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Biomedical subjects

L Nordström

Publications and source records attributed to L Nordström.

At least 19 recordsLinked to original sources
PubMed2005

Indications associated with increased cesarean section rates in a Swedish hospital.

OBJECTIVE: To analyze the indications and Robson classes associated with the rapid increase in cesarean section (CS) rates at Söder Hospital, Stockholm, Sweden, in the late 1990s. METHOD: Records of women who underwent CSs in 1994 and 1999 at Söder Hospital were retrospectively reviewed. Diagnostic frequency and Robson class, which takes into account characteristics such as parity, previous deliveries, prematurity, and fetal presentation, were compared for the 2 years. RESULTS: Suspected fetal distress (+1.6%; P = .0001), maternal request (+1.5%; P < .0001), and labor dystocia (+0.8%; P = .03) were associated with the increase in CS rates. The rate of CSs with cephalic presentation and spontaneous onset of labor at term, as well as the rate of CSs following induced labor or elective CSs, increases significantly in both nulliparas and multiparas (Robson classes 1-4) (P < .02). CONCLUSION: The increasing CS rate was due to maternal preference and lower thresholds of decision for physicians.

Cesarean Section↗
PubMed2004

On the sharpness of the interfaces in metallic multilayers.

We show that the three most relevant magnetic properties (magnetic moment, critical temperature, and interlayer exchange coupling) of metallic multilayers can be reproduced with good accuracy by first principles theory, provided that the picture of atomically sharp interfaces is abandoned and one allows instead for both interface alloying and interface roughness. The interface of a metallic multilayer (exemplified by the Fe/V system) is demonstrated to, at best, have interdiffusion essentially over two to three atomic layers on each side of the interface. Our conclusions are the result of combining experimental work with theoretical modeling, and we argue that this approach is the best avenue to obtain accurate information about the interface quality of metallic multilayers.

Journal Article↗
PubMed2003

Origin of magnetic anisotropy of Gd metal.

Using first-principles theory, we have calculated the energy of Gd as a function of spin direction, theta, between the c and a axes and found good agreement with experiment for both the total magnetic anisotropy energy and its angular dependence. The calculated low temperature direction of the magnetic moment lies at an angle of 20 degrees to the c axis. The calculated magnetic anisotropy energy of Gd metal is due to a unique mechanism involving a contribution of 7.5 microeV from the classical dipole-dipole interaction between spins plus a contribution of 16 microeV due to the spin-orbit interaction of the conduction electrons. The 4f spin polarizes the conduction electrons via exchange interaction, which transfers the magnetic anisotropy of the conduction electrons to the 4f spin.

Journal Article↗
PubMed2001

Warm tub bathing during labor: maternal and neonatal effects.

AIM: To study possible detrimental maternal and neonatal effects of immersion in warm water during labor. DESIGN: Prospective randomized controlled bathing during first stage of labor vs no bathing. SETTING: Obstetrical departments at a university hospital and two central hospitals. PRIMARY END-POINT: Referral of newborns to NICU. MATERIAL AND METHODS: Randomization took place by means of sealed opaque envelopes at each delivery unit. Preconditions for participation in the study were: singleton parturient wishing to bathe, a gestational duration of at least 35 weeks+0 days, a planned vaginal delivery, normal admission test, regular contractions and cervix dilated to at least 3-4 cm. Parturients randomized to the 'no bath' control group were allowed to use a shower. Rupture of the membranes was not a contra-indication to participation. Those excluded from randomization were women with intra-uterine growth retardation, meconium-stained amniotic fluid, or in the event that the tub was occupied by another randomized parturient. MAIN RESULTS: On average, parturients stayed in the tub for 50-60 min. No significant difference was seen regarding the referral rate to NICU among 612 cases vs 625 controls, OR 0.8; 95% CL 0.2, 3.1. The OR for epidural analgesia was 1.0; 95% CL 0.8, 1.3. Nor was any significant difference seen in the rate of perineal tear grade III-IV (OR 1.3), instrumental delivery (OR 1.1), cesarean section (OR 1.8), or maternal post partum stay on the ward. During the neonatal period, no significant difference was seen in the number of newborns with Apgar <7 at 5 min (4 vs 5), neonatal distress (OR 2.2) or tachypnéa (OR 1.0). CONCLUSION: In the present study no negative effects of bathing during labor could be discerned. The results indicate that expectant mothers wishing to bathe during labor may do so without jeopardizing their own, or their newborns' wellbeing after birth.

