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Biomedical subjects

M Aberg

Publications and source records attributed to M Aberg.

At least 19 recordsLinked to original sources

Myotonic dystrophy revealed at videoradiography of deglutition and speech in adult patients with velopharyngeal insufficiency: presentation of four cases.

Patients with velopharyngeal insufficiency (VPI) without cleft palate, who appear for the first time in adulthood for treatment, will probably reveal a high percentage of undiagnosed myotonic dystrophy (MD). Videoradiography of deglutition and speech reveals the diagnosis. Eleven adult noncleft palate patients with VPI were studied with videoradiography of the pharynx and esophagus. Three exhibited functional radiographic manifestations of MD during deglutition and speech. The diagnosis confirmed by neurologic examination was not known or suspected prior to videoradiography. An additional patient with VPI and suspected MD displayed the same constellation of radiographic findings. Follow-up examinations confirmed the diagnosis of MD. Three of the four patients had had symptoms of VPI since childhood, but none had complaints of deglutition problems except for accidental nasal regurgitations.

Adult

Basal cell carcinoma. An epidemiologic study in a defined population.

BACKGROUND: The incidence of basal cell carcinoma (BCC) in a defined population is unknown. METHODS: The incidence of histologically diagnosed cases of BCC in a defined population of a city in southern Sweden was studied. Four 2-year periods were examined from 1970 to 1986. Cases from 1970 and 1980 were reexamined microscopically. RESULTS: From 1970 to 1986, the age-standardized incidence of BCC was doubled. BCC was equally common in male and female patients. It was possible to trace another BCC in the medical history of 41% of the patients. The risk of development of BCC increased rapidly with age greater than 55 years. Approximately two-thirds of the tumors were found in the head and neck region. There was a possible increase in superficial multicentric tumors on the trunk but otherwise an essentially unchanged pattern in type and distribution. CONCLUSIONS: The age-standardized incidence of histologically diagnosed BCC was doubled from 1970 to 1986. The rapid increase should be taken into consideration when planning allocation of medical resources.

Adult

Effects of normovolemic hemodilution on blood flow in the rabbit ear.

The effect of isovolemic hemodilution using dextran-60 on arterial blood flow in the rabbit ear was investigated. The animals were anesthetized and an electromagnetic flow probe was applied around the central artery of the ear. Isovolemic hemodilution was performed during a 15 min exchange period. Two degrees of hemodilution were investigated [8.5 and 17 ml dextran-60/kg body weight (b.w.)] and compared with a nontreated control group. The two levels of hemodilution induced reductions in hematocrit to 29 and 21%, respectively, from the control level of about 40%. In all groups, blood pressure maintained constant levels throughout each experiment, which lasted 240 min. In the controls, ear artery blood flow was unchanged or decreased slightly during the experiment. The lower level of hemodilution caused a slight increase of blood flow after 4 h. In the group treated with 17 ml/kg b.w. dextran, blood flow gradually increased after 90 min following hemodilution. After 240 min, flow rates had increased to two- or threefold the initial rate in this group. Although other possibilities exist, the increased blood flow following hemodilution may be interpreted as reflecting a decreased resistance to flow in the tissue due to the decreased viscosity of the blood.

Animals

Infected wounds and repeated septicemia in a case of factitious illness.

During 19 years an assistant nurse, now 35 years old, has been repeatedly treated for several malingered and self-induced disorders escalating to self-mutilation. An ulcer of her right leg never epithelialised in spite of various local treatments and surgical intervention. During repeated attacks of self-induced septicemia altogether 11 different bacterial species were isolated; on 8 occasions Rhodococcus equi. The septicemias were successfully treated with antibiotics. The underlying psychiatric problem, a borderline personality disorder, has not been possible to treat in a conventional manner. Probably due to collaboration between the plastic surgeon and the psychiatrist she has had fewer attendances and shorter hospital stays lately. Her prognosis is still dubious as regards further self-mutilation and other expressions of self-destructive behaviour.

Actinomycetales Infections

Effects of desmopressin acetate (DDAVP) and dextran on hemostatic and thromboprophylactic mechanisms.

The effects on hemostatic and thromboprophylactic mechanisms of intravenous desmopressin (DDAVP, 0.3 micrograms/kg) and dextran 40 and 70 given both separately and in various combinations were evaluated in five male volunteers. Dextran did not inhibit the DDAVP-induced hemostatic changes. The dextran-induced decrease in platelet adhesiveness and the prolonged bleeding time were totally reversed by DDAVP. Hematocrit decrease was seen after both drugs, lasting longer when they were combined. We conclude that DDAVP and dextran may be used concomitantly, each with maintained beneficial properties. DDAVP will still act hemostatically by increasing platelet adhesiveness, factor VIII and von Willebrand factor and by shortening the dextran-induced prolongation of bleeding time. Dextran and DDAVP may even have additive antithrombotic effects due to the DDAVP-induced stimulation of the fibrinolytic activity, which is not inhibited by dextran, and to rheologic changes such as hematocrit decrease induced by both drugs.

