Biomedical subjects
Publications and source records attributed to B Bergström.
About 7 years after a malleolar fracture 113 patients were examined for development of arthrosis. The addition of films exposed in weight-bearing position with a.p. beam direction to views of the ankle joint exposed in supine position did not contribute to the diagnosis of arthrosis.
A permanent tracheostoma is often necessary in patients with respiratory diseases such as severe bronchial asthma or chronic bronchitis in order to reduce dead space. Another group of patients who require a permanent tracheostoma are those with laryngeal stenosis or bilateral vocal cord pareses whose general condition makes them unsuitable candidates for more advanced surgical procedures. This has usually been achieved by a conventional tracheostomy tube which, however, carries many problems; the ability to cough is greatly reduced when a sufficient intra-abdominal pressure cannot be acquired, speech is impaired, the tube has to be changed regularly, it must be fixed by bands around the neck, etc. These problems can be significantly reduced by using a short, straight tube placed in the stoma and kept securely in position by an outer flange and four flaps on the tracheal side. To this tube is attached a special two-way valve adjustable for either inspiration and expiration or for inspiration only in which case it also serves as a speech valve. Up to now this construction has been used in 16 patients with excellent results, one patient has had this device continuously since 1970 without any complications.
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Despite the overall high success rate of myringoplasty, the long-term results in ears with preoperative dysfunction of the Eustachian tube and with a small mastoid air cell system are disappointing. In this communication, we report an 83% healing rate after myringoplasty that included mastoidectomy with posterior and anterior tympanotomy in a selected group of patients with poor tubal function and small mastoids.
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Stenosis of the trachea, especially after prolonged intubation for mechanical ventilation or after direct trauma to the trachea, has become an increasing problem worldwide. The generally accepted treatment of choice is resection of the stenotic part of the trachea and end-to-end anastomosis; however, some patients have primary diseases (multiple injuries, cardiorespiratory failure, severe bronchial asthma, adrenal dysfunction, etc) that contraindicate any major tracheal surgery. In these cases, more conservative methods must be tried. Treatment with dilation using various types of stents, mostly combined with endotracheal excision of fibrous tissue, has been used in 20 patients during the period of 1965 to 1974 at the Department of Otolaryngology, University Hospital, Uppsala, Sweden. In the 17 patients who have completed treatment who have completed treatment (two patients still being treated and one patient died of myocardial infarction during treatment), nine were classified as having good clinical results, four as satisfactory, and four as failures. We believe that treatment of tracheal stenosis using dilation with stents is a reasonably good alternative in patients whose general condition makes them poor risks for major tracheal surgery.
Myringoplasty results in patients with poor tubal function and small cell systems are often disappointing, to both patient and surgeon. Surgical procedures to improve tubal function have been introduced but they all have the disadvantage of being rather elaborate and difficult to perform. The mastoid air cell system on the other hand does not offer the same problems of access. With the concept of creating an air-filled cavity in connection with the middle ear, mastoidectomy was performed in myringoplasty cases with poor tubal function and small (less than 9 cm2 lateral area) cell systems. Preliminary results show a healing rate of 82% in patients managed according to these principles, against 50% in corresponding cases when myringoplasty alone was done.
Defects on the tympanic wall of the facial canal may endanger the nerve in middle ear surgery. Their preoperative tomographic demonstration is therefore valuable. In an experimental investigation an attempt was made to assess the discernibility of artificial defects of different size by hypocycloid and spiral tomography of temporal bone specimens (both isolated and mounted in a tissue-equivalent skull phantom). The thickness of the wall was measured and its influence on the discernibility of the defects discussed.
76 patients with acute maxillary sinusitis were treated with oral erythromycin stearate (500 mg twice or 3 times a day for 10 days). The mean concentration of erythromycin in the sinus secretion after 3-5 days' treatment was 0.6 mug/ml with the lower dosage and 1.3 mug/ml with the higher. The concentration of erythromycin in the sinus secretion was, on the average, 10-20 times higher than the minimum inhibitory concentration (MIC) for group A streptococci and pneumococci, and reached MIC values for 15-30% of 100 examined strains of Haemophilus influenzae. 81% of the patients given the smaller and 94% of those given the larger dose improved or recovered. Radiological improvement was demonstrated in both groups. The infections with H. influenzae tended to respond somewhat less to the treatment than those with pneumococci. Comparisons of the roentgen findings and the findings at aspiration showed good agreement. An extra projection taken with the patient recumbent and the affected side downwards gave no information above that obtained from the routine projections. The large dose caused side effects more often (in 17/41 patients) than the smaller one (4/35 patients). In 10 patients treatment was discontinued because of side effects; 8 of them had received the larger dose.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Explore the source record for details and available documents.