Adult↗
PubMed2001

Efficacy of epoetin beta on hemoglobin, quality of life, and transfusion needs in patients with anemia due to hormone-refractory prostate cancer--a randomized study.

OBJECTIVE: Erythropoietin is shown to be an effective treatment for anemia in various types of cancers, however only limited studies have evaluated its benefits in advanced hormone-refractory prostate cancer (HRPC). This multi-center study investigated the influence of 2 different doses of epoetin beta on quality of life, hemoglobin level, need for blood transfusion, and safety, in the treatment of anemia in patients with metastatic HRPC. MATERIALS AND METHODS: This study randomized 180 patients to receive either epoetin beta 1000 IU or 5000 IU subcutaneously 3 times per week for 12 weeks. Hemoglobin was evaluated at study start and 6 time-points during the study. Quality of life (QoL) was assessed by the European Organization for Research and Treatment of Cancer questionnaire, QLC-C30, before treatment start and after 6 and 12 weeks of treatment. Best supportive care and blood transfusions were given, if clinically indicated. Additional laboratory values and adverse events were followed for safety. RESULTS: Hemoglobin increased significantly (>20 g/l) in 43% in the high dose (HD) group and 25% in the low dose (LD) group in response to treatment. Levels were significantly higher in the HD group than the LD group (p < 0.001) after 8 and 12 weeks. QoL improved significantly if the increase in hemoglobin was >20 g/l. Significantly more patients in the LD group received blood transfusions than the HD group (p < 0.005). There were no differences between the groups regarding overall quality of life and fatigue. The treatment was well tolerated in both groups. CONCLUSIONS: Epoetin beta is shown to be safe and effective for the treatment of anemia in many patients with HRPC. It is found to improve QoL and physical functioning, and relieve fatigue symptoms, in many of these critically ill patients.

Aged↗
PubMed2001

Lactate measurements in scalp and cord arterial blood.

Lactate has been measured to evaluate fetal metabolic acidosis for some decades. However, not until the past few years have reliable lactate meters become available for bedside obstetric practice. The new technology, which requires only 5 microl blood, has reduced the sampling failure rate of fetal scalp blood to almost nil. A growing body of evidence has also shown lactate to be good at predicting neonatal outcome.

Acid-Base Imbalance↗
PubMed2001

Fetal and maternal lactate increase during active second stage of labour.

OBJECTIVE: To determine longitudinally fetal and maternal blood lactate concentrations during the second stage of labour. DESIGN: Prospective, observational study of randomly selected labours. SETTING: Labour ward, Sultanah Aminah General Hospital, Johore Bahru, Malaysia. MAIN OUTCOME MEASURES: Fetal scalp and maternal venous blood lactate, umbilical arterial and vein lactate and acid-base balance at delivery. RESULTS: Sixty-nine women and their infants were monitored in the second stage of labour. Mean maternal venous lactate by the end of the first stage was 2.6 +/- 1.0 (+/- S.D.) mmol/L and increased to 3.6 +/- 1.4, 4.2 +/- 1.7. 4.8 +/- 1.6, 5.4 +/- 2.1 and 4.3 +/- 0.9 mmol/L, respectively, for every 15 minute of bearing down. Corresponding values for fetal scalp blood lactate were 2.4 +/- 1.1, 3.1 +/- 1.6, 3.2 +/- 1.8, 4.2 +/- 2.4, 4.9 +/- 2.8 and 5.8 +/- 1.9 mmol/L. The mean slope of maternal lactate increase was 0.070 mmol/L per minute (95% CI 0.050, 0.090) and for fetal lactate increase 0.032 mmol/L per minute (95% C.I.: 0.018, 0.045). The duration of active second stage was significantly associated with fetal lactate (P < 0.001) and maternal lactate (P = 0.03) at the time of crowning of the fetal head, and lactate in umbilical arterial and vein blood at delivery (P < 0.001). Expulsion time > or = 45 minutes, compared with shorter active second stage, and acidaemia at birth implied larger arterial-venous lactate differences (P < 0.001). Fetal lactate at crowning was also significantly associated with the umbilical arterial-veonus lactate difference (P = 0.03). CONCLUSIONS: Maternal and fetal lactate concentrations increase significantly with duration of the active second stage of labour, more rapidly in the mother. It is likely that fetal anaerobic metabolism is the main source for the fetal lactate increase.

