Biomedical subjects
Publications and source records attributed to J Mortensen.
Pharmacologic stress testing with adenosine in heart transplant recipients implies a high risk of atrioventricular block. Dipyridamole is preferable as a coronary vasodilator.
The purpose of this paper is to describe the subjective results after operation for ventral hernia. Patients operated for ventral hernia in the period from January 1, 1988 to December 31, 1992 were sent a questionnaire with a response rate of 87%. Forty-five percent had lasting discomfort, 30% were absent due to illness more than eight weeks after the operation and 22% were not able to go to work. These factors increase with the number of hernia operations. Regardless of the number of operations, about 70% of the patients wanted a new operation should the hernia recur. It is therefore important to give the patient an objective and detailed information to prevent from unrealistic expectations of the results of ventral hernia operation.
Exercise ECG and myocardial single-photon emission tomography (SPET) are fundamental in the non-invasive evaluation of patients suspected of having coronary artery disease (CAD). The purpose of the present study was to investigate the influence of physiological left ventricular hypertrophy (LVH) on myocardial sestamibi SPET in healthy young and old athletes. Eighteen young male elite athletes (ten rowers, five power/weight lifters and three triathletes) and 14 well-trained elderly rowers were studied. All underwent a bicycle test as part of a 2-day sestamibi SPET protocol. Attenuation correction was not performed. The studies were evaluated visually and quantitatively analysed by the CEqual program with its reference files and with a file from a local non-athletic age-matched population. Echocardiographic LVH was an inclusion criterion in the young athletes. Exercise ECG was normal in all subjects. In at least three of the young athletes a reversible defect was observed by visual analysis. On quantitative analysis one-third of the young athletes had "significant" (>10 pixels) defects compared with both the local reference base and the CEqual reference population. Nearly all defects were found in the anterior or inferior wall. The remaining subjects, including all old rowers, had normal SPET findings. Anterior and inferior wall defects are so common in healthy athletes with physiological LVH that the specificity of myocardial SPET, in contrast to exercise ECG, seems to be too low for evaluation of chest pain in this group. The mechanism of anterior and inferior defects may be related to hot spots (papillary muscles?) in the lateral wall. The specificity of SPET is maintained in athletes without LVH.
PURPOSE: To determine whether there is increased risk associated with excimer laser surgery of primary keratoconus. SETTING: Department of Ophthalmology, County Council Hospital, Ryhov, Jönköping, Sweden. METHODS: Twenty-four eyes in 23 patients with keratoconus had photorefractive keratectomy (PRK) to reduce the steepness of the cone. A VISX Twenty-Twenty B laser (193 nm) was used for the treatments. Spherical ablations, cylindrical ablations, or both were used. Patients were followed for a mean of 22 months (range 6 to 46 months). RESULTS: Fourteen patients (58%) had improved visual acuity. Eleven (46%) could manage with only spectacles, and three (13%) were fitted with contact lenses to get adequate visual function. All treated corneas healed, and no acceleration of the keratoconus was seen. CONCLUSION: No increased risk was associated with treating primary keratoconus with excimer laser PRK. We found that excimer laser surgery can improve vision and the ability to wear contact lenses, and it did not interfere with subsequent corneal transplantation surgery.
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OBJECTIVE: To determine the types, prevalence and development of respiratory abnormalities in patients with systemic sclerosis (SSc), and to correlate the results with clinical and serological findings. METHODS: 176 patients with SSc observed longitudinally were retrospectively included in the study. The change per year of vital capacity (VC), forced expiratory volume in one second/vital capacity (FEV1/VC), diffusing capacity (DLco) and diffusing constant (Kco) of carbon monoxide from the first till the latest pulmonary function test were correlated to clinical and serological findings, including anti-centromere, anti-Scl-70, and antinucleolar antibodies. RESULTS: An isolated reduction of DLco was seen in 47% and a restrictive ventilatory pattern in 25% of the patients. Restrictive ventilatory pattern correlated to pulmonary fibrosis, dyspnoea, a low prevalence (13%) of anti-centromere antibodies and a high prevalence of anti-Scl-70 antibodies (36%). Progression of DLco reduction was related to long disease duration, presence of anti-centromere antibodies and absence of treatment with penicillamine. CONCLUSION: Pulmonary involvement is common in patients with SSc. The occurrence of different serological abnormalities in patients with restrictive disease and in patients with progressive isolated reduction of DLco, suggests that the two types of pulmonary damage may have different pathogeneses rather than being different stages in the progression of pulmonary damage.
