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Biomedical subjects

M Hellström

Publications and source records attributed to M Hellström.

At least 91 records · Page 5Linked to original sources
PubMed1991

Disc degeneration and associated abnormalities of the spine in elite gymnasts. A magnetic resonance imaging study.

The thoracolumbar spine was examined by magnetic resonance imaging (MRI) and the history of back pain was analyzed in 24 male elite gymnasts (age range, 19-29 years) and in 16 male nonathletes (age range, 23-36 years). Disc degeneration, defined as reduced disc signal intensity, was significantly more common in athletes (75%) than in nonathletes (31%). The gymnasts also had a higher incidence of other abnormalities of the thoracolumbar spine, and there was a significant correlation between reduced disc signal intensity and the other abnormalities among the gymnasts. There were also significant correlations between back pain and reduced disc signal intensity and abnormal vertebral configuration when the gymnasts run a high risk of developing severe abnormalities of the thoracolumbar spine, and they often have a history of back pain.

Adult↗
PubMed1990

Six year follow up of infants with bacteriuria on screening.

OBJECTIVE: To determine the value of screening for bacteriuria in infants with special emphasis on the natural course of untreated asymptomatic bacteriuria, renal growth, and renal damage. DESIGN: Prospective six year follow up of infants with bacteriuria on screening in an unselected infant population. SETTING: Paediatric outpatient clinic. PATIENTS: 50 Infants (14 girls, 36 boys) with bacteriuria on screening verified by suprapubic aspiration from an unselected population of 3581 infants in a defined area of Gothenburg. INTERVENTIONS: Children with asymptomatic bacteriuria and normal findings on initial urography were untreated, although other infections were treated. MAIN OUTCOME MEASURES: Culture of urine and determination of C reactive protein concentration every six weeks for the first six months after diagnosis, every three months from six months to two years, and every six months between two and three years; thereafter yearly urine culture. Evaluation of renal concentrating capacity with a desmopressin test; radiological examination, including first and follow up urography and micturition cystourethrography without antibiotic cover; and measurement of renal parenchymal thickness and renal surface area. RESULTS: Of the original 50 infants, 37 (12 girls, 25 boys) were followed up for at least six years. Two infants developed pyelonephritis within two weeks after bacteriuria was diagnosed; the others remained free of symptoms. 45 Infants were untreated; the bacteriuria cleared spontaneously in 36 and in response to antibiotics given for infections in the respiratory tract in eight. Recurrences of bacteriuria were observed in 10 of the 50 children, of whom one had pyelonephritis. No child had more than one recurrence. At follow up urography in 36 of the 50 children (9 girls, 27 boys) after a median of 32 months no child had developed renal damage. First samples tested for renal concentrating capacity showed significantly higher values than those from a reference population (mean SD score 0.50, 95% confidence interval 0.21 to 0.79; p less than 0.001), but the last samples showed no significant difference (mean SD score 0.08, -0.24 to 0.40; p greater than 0.05). CONCLUSIONS: Mass screening for bacteriuria in infancy results primarily in detection of innocent bacteriuric episodes and is not recommended.

Algorithms↗
PubMed1990

Radiologic abnormalities of the thoraco-lumbar spine in athletes.

A radiologic study of the thoraco-lumbar spine was performed in 143 (117 male and 26 female) athletes (wrestlers, gymnasts, soccer players and tennis players), aged 14 to 25 years and 30 male non-athletes, aged 19 to 25 years. Film interpretation was made after mixing the films from all groups and without knowledge of the individual's identity. Various types of radiologic abnormalities occurred in both athletes and non-athletes but were more common among athletes, especially male gymnasts and wrestlers. Abnormalities of the vertebral ring apophysis occurred exclusively in athletes. Combinations of different types of abnormalities were most common in male gymnasts and wrestlers.

Adolescent↗
PubMed1989

Fever, bacteriuria and concomitant disease in children with urinary tract infection.

A total of 124 children aged 0.2 to 6 years were enrolled in a study of first time febrile urinary tract infection. The patient population was stratified in groups according to the stringency of criteria for fever and bacteriuria and the presence of concomitant disease. The major group of 88 patients consisted of children with fever greater than or equal to 38.5 degrees C measured at the hospital within 24 hours of diagnosis, bacteriuria verified by suprapubic bladder aspiration or repeated cultures of voided urine, but without concomitant disease. These children were mainly infected with attaching Escherichia coli specific for galactose alpha (1----4) beta galactose containing receptors and had laboratory evidence of inflammation. Another group of 11 children were distinguished with strictly defined bacteriuria and concomitant disease. These children were infected with nonattaching bacteria and had lower concentrations of C-reactive protein in serum and lower microsedimentation rates than the major group. Five of these children had a reduction in renal concentrating capacity. The study emphasizes the heterogeneity among patients with fever and bacteriuria but does not rule out the possibility of renal involvement in any subgroup.

Acute Disease↗
PubMed1989

Secretor state and renal scarring in girls with recurrent pyelonephritis.

The non-secretor phenotype was significantly associated with the occurrence of renal scarring among patients with recurrent pyelonephritis. Girls (n = 77) with recurrent pyelonephritis were followed from the first known episode of infection for up to twelve years with repeated radiological investigations. They were divided into two categories: those with renal scars (n = 35) and those who did not develop scars (n = 42). There was a significant over-representation of non-secretors among the patients with scarring, (14/35, 40%) compared to the healthy controls (21.8%, P less than 0.05). The frequency of non-secretors among the girls who did not develop scars in spite of repeated episodes of acute pyelonephritis was not significantly different from the healthy controls (9/42, 21% n.s.). This study provides a basis for analysis of the influence of secretor state on host-parasite interaction in the urinary tract.

