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Biomedical subjects

L E Ivarsson

Publications and source records attributed to L E Ivarsson.

9 recordsLinked to original sources
PubMed1999

[Necrotising fasciitis--a surgical challenge].

Necrotizing fasciitis is a severe, potentially fatal, soft tissue infection. Group A streptococci are the main infectious agents. Early surgical treatment is decisive for the outcome. This report includes 20 patients treated consecutively during a four and a half year period, ten women and ten men, 28 to 78 years of age. Condition at admission to hospital, time from symptom appearance to operation, treatment and results are described. All patients had signs of local infection with rubor and swellings. Severe localized pain was typical. Surgical diagnostic exploration confirmed the diagnosis and led to prompt surgical debridement of all affected tissues. Three patients died, 12 survived without severe sequela and five survived with amputated leg or arm. Necrotizing fasciitis has changed from being a rare disease primarily affecting immunocompromised patients to occurring more frequently also among otherwise healthy individuals. By diseases with local soft tissue infection a liberal use of surgical exploration leads to diagnosis. Increased knowledge of the disease and adherence to a treatment protocol based on antibiotic therapy and mandatory aggressive surgery has probably improved the results with no case fatality in the latter half of the study period.

Adult↗
PubMed1988

Assessment of gastric blood flow with laser Doppler flowmetry.

The use of laser Doppler flowmetry (LDF) to measure gastric blood flow was evaluated in the cat and man. The reproducibility of laser Doppler flowmetry recordings was studied in the feline stomach. In five cats flowmeter signals and venous outflow of the stomach were simultaneously recorded. The flowmeter recordings were made during operation and gastroscopy in 140 patients by means of two different (PF1-4-kHz and PF2-12-kHz) laser Doppler systems. The flowmeter recordings were highly reproducible during the cat experiments, with a coefficient of variation varying between 4% and 13%. Angulation of the probe within 60-120 degrees against the tissue under study did not affect the flowmeter signal. Pressure of the probe against the studied tissue attenuated the flowmeter signal 42 +/- 13% (n = 10). A significant correlation coefficient (r = 0.76; p = 0.01; n = 30) was obtained between flowmeter signal and venous outflow of the stomach. In man the PF2-12-kHz system yielded a higher flowmeter signal (14.5 +/- 6.9 V; 32 patients) than the PF1-4-kHz system (7.9 +/- 2.5 V; 108 patients). Flow dimensions were calculated by using results previously obtained in the intestines. The estimated blood flow values amounted to 31 +/- 10 and 57 +/- 27 ml min-1 100 g-1 for the PF1-4-kHz and PF2-12-kHz systems, respectively. In conclusion, laser Doppler flowmeter is a promising technique for studying gastric perfusion during operation and endoscopy. Motion artifacts are the major drawback of the present laser Doppler systems.

Adult↗
PubMed1984

Treatment of acute massive gastroduodenal haemorrhage with cimetidine in elderly patients.

Ninety-two patients over the age of 60 with acute upper GI-haemorrhage were included in a prospective randomized doubleblind three-centre study of the effect of a five day treatment with cimetidine. Twenty patients had to be excluded because of different reasons. The remaining 72 patients bled from either erosive gastritis, gastric ulcer or duodenal ulcer. Thirty-two patients received cimetidine and 39 placebo. There was no difference in the number of transfusions, rebleedings or operative interventions. Mortality was 1/33 (3%) in the cimetidine group compared to 5/39 (13%) in the placebo group (NS). In the gastric ulcer group there was no mortality among 10 cimetidine patients compared to a mortality of 4 of 12 (33%) patients receiving placebo (p less than 0.05). It is concluded with caution that cimetidine might be effective in haemorrhage from gastric ulcer in patients 60 years and older. For convincing conclusions a larger study of patients with bleeding ulcers is desirable.

Acute Disease↗
PubMed1984

Intraoperative measurements of gastric blood flow in man: effects on blood flow of acid secretory stimulation and inhibition.

Gastric blood flow in man can be measured with an isotope washout technique, utilizing 85Krypton . Measurements are performed intraoperatively, during general anesthesia, after intraarterial injections of the tracer into the stomach wall. Both total blood flow to the stomach and the flow distribution to the separate wall layers can be estimated. The antrum and the body of the stomach can be studied separately. Repeat measurements are possible, enabling the blood flow to be studied both at rest and/or after induction or inhibition of acid secretion.

Duodenal Ulcer↗
PubMed1982

Gastric blood flow and distribution in anesthetized cat and man as studied by an inert gas elimination method.

Gastric blood flow and its intramural distribution were studied in anesthetized cat and man by recording the elimination of intra-arterially injected krypton-85. The elimination was monitored with two external detectors--a scintillation detector recording the disappearance of gamma-activity from the entire gastric wall and a G-M tube recording the disappearance of beta-activity from the muscle layer only. Total and muscle layer blood flow could be calculated from the washout curves, and, knowing these variables, the blood flow to the mucosa-submucosa could be indirectly calculated. Gastric blood flow in the cat and man closely resembled each other, both in magnitude and distribution. Total blood flow in man 'at rest' was 12 +/- 4 ml/min and 100 g tissue (mean +/- S.D.; no. = 20), muscle blood flow amounting to 7 +/- 3 and mucosa-submucosa flow to 16 +/- 8 ml/min and 100 g muscle and mucosa-submucosa tissue, respectively. The distribution to the muscle layer was 26 +/- 14% and to the mucosa-submucosa 74 +/- 14% of total gastric blood flow.

Anesthesia, General↗
PubMed1982

Gastric blood flow and distribution: the effect of pentagastrin in anesthetized cat and man as studied by an inert gas elimination method.

Using a krypton-85 elimination method previously described, the effect of pentagastrin on gastric blood flow has been studied in 28 anesthetized patients, 12 control patients, and 16 patients with duodenal ulcer disease. Both in control and duodenal ulcer patients a significant increase in total blood flow was found, reflecting an increase of flow in the mucosa-submucosa layer of the corpus. In normal subjects a 5-fold increase in flow was found in this tissue layer, whereas the corresponding increase in duodenal ulcer patients was 12-fold. Concomitantly, a significant decrease of flow distribution to the muscle layer was seen. In the antrum pentagastrin did not cause any significant changes in either mucosa-submucosa or muscle layer blood flow. No qualitative differences in the response to pentagastrin, with regard to the gastric blood flow, was found between normal subjects and duodenal ulcer patients.

Adult↗
PubMed1977

Single-dose antibiotic prophylaxis in appendectomy.

Prophylactic antibiotics will reduce the number of wound infections after so-called clean-contaminated gastrointestinal operations. The prophylactic regimen must be designed with the pharmacokinetical properties of the used drug, in mind. A safe and simple, easily standardized procedure, applicable in both elective and acute clinical situations is preferable. A single-dose regimen with prophylactic cephaloridine has been tried and evaluated.

Appendectomy↗