Four hundred and four patients operated for ventral hernia during a five year period were reviewed with special emphasis on morbidity, mortality and number of days in hospital. The patients were divided into 357 patients who had been operated for ventral hernia only once (A) and 47 patients who had been operated more than once for ventral hernia (B). There were no significant differences between the two groups regarding to ages or preoperative condition. The postoperative complications were 21% in group A and 12% in group B, although this was not statistically significant. Of those who suffered a complication after the operation, 76% had a competing illness prior to the operation. The overall mortality was 0.5%. The patients were hospitalized for a total of 4846 days. In view of the results of this material and of the high recurrence rate demonstrated in the literature, a restrictive attitude towards operations for ventral hernia is recommended.
The article describes a follow-up study extending over a period of two years (1992-93) of patients admitted with a diagnosis of acute myocardial infarction to a Norwegian district hospital. The mortality was 13.8%. In Norway, treatment of acute myocardial infarction is generally standardized, with only minor variations between hospitals. This follow-up illustrates that patients with uncomplicated acute myocardial infarction who do not require emergency surgical intervention can be safely treated in a district hospital.
UNLABELLED: Gentacoll (Schering-Plough A/S, DK-3520 Farum, Denmark) implant is a biologically absorbable collagen with gentamicin, which enables local use of gentamicin in an abscess cavity. PURPOSE: To increase healing rate in treatment of perianal abscess with primary suture, the effect of intraoperative parenteral clindamycin and Gentacoll was investigated against monotherapy with intraoperative clindamycin in a randomized study. METHODS: One hundred seven patients, 55 in the Gentacoll group and 52 in the control group, were enrolled in the study and followed for three months. RESULTS: Twelve patients (22 percent) in the Gentacoll group developed a new abscess and/or fistula. In the control group nine patients (17 percent) developed a recurrent abscess or a fistula. In both groups 43 patients had an uneventful course. The differences between the two groups were not significant. Of all 107 patients, 19.5 percent had recurrent disease in the follow-up period. Duration of hospitalization and reconvalescence were identical in both groups. One case of superficial thrombophlebitis was seen after clindamycin. No other adverse effects to either Gentacoll or clindamycin were seen. CONCLUSION: The study shows that Gentacoll is a safe preparation but is without value as a supplement to clindamycin in the treatment of acute perianal abscess with primary suture. The study has documented the value of this treatment under cover with a intraoperative dose of clindamycin.
Resium, an old Spanish herb, is claimed to remove gallstone symptoms and to dissolve gallstones. Ten patients admitted for cholecystectomy because of intermittent bile cholics participated in a study for six months to evaluate the effects. None had had complications to their gallstone disease, and all had normal liver biochemistry and a normal well-functioning gallbladder before entry into the study. By ultrasonography minor changes in both directions in stone number and volume were seen. Five patients experienced some relief of symptoms, while the rest had unchanged, or worse symptoms. No adverse events to Resium were seen. In conclusion no effect of Resium upon gallstone size and volume was seen. The design of the study does not allow any conclusion about symptomatic effect to be drawn.
Thirty-four patients (23 females and 11 males) aged 13-71 years had acute appendicitis on both clinical and laparoscopic evaluation. Twenty-eight patients (82%) were treated laparoscopically whereas conversion to open appendectomy was necessary in six patients. Operation time for laparoscopic appendectomy ranged from 25-90 min. (mean 58 min.), and the patients were discharged 1-14 days after the operation (mean 2.8 days). Five patients developed complications, wound infection in one case, intraperitoneal infectious complications in three cases and postoperative fever in one case. Mean convalescence was two weeks. All patients were satisfied with the performed procedure and the cosmetic result and all were doing well one month after the operation, except for one patient who had pain in the right iliac fossa. The initial results of laparoscopic appendectomy are promising.
Thirty-two patients aged 15-89 years developed postoperative bile leakage. Twenty-eight had undergone cholecystectomy, with choledocholithotomy in 11, and four had had miscellaneous operations. Endoscopic retrograde cholangiopancreatography (ERCP) showed leakage from the cystic stump in 19 cases, from the T-tube track in five, from gallbladder and liver abscess in two and from major bile ducts in 6 cases. Major bile duct lesions were only mapped, but not managed endoscopically, whereas the remaining 26 patients were treated successfully with internal stenting (22) or endoscopic sphincterotomy (four). One patient developed cholangitis and was managed by antibiotics, no other complications were related to the procedures. ERCP procedures are effective for the most common causes of postoperative bile leakage and ought, therefore, to be the method of first choice for dealing with bile leakage.