Adult↗
PubMed2001

Preoperative treatment of anemic women with epoetin beta.

AIM: To compare the effects of preoperative treatment with recombinant human erythropoietin (EPO) and iron with iron only on hemoglobin levels (Hb) in anemic women prior to hysterectomy. METHODS: The study was an open-labelled randomized parallel study. Fifteen women scheduled for hysterectomy due to uterine myoma were given oral iron and EPO (NeoRecormon) 4 weeks prior to surgery (group I) and 16 women were given oral iron only (group II). RESULTS: Group I showed a significantly greater increase in mean Hb during the pre-surgery study period compared with group II (p=0.007). Two weeks postoperatively, however, there was no significant difference in mean Hb between the two groups. CONCLUSION: We found that a significantly greater increase in Hb was achieved with iron in combination with EPO, although in most cases iron only seemed to be as efficacious as iron+EPO in correcting anemia in myoma patients pre-operatively.

Administration, Oral↗
PubMed2000

Intrapartum tocolysis has no effect on fetal lactate concentration.

OBJECTIVE: To assess the fetal metabolic effects of intrapartum maternal tocolysis with terbutaline in the presence of fetal heart rate abnormalities, with a special emphasis on lactate concentration, in view of its potential use as a marker of fetal condition. DESIGN: Descriptive study. SETTING: Two labour wards, National University Hospital, Singapore, and Ostersund Hospital, Sweden. METHODS: Eight parturients with abnormal intrapartum fetal heart rate recordings were given bolus i.v. injection of 0.25 mg terbutaline and monitored both before and 20 minutes after treatment. RESULTS: Maternal venous glucose increased from 5.0 (0.9) (mean (SD)) to 5.6 (1.2) mmol/l (p=0.002) and fetal scalp blood glucose rose from 4.1 (1.8) to 4.7 (1.4) mmol/l (p=0.009) 20 minutes after the injection. No significant change was found in maternal or fetal lactate concentrations. CONCLUSION: Terbutaline tocolysis for "intrauterine resuscitation" does not affect fetal lactate concentration 20 minutes after treatment.

Acid-Base Equilibrium↗
PubMed2000

Accidental falls and related fractures in 65-74 year olds: a retrospective study of 332 patients.

We investigated, by studying medical records, background factors and consequences of accidental falls of patients 65-74 years who attended the Department of Orthopedics' emergency clinic in Lund. We also assessed possible prevention measures. Fractures occurred in three quarters of the registered falls. Women were more prone to sustain fractures than men. Forearm fractures were commonest among women while hip fractures were commonest among men. One third of the patients were admitted to an orthopedic ward because of the fall. The patients who were less healthy had sustained fractures oftener and also needed more hospital care. Information regarding risk factors for falls and fractures were often missing in the patients' medical records. Impaired walking and balance, and medication increased the risk of falls. Such patients constitute a high risk group for future falls and fractures. A newly developed instrument is suggested as a routine in the emergency department to increase the awareness of risk factors for falls in the elderly. Satisfactory documentation is a prerequisite for further treatment and referrals to prevent falls and fractures.

Accidental Falls↗
PubMed1999

Umbilical artery blood gas and lactate in healthy newborns.

