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Biomedical subjects

I Wickström

Publications and source records attributed to I Wickström.

At least 19 recordsLinked to original sources
PubMed1993

The effect of postoperative intravenous feeding (TPN) on outcome following major surgery evaluated in a randomized study.

Three hundred patients undergoing major general surgical procedures were randomized by means of a computer-assisted algorithm to receive either total parenteral nutrition (TPN) from the first postoperative day or only prolonged glucose administration (250-300 g/day) up to 15 days after operation. All patients receiving TPN were treated individually based on daily measurements of energy and nitrogen balances. The treatment goal was to keep the patients in positive energy balance (+20%) and close to nitrogen balance. The effects of the two "nutrition regimens" on outcome such as mortality rate, complications, the need of additional medical support and patient-related functional disabilities were investigated. No selection of patients was made, that is, malnourished patients were also randomized. There were no differences among TPN versus glucose treatment when results were analyzed according to intent to treat. Approximately 60% of all patients were able to start eating within 8 to 9 days after operation. No differences were observed between such patients regardless of being treated with TPN or glucose only. Patients on glucose treatment during 14 days had a significantly higher mortality rate (p < 0.05) than patients on either continuous and uncomplicated TPN treatment or short-term glucose treatment. Similar results for mortality rates also were seen with regard to severe complications (cardiopulmonary problems, sepsis, and wound-healing insufficiencies), functional disturbances, the need of additional medical support, and abnormalities in nutritional state. Twenty per cent of the patients randomized to TPN treatment showed a statistical trend (p < 0.10) toward a higher mortality rate (36%) compared with patients randomized to prolonged glucose treatment (21% mortality rate). These patients could not be identified by evaluation of preoperative factors. Thus, the overall evaluation of the results makes it likely that a fraction of high-risk patients (approximately 20%) were not doing well on immediate postoperative intravenous feeding, and it is possible that TPN to such patients accentuated their morbidity rate. Although patients (20%) on prolonged semi-starvation (14 days glucose treatment) had increased mortality rate and severe complications, it was possible that undernutrition induced a slightly different complication scenario than induced by TPN in the high-risk patients. The results demonstrate that in most surgical patients (60%), postoperative semi-starvation is not a limiting factor for outcome. In remaining 40%, inadequate nutrition was associated with both increased morbidity and mortality rates. In this sense, inadequate nutrition represents both too much and too little, whereas overfeeding seemed to be a larger problem than underfeeding.(ABSTRACT TRUNCATED AT 400 WORDS)

Algorithms↗
PubMed1992

Prevalence of carnitine depletion in critically ill patients with undernutrition.

The aim of this study was to evaluate to what extent secondary carnitine deficiency may exist based on the prevalence of subnormal carnitine status in patients with critical illness and abnormal nutritional state. Healthy control patients (n = 12) were investigated and compared with patients with possible secondary carnitine deficiency, ie, patients with overt severe protein-energy malnutrition (PEM, n = 28), postoperative long-term (greater than 14 days) parenteral glucose feeding (250 g glucose/d, n = 7), severe liver disease (n = 10), renal insufficiency (n = 7), and sustained septicemia with increased metabolic rate (n = 8). Nutritional status, energy expenditure, creatinine excretion, and blood biochemical tests were measured in relationship to free and total carnitine concentrations in plasma and skeletal muscle tissue, as well as urinary excretion of free and total carnitine. The overall mortality rate was 48% within 30 days of the investigation in study patients with the highest mortality in liver disease (90%). The hospitalization range was 14 to 129 days in study patients. Most study patients had lost weight (4% to 19%) and had abnormal body composition. Patients with liver disease, septicemia, renal insufficiency, and those on long-term glucose feeding had significantly higher than predicted metabolic rate (+25% +/- 3%), while patients with severe malnutrition had decreased metabolic rate compared with controls. Patients with liver disease had increased plasma concentrations of free (96 +/- 16 mumol/L) and total (144 +/- 27 mumol/L) carnitine compared with controls (45 +/- 3, 58 +/- 7 mumol/L, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Electromyographic registration of diaphragmatic fatigue during sustained trunk flexion in cervical cord injured patients.

When performing forward trunk flexion, cervical cord injured (CCI) patients exhibit continuous and high EMG activity in the diaphragm and elevated abdominal pressures. This study addressed the question whether the trunk flexion manoeuvres cause such a high force development in the diaphragm that this muscle shows EMG signs of fatigue. Six patients with complete cervical cord lesions were tested sitting in their own wheelchairs. The tension-time indices obtained when patients were sitting in a relaxed position were moderately to markedly higher than in normal subjects. The force developed during trunk flexion averaged 30% of the maximal transdiaphragmatic pressure and was accompanied by clear EMG findings of diaphragmatic fatigue in all patients except one. The acute diaphragmatic load in certain CCI patients may well produce ischaemia and increase the risk of tissue impairment. Therefore, there appears to be a need for differing strategies in the short and in the long term treatment of CCI patients; longitudinal evaluation of main diaphragmatic function may be useful for an adequate amount of respiratory muscle training.