Adult

Reconstruction with a free vascularized fibular graft for malignant bone tumor.

Seven patients with a bone tumor were operated on with local excision and a free vascularized fibular graft. Four of the patients received both chemotherapy and radiotherapy. The blood flow in the grafts was evaluated by scintigraphy within 1 week after the operation. The median follow-up time was 4 (1-5) years. All but one graft-host junction healed primarily. There were 5 graft fractures in 3 patients. Four of the fractures occurred in 2 patients who received preoperative and postoperative chemotherapy and radiotherapy. Three of these fractures healed without surgery. Resorption of the grafts was never seen, whereas hypertrophy was observed in 6 patients. None of the patients had any permanent morbidity at the donor site. One patient had tumor recurrence and died after 2 years. Our findings indicate that a vascularized bone graft is also a useful alternative for reconstruction of large bone defects in patients receiving both chemotherapy and radiotherapy.

Adolescent

The effect of triglycyl-lysine-vasopressin (terlipressin INN, Glypressin) on skin blood flow, measured with laser Doppler flowmetry, thermography and plethysmography. A dose-response study.

Triglycyl-lysine-vasopressin (TGLVP) has been shown to reduce blood loss in connection with early excision of experimentally induced burns in pigs. In order to determine an appropriate dosage of TGLVP in patients with burns, a dose-response study was undertaken. TGLVP was administered intravenously in various doses to healthy volunteers, and skin blood flow was measured with laser Doppler flowmetry, thermography and plethysmography. Blood pressure, heart rate and electrocardiac activity were monitored as well as serum and urine changes. The doses of 5, 10 and 20 micrograms TGLVP/kg b.wt. caused statistically significant reduction of skin blood flow; minimal values were 35, 26 and 25% of predrug values for the three doses, respectively. Thermography and plethysmography were less sensitive for detecting effects of TGLVP than laser Doppler flowmetry. Minor effects on blood pressure and heart rate were recorded after TGLVP, but no disturbances in electrocardiac activity. Urinalyses revealed an antidiuretic action of TGLVP. The study supports earlier findings and suggests a dose level of TGLVP for the use in excision of burns.

Adult

The influence of dextran and saline solution upon platelet behavior after microarterial anastomosis.

Microarterial anastomoses were performed on the central arteries of the ears in rabbits. An untreated control group was compared with two groups treated with saline solution and dextran 70 in saline solution respectively. Anastomotic bleeding times were prolonged in both treated groups. In vivo accumulation of 32phosphorous labelled platelets infused prior to any treatment was measured at the anastomotic sites for two hours after anastomosis. Treatment with saline solution resulted in prolonged periods of platelet accumulation--desaggregation processes and abnormally high levels in 50 per cent of the rabbits. Treatment with dextran resulted in increased quantitative accumulation of platelets at all times compared with the control groups. In some rabbits treated with dextran, platelet accumulation patterns indicated microembolization due to increased platelet thrombus fragility. Despite increased platelet accumulation in the dextran groups all vessels showed good patency and only small amounts of thrombosis material compared with the control and saline solution groups. Poor patency was registered only in one instance in the control group and two instances in the saline solution group. Using ex vivo platelet aggregometry, saline solution slightly decreased and dextran slightly increased platelet aggregability. The conclusion is that dextran does not act as an antiplatelet agent but minimizes formation of dangerous solid fibrin platelet thrombi due to a defective fragile fibrin structure adn perhaps increased fibrinolysis.

Animals

Circulatory and renal effects of triglycyl-lysine-vasopressin and excision in experimental burns.

The circulatory and renal effects of a deep dermal burn, covering one third of the total body surface area were studied in 12 thiopentone/N2O anesthetized piglets. Central circulation and renal function was monitored during 24 h and regional blood flows were determined before burn, 5 and 24 h after burn using radioactively labeled microspheres. One group was treated conservatively with fluid infusion only (control group) and the other with fluids, intermittent injections of a long-acting hormonogen, triglycyl-lysine-vasopressin (TGLVP), and excision 5 h after burn. There was earlier circulatory recovery in the TGLVP excision group with significantly higher arterial blood pressure and cardiac output than in the controls. TGLVP induced a major redistribution of blood flows, favoring the liver at the expense of the gastrointestinal tract, carcass and skin, while the blood flows were unchanged to the brain, heart and kidneys. There were also increased excretions of sodium and potassium and a temporarily increased diuresis. The earlier circulatory stabilization and blood flow redistribution might have clinical implications in burn care.

