Biomedical subjects

C Backman

Publications and source records attributed to C Backman.

At least 19 recordsLinked to original sources

PubMed1995

Arthritis hand function test: inter-rater reliability among self-trained raters.

OBJECTIVE: The purpose of this project was to examine the inter-rater reliability of the Arthritis Hand Function Test (AHFT), a new instrument for measuring hand strength and dexterity in adults with arthritis. METHODS: Six occupational therapists (two at each of three sites) trained themselves as AHFT administrators using the test manual and training videotape. They recruited 30 adult subjects (10 at each site) with rheumatoid arthritis or osteoarthritis affecting the hands. There were 21 women and 9 men in the sample (mean age, 57.5 years; average time since diagnosis, 14.8 years). Subjects were tested twice, once by each rater from that site. RESULTS: Inter-rater reliability ranged from 0.45 to 0.99 (Pearson r). Because subjects were tested twice, AHFT scores were examined for an order effect. Although scores on all strength items declined by the second test session, and improved for all dexterity items, only the aggregate applied dexterity score showed significant change across all three sites (P = 0.002, 0.001, and 0.031, respectively). CONCLUSIONS: These results suggest the AHFT is a reliable instrument for measuring hand strength and dexterity that requires minimal training on the part of occupational therapist raters.

Arthritis↗

PubMed1995

Pulmonary venous systolic flow fraction in patients with mitral regurgitation: transoesophageal echocardiographic findings in relation to haemodynamic and angiographic evaluation.

In patients with mitral regurgitation (MR), pulmonary venous systolic flow fraction (PVSFfr) recorded using pulsed Doppler transoesophageal echocardiography (TEE) was compared with PVSFfr in normal subjects, to angiographic grading and to haemodynamic parameters. PVSfr was calculated as the systolic flow velocity integral divided by total inflow integral. PVSfr is negative when systolic flow is reversed. Forty patients with MR were studied. PVSFfr < 0 was 100% sensitive for angiographic severe MR (specificity 83%). In 35 patents heart rate differed by 10 bpm or less between TEE and cath, either at rest or during stress. PVSFfr was correlated with angiographic grade (r = -0.69, P < 0.0001), with mean PCW (r = -0.61, P < 0.0001), with the v-wave (r = -0.72, P < 0.0001), with systolic blood pressure (r = 0.48, P < 0.005) and with left atrial diameter (r = -0.52, P < 0.005). Stepwise forward multiple linear regression analysis revealed the v-wave, angiographic grading and systolic blood pressure to be independent predictors of PVSFfr. PVSFfr differed in normal subjects, patients with 0-2+ and patients with 3-4+ regurgitation. PVSFfr is a valuable index in assessing mitral regurgitation. This index may be less dependent on equipment and operator than colour flow imaging.

Adult↗

PubMed1995

Comparison of some criteria for diagnosing a myocardial infarction after aorto-coronary bypass grafting (CABG).

The incidence of myocardial infarction during a 1-year follow-up period after coronary bypass surgery (CABG), i.e. a recent myocardial infarction (RMI), was studied in 86 patients. Different criteria for the diagnosis of a RMI were compared. Clinical observation, including ECG and serum enzyme analysis, diagnosed RMI in 8% of patients. Specific ECG changes indicating RMI (ECGsp) occurred in 12% of cases, and if less specific ECG changes were also taken into account (ECGsp+nonsp) RMI was found in 30% of cases. Asynergy, detected by two-plane ventriculography, indicated RMI in 24% of the patients, and was probably the most valid of the criteria examined. The differences in diagnostic accuracy of the various criteria highlight the importance of defining diagnostic criteria.

Adult↗

PubMed1994

Contaminated collection media as a cause of pseudoinfection.

Following the appearance of positive Gram's stains from sterile surgical cases, an investigation was begun. Nonviable but stainable bacteria were found in the gel-based transport media. The use of a cause-and-effect diagram helped to show the numerous items that affected the problem.

Bacteria↗

PubMed1994

Anaesthesia for abdominal vascular surgery in patients with coronary artery disease (CAD), Part I: Isoflurane produces dose-dependent coronary vasodilation.

