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Biomedical subjects

L Boman

Publications and source records attributed to L Boman.

9 recordsLinked to original sources
PubMed1999

Two models of care as evaluated by a group of women operated on for breast cancer with regard to their perceived well-being.

The main aim of this study was to evaluate two different models of care for breast cancer patients with regard to the patients' perceived well-being. Twenty-nine patients were treated in an established care model and 115 patients were treated at a surgical breast clinic with an increased personnel continuity and a short hospital stay. Two questionnaires were used. The Sense of Coherence (SOC) Scale and a study-specific questionnaire concerning perceptions of the hospital stay, information received, body image, social support, pain, health and psycho-sociological well-being. Regression analyses were used to study the effects of the care models and the SOC on the patients' perceived well-being. The results showed that the care model with high personnel continuity had a significant positive effect on the patients' emotional state, mental well-being and perception of postoperative pain evaluated 1 year after surgery. The strongest predictors of the patients' well-being postoperatively were their perceived well-being before surgery. Furthermore, the stronger the SOC the more positive were the patients' emotional perceptions, perceived general health and mental well-being after surgery. The duration of the hospital stay did not show any effect on the patients' well-being. It is concluded that an early preoperative psycho-social assessment of the patients is of importance in planning the care, to help patients cope with the disease and its treatment. It is suggested that a care model with high personnel continuity for breast cancer patients could facilitate that assessment.

Adult↗
PubMed1998

Biliary-intestinal bypass in the treatment of obesity: long term follow up.

OBJECTIVE: To evaluate the long term outcome after biliary-intestinal bypass for morbid obesity. DESIGN: Retrospective study. SETTING: County hospital, Sweden. SUBJECTS: 120 consecutive patients operated on between 1977 and 1990. INTERVENTIONS: A variation of jejunoileal bypass in which the excluded bowel was anastomosed to the gallbladder. MAIN OUTCOME MEASURES: Weight, concentrations of blood lipids and glucose in blood, results of liver function tests, reversal rates, and complications. RESULTS: The mean body mass index was reduced by 39% (from 42 kg/m2 to 26 kg/m2), serum cholesterol and triglyceride concentrations by more than 30%, and fasting blood glucose concentrations by 1 1%. There were no cases of irreversible hepatic failure, diabetes, deaths related to the operation, or progressive renal failure. The incidence of renal calculi increased by a ratio 2.3. The reversal rate/year was 2% (n = 20). CONCLUSION: We conclude that biliary-intestinal bypass may be used to treat cases of obesity associated with seriously high blood lipid concentrations and where gastric restrictive operations are less suitable.

Adult↗
PubMed1998

Do arthralgias occur after bilio-intestinal bypass for morbid obesity.

BACKGROUND: Intestinal bypass operations are used occasionally for treating morbid obesity if other methods are unsuitable. Jejuno-ileal bypass (JIB) operations are considered to be a cause of occasional joint pain related disorders. However, bilio-intestinal bypass (BIB) is intended to avoid the blind loop syndrome. This study compared joint pain disorders in an operated BIB group, an obese nonoperated control group, and a lean reference group. METHODS: Using a questionnaire in a cross-sectional study, pain disorders were investigated in age-, sex- and weight-matched groups of operated, obese and lean subjects. The operated group had previously had a BIB and was matched using the preoperative BMI (body mass index, kg/m2). RESULTS: Mean time since operation was 12.4 years (SD 3.4) and the BIB group had lost 15.2 kg/m2 compared with the obese control group. These two groups had a high frequency of pain disorders of similar distribution, differing significantly from the lean reference group. No evidence of major differences in the type of pain disorders could be seen in the two groups. CONCLUSION: Pain disorder was an integral part of an obese syndrome, and was not affected significantly by weight reduction after BIB. The study appears to support the view that approximately 4% of patients develop arthritis vasculitis syndrome after BIB.

Adult↗
PubMed1997

Needs as expressed by women after breast cancer surgery in the setting of a short hospital stay.

The aim of this study was to describe needs as expressed by a group of women after surgery for breast cancer in the setting of a short hospital stay. Ten days after surgery, 97 women answered an open-ended question about their perception of the care given. A content analysis inspired by the method of Grounded Theory was used. Satisfaction with the personal treatment and feelings of abandonment were identified as the two main themes. Expressed needs (n = 113) were classified in five categories: Trust, Information, Practical Assistance, Personal Treatment and Emotional Support, of which Trust appeared to be the core concept. In addition, time and space emerged as two dimensions that were interwoven with the categories of needs. The patients' perception of trust in the staff was interpreted as depending on whether the needs in the other categories were satisfied or not. It is hypothesized that, to fulfil the patients' need of trust, the patients have to be satisfied at least with information, practical assistance, personal treatment and emotional support. We consider that, in an organization with a high degree of continuity, when the patients are aware of the physician and nurse responsible, the possibilities for trust are increased, especially in short hospital stays.