Animals

Endothelialization following end-to-end and end-in-end (sleeve) microarterial anastomoses. A scanning electron microscopic study.

Eighteen microvascular end-to-end and eighteen end-in-end anastomoses were performed on the central arteries (diameters 0.8-1.2 mm) of rabbit ears. Specimens taken after intervals of 1-2 hours and 3, 7, 14, 30 and 90 days were studied using a scanning electron microscope. At 1-2 hours platelets and to a minor extent erythrocytes and fibrin had accumulated in defects between the vessel ends on sutures and at the suture holes of all end-to-end anastomoses. This had also occurred at the distal end of the telescoped segment in all end-in-end anastomoses. At 3 days endothelial desquamation at anastomotic sites and clamp sites was found in both end-to-end and end-in-end anastomoses. The exposed subendothelial surface was covered with a carpet of platelets, and frequently numerous leucocytes were found. Between 3 and 7 days, new endothelial cells appeared at the junction between the vessels in end-to-end anastomoses and in all areas damaged by vascular clamps. At the ends of the sleeved segments reendothelialization was observed over platelet aggregates. Between 7 and 14 days neo-endothelialization seemed to be virtually completed in both types of anastomosis. In the vicinity of the anastomoses, the appearance of the new endothelium was frequently abnormal with irregularly formed cells. Characteristic clefts and holes were seen between these abnormal (pleomorphic) endothelial cells. Histological findings from the same vessel specimens show that areas with abnormal endothelialization correspond to segments with intimal hyperplasia. Such areas were found in specimens throughout the entire period studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

Triglycyl-lysine-vasopressin or lysine-vasopressin in early excision of burns. An experimental study comparing the effects on blood loss, hemodynamics and renal function.

Twelve piglets were submitted to a third degree burn covering one third of total body surface area under general anesthesia. Fluid treatment was given in amounts corresponding to 2.4 ml/kg/% burn/24 h, and hemodynamics and renal function were monitored for 24 h. Regional blood flows were determined with the aid of the radioactive microsphere technique before burn, 5 and 24 h after burn respectively. One group was treated with triglycyl-lysine-vasopressin (TGLVP) as bolus injections and the other with lysine-vasopressin (LVP) in infusion. Both groups were submitted to excision of the burned tissues after 5 h. Total blood loss was 39 +/- 9 g in the TGLVP group and 51 +/- 7 g in the LVP group (n.s.). TGLVP changed the distribution of cardiac output (CO) more than LVP did, leading to smaller blood flows to the splanchnic organs, skin and carcass while the perfusion of the brain, heart, liver and kidneys was similar after 5 h. The burn caused a 30% decrease of CO in both groups. After the first TGLVP injection there was a small further decrease in CO but after excision there were similar recoveries of CO in both groups. After 24 h the CO redistribution remained during LVP infusion, but those effects had almost vanished in the TGLVP group. Total diuresis and the glomerular filtration rate tended to be larger during LVP treatment but there was no significant difference in serum creatinine after 24 h. Thus both drugs decrease blood loss during early excision and they seem to have similar effects on circulation and renal function.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

Reduction of blood loss by triglycyl-lysine-vasopressin during early excision of burns in pigs.

In a burn model using anesthetized piglets, the circulatory and renal effects and the blood loss during and after excision were compared in two groups, one treated by triglycyl-lysine-vasopressin (TGLVP) given as intermittent bolus injections and the other serving as control. The third degree burn covered approximately 33% of the body surface area, and a solution containing 100 mmol NaCl/l in 2.5% glucose was infused at a rate of 2.4 ml/kg/% burn. Regional blood flows were determined before burn, 5 and 24 h after burn with the aid of radioactively labeled microspheres. Cardiac output (CO) decreased about 30% after burn and there was a slight further decrease of CO after the first TGLVP dose. After the excision there were similar restitutions of CO in the two groups. TGLVP induced an increase of blood flow to the hepatic artery, did not change flows to the brain, heart and kidneys and decreased flows to the preportal organs, carcass and skin 5 h after burn. After 24 h the perfusion of the skin and pancreas remained low but there were no differences in other organs. There was a significant decrease of blood loss associated with burn excision performed 5 h after burn in the TGLVP treated group, mean blood loss 39 g/25 kg versus 145 g/25 kg in the control group. There was a temporary increase in diuresis following TGLVP and also increased excretions of sodium and potassium. The results obtained in this study and possible clinical applications are discussed.

Animals

[Laser surgery].

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