenter study. The study was in two parts. One was in women with symptoms from the breasts (the clinical study) comprising 3178 examined breasts with 198 cancers; the other in asymptomatic women (the screening study) comprising 1909 examined breasts with 126 cancers. In women with symptoms from the breasts, lightscanning did not contribute to clinical examination and mammography. In the screening situation, it was poor to pick up small cancers. Mammography alone falsely diagnosed cancer in 6.9% of the patients whereas lightscan falsely diagnosed cancer in 19.1%. Lightscan was not better than mammography in young women. The study shows that lightscanning in its current form is inferior to standard mammography.

Adult↗
PubMed1990

Skeletal remineralization after surgery for primary and secondary hyperparathyroidism.

Bone mineral was measured by photon absorptiometry before and after parathyroid surgery in patients with primary or secondary hyperparathyroidism (HPT). The mean bone mineral density of lumbar vertebrae was 0.82 +/- 0.04 (SEM) gm/cm2 in primary HPT (n = 7) and 0.86 +/- 0.05 gm/cm2 in secondary HPT (n = 11). These values are significantly lower than for age-matched normal subjects. After successful parathyroid surgery, the bone mass of the distal radius and lumbar vertebrae increased by approximately 10% within 3 months after operation and then remained stable during the first postoperative year. In conclusion, parathyroid surgery is followed by a significant increase of bone mass in primary and secondary HPT. The substantial increase in bone mass in parts of the skeleton consisting predominantly of trabecular bone, as well as in sites with predominantly cortical bone, indicates that remineralization after operation involves a generalized increase in bone mass.

Adenoma↗
PubMed1989

Neutrophil leucocyte function in primary hyperparathyroidism.

Neutrophil leucocyte chemotaxis, phagocytosis and oxidative metabolism were measured in six patients with primary hyperparathyroidism (HPT) who underwent parathyroidectomy. The preoperative neutrophil chemotaxis value was 6.2 +/- 0.3 arb.U. and this decreased to 5.8 +/- 0.5 arb.U. (p less than 0.05) on the third postoperative day and to 5.4 +/- 0.3 arb.U. three weeks later. Serum calcium levels were 2.95 +/- 0.06 mmol/l preoperatively and decreased to 2.20 +/- 0.05 (p less than 0.05) and 2.34 +/- 0.05 mmol/l (p less than 0.05) on the third and 21st day after parathyroidectomy. Phagocytosis measured as the intracellular uptake of complement-opsonized yeast particles by neutrophils was not influenced by operation. In a control group, six patients undergoing hemithyroid ectomy due to microfollicular tumours were studied. In this group leucocyte chemotaxis, phagocytosis and serum calcium levels were not significantly different before and after surgery. Neutrophil oxidative metabolism, measured by the ability of the cells to reduce nitroblue tetrazolium (NBT), was similar in the HPT and control groups both before and after operation. The results indicate that HPT is associated with an abnormal leucocyte migration which is reversed after successful parathyroidectomy.

Calcium↗
PubMed1988

Skin circulation in the nipple after reduction mammaplasty by upper and lower glandular resections.

Avascular necrosis of the nipple is a serious complication of reduction mammaplasty with nipple transposition. A study was undertaken to measure the skin circulation in the nipple before, during and after this operation. In 14 patients undergoing a reduction mammaplasty according to the method of Strömbeck, the skin circulation was measured in 25 breasts with laser doppler flowmetry (LDF) and fluorescein flowmetry (FF). LDF showed that the skin circulation increased after de-epithelialization to 204.4 +/- 31.0% of the preoperative value (100%) (mean +/- SEM, p less than 0.01). After the upper and lower glandular resection the circulation was reduced to 90.7 +/- 12.3% of the preoperative value. The division of the lateral pedicle did not affect the circulation. After the skin had been sutured, the circulation was 71.5 +/- 9.1% of the preoperative value (p less than 0.01). One to four days postoperatively the circulation was 100.3 +/- 13.2% of the preoperative value. At FF uniform fluorescence was observed in the nipple postoperatively in all patients but two, in whom avascular necrosis later developed. Our results thus show that the circulation in the nipple after reduction mammaplasty by the Strömbeck method is adequate and that it is safe to divide the lateral dermal pedicle.