Adult↗
PubMed1997

Lipoprotein A levels after intestinal bypass operation for morbid obesity.

BACKGROUND: Serum Lipoprotein A [Lp(a)] is considered an independent risk factor for cardiovascular disease. Reduction of other risk factors such as serum triglycerides and serum cholesterol is seen after weight reduction but it has been difficult to demonstrate a similar reduction of Lp(a). In this study Lp(a) is studied following weight reduction after intestinal bypass surgery for obesity. METHODS: A cross-sectional study was performed in which Lp(a) levels were compared between patients operated with intestinal bypass surgery for obesity (bilio-intestinal bypass) and a closely matched control group. The controls were chosen so as to correspond to the operated patients' preoperative body mass indices. RESULTS: The operated group had reduced their body mass index from a mean of 42 kg/m2 to a mean of 29 kg/m2 and had a significantly lower mean serum Lp(a) level (113 mg/l, SEM 34) than controls (207 mg/l, SEM 37), p < 0.05. CONCLUSION: Lowered Lp(a) levels are correlated to substantial weight loss following intestinal bypass surgery for obesity.

Adult↗
PubMed1993

Effects of early discharge from hospital after surgery for primary breast cancer.

OBJECTIVE: To evaluate the effects of early discharge from hospital on women being operated on for primary breast cancer. DESIGN: Open study in self-selected patients. SETTING: Karolinska and Sabbatsberg Hospitals, Stockholm. SUBJECTS: 169 consecutive patients operated on for primary breast cancer. MAIN OUTCOME MEASURES: All patients were asked to fill in a questionnaire about their perception of their disease and factors associated with the operation. RESULTS: 118/169 patients participated, and of these 28 (24%) chose early discharge with the drain still in place. They were compared with the 90 patients (76%) who were discharged without a drain. The median stay in hospital for those who chose early discharge was 2 days, and for those who remained in hospital until the drain was removed, 6 days. There were no differences between the groups in type or incidence of complications, and the groups were equally satisfied with their length of hospital stay and their treatment in hospital. Those who opted for early discharge were significantly younger than those who did not (mean SD) 52 (14) compared with 62 (13) years, p = 0.001). CONCLUSION: Early discharge from hospital with the drain still in place after operation for primary breast cancer was not found to be associated with any untoward events.

Age Factors↗
PubMed1987

Iliocaval compression syndrome.

Iliocaval compression syndrome is a significant disorder in a number of patients who have lower extremity venous complaints. The diagnosis may be suspected by positive findings on exercise strain gauge venous plethysmography and unilaterally increased ambulatory venous pressures. The diagnosis is confirmed by ascending and, in some instances, descending venography which demonstrates the iliocaval compression with or without intraluminal web formation. Transstenosis pressure gradients may be measured to confirm the hemodynamic significance of the lesion. We advocate direct operative repair of the iliocaval junction with rerouting of the iliac artery and excision of the iliocaval webs with cephalic vein patch angioplasty. It provided good results in the present study when coupled with an adjunctive regimen of perioperative subcutaneous heparin and warfarin. Further investigation into the exact prevalence and significance of the iliocaval compression syndrome is needed. Only an aggressive approach to patients with lower extremity venous complaints will help clarify the exact prevalence and natural history of this disorder.

Adult↗
PubMed1978

On the kinetics of the reaction between human antiplasmin and a low-molecular-weight form of plasmin.

The reaction between antiplasmin (A) and a low-molecular-weight form of plasmin (P) proceeds in at least two steps: a fast reversible second-order reaction followed by a slower irreversible first-order transition, and may be represented by: P +A k1 in equilibrium k-1 PA k2 leads to PA'. The low-Mr plasmin, which is obtained by limited elastase digestion, is composed of an intact B chain and a small A chain lacking the lysine-binding sites. The k1 of the reaction is (6.5 +/- 0.5) x 10(5) M-1 s-1 which is 30--60 times smaller than that for normal plasmin and antiplasmin. The dissociation constant of the first step is 1.9 x 10(-9) M which is 10 times higher than for normal plasmin and antiplasmin. The rate constant of the second step is (4.2 +/- 0.2) x 10(-3) s-1 for both normal and low-Mr plasmin. Low Mr plasmin which has substrate bound to its active site does not react or reacts only very slowly with antiplasmin. The reaction rate, however, is only slightly influenced by 6-aminohexanoic acid in concentrations up to 1 mM which decrease the reaction rate of normal plasmin approximately 50-fold. The findings further indicate that the lysine-binding site(s) of plasmin are of great importance for the rate of its reaction with antiplasmin.

Binding Sites↗