Biomedical subjects
B Börjesson
Publications and source records attributed to B Börjesson.
The social consequences of insulin-treated diabetes mellitus in patients 20-50 years of age. An epidemiological case-control study.
In order to investigate the social consequences of diabetes we sent a questionnaire to all diabetic patients aged 20-50 years and 1.125 matched non-diabetic controls living in the county of Västerbotten in Northern Sweden. The response rate was 87% and 72%, respectively. Patients more often lived alone (18 vs 13% p less than 0.05) and had no children (39 vs 31% p less than 0.01). They were more often the only child of their parents (14 vs 8%, p less than 0.01). Thirty-seven percent of the patients and 22% of the controls (p less than 0.001) had been absent from work because of illness more than one month continuously during the last 3 years and had more often than controls prematurely retired from work (8 vs 2% p less than 0.001). Patients more often had hobbies (86 vs 76%, p less than 0.001) and were participating in social activities (52 vs 41%, p less than 0.001), but were less satisfied with their leisure time (71 vs 80%, p less than 0.001). Forty percent of the patients vs 31% of the controls (p less than 0.01) did not visit neighbours. Fifty-one percent of the patients vs 44% of the controls (p less than 0.05) never spent leisure time with their work mates. No significant differences were found in education, socioeconomic class, dwelling or household economy. The study shows that there are social differences between diabetic patients and non-diabetic people even though they are not overwhelming.
Difficulty in detection of hernia and hydrocele in cryptorchidism.
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Prospective evaluation of human chorionic gonadotropin in the treatment of cryptorchidism.
Of 158 boys consecutively referred for undescended testis, 77 were found to have true cryptorchidism. Human chorionic gonadotropin (HCG) was given to 60 boys (63 undescended testes) in a dose of 5,000 U (patient age 4-6 years) or 10,000 U (7-9 years). The parents of seven others preferred direct referral for orchiopexy. Minor side effects occurred in 18 boys. Significant increase in weight increment velocity was seen among 7-9-year-olds. Descent of testis occurred in 59% (95% cl 46-71%), with the incidence significantly higher in the older group. Mobile testes were more likely to descend. At surgery following failed HCG treatment, hernia or hydrocele was unexpectedly found in 77% of cases, and 19% of the testes were ectopic in the superficial inguinal pouch. The risk of repeat orchiopexy was not less than in a previous series of primary orchiopexy. Although surgery could be avoided in approximately half of the patients in this series, it is not yet decisively established if HCG should be used diagnostically or therapeutically. Improved pre-treatment identification of ectopia and hernia is required.
Factors affecting the outcome of orchiopexy for undescended testis.
Orchiopexy was performed on 135 testes in 121 patients aged up to 15 (median 6) years who had no previous inguinal surgery or hormonal treatment. Hypoplasia at the time of orchiopexy (34/135) was significantly less common when the testis was in or peripheral to the superficial inguinal ring than when it was intracanalicular. The position did not influence the outcome of surgery or the risk of postoperative hypoplasia (9 cases). At follow-up 87% of the testes were in the scrotum. Reoperation was required for four of nine which were anchored to the femoral skin or with suture through testis and scrotal wall. Tension on the spermatic cord significantly increased the failure risk. Simultaneous herniotomy was associated with 15%, and dissection only (including excision of the vaginal process remnant) with 6% orchiopexy failure. Retroperitoneal dissection to avoid tension on the cord significantly reduced the failure rate without increasing the risk of postoperative hypoplasia. Orchiopexy performed with optimal technique by experienced surgeons is a safe and effective alternative to hormonal treatment.
Testis position and age at orchidopexy.
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Infantile autism in children of immigrant parents. A population-based study from Göteborg, Sweden.
A population-based study of infantile autism from western Sweden has been completed. Urban children with autism more often than age-matched children in the general population had immigrant parents from 'exotic' countries. No such trend was seen in rural children with infantile autism.
Cholescintiscan or infusion cholecystography in acute cholecystitis. A prospective study.
Two methods of diagnosing acute cholecystitis--cholescintigraphy and infusion cholecystography--were compared in a prospective study of 105 patients. Sensitivity and specificity were very high (96-99% and 91%, respectively), without difference between the two methods. Infusion cholecystography gave transient rise in liver enzyme levels in more than half of the patients. Cholescintigraphy gave no side effects. Cholescintiscan could be performed at moderately elevated bilirubin levels. It also gave information concerning liver malignancy in four patients. On these grounds, cholescintigraphy is the preferable of the two methods.
Emergency and long-term transesophageal sclerotherapy of bleeding esophageal varices. A prospective study of 50 consecutive cases.