Adult↗
PubMed1986

Ophthalmopathy and hyperthyroidism. A comparison between patients receiving different antithyroid treatments.

The ocular manifestations in 125 thyrotoxic patients observed for 6-20 years are presented. The incidence and development of ophthalmopathy in three different treatment group medical- (eta = 72), radionuclear (eta = 36) and surgical (eta = 17) are showed. The degree of ophthalmopathy is similar in all groups, and no statistically significant difference is found in the development of ophthalmopathy.

Adolescent↗
PubMed1986

Jejunal diverticula causing massive haemorrhage.

Two elderly patients with massive bleeding from jejunal diverticulosis are reported. Scintigraphy revealed the bleeding source. Emergency resection of the involved portion of jejunum cured the patients. Few such cases have been published. Although very rare, one must always have in mind jejunal diverticula to be the source of gastrointestinal haemorrhage.

Aged↗
PubMed1986

The catecholamine concentration in central veins of hypertensive patients--an aid not without problems in locating phaeochromocytoma.

The concentrations of adrenaline, noradrenaline and cortisol in blood sampled at routine attempts at catheterization of the adrenal and renal veins, the inferior vena cava and the azygos and hepatic veins were measured in six patients with a phaeochromocytoma and six patients with hypertension due to other causes. In the non-tumour patients the adrenaline and noradrenaline concentrations, compared with normal values for peripheral venous blood, were abnormally high in five out of seven samples from the site of the left adrenal vein but in only one out of seven from the right side. In all the adrenal vein samples with an abnormally high catecholamine concentration the cortisol level was also elevated, and it was at least 100 per cent higher than in samples from the inferior vena cava. This suggests that a high catecholamine concentration linked with an elevated cortisol level is merely an indication of correct adrenal vein sampling and is not necessarily evidence of a tumour. In successful attempts of sampling adrenal venous blood (cortisol levels increased), concentrations of adrenaline and noradrenaline of up to 100 and 20 nmol/l, respectively, can be regarded as normal. From a retrospective analysis of catecholamine levels in the six tumour patients it is clear that owing to the variability of venous drainage from the right adrenal gland, the technique of adrenal venous blood sampling may be unreliable and even misleading in attempts to locate a phaeochromocytoma. This is also true in patients with generally elevated catecholamine levels.

Adrenal Gland Neoplasms↗
PubMed1986

The value of diaphanography as an adjunct to mammography in breast diagnostics.

Histologically classified carcinoma and benign breast disorder was present in 100 respectively 163 cases of symptomatic women. The results of diaphanography were correlated with those obtained by clinical examination, mammography and histology. A false negative diagnosis was made in 17 cases (15.5%) using diaphanography and in 13 cases (11.8%) using mammography. A false positive diagnosis was made in 15 cases (9.2%) with diaphanography and in 33 cases (20.2%) with mammography. The use of both mammography and diaphanography reduced the number of false negatives from 11.8 per cent to 5.5 per cent. In conclusion, diaphanography has been demonstrated to be a useful adjunct to mammography.

Adult↗
PubMed1986

The ambulance helicopter is a prerequisite for centralised emergency care.

During the summer seasons of 1978-1983 (56 weeks), trial activity with a physician-manned ambulance helicopter was carried out in the County of Stockholm (population 1.5 million). The area includes an extensive archipelago. Within the region there are 11 large general hospitals, three of which are supplied with a helicopter pad. During the trial period 1 246 helicopter missions were undertaken, of which 943 resulted in emergency transportation of the patient (83% by helicopter, 17% by ambulance). The number of missions per day varied from 0-11, with a mean number of 3.2. The turn-out time from receipt of the call to arrival at the scene of the accident or illness was less than 30 minutes in 75% of the cases. Of the emergency calls, 57% involved cases of illness and 43% accidents. Therapeutic intervention by doctors at the scene was considered to have been of vital importance in 22% of the cases, desirable in 28% and unnecessary in 50%. This intervention was regarded as life-saving in 18 cases (2%). By special training of emergency call operators, the number of unnecessary helicopter missions could be minimised (9% of all missions). To continuing specialisation and centralisation of emergency care with extended catchment areas, demands an advanced transport system. This trial has shown that through the use of a physician-manned ambulance helicopter the emergency care within the region can be centralised with retention of adequate turn-out times.