This study aimed to establish the normal range of umbilical artery pH, pCO2, base deficit and lactate in normal term and preterm newborn. Umbilical artery pH, pCO2, base deficit and lactate was measured in 637 newborn babies. The study included 555 babies at term with Apgar score equal to or more than 7 at 5 minutes, not requiring assisted ventilation and not admitted to the neonatal unit (NNU), as well as 47 preterm babies with Apgar score equal to or more than 7 at 5 minutes who were admitted to the NNU for observation only because of prematurity. Data was presented as mean and SD. Statistical analysis was done by t-test and simple linear regression analysis. In the newborn at term mean umbilical artery blood gas and lactate were as follows; pH = 7.25 (+/- 0.08), pCO2 = 45.66 (+/- 1.88) mmHg, base deficit = 7.69 (+/- 3.88) mEq/L, lactate = 2.96 (+/- 1.8) mMol/L. In preterm newborn the values were; pH = 7.25 (+/- 0.04), pCO2 = 51.78 (+/- 13.00) mmHg, base deficit = 5.29 (+/- 1.87) mEq/L, lactate = 2.55 (+/- 1.87) mMol/L. The range of umbilical artery blood gas and lactate parameters in term and preterm fetuses with good neonatal outcome were derived. There was a statistically significant difference in pCO2 and base deficit between term and preterm newborn. There was no linear correlation between lactate, pH, pCO2, base deficit and fetal glucose respectively in term or preterm infants.

Acid-Base Equilibrium↗
PubMed1998

Lactate, lactate/pyruvate ratio and catecholamine interrelations in cord blood at delivery in complicated pregnancies.

The interrelationships between lactate, lactate/pyruvate (L/P) ratio and catecholamines (CA) in cord artery and vein blood were studied in 56 pregnancies who had complications in the antenatal period or during labour. This group of babies had higher CA levels and were more acidaemic than fetuses after normal pregnancies and labour. There were stronger correlations between lactate and noradrenaline (NA) (R = 0.56, P < 0.001), adrenaline (A) (R = 0.41, P = 0.002) and dopamine (DA) (R = 0.42, P = 0.001) in cord artery blood, than previously reported for normal deliveries. Correlations between L/P ratio and CAs were also significant, although weaker. Multiple regression analysis, using cord artery lactate as the dependent variable, revealed significant correlations for pH (P = 0.01) and pyruvate (P < 0.001) but not for the CAs. The subgroups with high lactate (> 75th centile) had significantly higher NA (P = 0.007) and DA (P < 0.001) in cord artery and NA (P < 0.001) and A (P < 0.001) in cord vein blood, as compared with the subgroup who had lower lactate concentrations. We conclude that fetal hypoxia induces fetal CA production as well as anaerobic metabolism with lactate production. However, the adrenergic stimulation seems not to contribute significantly to the fetal lactate production.

Asphyxia Neonatorum↗
PubMed1998

[Parturients are under-treated. Only 21 out of 55 clinics administer oxytocics routinely during the third stage of labor].

A questionnaire answered by all 55 Swedish labour wards in 1995 showed oxytocic treatment to be given routinely to all parturients during the third stage of labour at only 38% (21/55) of the units, and that five of these 21 units were considering cessation of the practice. At a further 25 units the treatment was given routinely only in selected risk cases, the most common risk factors being a history of postpartum haemorrhage (a criterion at 20 units), multiple pregnancy (14 units), prolonged labour (12 units), and a large baby (8 units). Of the remaining nine units, where oxytocic treatment was given only on clinical indications (i.e., postpartum haemorrhage), two were considering the introduction of routine treatment. In view of results obtained in a recent randomised, placebo controlled Swedish study, the authors of the article conclude that, if clinical practice in this respect has remained unchanged since the questionnaire study was performed, Swedish parturients are undertreated with oxytocics during the third stage of labour.

Female↗
PubMed1998

Lactate and acid-base balance at delivery in relation to cardiotocography and T/QRS ratios in the second stage of labour.