The effects of anaesthesia for major abdominal vascular surgery on coronary flow regulation and mechanisms of myocardial ischaemia were studied in 56 patients with CAD, using a randomized, partly double-blinded protocol. After induction with fentanyl (3 micrograms.kg-1) and thiopentone (2-4 mg.kg-1) and tracheal intubation, principal anaesthetics were nitrous oxide/oxygen (60/40) with isoflurane (n = 20), halothane (n = 19) or fentanyl (15-20 micrograms.kg-1) (n = 17). Conventional invasive techniques and coronary venous retrograde thermodilution were used to assess systemic and coronary haemodynamics. Coronary vascular resistance was estimated from myocardial oxygen extraction. Myocardial ischaemia was diagnosed by 12-lead ECG and/or anterior wall motion abnormalities by cardiokymography and/or myocardial lactate production. When adjustment of anaesthetic dose was insufficient for haemodynamic control, i.v. phenylephrine and nitroglycerine were administered to treat hypotension and hypertension or cardiac failure respectively. Measurements were performed at four specific intervals; awake, before surgery and 10 and 30 min after abdominal incision. Comparable changes of systemic haemodynamics and myocardial oxygen consumption were observed in the three groups. Coronary vasodilation was evidenced in isoflurane patients only and was linearly dose-dependent (P < 0.001). Partial Least Squares Projections to Latent Structures modelling with cross validation confirmed this dose-dependency and ruled out a clinically measurable influence by intervention drugs or simultaneous systemic haemodynamic abnormalities. The incidence of myocardial ischaemia during anaesthesia and surgery was comparable in the three groups (35, 37 and 24%, respectively) and there was an association with systemic haemodynamic aberrations in 19 of the 27 ischaemic episodes. In contrast to ischaemic halothane and fentanyl patients, isoflurane patients with ischaemia had significantly lower myocardial oxygen extraction (P = 0.008 and P = 0.001, respectively), indicating that the oxygen extraction reserve was not utilized in a normal way during ischaemia.

Abdomen↗

PubMed1994

Anaesthesia for abdominal aortic surgery in patients with coronary artery disease, Part II: Effects of nitrous oxide on systemic and coronary haemodynamics, regional ventricular function and incidence of myocardial ischaemia.

This study examines the effects of nitrous oxide on haemodynamics, anterior left ventricular (LV) function and incidence of myocardial ischaemia in abdominal vascular surgical patients with coronary artery disease. Forty-seven patients were randomly assigned to isoflurane-fentanyl anaesthesia with nitrous oxide-oxygen vs air-oxygen (control). Systemic and coronary haemodynamics, 12-lead ECG, LV anterior wall motion by cardiokymography (CKG) and myocardial lactate balance were recorded at four intervals: before and during anaesthesia and 10 and 30 minutes into surgery. Systemic haemodynamics were controlled by anaesthetic dose, and, when insufficient, by i.v. nitroglycerine (NG) in case of LV failure (PCWP > 18 mmHg) and by phenylephrine during hypotension. We found that nitrous oxide was associated with greater need for i.v. nitroglycerin (patients: P = 0.031, episodes P = 0.005) and more myocardial ischaemia (patients P = 0.012, episodes P = 0.001) despite systemic and coronary haemodynamics comparable to the control group. We conclude that nitrous oxide, known to have both sympathomimetic and cardiodepressive actions, produced cardiodepression in the face of sympathetic stimulation. Our study design did not allow to conclude if myocardial ischaemia was the consequence of increased wall stress or a reason for the observed LV dysfunction. The higher incidence of introperative myocardial ischaemia and need for NG did not cause increased cardiac morbidity.

Abdomen↗

PubMed1994

Effects of digitalis, anti-anginal drugs and arterial hypertension on the relationships between exercise ECG and angiocardiographic variables and on the diagnostic accuracy of exercise ECG in patients with coronary heart disease.

We have previously found a statistically significant correlation between some exercise ECG variables and angiocardiographic scores used to evaluate the extent and type of coronary heart disease (CHD). In the present study we examined the effects of digitalis, beta-adrenergic blockers, slow release nitrates, calcium channel blockers, presence of arterial hypertension (AHT), and angiocardiographic changes on the exercise ECG variables. The effects of drugs and AHT were small as compared to the effects of the angiocardiographically detected pathological changes caused by the CHD. Sensitivity and specificity of the exercise ECG ST criteria in identifying patients with an angiocardiographic criterion indicating coronary insufficiency were not much different in the whole group and in the subsets with AHT or medication with digitalis and anti-anginal drugs.

Adrenergic beta-Antagonists↗

PubMed1992

Effects of ethanol on development of dorsal raphe transplants in oculo: a morphological and electrophysiological study.