Cervical Vertebrae↗
PubMed1992

The role of the diaphragm in trunk extension in tetraplegia.

Interest has been focused on the diaphragm as the all important respiratory muscle in tetraplegia for decades but its unique role as a trunk extension muscle has not been considered. This study set out to establish the relationship, if any, between the roles of the diaphragm during arm exercise and trunk flexion. Eight male complete cervical cord injuries (CCI) patients, sitting in their wheelchairs, were studied during rest, trunk flexion and start of arm cranking. The average flow, volume, oesophageal and gastric pressures (Poes and Pga) and the myoelectric activity of the diaphragm (EMGdi) were recorded. The EMGdi pattern changed from phasic activity at rest to continuous or almost continuous activity during trunk flexion. Patients were then either spontaneously holding their breath or breathing irregularly with rapid or shallow breaths. Also, the normalised EMGdi signal strength increased by an average of 150% and the mean Pga by about 3 kPa, while mean Poes decreased by about 0.5 kPa. At the start of exercise, patients with poor triceps function, less than MRC grade 3, exhibited similar ventilatory and EMGdi changes as had been seen in trunk flexion. In patients with better triceps function, only minor changes in these variables were observed. The findings suggest that the diaphragm acts both as a trunk extensor muscle and a respiratory muscle. During posture imbalance, the postural needs temporarily override the respiratory needs.

Adult↗
PubMed1990

Quality of semen after repeated ejaculation treatment in spinal cord injury men.

The study was designed to document the effects of regular drainage after penile vibrator stimulation on the quality of semen in SCI men. Twenty three tetraplegics and 9 paraplegics, 18 to 40 years of age and with neurological levels ranging from C4 to L1, were examined between 1 and 23 years after injury (median 2 years). None had ejaculated after the injury. Penile vibrator stimulation was tried in patients with cervical or thoracic lesions who showed reflex hip flexion on scratching the soles of the feet, 29 out of 32, and rectal electrostimulation in the remaining 3 low lesions with no reflex function in lumbar and sacral segments. The stimulation yielded semen in 29 (91%) of the men; 22 had antegrade and 7 retrograde ejaculation. Sixteen of the 22 patients with antegrade ejaculation entered a home programme of vibrator stimulation prescribed once weekly. Four to 6 months of stimulation resulted in a rise of semen volume and of fructose and acid phosphatase levels in the seminal plasma, suggesting improved function of the seminal vesicles and the prostate. The percentage of motile sperms was low both before and after the treatment period. Despite this, the total count of motile sperms per ejaculate was already high in the patient's first ejaculates compared to the laboratory normal standard, and further clearly increased after the stimulation period. A standardised functional test measuring sperm penetration capacity showed strong evidence of long term stimulation effect. It is suggested that the test is used in the assessment of fertility potential in SCI men.

Adolescent↗
PubMed1990

Cardiac output determinations in the pig--thoracic electrical bioimpedance versus thermodilution.

The accuracy of transthoracic electrical bioimpedance (TEB) for continuous, noninvasive measurement of cardiac output (Qt) in pigs was assessed in comparison with the thermodilution (TD) technique. Using the TEB technique, the different thoracic habitus of the pig had to be corrected for A good correlation with the TD technique was obtained (r = .87; p less than .001; n = 86) using thoracic length value (the measured value plus 25%) in an NCCOM3-R6 cardiodynamic computer for Qt values ranging from 2.9 to 9.8 L/min in pigs weighing from 40 to 75 kg. However, the Qt values given by the NCCOM3 were systematically 11% to 15% higher over the full range of values than the average of NCCOM-3 and TD Qt values. On the basis of the good agreement in the present study between the TEB and TD techniques over a broad range of Qt values, we conclude that TEB offers a valuable continuous, noninvasive alternative to TD for Qt determinations in experimental porcine models.

Animals↗
PubMed1984

The influence of irradiation time per treatment session on acute and late skin reactions: a study on human skin.