Fifty consecutive unselected patients with endoscopically proven bleeding esophageal varices were on 76 occasions during 3 years treated with transesophageal sclerotherapy. One-week hemostasis was obtained in 89%, with a hospital mortality of 14%. Three major complications (1.1%) occurred, with one fatal outcome. Long-term repeated sclerotherapy was instituted according to our protocol in all the survivors. During a mean follow-up period of 26 months 19 patients have been treated with sclerotherapy alone, 10 had elective and 2 had emergency operative procedures because of rebleeding. Six fatal bleedings occurred, four after sclerotherapy alone. The 3-year survival is calculated to be 49%. Sclerotherapy has proven to be effective and safe and can be recommended especially in the acute situation. It can also be used as long-term treatment, but rebleedings will in several cases necessitate operative procedures.
Peritoneovenous shunting for intractable ascites.
For 5 years (1976-1981) peritoneovenous shunting has been used in 32 patients with intractable ascites--that is, in patients in whom medical therapy has failed. All operations but one were performed using local anesthesia. The LeVeen shunt was used in 29 patients and the Denver shunt in three patients. Good palliation was achieved in 14 of 23 patients with ascites due to liver cirrhosis. Seven out of eight patients with tense ascites secondary to malignancy were relieved. Complications were seen in six patients. In one patient severe disseminated intravascular coagulopathy made removal of the shunt necessary. Leakage, local infection, and skin necrosis, when present, could successfully be treated without removing the shunt. The surgical procedure is simple and offers relief to most patients with tense ascites resistant to medical therapy.
Acute treatment of bleeding oesophageal varices. A retrospective study of 88 patients.
The records of 88 patients bleeding 140 times from oesophageal varices were retrospectively evaluated. The treatment consisted mainly of intravenous vasopressin and balloon tamponade. Percutaneous transhepatic and transoesophageal sclerotherapy were used as additional treatments. Acute operation was avoided as long as possible. With this conservative attitude the hospital mortality was 24%. A high mortality was correlated with low serum albumin, initial unconsciousness, high blood transfusion demand, and alcoholism. The first bleeding episode of the patient had a higher mortality than the following ones. Our experience with a conservative attitude in stopping bleeding from oesophageal varices has made it possible to construct an outline for treatment which can be followed in most of these patients.
Gastrointestinal bleeding caused by haemosuccus pancreaticus. A presentation of two cases.
Two cases of gastro-intestinal bleeding due to haemosuccus pancreaticus (hemorrhage through the pancreatic duct) are presented. Both patients had hematemesis and melena in combination with epigastric pain and hyperamylasemia. Angiography revealed aneurysms of the splenic artery as the probable source of bleeding. Central ligation of the splenic artery with splenectomy cured both patients. Angiographic obliteration of the splenic aneurysm was used preoperatively in one case.
[Transoesophageal sclerosing of bleeding oesophageal varices].
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Developments in management of portal hypertension: a plea for selective symptomatic treatment.
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Subcutaneous transposition of the spleen: a method for treatment of complications in portal hypertension?
Eleven patients with portal hypertension were treated with subcutaneous transposition of a resected spleen. In eight of the patients the operation was performed after variceal bleeding. In this group there was one operative mortality--a 77-year-old woman. Another patient died after 28 months in upper gastrointestinal bleeding. Autopsy showed varices in the gastric fundus and a cancer in the cardia. The other six patients are alive and in good health after 41--60 months. The operation was performed in another three patients, who had not bled. The indication was hypersplenism and esophageal varices in two and severe thrombocytopenia in one. Two of these patients (both with advanced hepatic disease) died postoperatively. The operation is proposed as an alternative method in the treatment of portal hypertension--especially when the main problem is hypersplenism. The operation has no negative effects on liver function and does not cause encephalopathy. Hypersplenism is cured. The survival time and freedom from postoperative bleeding among those who bled preoperatively is in the present material very satisfactory. However, the operation cannot be recommended for the prophylactic treatment of patients with esophageal varices who have not bled--at least not in the patient with advanced hepatid dysfunction.
Obliteration of esophageal varices by PTP: a follow-up of 43 patients.
The percutaneous transhepatic portal vein catheterization (PTP) with selective obliteration of the coronary vein and/or the short gastric veins in treating bleeding esophageal varices was introduced in 1974. In order to prevent recanalization of the vessels Bucrylate (isobutyl-2-cyano-acrylate) has been used in 43 patients 55 times during a period of 34 months (October 1975 to July 1978). The obliterative treatment was followed by rebleeding in 35% of the cases and continued bleeding occurred in two patients. Fourteen patients were treated on 16 occasions during acute bleedings, and five of these (36%) died within two months from a portal vein thrombosis caused by the obliterative procedure. Because of these findings PTP with obliteration of the veins feeding the esophageal varices is not recommended as an elective way of treatment. It should only be used in the acute bleeding patient when transesophageal sclerosering therapy, continuous vasopressin infusion and balloon tamponade have failed. Fifty-six per cent of the patients acutely treated stopped bleeding for more than one week, thus avoiding an emergency shunt or devascularization operation which are associated with a high mortality rate.
VIRUS--a laboratory information system for clinical virology.
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[Wilms' tumor--cases in Lund, 1953-74].
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