The purpose of this project was to investigate ethanol influence on the development of serotonin-containing (5-HT) neurons of the dorsal raphe nucleus in rat. Fetal tissue of embryonic day 17 from the dorsal brainstem was grafted to the anterior chamber of the eye of adult albino rats. The experimental group was exposed to 16% ethanol in the drinking water, and the control group received water ad libitum. After 4 weeks, morphological and electrophysiological evaluations were performed. Immunohistochemical analysis showed that 5-HT-immunoreactive fibers from ethanol-treated transplants had a disturbed outgrowth pattern into the host iris as compared to the control group. Furthermore, the outgrowth area and axon bundle formation was significantly greater in the control group than in the ethanol group. Electrophysiological recordings revealed a dose-dependent biphasic effect of locally applied ethanol on transplanted monoaminergic neurons. Low doses of ethanol (0.5-3 mM) induced an increase in basal firing rate of control neurons, while higher doses (10-100 mM) caused inhibition. However, monoaminergic neurons in the ethanol group showed a decreased neuronal sensitivity to locally applied ethanol. The same dose of locally applied ethanol which produced an excitation of neuronal activity in the ethanol transplants produced an inhibition in the control grafts. The dose-response curve was shifted to the right. The present results suggest that chronic ethanol exposure during early development leads to altered axonal outgrowth from brainstem 5-HT neurons, as well as decreased sensitivity of these neurons to locally applied ethanol.

Animals↗

PubMed1991

Cold-induced arterial spasm after digital amputation.

The incidence and intensity of cold-induced digital vasospasm was investigated in 18 patients with digital amputation injuries. Nine patients had undergone replantation surgery, while in the remaining nine cases the injury had been treated by stump revision and closure. The vascularity of the injured digits and of uninjured fingers in both hands, was studied. The results confirm that cold-induced vasospasm is no more conspicuous in replanted fingers than in amputation stumps. Pathological vascular reactions to cold were also common in uninjured fingers in both hands.

Adolescent↗

PubMed1991

Replantation of the completely avulsed thumb using long arterial and venous grafts.

Long arterial and venous grafts (10-15 cm. in length) were used in the replantation of thumbs amputated by avulsion. All replanted parts survived and thrombosis requiring anastomotic revision did not occur in any of the cases. Based upon a consideration of different factors that may lead to the formation of thrombus in reconstructed vessels, a method is recommended for routine use in replantation of the thumb, with specific reference to avulsion injuries.

Adult↗

PubMed1991

Effects of cold exposure on the circulation of replanted fingers during the early postoperative period.

The replanted finger after a complete amputation is an excellent model for the study of many aspects of vascular physiology. In the present clinical study, 10 patients were investigated to evaluate the incidence of cold-induced vasospasm in replanted digits during the early postoperative period. The results indicate that cold-induced vasospasm is not a risk factor in the early postoperative phase after digital-replantation surgery. It is concluded that cold-induced spasm of the digital arteries is primarily a central, nerve-mediated reflex.

Adult↗

PubMed1991

Digital amputation, replantation, and cold intolerance.

In a controlled, retrospective, clinical study, the relationships between traumatic digital amputation, digital replantation, and cold intolerance were investigated. The results of the investigation indicate that cold intolerance is a major reason for disability after digital amputation. They also indicate that the cold intolerance experienced after digital replantation is due to the original injury, and that it is not aggravated by the reconstructive surgery. Cold intolerance, in and of itself, is not a contraindication to digital replantation, regardless of whether the patient lives or works in high- or low-temperature environments.

Adolescent↗

PubMed1991

Is HLA B27 antigen a predictor of cardiac or pulmonary disease in patients with rheumatoid arthritis?

Pericarditis was a frequent echocardiographic finding in 20 HLA B27 positive patients with erosive, seropositive rheumatoid arthritis (RA) and in 20 B27 negative RA controls (35% and 30% respectively). There was no significant difference in echocardiographic 2-D or M-mode measurements between the groups. A 48 hour continuous electrocardiographic monitoring, showed that ventricular extrasystoles were more frequent (p less than 0.01) in the B27 negative patients. Pulmonary diffusion capacity was reduced in 25% of the patients in both groups. There were no association between clinical or laboratory data and the cardiac or pulmonary findings except for the finding of a higher frequency of treatment with corticosteroids in patients with pericarditis.

Arthritis, Rheumatoid↗

PubMed1991

Blood flow in chronic Achilles tendinosis. Radioactive microsphere study in rabbits.

