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Biomedical subjects

J Swedberg

Publications and source records attributed to J Swedberg.

At least 19 recordsLinked to original sources

Patient response to sigmoidoscopy recommendations via mailed reminders.

The survey reported here was undertaken to determine how many people would schedule a sigmoidoscopy after being informed by letter about the American Cancer Society's (ACS's) recommendations for colorectal screening. Letters (1,024) were sent to all patients aged over 50 years who were registered in a community-based family practice residency program. Four hundred twenty-nine responded. Of those who responded, 16.8 percent indicated interest in a rectal examination, 21 percent were interested in testing their stool for occult blood, 13.1 percent desired a sigmoidoscopy, and 11.7 percent indicated that they had previously had a sigmoidoscopy. The following reasons were given by responders who were not interested in sigmoidoscopy: 42 percent felt good and did not perceive a need, 31 percent were concerned about cost, 12.1 percent were concerned about discomfort, and 8.6 percent stated fear as a reason for their response. Of the 56 patients who indicated interest in a sigmoidoscopy, 10 patients had the procedure done (flexible 60-cm sigmoidoscope). Although the ACS recommends that everyone aged over 50 years have a sigmoidoscopy, few patients in this population who responded have had the procedure done. Encouragement and education for patients in colorectal screening, however, is worthwhile. Two colorectal carcinomas were detected as a result of this survey.

Ambulatory Care Facilities

Wound botulism.

Explore the source record for details and available documents.

Adult

Neonatal sepsis.

Neonates are susceptible to infection since several elements of the immune system are deficient. At present, the most common pathogens are Group B streptococci and Escherichia coli. Prolonged rupture of membranes with amnionitis is a high-risk setting. Clinical signs suggesting neonatal sepsis include respiratory distress, poor feeding, hypothermia, seizures and hypotonia. After the sepsis work-up is completed, the initial choice of antibiotics is based on the prevailing organisms and antibiotic sensitivities within the community.

Anti-Bacterial Agents

The maximum exercise stress test: is it a behavior-modification tool?

The controlled study presented demonstrates the results obtained when using the maximum exercise stress test (MEST) as a behavior-modification tool for coronary artery disease risk factors. Changes in attitudes, behaviors, and objective measurements of health were assessed in a low-risk population. Only exercise level was significantly altered (P less than .03). Changes in the other measured parameters were insignificant. The MEST test is also expensive, and no benefit has been demonstrated in terms of its ability to decrease the morbidity and mortality seen in coronary artery disease.

Adult

Oral rehydration therapy in diarrhea. Not just for Third World children.

Oral rehydration therapy is an effective, practical, and economical means of treatment for dehydration secondary to diarrhea. The regimen can be used on an outpatient basis with a substantial reduction in both cost and hospital-induced anxiety. It is not necessary to discontinue breast-feeding infants with diarrhea, and early feeding does not prolong the diarrheal illness.

Administration, Oral

Immunization update.

Passive immunization is available against rabies, varicella, tetanus and hepatitis A and B. Active immunization is, in general, more efficacious with live attenuated viruses than with many of the bacterial vaccines. Toxoids, too, are very effective immunizing agents. Immunization usually starts at two months of age with DTP and oral poliovirus vaccine. For patients at high risk for secondary complications, influenza and pneumococcal immunizations are advisable. Hepatitis B vaccine is now available for persons at high risk because of their occupations.

Age Factors

Hemorrhagic shock.

Shock is a consequence of insufficient blood flow for adequate oxygenation at the cellular level. Early recognition of the signs permits prompt therapy to maintain the effective circulating volume before irreparable organ damage occurs. Classification of shock on the basis of percentage of blood loss is helpful in guiding initial management. Replacement of red blood cells may be required for acute blood loss of more than 25 percent of the patient's circulating volume. Adequate arterial PO2 is essential for maintaining cellular oxygenation.

Blood Circulation

Our experience with the Carpentier-Edwards bioprosthesis.

Sixty Carpentier-Edwards porcine valve bioprostheses stabilized with glutaraldehyde were implanted in 55 patients with acquired and congenital heart disease. The follow-up period ranged between 1 and 12 months. There were 3 hospital deaths (5%) and 2 late deaths (4%) in 24 mitral, 24 aortic, 5 mitral-aortic, 1 tricuspid and 1 pulmonary valve replacements. All patients were anticoagulated from the second postoperative day onwards for a period of 3 months after which those with sinus rhythm had their anticoagulants withdrawn. Paravalvular leakage led to re-operation in 3 cases (4%). No valve failure due to cusp rupture was encountered and no thromboembolic complications have occurred. Thirty-three patients were studied postoperatively by non-invasive methods and the results are presented.

Adolescent

Congenital aortic stenosis. A retrospective study on 32 operated patients.

The magnitude of the peak systolic pressure gradient (PSPG) over the aortic valve was often determining factor when deciding for or against operation of the congenital aortic stenosis. The impression that PSPG alone was an inadequate parameter for assessment of the degree of stenosis was supported by the present retrospective analysis of 32 patients operated upon for this anomaly. A gradient of 75 mmHg or more indicates a tight stenosis but a lower value does not exclude a pronounced constriction of the orifice, any more than does absence of symptoms or signs of left ventricular hypertrophy (LVH) on the ECG. It is probably not only the size of the stenotic orifice that determines the prognosis in aortic stenosis but also other factors, e.g. function of the left ventricular myocardium. A hypothesis was put forward by one of us (M. V.) that the location of the valvular ostium, central or peripheral, can be of importance and that turbulence-induced vibrations of the left ventricular wall may depress the myocardium. Differences in the pathoanatomy of the stenotic aortic valves did not explain the poor correlation between e.g. symptoms or LVH and PSPG or the size of the remaining orifice in the present study.

Adolescent

Present indications for a myocardial pacemaker electrode.

A myocardial electrode was implanted in 43 patients on special indications at a pacemaker centre, where the transvenous technique was used as the routine method for implantation of a stimulating electrode. The electrode was inserted through a small anterior thoracotomy or at open-heart surgery. The complications and deaths during the follow-up period of two-and-a-half years are reported. The results to date are quite satisfactory. Indications are suggested and the main advantages of a myocardial electrode in clinical use are discussed. The Medtronic myocardial electrode model 6917 should be resorted to as a very good alternative on failure of pacing with an endocardial lead. The hazards of thoracotomy must, however, be borne in mind. This approach should be used with restraint in very old patients and in patients with severe heart disease, particularly those with a recent myocardial infarction.

Adolescent

Human wakefulness and biological rhythms after birth.

Both a sleep-wakefulness cycle and a basic rest-activity cycle were observed in 20 normal infants left undisturbed for ten hours following birth. Behavioral wakefulness occurred immediately following delivery and in between sleep periods despite the lack of feeding and other intervention. Medication given to mothers during labor resulted in decreased amounts of infant wakefulness and increased amounts of quiet (non rapid eye movement) sleep.

Animals