Aircraft↗
PubMed1977

Secondary hyperparathyroidism and its sequelae in renal transplant recipients. Long term findings in a series of conservatively managed patients.

The prevalence and duration of secondary hyperparathyroidism in 42 renal transplant recipients, and the sequelae of this condition, were studied. Immediately before transplantation, an elevated PTH-value was recorded in 76% of the patients, postoperatively there was a marked drop. Early after successful transplantation, 57% of the patients had hypercalcemia. At follow-up 3 years later, moderate hypercalcemia persisted in half of the patients but only 3 patients had significantly elevated PTH. The quality of renal graft function was not inferior in the hypercalcemic patients. Subperiosteal bone resorption and soft tissue calcifications were more common among the hypercalcemic patients. Our data suggest that secondary hyperparathyroidism can be managed conservatively in most renal transplant recipients. If progressive bone changes occur, surgical removal of parathyroid tissue should be considered.

Child↗
PubMed1977

The role of parathyroidectomy in the treatment of secondary hyperparathyroidism before and after renal transplantation.

In a series of 335 renal transplant recipients, 28 patients underwent parathyroidectomy due to secondary hyperparathyroidism. Twenty patients were operated on prior to renal transplantation, 8 subsequent to it. Solitary adenomas were found in 6 cases, diffuse hyperplasia in 22. Fifteen of the patients with diffuse hyperplasia underwent total parathyroidectomy with autotransplantation of parathyroid fragments into the sternocleidomastoid muscle, subtotal parathyroidectomy was performed in 7. Four hypercalcaemic patients underwent parathyroid surgery because of deteriorating transplant function but without improvement. Following parathyroidectomy, 21 patients became hypocalcaemic. 15 of these patients had undergone total parathyroidectomy and autotransplantation. Dihydrotachysterol substitution was accompanied by toxic symptoms in three patients on dialysis and by deteriorating renal function in two transplanted patients. Therefore, subtotal parathyroidectomy is recommended as the surgical procedure of choice in the treatment of secondary hyperparathyroidism before, as well as after renal transplantation.

Adolescent↗
PubMed1976

Prevalence of hypercalcaemia in a health screening in Stockholm.

A free health check, offered to 21417 20-63-year-old employees of the Stockholm City and County Council in 1971-73, was accepted by 15903 persons. The examination included a multichannel chemical analysis of a single blood sample. Serum calcium levels greater than or equal to 11.0 mg/100 ml (2.75 mmol/l) and greater than or equal to 11.1 mg/100 ml (2.78 mmol/l) were encountered in 3.9% and 1.1% of the population, respectively. Among subjects below 50 years of age, the calcium concentration was significantly higher in males than in females. This difference disappeared in older subjects, essentially because the calcium level decreased with advancing age in the men. To a further investigation were invited 178 subjects with a single serum calcium registration greater than or equal to 11.1 mg/100 ml (2.78 mmol/l). Of this group, 95 persons (53.4%) exhibited hypercalcaemia (HC) on repeated testing. Twelve had been operated on prior to the actural follow-up and found to have parathyroid adenomata. Twenty subjects were on continuous treatment with diuretics of the thiazide type and seven had diseases that might induce HC (two had hyperthyroidism, two hypothyroidism, one sarcoidosis, one hypernephroma and one mammary carcinoma). In 56 patients the laboratory and physical examinations did not reveal any obvious cause for the HC except possible hyperparathyoidism (HPT). Eighty (84.2%) of the 95 HC subjects were women, mostly over 50 years. The 95 persons constituted 6% of the total number of health-screened persons. The highest prevalence, 13%, was recorded for women aged 60-63. The prevalence of HPT in the total material was 3.6%, which is higher than that found in several other studies. This is based on surgical findings to date.