Cerium-labeled microspheres were used for blood-flow measurements in 7 New Zealand white rabbits with exercise-induced chronic Achilles paratenonitis and tendinosis. The blood flow increased 1.9 times more on the exercised side as compared with the contralateral, unexercised (control) side with respect to both the tendon and the paratenon. The blood flow of the tendon of the exercised leg showed a strong correlation with the blood flow in the paratenon of the ipsilateral side (r = 0.81). We concluded that the relative contribution of blood from the paratenon to the tendon remained unaltered in the exercised tendon and that degeneration of the tendon cannot be primarily explained by chronic circulatory impairment.

Achilles Tendon↗

PubMed1991

Reaction of patients with effort angina to cold exposure during exercise.

An attempt has been made to characterize so-called "responders" to cold among patients with effort angina. Forty-nine such patients, unselected with regard to their history of reactions to cold, who showed ST depressions during and after exercise, were examined. They worked on a bicycle ergometer close to their maximum capacity, Wmax, at room temperature (about 23 degrees C) and in a cold room (-15 degrees C). ECG was recorded and a rating scale was used to estimate the perceived exertion during exercise (RPE). The presence of angina pectoris during exercise and its duration after exercise was recorded by an EA score. An EA/W index was used to estimate the severity of the effort angina. In the whole group, the mean Wmax decreased and the mean ST depressions, RPE, and EA/W index (but not EA score) increased on exposure to cold. The changes in these variables due to exposure to cold were all associated (but not the EA score). Criteria requiring a decrease in Wmax or increase in ST depression, RPE or EA/W index on cold exposure identified 53 to 63 percent of the patients. By combining the criteria, the number of patients, who were identified, decreased. If all the criteria were applied, about 30 percent of the patients were identified as "responders" to cold and they showed the most marked responses. Thus several exercise ECG test parameters may be used to reliably define "responders" to cold exposure. This may enhance future studies of the response reaction.

Adult↗

PubMed1990

Chronic achilles paratenonitis with tendinosis: an experimental model in the rabbit.

An experimental model for inducing chronic Achilles paratenonitis with tendinosis in the rabbit is presented. Thirteen rabbits were exercised in a kicking machine producing passive flexions and extensions of the ankle joint. Active contractions of the triceps surae muscles were induced by electric stimulation via surface electrodes. The animals were exercised for 5 to 6 weeks, with a rate of 150 flexions and extensions per minute for 2 h, three times a week. Light microscopic examination showed degenerative changes of the tendon, and increased number of capillaries, infiltrates of inflammatory cells, edema, and fibrosis in the paratenon. We conclude that chronic Achilles paratenonitis with tendinosis can be experimentally induced in a standardized manner in rabbits.

Achilles Tendon↗

PubMed1990

Impairment of estramustine phosphate absorption by concurrent intake of milk and food.

The effect of milk and food on the pharmacokinetics of estramustine phosphate was investigated in six patients with prostatic cancer. In a randomized three-way cross-over study, the patients were given single doses of the drug together with low calcium water, low calcium food and milk. The evaluation was based upon the plasma concentration of two metabolites, estromustine and estrone, as parent drug could not be detected in plasma. The tmax and lag time of estromustine were significantly increased by milk and food intake and Cmax and AUC were significantly decreased. In comparison with water, the AUC of estromustine was 41% when the drug was taken with milk and 67% after simultaneous intake of standardized food. Corresponding figures for the peak values were 32 and 57%, respectively. The effect of milk and food intake on the pharmacokinetics of estrone was similar. Studies in vitro demonstrated that the dissolution of estramustine phosphate disodium was markedly impaired in the presence of calcium. It was concluded that the rate and extent of absorption of estramustine phosphate were decreased when the drug was taken with milk or food due to the formation of a poorly absorbable calcium complex. To obtain high and reproducible absorption of Estracyt, the drug should not be taken together with milk, milk products or other calcium-rich food or drugs.

Aged↗

PubMed1990

Pre- and postoperative evaluation of renal function with five different tests in patients with primary hyperparathyroidism.

Renal function was investigated immediately before and 1 year following parathyroidectomy in 19 patients with moderate hypercalcaemia. On both occasions, all patients underwent five different tests of glomerular and tubular function: plasma creatinine, creatinine clearance, 51Cr-EDTA-clearance, beta 2-microglobulin excretion and the desmopressin test. Glomerular filtration rate, as assessed by plasma creatinine and clearance of both creatinine and 51Cr-EDTA, was normal in most patients, and was little affected by restoration of normocalcaemia. Renal concentrating capacity, as determined by the desmopressin test, was abnormally low in 14 of 19 patients, but increased significantly after surgery. It is concluded that serious renal damage is seldom encountered in present-day HPT patients, but that a treatable decrease in renal concentrating capacity often exists.

Adult↗