A comparison of the radiation effect of altering the treatment time per session in fractionated radiotherapy was performed on human skin with 12 MeV electrons. Four fractions of 7.2 Gy were given within 22 days, once a week. The dose per fraction was administered in 4 min and 32 min, respectively. The dose rate was about 2 Gy/min and the prolonged treatment time was achieved by dividing each dose fraction into three equal subfractions with intervals of 14-15 min. Prolongation of the treatment time resulted in a significant reduction of the skin erythema (p less than 0.001), pigmentation (p less than 0.05) and the degree of telangiectasia at 5 years (p less than 0.001). The relative biological effectiveness (RBE) for the prolonged (32 min), in relation to that of the short (4 min) treatment time, RBE4 min/32 min, was 1.09-1.10 for erythema and 1.07-1.12 for telangiectasia. These findings indicate that prolongation of the treatment time per session has to be adjusted for in clinical radiation oncology.

Breast Neoplasms↗
PubMed1984

A comparative study of the efficiency of intragastric and parenteral nutrition in man.

Solutions intended for parenteral nutrition were infused at constant rates intravenously and intragastrically in five healthy volunteers. Whole body utilization of nutrients was measured by indirect calorimetry and determination of nitrogen excretion in relation to circulating levels of substrates. Energy balance and urinary nitrogen excretion were the same in all subjects irrespective of whether nutrition was given intravenously or intragastrically. Minor differences in circulating levels of glucagon, alpha-amino nitrogen, and triglycerides were observed but had no impact on the energy and nitrogen metabolism. The results show that whole-body utilization of calories is the same with parenteral and enteral nutrition as evaluated over short time periods from the start of infusion. This is probably also true for amino acids.

Aged↗
PubMed1983

Thallium poisoning--toxin elimination and therapy in three cases.

Three cases of thallium poisoning occurred within the same family after eating a meal of poisoned sour milk. The 58 year old mother died after four days cardiovascular insufficiency. Massive thallium concentrations were found in blood, urine, liver and kidney. The 59 year old father presented after four days with a neurology typical for classic thallotoxicosis with potentially lethal blood thallium levels. This patient recovered after therapy including Prussian Blue, forced diuresis and two six hour hemoperfusions with a charcoal column. Urinary elimination of thallium over two weeks was almost 300 mg, whereas a maximum total of 63 mg were removed with hemoperfusion. A retrospective estimate of the total dose ingested and the large distribution volume of thallium suggest that hemoperfusion did not affect the course of the intoxication. The 28 year old son, later convicted for homicide, was admitted on the tenth day after the meal with very discrete neurological symptoms. This patient had low blood and urine thallium levels. He recovered uneventfully after treatment with Prussian Blue and forced diuresis. However, both surviving patients developed alopecia after two weeks. All three patients had raised liver transaminases. Intensive therapy with gut decontamination, Prussian Blue and forced diuresis should be the mainstay of therapy.

Adult↗
PubMed1982

Hemodynamic and metabolic effects of ketamine anesthesia in the geriatric patient.

The cardiovascular and metabolic effects of ketamine as the sole anesthetic agent for surgical correction of fractured neck of femur were studied in eight spontaneously breathing geriatric patients (mean age 83 years) before premedication, at the end of operation, and 15 min and 2 h after the end of anesthesia. Arterial blood pressure, cardiac index, left ventricular stroke work index and oxygen consumption increased during anesthesia but had returned to preoperative levels 15 min after the end of anesthesia. Vascular resistance, heart rate and stroke volume index were not significantly changed. During anesthesia, arterial carbon dioxide tension increased whereas arterial pH and arterial BE decreased. The levels of glucose and lactate increased in both blood and skeletal muscle during anesthesia and remained elevated throughout the period studied but the lactate:pyruvate ratio was unchanged. High energy phosphagen levels in skeletal muscle did not change. Ketamine anesthesia in the spontaneously breathing geriatric patient induces cardiovascular stimulation and metabolic changes indicative of an increased sympathetic stimulation, whereas respiration is slightly depressed. The magnitude of these changes is, however, small and it thus seems that ketamine can be safely used as the sole anesthetic agent for hip fracture surgery in the average geriatric patient.

Aged↗
PubMed1982

Survival of female geriatric patients after hip fracture surgery. A comparison of 5 anesthetic methods.

Female geriatric patients (mean age 80.9 years; n = 169) undergoing surgery for hip fracture were given epidural, neurolept analgesia, ketamine, enflurane or halothane anesthesia. The rate of survival in the different groups was studied up to 4 years after the operation and compared with the expected survival of normal groups of women with the same age distribution. Mortality at 1 month (6.5%) was equally distributed between the anesthetic methods and was not correlated to age or the type of fracture. The preoperative condition of the patient seemed to be the most important factor for survival. At 6 months, the rate of mortality was 17.2%. Together with age, the type of fracture was the most important determinant for survival. Differences in late survival between the groups were recorded, but the clinical significance of these differences is uncertain since many factors other than the anesthetic method may be more important.

Aged↗