OBJECTIVE: To compare foetal electrocardiogram (T/QRS ratio) and cardiotocography (CTG) during the second stage of labour with lactate and acid-base balance in cord artery blood at delivery. DESIGN: Forty-six parturients delivered at the National University of Singapore were monitored during the second stage of labour with T/QRS ratios and CTG. At delivery blood from a segment of clamped cord was sampled for lactate and acid-base balance analyses. The Spearman Rank correlation, the Mann Whitney U-test and the Kruskal Wallis ANOVA were used when appropriate. RESULTS: Maternal pushing time was significantly correlated to lactate (R = 0.51; P = 0.0003), pH (R = -0.38; P = 0.009) and base deficit (R = 0.33; P = 0.026), but not to T/QRS ratio (R = 0.002; P = 0.99). No significant correlation between lactate and T/QRS ratios (R = 0.06; P = 0.70) or type of CTG pattern was found (P = 0.10), though there were significant differences in pH (P = 0.029) and T/QRS ratios (P = 0.037) between groups with different FHR abnormalities. CONCLUSION: Lactate increases progressively with maternal pushing time. No significant correlation was found between lactate and the T/QRS ratio. Lack of correlation is likely to be due to poor sensitivity of foetal ECG at this level of foetal stress, though the influence from transplacentally transferred maternal lactate cannot be excluded.

Acid-Base Equilibrium↗
PubMed1998

Metabolic control and pregnancy outcome among women with insulin-dependent diabetes mellitus. A twelve-year follow-up in the country of Jämtland, Sweden.

OBJECTIVE: To assess metabolic control and pregnancy outcome in women with insulin-dependent diabetes mellitus (IDDM) in a defined rural area of Sweden and to compare results for three four-year periods (1982-85, 1986-89, 1990-93). MATERIAL AND METHOD: All pregnancies in women with IDDM during the 12-year period, 1982-93, received their antenatal care from a 'diabetic team' at the County Hospital, Ostersund. There were 50 women in the series, accounting for a total of 91 pregnancies. Spontaneous or induced abortions occurred in 19 cases. Case notes from maternity, neonatal and pediatric care were retrospectively scrutinized. RESULTS: In period one 31% of the pregnancies occurred in gravidae with diabetes classified as White D, F or R, as compared with 46% and 71% during periods two and three (p=0.001). Maternal hypertension was also more frequent in period three (12%, 26% and 54%, respectively; p=0.001). Fewer antenatal admissions (p=0.02) but more frequent ultrasound scannings (p=0.014) were recorded for period three. HbA1c levels decreased continuously from prepregnancy through first and third trimesters (9.7%, 8.4%, and 7.4%, respectively; p<0.0001). Perinatal mortality and frequencies of congenital malformations were both 4.2% (95% CI 0.5-8.8%), whereas the miscarriage rate was 14.3% (95% CI 6.8-21.8%). CONCLUSIONS: As compared with the first 4-year period, 1982-85, the third period, 1990-93, was characterized by a greater proportion of gravidae with more serious diabetes and a higher rate of pregnancy complications, though the outcome was nonetheless good, suggesting the diabetic pregnancy care program to have been efficacious.

Adult↗
PubMed1998

Intrapartum fetal hypoxia and biochemical markers: a review.

Intrapartum fetal hypoxia is a rare event, although fetal intrapartum surveillance is discussed as a subject of major importance. This is mainly because of consequences of fetal hypoxia that may lead to cerebral palsy. A fetus suffering from hypoxia initially compensates by producing energy through anaerobic metabolism. At some stage, the fetus becomes decompensated and basic cellular functions fail, with risks of permanent morbidity or mortality. How long a fetus can survive on anaerobic metabolism differs because metabolic reserves differ, i.e., growth-restricted fetuses might deteriorate at an earlier stage. An increasing body of evidence has clarified brain-damaging mechanisms. Neuronal loss occurs in two phases: during the primary hypoxic event and later during the reperfusion/reoxygenation phase. Animal studies have suggested the possibility of prophylactic treatment to prevent neuronal loss after the hypoxic event. Intrapartum diagnostic tools should aim for detecting fetal hypoxemia/hypoxia when the fetus is still compensated. This may be achieved by assessment of biochemical data such as pH, lactate, and oxygen saturation, with the aim of prophylactic intervention before the fetus becomes decompensated. The measurement of cord blood levels of oxygen free radicals and excitatory amino acids at the time of birth may prove to be helpful in determining the risk of brain damage and evaluating the effect of prophylactic treatments to prevent or ameliorate brain injury from hypoxia.

Biomarkers↗