ABO Blood-Group System↗
PubMed1989

Voiding cystourethrography as a predictor of reflux nephropathy in children with urinary-tract infection.

Most children who develop renal damage (scarring) after urinary-tract infection have vesicoureteral reflux. Voiding cystourethrography is therefore usually recommended as the initial radiologic study in children with urinary-tract infection. However, renal damage may occur also in the absence of reflux. The aim of this investigation was to determine the sensitivity and predictive value of reflux during voiding cystourethrography in identifying children at risk for renal damage. Eighty-four consecutive children, 2 months to 6 years old, with nonobstructive, first-known, febrile urinary-tract infection underwent voiding cystourethrography and urography. Twenty-seven (32%) had reflux and 10 (12%) had or developed renal damage. Two of the children and four of the kidneys with renal damage had no reflux at initial examination. The sensitivity of reflux as a marker for renal damage was 80%, specificity was 74%, positive predictive value was 30%, and negative predictive value was 96%. Thus, most children who develop renal damage after urinary-tract infection have reflux during voiding cystourethrography. However, there is a risk, albeit small, for renal damage to occur in the absence of reflux.

Child↗
PubMed1988

Bacterial virulence and inflammatory response in infants with febrile urinary tract infection or screening bacteriuria.

Two populations were analyzed prospectively after a first episode of urinary tract infection. Asymptomatic infants were screened at 2 weeks and at 3 and 10 months of age, and bacteriuria was confirmed by bladder puncture. Infants with febrile urinary tract infection were enrolled during the same study period. The inflammatory response was characterized by the presence of fever, serum C-reactive protein, microsedimentation rate, urinary leukocyte excretion, and width of the ureters. The bacteria were defined for O:K:H serotype, hemolysin production, resistance to the bactericidal effect of serum, attachment to uroepithelial cells, and specificity for the globoseries of glycolipid receptors. In agreement with previous studies, the frequency of increased inflammatory signs and of attaching Escherichia coli was significantly higher in infants with febrile urinary tract infection than in the screening group. Within both patient groups, however, children infected with attaching E. coli strains had significantly more inflammatory signs. The results suggest that adherence facilitates the presentation of bacterial components capable of causing inflammation in the tissues in the urinary tract.

Blood Sedimentation↗
PubMed1987

Renal growth after neonatal urinary tract infection.

This study presents the result of 12-21 years' follow-up in a group of children with neonatal urinary tract infection (onset within 1 month after birth) in whom early renal growth retardation was noted without concomitant classical renal scarring. In all cases the neonatal infection was diagnosed and treated within a few days of onset and the patients were closely supervised thereafter. Renal length, parenchymal thickness and area were measured at urography. At first follow-up (22 children, mean age 4.1 years) a significant reduction of renal parenchymal thickness was noted. Long-term follow-up (18 patients, mean age 17 years) demonstrated a normalization of renal size in the entire group, although less complete in the subgroup with reflux. There were two major findings in the present study. Firstly, renal growth retardation was seen after neonatal infection, both with and without reflux. Secondly, normalization of renal size in previously small kidneys was demonstrated, suggesting that growth retardation can be a reversible phenomenon. The tendency for such normalization was slightly more marked in children without reflux. Reduction of parenchymal thickness without calyceal deformity, therefore, does not necessarily mean irreversible damage, and differentiation between permanent scarring and temporary growth retardation can thus only be made at later follow-up, possibly not until after puberty. The demonstration of renal growth retardation in spite of early diagnosis and treatment emphasizes the great vulnerability of the kidney in the newborn.

Female↗
PubMed1987

Dietary fibers in the preparation of the bowel for diagnostic barium enema.

The effect on colon cleanness of adding dietary fiber or placebo to a standard bowel preparation scheme before diagnostic barium enemas was tested in a randomized, double-blind study including 120 consecutive outpatients admitted for diagnostic barium enemas. Colon cleanness was scored as satisfactory, intermediate, or unsatisfactory. No case of unsatisfactory cleansing appeared in the group given fiber. Mean score was slightly better in the fiber group but the difference was not statistically significant. Dietary fiber does not have a negative effect on colon cleansing but may instead have a beneficial effect, which is possibly more pronounced in patients with constipation.

Adult↗
PubMed1987

Ureteral dilatation in children with febrile urinary tract infection or bacteriuria.

Little information is available on the relationship between urinary infection in children and infants, with or without vesicoureteral reflux, and dilatation of the urinary tract. The purpose of this study was to determine the effects of infection and reflux on the diameter of the ureter at excretory urography in children with acute, febrile urinary tract infections and in infants with bacteriuria found at screening. Standardized measurements of ureteral diameter were obtained for 79 children (2 months to 6 years old) with urinary tract infections and for 45 infants with bacteriuria. Patients with urinary tract obstruction or malformations were excluded. Seventy-one children with febrile urinary tract infection had ureteral visualization that allowed measurements. Ureteral diameter in this group was significantly wider than in a reference group, and 42 children (59%) had ureteral diameters that were more than 2 standard deviations above the normal mean. Ureteral diameter at excretory urography increased with increasing grades of reflux, but dilatation occurred also in the absence of reflux. Twenty-two of the 45 infants in the group with bacteriuria had sufficient ureteral visualization for measurements. The ureters in this group were wider than in the reference group, and eight infants had ureteral diameters that were more than 2 standard deviations above the normal mean. We conclude that ureteral dilatation is a common effect of acute urinary tract infection and bacteriuria in children.

Bacteriuria↗