Adult↗
PubMed1976

Urinary phosphate excretion after total thyro-parathyroidectomy in thyroid carcinoma.

It is well established that deficiency of parathyroid hormone causes an increase of the tubular reabsorption of inorganic phosphate. Earlier evaluations, however, are based on animal experiments or in clinical studies where the degree of a postoperative hypoparathyroidism is not clearly defined. Eight patients with thyroid cancer have been operated on with a total thyroparathyroidectomy, biopsy of all identified parathyroids and autotransplantation of these glands. During a postoperative period of 3-5 days there is an arrest of the paraghyroid function before the glands have a new vascular supply. The levels in the serum and urine of calcium, phosphate, sodium, potassium, magnesium, chloride and creatinine were recorded. The excretion of phosphate diminished to unmeasurable values, indicating a complete tubular reabsorption of phosphate. After 5-6 days, when the autografted parathyroids began to function, phosphate reappeared in the urine together with a slow increase in S-Ca. No substitution with calcium or vitamin D was given in the postoperative period.

Adult↗
PubMed1976

Indications for surgery in the elderly patient with primary hyperparathyroidism.

The major symptoms presented by the elderly patient with primary hyperparathyroidism (HPT) were studied in 30 patients, all of whom were over 70 years of age (70-89). Neuromuscular symptoms, fatigue or mental symptoms were the main complaint in 14 patients. Nephrolithiasis, pancreatitis, skeletal changes or thyroid diseases were associated with HPT in 13 patients. Three patients were considered to be asymptomatic. Seven out of the eight patients with neuromuscular symptoms, and two of the three patients with extreme fatigue as the dominant symptom, improved postoperatively. This study indicates that for elderly patients with HPT especially when associated with neuromuscular symptoms or fatigue, surgical therapy is the treatment of choice.

Adult↗
PubMed1976

Diurnal variations in the urinary excretion of calcium and phosphate in hyperparathyroidism.

The urinary excretion of calcium and phosphate during the day and night was studied in 20 patients with primary hyperparathyroidism and in the same number of controls with normal function of the parathyroids. A significant difference in TRP between day and night was found in the controls but not in the HPT group. In other respects there were no substantial differences between day and night. The higher excretion of calcium observed in the HPT group was largely attributable to the patients with remal calculi. The simplified sampling procedure when only night urine is analysed has no disadvantages-it is more likely to improve the diagnostic reliability as it reduces the influence of meals, for example.

Adult↗
PubMed1975

Primary hyperplasia of the parathyroids.

Eight cases of primary hyperplasia of the parathyroid are reported among 322 cases of primary hyperparathyroidism. Preoperatively, all had high serum calcium. Six cases were water-clear, one chief cell, and one mixed hyperplasia. The case of chief cell hyperplasia was misdiagnosed primarily as adenoma. Its exact nature was recognised retrospectively. Identification and biopsy with frozen section of all the parathyroid glands is stressed. This is essential to rule out the presence of multiple adenoma or adenomatous formation in hyperplasia. When hyperplasia was proved, total parathyroidectomy and autotransplantation of parathyroid tissue equivalent to 1/2 or one normal-sized parathyroid gland was done in 7 cases. Although one patient had hyperplastic tissue in situ, the results of this management are considered to be satisfactory. On to six years postoperatively, all surviving patients are without symptoms of hyperparathyroidism and have normal serum calcium. Two patients required a small dose of Vit D-2 to sustain a normal calcium level. Total parathyroidectomy and autotransplantation of parathyroid tissue (PTA) is preferred to subtotal parathyroidectomy in cases of primary hyperplasia. There is a good primary result and reoperation can be easily done if there is recurrence of hyperparathyroidism.

Adult↗
PubMed1975

Dexon for sutures and ligatures.

Dexon has been used in 375 operations of various types on 360 patients. No wound infection was observed in the group of 'clean' cases. As Dexon is absorbed completely but relatively slowly and at an even rate, it can even be used in most instances instead of non-absorbable suture and ligature materials. When used for sutures and ligatures in operations of various types, Dexon costs about the same as catgut.

Humans↗