The aim of this study was to establish reference values for mucociliary clearance and mucociliary clearance reserve capacity as determined by beta 2-adrenergic agonist-induced increase in mucociliary clearance. We studied 62 healthy females (n = 33) and males (n = 29). Their ages ranged evenly between 18 and 84 years. Fifty-three of the subjects were life-long non-smokers, while nine were ex-smokers. Multiple linear regression analyses showed that mucociliary clearance was significantly faster when the radioaerosol was deposited in the central airways than when it was deposited in the peripheral airways, and faster in life-long non-smokers than in ex-smokers. There was no influence of age, and no convincing association with sex. The variation was less within than between subjects. Mean mucociliary clearance reserve capacity was 21.3% (SD: 10.0%, P < 0.0001). The beta 2 agonist-induced increase in lung mucociliary clearance was significantly larger (P < 0.05) than the stimulation which has previously been reported in patients with asthma, bronchiectasis or cystic fibrosis. The signal-to-noise ratio of the mucociliary clearance reserve capacity in relation to measurement of baseline mucociliary clearance indicates that measurement of mucociliary clearance reserve capacity may be a more efficient means of distinguishing between "normal" and "abnormal" mucociliary clearance than single measurement of baseline mucociliary clearance.
In a prospective randomized trial the frequency of infectious complications and natural killer cell function were investigated in 197 patients undergoing elective colorectal surgery and having either no blood transfusion (n = 93), transfusion with whole blood (n = 56), or filtered blood free from leucocytes (n = 48). Postoperative infections developed in 13 patients transfused with whole blood (23%), in one patient transfused with blood free from leucocytes (2%) and in two non-transfused patients (2%) (p < 0.01). Natural killer cell function was significantly (p < 0.001) impaired up to 30 days after surgery in patients transfused with whole blood. These data provide a strong case against the use of whole blood transfusion in patients undergoing elective colorectal surgery.
STUDY OBJECTIVE: It has been suggested that the defective cyclic AMP-dependent Cl- secretion and the increased Na+ absorption from airway epithelia in cystic fibrosis (CF) may lead to dehydrated secretions and impaired mucociliary clearance. Beta 2-adrenergic agonists are unable to stimulate the Cl- transport in the airways in CF while being able to do so in normal airways. Thus, we questioned whether the beta 2-adrenergic agonist, terbutaline, would improve mucociliary clearance in patients with CF as it does in healthy subjects. DESIGN: A double-blind, randomized cross-over trial. SETTING: Whole lung and regional mucociliary clearance of a radioaerosol was measured for 3 h by gamma camera. One minute of cough clearance was measured at 3 h. Pulmonary function was measured before and after the gamma camera study. PATIENTS: Ten young patients with CF were studied; three were heterozygous for deletion of the phenylalanine at position 508 (delta F508), and seven were delta F508 homozygous. INTERVENTIONS: Inhalation of 1 mg of terbutaline (4 puffs) and placebo via a metered-dose inhaler by spacer. MEASUREMENTS AND RESULTS: The largest differences in tracheobronchial retention (percent) in the whole lung and regional lung zones were generally observed within 1 h after terbutaline and placebo treatment: whole lung (mean +/- SD), 60 +/- 22 percent and 63 +/- 20 percent; central zone, 41 +/- 19 percent and 50 +/- 25 percent; midzones, 65 +/- 27 percent and 63 +/- 19 percent; and peripheral zones, 77 +/- 28 percent and 72 +/- 28 percent, respectively [p > 0.1]. Whereas none of these differences was statistically significant, subanalyses suggested an improvement in mucociliary clearance by terbutaline in the three delta F508 heterozygous patients but not in the seven delta F508 homozygous patients. One minute of voluntary coughing resulted in clearance of less than 8 percent of the initial radioactivity, with a trend of more peripheral zone clearance after terbutaline compared with placebo. A small significant decrease in airway resistance was detected 3 h after terbutaline. CONCLUSIONS: We conclude that 1 mg of terbutaline did not improve mucociliary clearance significantly in the patients with CF. Also, the effect of terbutaline was much less than demonstrated earlier in healthy subjects. This is consistent with earlier findings of a lack of beta-adrenergic modulation of Cl- transport in CF. Thus, no rehydration of the dry mucus in CF is expected, and a possible beta 2-agonist-induced increase in ciliary beating would have only a minor effect on overall mucociliary clearance.
Eight patients aged 56-85 years were operated on as emergencies because of left sided mechanical colonic obstruction. The whole colon was mobilized, a Foley-catheter introduced into coecum preferably through the appendicular stump or alternatively a terminal ileotomy and a scavenger tube was introduced into the left colon proximal to the obstruction. By antegrade lavage with isotonic sodium chloride assisted manually colon was emptied, the pathological process resected and a primary anastomosis performed. No cases of anastomotic leakage or infectious complications occurred. One patient had to be operated on again because of a small wound dehiscence. The mean hospital stay was 13 days. The advantages of the treatment are that the patient is managed at the emergency operation, the frequency of complications is low and hospital stay short. It is therefore a good alternative to procedures involving temporary colostomy.